{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:03:37Z","timestamp":1784797417493,"version":"3.55.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antibiotic re-exposure after an episode of Clostridioides difficile infection (CDI) is common and is a strong risk factor for recurrent CDI (rCDI). Two randomized controlled trials (RCTs) of vancomycin prophylaxis during antibiotic re-exposure were recently published, which we sought to evaluate by meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We updated a recent systematic review search of MEDLINE and Embase via Ovid to 9 March 2026. RCTs of vancomycin during antibiotic re-exposure as secondary CDI prophylaxis were included. Quality was assessed by the Cochrane RoB2 tool. A Bayesian meta-analysis of 56-day rCDI was conducted on the odds ratio (OR) scale using a weakly informative prior. The probabilities of any benefit (i.e. OR\u200a&amp;lt;\u200a1) and that the number needed to treat (NNT) was &amp;lt;20 (i.e. risk difference\u200a&amp;gt;\u200a5%) were computed from the posterior. The 95% predictive interval (95% PI) was computed, which corresponds to the predicted range of the effect estimate of a future RCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two RCTs at low risk of bias were included, which comprised 102 patients. The pooled OR was 0.61 [95% credible interval (95% CrI)\u200a=\u200a0.27\u20131.40], which corresponded to a probability of any benefit with vancomycin prophylaxis of 88.0% and a probability that the NNT was &amp;lt;20 of 75.9%. The 95% PI was 0.19\u20132.00.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on two small RCTs, there is a reasonable probability that secondary vancomycin prophylaxis during antibiotic re-exposure reduces 56-day rCDI. However, these results remain uncertain as the 95% PI is wide and consequently larger trials are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlag141","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:40:29Z","timestamp":1783424429000},"source":"Crossref","is-referenced-by-count":0,"title":["Secondary vancomycin prophylaxis during antibiotic re-exposure for the prevention of recurrent\n                    <i>Clostridioides difficile<\/i>\n                    infections: a systematic review and Bayesian meta-analysis"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6790-220X","authenticated-orcid":false,"given":"Connor","family":"Prosty","sequence":"first","affiliation":[{"name":"Faculty of Medicine, McGill University , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]},{"name":"Division of Experimental Medicine, Department of Medicine, McGill University , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Sorin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, McGill University , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0783-0624","authenticated-orcid":false,"given":"Emily G","family":"McDonald","sequence":"additional","affiliation":[{"name":"Division of Experimental Medicine, Department of Medicine, McGill University , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]},{"name":"Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]},{"name":"Division of General Internal Medicine, Department of Medicine, McGill University Health Centre , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2267-4239","authenticated-orcid":false,"given":"Todd C","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Experimental Medicine, Department of Medicine, McGill University , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]},{"name":"Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]},{"name":"Division of Infectious Diseases, Department of Medicine, McGill University Health Centre , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026072304301149000_dlag141-B1","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1056\/NEJMoa1910215","article-title":"Trends in U.S. Burden of Clostridioides difficile infection and outcomes","volume":"382","author":"Guh","year":"2020","journal-title":"N Engl J Med"},{"key":"2026072304301149000_dlag141-B2","doi-asserted-by":"crossref","unstructured":"Kimura T, Snijder R, Sugitani T. Characterization and risk factors for recurrence of Clostridioides (Clostridium) difficile infection in Japan: a nationwide real-world analysis using a large hospital-based administrative dataset. J Infect Chemother \u00a02019; 25: 615\u201320. 10.1016\/j.jiac.2019.03.011","DOI":"10.1016\/j.jiac.2019.03.011"},{"key":"2026072304301149000_dlag141-B3","doi-asserted-by":"publisher","first-page":"105041","DOI":"10.1016\/j.cmicom.2024.105041","article-title":"Oral vancomycin prophylaxis for the prevention of recurrent Clostridioides difficile infection during re-exposure to systemic antibiotics: a systematic review and meta-analysis","volume":"1","author":"Prosty","year":"2024","journal-title":"CMI Commun"},{"key":"2026072304301149000_dlag141-B4","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/cix1085","article-title":"Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)","volume":"66","author":"McDonald","year":"2018","journal-title":"Clin Infect 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