Work

203. Screening and Targeted Prophylaxis for Clostridioides Difficile Infection: STOP-CDI

Year: 2025

Type: article

Abstract: Background Patients receiving immunosuppression for oncology treatment and transplantation are at highest risk for developing hospital-onset C.difficile infection (HO-CDI). We studied a prophylactic enteral vancomycin intervention implemented to reduce HO-CDI during high-risk inpatient admissions among immunocompromised patients. Methods The STOP-CDI intervention was implemented on 11/2021 at the Hospital of the University of Pennsylvania. Patients admitted for solid-organ transplant, autologous stem cell transplant, CART, or treatment for leukemia were screened for colonization with C.difficile. Colonized patients were placed in contact isolation and were recommended oral vancomycin prophylaxis for a duration of 10 days or until discharge. Patients were compared to concurrent controls and historical controls in the two years prior to implementation of the STOP-CDI intervention. Concurrent controls were eligible for screening, but research staff were not available to perform screening. The primary study outcome was the development of HO-CDI, defined as a positive clinical diagnostic test after hospital day 3 but prior to discharge. Secondary outcomes included 90 day CDI, stool output, length of stay, VRE infection, and mortality. The impact of the STOP-CDI intervention was assessed using logistic and Poisson regression, with propensity-score weighting calculated using inpatient treatment category. Results Between 11/2021 and 12/2023, 692 patients were screened for C.difficile, 11% were colonized. Characteristics of those enrolled and matched controls are displayed in Table 1. Compared to matched controls, the odds of HO-CDI was significantly lower in the intervention group (OR 0.21, P< 0.001) with a number needed to screen of 31 (Figure 1). We also identified significant reductions in 90-day HO-CDI, stool output, and length of stay (Table 2). There was no detected difference in VRE infection or mortality. Conclusion The STOP-CDI intervention was effective at reducing HO-CDI, LOS, and symptoms of C.difficile in this high-risk cohort. Future work will assess the ability of a targeted screening and prophylaxis approach to reduce transmission of C.difficile on units and its utility in other patient populations.Figure 1.Number Needed to Screen to Prevent One Hospital-Onset C.difficile Infection. Disclosures All Authors: No reported disclosures

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofae631.061