2406. Trends of Clostridioides difficile-Associated Diarrhea at a Tertiary Care Center in India

BACKGROUND: Clostridioides difficile has been recognized as a significant cause of morbidity and mortality globally. Its infection can range from asymptomatic carriage to antibiotic-associated diarrhea and colitis. Reports of outbreak with the hypervirulent strain (N1/NAP1 Ribotype 027) has raised the concern on the magnitude and severity of C. difficile infections. This study aimed to determine the prevalence of C. difficile-associated diarrhea (CDAD) among the patients at a tertiary care hospital in India. METHODS: A retrospective analysis from January 2015-December 2018 was done to determine the trends of C. difficile infection. ELISA for detection of toxins A and B was performed on stool samples. A diagnosis of CDAD was made in all patients with stool samples positive for toxins A and B. RESULTS: Samples from 1311 patients were received from January 2015-December 2018 from patients with suspected nosocomial diarrhea. 9/1311 were culture positive for C. difficile, 7/9 were both culture and ELISA positive. A total of 74 patients were positive for ELISA for detection of toxins A and B. The prevalence of CDAD in the years 2015–2018 were as follows: 4.01% (10/249) in 2015, 10.03% (26/259) in 2016, 4.7% (21/446) in 2017 and 5.32% (19/357) in 2018, respectively. Malignancy was found to be the most common underlying pathological condition 15/69. Most common group of antibiotics used in these patients of CDAD were carbapenems 20/64. Amongst 82.6% (57/69) of the patients were hospitalized. Diarrhea was associated with fever in 40.5% (28/69) of the patients. CONCLUSION: Our results show over all variable prevalence of CDAD over the years and was higher in the year 2016. Timely appropriate diagnosis, high index of suspicion in high-risk patients and proper implementation of antimicrobial stewardship programs may help in reducing morbidity and mortality in patients of CDAD. DISCLOSURES: All authors: No reported disclosures.