Table 1.
Characteristics of included studies.
| Author [Ref.] | Year of Publication |
Study Design and Type of Prophylaxis | Study Period | N. Patients (OVP vs. Controls) |
Characteristics of the Population |
OVP Dose | OVP Duration |
Event Definition | Time of Follow-Up |
Incidence of CDI (OVP vs. Controls) |
More Frequent Class of Antibiotic Used as SAT (OVP vs. Controls) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Carignan et al. [33] | 2016 | Retrospective cohort—Secondary | 2003–2011 | 227 vs. 324 | Adults receiving antibiotics within 90 days of initial/recurrent CDI/secondary prophylaxis | 125 mg qid (84%) | 7 days | diarrhea + toxin evidence or typical colitis |
6 months | 28% vs. 32% | NA (however, patients receiving second-generation cephalosporins more likely to experience rCDI) |
| Van Hise et al. [34] | 2016 | Retrospective cohort—Secondary | 2010–2014 | 71 vs. 132 | Adults with history of CDI, subsequently hospitalized and treated with systemic antimicrobial therapy/secondary prophylaxis | 125 mg or 250 bid (59%) | 14 days | diarrhea + NAAT | 4 weeks | 4.2% vs. 26.6% (p < 0.001) |
Aminopenicillin, 49.3% vs. 47.7% (p = 0.88) |
| Papic et al. [35] | 2018 | Retrospective cohort—Primary | 2015–2017 | 71 vs. 173 | Elderly patients hospitalized for more than 72 h who received parenteral antibiotics for more than 24 h/primary prophylaxis | 125 mg once daily | 9 days | diarrhea + two-stage algorithm (GDH for screening and NAAT) | During index hospitalization |
0% vs. 10.4% (p = 0.0022) |
Piperacillin-tazobactam (53.5%) vs. any cephalosporin (43.4%) |
| Splinter et al. [36] | 2018 | Retrospective cohort—Secondary | 2012–2015 | 11 vs.18 | Adults renal transplanted patients with history of CDI/secondary prophylaxis | 125 mg bid | 19 days | NAAT | 30 days | 0% vs. 8 % (p = 0.54) | NA |
| Bajrovic et al. [37] | 2019 | Retrospective cohort—Primary | 2007–2013 | 82 vs. 554 | Adults receiving lung transplantation | 125 mg bid (median) | 14 days | diarrhea + NAAT | During index hospitalization |
1.2% vs. 5.9% | Intravenous vancomycin, 100% vs. 69% (p < 0.01) |
| Caroff et al. [38] | 2019 | Retrospective cohort—Secondary | 2009–2015 | 193 vs. 597 | Adults given at least 1 dose of systemic antibiotic with history of CDI in previous 30–150 days/secondary prophylaxis | NA | 2 days | toxin evidence or NAAT | 90 days | 9.8% vs. 9.4% | High-risk antibiotics according to study’s definition, 66% vs. 85% (p < 0.01) |
| Ganetsky et al. [39] | 2019 | Retrospective cohort—Primary * | 2015–2016 | 90 vs. 55 | Adults receiving allogenic hematopoietic cell transplantation | 125 mg bid for the duration of stay | 29 days | 2/3-stage algorithm (GDH for screening, toxin detection or NAAT) | 90 days | 0% vs. 20% (p < 0.001) |
Anti-Gram-negative antibiotics according to study’s definition, 76% vs. 71% (p = 0.54) |
| Knight et al. [40] | 2019 | Retrospective cohort—Secondary | 2013–2015 | 32 vs. 59 | Adults with history of CDI, subsequently hospitalized within 12 months and treated with systemic antimicrobials/secondary prophylaxis | 125 or 250 (69%) mg qid | 8.5 days | diarrhea + NAAT | 12 months | 6.3% vs. 27.8% (p = 0.011) |
Penicillins vs. cephalosporins (in terms of sums of daily doses received) |
| Morrisette et al. [41] | 2019 | Retrospective cohort—Secondary | 2014–2018 | 21 vs. 29 | Hematological adults with and without HSCT treated for the initial episode of CDI first with planned oral vancomycin monotherapy and must have been receiving a BSA at time of CDI diagnosis and/or during the course of CDI treatment/prophylaxis | 125 mg bid | 7 days | diarrhea + NAAT | 60 days | 10% vs. 35% (p = 0.051) |
Third/fourth generation cephalosporins, 95% vs. 93% (p > 0.99) |
| Johnson et al. [42] | 2019 | Randomized, prospective, open label—Primary | 2018–2019 | 50 vs. 50 | Adults admitted for more than 72 h, aged ≥60 years, hospitalized ≤30 days prior to the index hospitalization, and received systemic antibiotics during that prior hospitalization | 125 mg once daily | 12 days | diarrhea + NAAT | 3 months post-discharge | 0 vs. 12% (p = 0.03) | Cephalosporins (in terms of days of therapy, 173 vs. 171) |
| Bao et al. [43] | 2021 | Retrospective cohort—Secondary | 2013–2019 | 30 vs. 44 | Pediatric population, 50% affected by a malignancy | 10 mg/kg (up to 125 mg per dose for non-severe CDI and 500 mg per dose for severe or fulminant CDI) |
12 days | diarrhea + NAAT or typical colitis | 8 weeks | 3% vs. 25% (p = 0.02) | Third/fourth generation cephalosporins, 64% vs. 57% (p = 0.55) |
Abbreviations: bid, bis in die; CDI, Clostridioides difficile infection; GDH, glutamate dehydrogenase; HSCT, hematopoietic stem cell transplantation; NA, not available; NAAT, nuclear acid amplification tests; OVP: oral vancomycin prophylaxis; qid, quarter in die; rCDI, recurrent Clostridioides difficile infection. * In this study the majority of patients underwent primary prophylaxis, but 15.6% of patients in the OVP arm had actually a previous episode of CDI compared with 9.1% of subjects in the comparator group (separate data were not available).