239. Implementation of a Vertical Antimicrobial Stewardship Intervention for Patients Colonized with Clostridium difficile

BACKGROUND: Clostridium difficile remains a pathogen of importance as global infections steadily rise. While traditionally thought of as a nosocomial infection, C. difficile prevalence is increasing in the community. This may be due partly to asymptomatic gastrointestinal colonization with C. difficile. Disruption of the gut microbiome in colonized patients (patients) through the use of antibiotics (ABX) and acid-suppressive therapy (AST) may lead to active colitis. In an effort to prevent progression to active disease, a novel vertical antimicrobial stewardship (AMS) intervention was initiated at our hospital on May 1, 2017. This study aims to describe our experience with this intervention. METHODS: This single-center, descriptive study evaluated the impact of a vertical AMS intervention for patients colonized with C. difficile as identified by surveillance nucleic acid amplification test (NAAT) upon hospital admission. Between May 1 and December 10, 2017, patients on five units [two hematology/oncology (HO), solid-organ transplant (SOT), intensive care unit (ICU), medicine ward (MED)] were screened, with surveillance results reported to the AMS team. Positive results prompted the AMS pharmacists to evaluate patients for potential ABX and AST de-escalation interventions (INTV) daily until discharge. RESULTS: Of the 37 patients who developed active colitis, ABX INTVs were made on 6 (16%) with 33% acceptance and AST INTVs were made on 10 (27%) with 50% acceptance. CONCLUSION: The rate of progression from colonization to colitis was low in all patient populations studied, despite high rates of ABX and AST use. Further research into what causes progression from colonization to colitis is needed. DISCLOSURES: All authors: No reported disclosures.