Oral vancomycin prophylaxis for the prevention of recurrent Clostridioides difficile infection during re-exposure to systemic antibiotics: A systematic review and meta-analysis
Bibliographic record
Abstract
Background Patients who have had Clostridioides difficile infection (CDI) are at high risk of recurrence following antibiotic re-exposure. Secondary oral vancomycin prophylaxis during antibiotic re-exposure may mitigate this risk. Objectives We conducted a systematic review and meta-analysis on the effectiveness and safety of vancomycin prophylaxis versus placebo/no prophylaxis for the prevention of recurrent CDI (rCDI) during antibiotic re-exposure. Methods Data Sources: Embase, MEDLINE, and CENTRAL. Study Eligibility Criteria: Randomized controlled trials (RCT) or comparative observational studies. Participants: Adults with recent (as defined in the studies) CDI who were re-exposed to systemic antibiotics. Interventions: Vancomycin prophylaxis (of variable doses) versus placebo/no prophylaxis. Assessment of Risk of Bias: Cochrane's ROBINS-I and RoB2 tools for comparative observational studies and RCTs, respectively. Methods of Data Synthesis: Recurrent CDI, all-cause mortality, and safety outcomes were pooled by random-effects meta-analysis and reported as odds ratios (OR). Results Eight observational studies were included in the systematic review and meta-analysis. All were at high risk of bias. The total population comprised 2156 patients, including 656 who received vancomycin prophylaxis and 1500 who did not; antibiotic re-exposure occurred within a median of 1 to 12 months after a qualifying episode of CDI. Vancomycin prophylaxis (125–1000 mg daily) was associated with a significantly reduced odds of rCDI compared to no prophylaxis (OR=0.41, 95 % Confidence Interval [95 %CI]=0.20–0.87). All-cause mortality was comparable between the two groups (OR=0.93, 95 %CI=0.62–1.40). None of the included studies reported on adverse events. Conclusions The existing evidence base, consisting entirely of low quality observational studies, suggests that vancomycin prophylaxis could be effective in reducing the risk of rCDI with antibiotic re-exposure. These findings support a definitive RCT to firmly establish the efficacy and safety of vancomycin prophylaxis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.037 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".