Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 7, Number 6, June 2015, pages 422-427


Vancomycin Enemas as Adjunctive Therapy for Clostridium difficile Infection

Figures

Figure 1.
Figure 1. CDI treatment for the control group (top) and VPR group (bottom). To be listed as exposed to antimicrobial, the patient had to receive at least 1 day of that therapy. Number of antibiotics > number of patients due to concomitant therapy.
Figure 2.
Figure 2. Flow chart for combined primary outcomes.
Figure 3.
Figure 3. Plot of odds ratio and 95% confidence interval of variables independently associated with the combined endpoint of colectomy and death.

Tables

Table 1. Characteristics of Study Patients and Controls
 
AllRectal vancomycin (n = 24)No rectal vancomycin (n = 48)P value
LOS: length of stay. *Includes prednisone ≥ 20 mg, antineoplastic, antimetabolite, and any immune modulator therapy.
Age (SD), years61.3 (15.4)61.8 (15.9)61.1 (15.3)0.86
Gender (% male)36 (50)11 (45.8)25 (52.1)0.62
Immunosuppression* (%)12 (16.7)4 (17.4)8 (16.7)0.94
Albumin (SD), g/dL1.95 (0.63)2.01 (0.59)1.91 (0.66)0.56
APACHE II (SD)20.0 (5.4)20.0 (5.4)20.0 (5.5)1.00
Overall LOS (median, IQR)26.5 (16.5 - 46.5)25.0 (19.5 - 37.5)28.0 (15.5 - 48.0)0.62
ICU LOS (median, IQR)13.0 (2.5 - 25.0)12.0 (0 - 27.5)14.0 (3.5 - 23.5)0.72
Episode severity0.18
  Mild-moderate4 (5.6)1 (4.2)3 (6.3)
  Severe28 (38.9)6 (25)22 (45.8)
  Severe complicated40 (55.6)17 (70.8)23 (47.9)

 

Table 2. Published Reports of VPR
 
Author (year)Case report or series (n)Dose of VPRConcomitant therapiesComments
Pasic et al [20] (1993)Report2 g loading with 100 mg q6h and 100 mg PRN watery stoolNoColitis resolution; death from sepsis on POD 52
Shetler et al [21] (2001)Series (7)250 mL of premixed solution (1 g vancomycin in 1 L sterile H2O) q6hYes (all IV metronidazole, 5/7 oral vancomycin)Colitis resolution in four of the seven patients
Nathanson et al [22] (2001)Report500 mg in 500 mL saline BIDYes (IV metronidazole for 10/10 days)Colitis resolution with discharge to home
Apisarnthanarak et al [23] (2002)Series (9)Variable (0.5 - 1 g q4 - q12h)Yes (all IV/oral metronidazole, 7/9 oral vancomycin)Resolution in 89%
Kim et al [24] (2013)Series (47)1 g q6hYes (oral vancomycin and IV)Resolution without surgery in 70%