In this episode, I’ll discuss whether oral vancomycin use for C diff increases the risk of VRE.
Recent changes to the C diff guidelines moved vancomycin up to first line treatment for C diff infection, regardless of the level of disease severity. Such a large increase in vancomycin use carries a theoretical concern that the incidence of vancomycin-resistant Enterococci (VRE) will also increase. This concern was reflected in a letter to the editor criticizing the move of vancomycin to first line treatment for mild C diff infection.
A recent retrospective cohort study examined this issue. Over 80,000 patients across multiple centers were included in this analysis.
The authors found that patients treated with oral vancomycin were no more likely to develop VRE within 3 or 6 months than metronidazole-treated patients.
The two main concerns with using vancomycin first line for mild C diff were cost and VRE risk. The cost concern was addressed in the study I reviewed in episode 310, and this study effectively addresses the VRE risk concern.
Members of my Hospital Pharmacy Academy have access to a detailed training on C. diff, including pearls on treatment and prevention strategies in addition to many other resources to help you in your practice. To get immediate access, go to pharmacyjoe.com/Academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.