{"doi":"10.1016/j.cmi.2025.08.004","title":"Screening and targeted prophylaxis for Clostridioides difficile infection","abstract":"OBJECTIVE: Patients receiving immunosuppression for oncology treatment and solid organ transplantation are at high risk for developing hospital-onset Clostridioides difficile infection (HO-CDI). We studied the impact of a prophylactic enteral vancomycin intervention on the reduction of HO-CDI during high-risk inpatient admissions among immunocompromised patients. METHODS: The screening and targeted prophylaxis (STOP) intervention was implemented over a 2-year period. Patients admitted for solid organ transplant, autologous stem cell transplant, chimeric antigen receptor T-cell, or treatment for leukaemia were screened for colonization with C. difficile. Colonized patients were placed in contact isolation and were advised to start anti-C.difficile antibiotic prophylaxis. To assess the effect of this intervention on both C.difficile testing and incident HO-CDI, comparison was made to historical controls in the 2 years before implementation of the STOP intervention, both unweighted and weighted by treatment category and separately by treatment category and severity of illness. RESULTS: From November 2021 to December 2023, 696 patients were screened for C difficile, among whom 11.1% (77/696) were found to be colonized and received the prophylactic intervention. Compared with treatment-weighted controls, the odds of HO-CDI were significantly lower in the intervention group (6/696 [0.88%] vs. 81/1450 [5.6%]; odds ratio [OR], 0.15; 95% Credible Interval [CrI], 0.06-0.30). Significant reductions in 90-day CDI (OR 0.40, 95% CrI 0.25-0.64), stool output (incidence rate ratio, 0.84; 95% CrI, 0.77-0.92), and length of stay (-2.5 days; 95% CrI, -3.4 to -1.5) were also observed in the intervention group. There was no detected difference in vancomycin-resistant Enterococci infection (OR, 0.77; 95% CrI, 0.33-1.75) or mortality (OR, 0.44; 95% CrI, 0.11-1.49). DISCUSSION: The STOP intervention was effective at reducing HO-CDI, length of stay, and symptoms of C difficile in this high-risk cohort.","journal":"Clinical Microbiology and Infection","year":2025,"id":534449,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9651,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":460814,"name":"Judith A. Anesi","orcid":"0000-0001-6671-4557","position":1,"is_corresponding":false},{"id":460816,"name":"Pam Tolomeo","orcid":"0000-0001-5594-8884","position":2,"is_corresponding":false},{"id":732201,"name":"Laurel Glaser","orcid":"0000-0001-8463-5107","position":3,"is_corresponding":false},{"id":1067291,"name":"Laura Cowden","orcid":null,"position":4,"is_corresponding":false},{"id":523281,"name":"Leigh Cressman","orcid":null,"position":5,"is_corresponding":false},{"id":1340561,"name":"Elizabeth Huang","orcid":"0000-0001-8209-0609","position":6,"is_corresponding":false},{"id":1417065,"name":"Alexa Patel","orcid":"0009-0005-3176-856X","position":7,"is_corresponding":false},{"id":287738,"name":"Ebbing Lautenbach","orcid":"0000-0003-4772-2409","position":8,"is_corresponding":false},{"id":294611,"name":"David A. Pegues","orcid":"0000-0002-5295-0046","position":9,"is_corresponding":false},{"id":522319,"name":"Brendan J. Kelly","orcid":"0000-0003-2023-646X","position":10,"is_corresponding":false},{"id":1417609,"name":"Mathew J. Ziegler","orcid":null,"position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T02:51:47.434742Z","pmid":"40816469","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}