Detectable Vancomycin Stool Concentrations in Hospitalized Patients with Diarrhea Given Intravenous Vancomycin

• Main Authors: Taryn A. Eubank (Author), Chenlin Hu (Author), Anne J. Gonzales-Luna (Author), Kevin W. Garey (Author)
• Format: Book
• Published: MDPI AG, 2023-09-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.3390/pharma2040024; 2813-0618
• Keywords: glycopeptides; stool; pharmacokinetics; <i>Clostridioides difficile</i>; microbiome; Therapeutics. Pharmacology; RM1-950; Other systems of medicine; RZ201-999; Public aspects of medicine; RA1-1270
• Source: Pharmacoepidemiology, Vol 2, Iss 4, Pp 283-288 (2023)

Vancomycin is not appreciably passaged via the colonic membrane to the gastrointestinal (GI) tract in persons with an intact gut epithelium due to its large chemical structure. However; hospitalized patients with diarrhea often have a disrupted GI tract. The aim of this study was to determine the frequency of detectable vancomycin concentrations in the stool of patients with antibiotic-associated diarrhea receiving IV vancomycin. This was a multicenter cohort study of hospitalized patients with stool samples collected for <i>Clostridioides difficile</i> testing. Leftover stool samples were collected from patients who had received at least 3 days of IV vancomycin. Fecal vancomycin was quantified by high-performance liquid chromatography. The study cohort included 33 unique patients, majority female (54.5%) aged 60 years (range 23-84). Eighteen of thirty-three patients (54.5%) tested positive for <i>C. difficile</i> toxins. The average duration of systemic vancomycin administration prior to stool collection was 3.5 (range 2-15) days. Three of 33 (9%) stool samples had a detectable vancomycin concentration (range 1.2-13.2 mcg/mL). These concentrations may promote the development of vancomycin-resistant <i>Enterococcus</i> or van mutations in <i>C. difficile</i>, leading to vancomycin resistance. Further studies on implications are warranted.