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- W3136397320 abstract "<h3>Purpose</h3> <i>Clostridium difficile</i> infection (CDI) is associated with increased morbidity and mortality after thoracic transplant. In response to a series of cases, our institution implemented primary CDI prophylaxis with oral vancomycin 125 mg twice daily. <h3>Methods</h3> We retrospectively reviewed all thoracic transplant recipients from January 2018 to March 2020. Exclusion criteria included postoperative antibiotics < 48 hours, history of CDI, less than 80% overlap of prophylaxis with antibiotics, and in-hospital mortality. Patients were categorized based on the receipt of oral vancomycin prophylaxis (OVP) or no prophylaxis (No PPX). The primary outcome, CDI during index hospitalization, was compared using Kaplan-Meier survival analysis. <h3>Results</h3> In total, we reviewed 164 thoracic transplant recipients. We excluded 55 patients for a final cohort of 109 patients. There were 63 lung and 46 heart transplant recipients. Twenty-two patients (20%) received prophylaxis and 87 patients (80%) did not. Baseline demographics and hospitalization or receipt of antibiotics within prior 90 days did not differ between groups. Median length of stay was 30 and 43 days in the No PPX and OVP groups, respectively (p=0.01). Post-transplant, more patients in the OVP group were mechanically ventilated greater than 72 hours (16% vs. 46%, p=0.003) or on ECMO (7% vs. 27%, p=0.006). Median duration of antibiotics was 18 and 28 days in the No PPX and OVP groups, respectively (p=0.002). OVP overlapped a median of 95% of antibiotic days and continued for a median of 4 days after antibiotic discontinuation. During hospitalization, CDI occurred in 6 patients (7%) in the No PPX arm and 0 patients in the OVP arm (p=0.35). CDI-free survival did not differ between groups based on the Kaplan-Meier survival analysis (p=0.16). <h3>Conclusion</h3> Despite a higher degree of post-transplant organ support and significantly longer duration of antibiotics and length of stay, the incidence of CDI trended lower with the use of OVP. Primary OVP should be investigated in larger cohorts." @default.
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- W3136397320 date "2021-04-01" @default.
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- W3136397320 title "Impact of Primary Clostridium Difficile Prophylaxis in Thoracic Transplant Recipients" @default.
- W3136397320 doi "https://doi.org/10.1016/j.healun.2021.01.961" @default.
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