Revista de Gastroenterología de México Revista de Gastroenterología de México
DOI: 10.1016/j.rgmxen.2017.07.018
Letter to the Editor
Response to Dr. Tobar-Marcillo and his coauthors: “Chemoprophylaxis in the prevention of Clostridium difficile infection: Still a ways to go”
Respuesta al Dr. Tobar-Marcillo y a sus coautores: «Quimioprofilaxis en la prevención de infección por Clostridium difficile, un camino por recorrer»
M.E. Icaza-Chávez,
Star Médica, Mérida, Yucatán, Mexico
Dear Editor:

I appreciate the interesting comments made by Tobar-Marcillo et al. in their Letter to the Editor “Chemoprophylaxis in the prevention of Clostridium difficile infection: Still a ways to go”.1 As Dr. Tobar correctly states, the retrospective study by Rodríguez et al.2 showed that primary anti-Clostridium difficile (CD) prophylaxis prevented CD infection (CDI) in individuals at high risk for said infection that took antibiotics, and the retrospective study by Van Hise et al.3 demonstrated that antibiotics used as anti-CD prophylaxis in individuals that already presented with CDI and that required antibiotic treatment for a different indication, prevented a subsequent CDI attack.

Fischer et al. 4 considered the work presented at the 2016 DDW relevant, because the long-term risk for CDI recurrence after successful fecal microbiota transplant (FMT), with or without exposure to an antibiotic nonspecific for CDI, is unknown. They also stated that the prophylactic use of anti-CDI antibiotics (vancomycin, metronidazole, or fidaxomicin) or probiotics in patients with those characteristics is not known, making the administration of those antibiotics or probiotics for that indication a subject of debate. By means of a personal communication, Allegretti, a coauthor of the Fischer study, commented to me that the work presented in the poster session (Tu1914) at the 2017 DDW in Chicago is the continuation of the study mentioned by Dr. Tobar.

Fischer et al.5 conducted a multinational, retrospective study in the United States and Canada on 426 patients that received successful FMT for CDI. The overall reinfection rate was 10.3%, and it was 18.3% after the use of non-anti-CD antibiotics. Specifically, the reinfection rate was 31% with fluoroquinolones, 19% with cephalosporins, and 15% with amoxicillin/amoxicillin-clavulanate. Interestingly, CD reinfection with the prophylactic use of anti-CD antibiotics, together with non-anti-CD antibiotics, was 27.8%, versus 14.3% without their use (p=0.12). Reinfection was 27.5% with the use of probiotics versus 13.8% without their use (p=0.08). The risk was significant and greater with the use of probiotics plus anti-CD antibiotics than without their use, at 46.7% versus 14.3%, respectively (p=0.007). Therefore, the authors concluded that prophylactic anti-CD antibiotics or probiotic use in patients with previous FMT did not reduce the risk for CDI recurrence. Those results are surprising, and as the authors suggest, a prospective study is necessary to demonstrate their data.

Data confidentiality

The authors declare that no patient data appear in this article.

Financial disclosure

No financial support was received in relation to this study/article.

Conflict of interest

The authors declare that there is no conflict of interest.

References
1
M.E. Icaza-Chávez
Actualidades en cuanto a la infección por Clostridium difficile
Revista de Gastroenterología de México., 81 (2016), pp. 16-18
2
S. Rodriguez,M. Hernandez,G. Tarchini
Risk of Clostridium difficile infection in hospitalized patients receiving metronidazole for a non-C. difficile infection
Clin Gastroenterol Hepatol., 12 (2014), pp. 1856-1861 http://dx.doi.org/10.1016/j.cgh.2014.02.040
3
N. Van Hise,A. Bryant,E. Hennessey
Efficacy of oral vancomycin in preventing recurrent Clostridium difficile infection in patients treated with systemic antimicrobial agents
Clin Infect Dis., 63 (2016), pp. 651-653 http://dx.doi.org/10.1093/cid/ciw401
4
M. Fischer,E. Phelps,R. Bolla
93 Long-term risk of Clostridium difficile infection recurrence with or without antibiotic exposure following successful fecal microbiota transplant
Gastroenterology., 150 (2016), pp. S23
5
Fischer M, Kao DH, Phelps EL, et al. Should we recommend anti-Clostridium difficile antibiotic or probiotic prophylaxis?: Risk of Clostridium difficile infection with systemic antimicrobial therapy following successful fecal microbiota transplant. Sesión de carteles presentada en: DDW; 2017 mayo 6-9, Chicago IL. Tu1914.

Please cite this article as: Icaza-Chávez ME. Respuesta al Dr. Tobar-Marcillo y a sus coautores: «Quimioprofilaxis en la prevención de infección por Clostridium difficile, un camino por recorrer». Revista de Gastroenterología de México. 2017. http://dx.doi.org/10.1016/j.rgmx.2017.07.001

Corresponding author at: Calle 26 No. 199, Int. 430, Fracc. Altabrisa, C.P. 97133 Mérida, Yucatán, Mexico. Tel.: +9992006947. (M.E. Icaza-Chávez maruicaza@gmail.com)
Copyright © 2017. Asociación Mexicana de Gastroenterología
DOI: 10.1016/j.rgmxen.2017.07.018