2402. Clinical Outcomes Associated with an Emerging Clostridioides difficile Ribotype 255 in Texas

BACKGROUND: PCR ribotyping of Clostridioides difficile strains is commonly used to describe the epidemiology of C. difficile infection (CDI). Certain ribotypes (RT) have been associated with more severe disease and clinical outcomes, such as RT 027, while others are considered less virulent, such as RT 014-020. Texas statewide surveillance identified the emergence of a rarely-described RT 255 beginning in 2015, which now represents the fifth most common ribotype across the state. Here we describe clinical outcomes associated with an emergent RT 255 in Texas. METHODS: A retrospective cohort study was conducted including patients from two tertiary care centers in Houston, Texas. Patients infected with C. difficile strains of either RT 255, 014-020, or 027 between 2016–18 were included. The primary outcome was disease severity as classified by the 2017 IDSA guidelines. Multivariable logistic regression analysis was done to control for other patient factors. Results were significant at P < 0.05, and all statistical analyses were completed using SPSS, version 25. RESULTS: A total of 150 patients were included (50 patients infected with each RT). Overall, 53% of the patients had severe or fulminant disease most commonly due to RT 027 (80%) followed by RT 014-020 (40%) and RT 255 (38%). Patients infected with RT 255 or 014-020 had a 75% relative reduction in the odds of severe disease compared with RT 027 after controlling for patient age and serum albumin level (OR, 0.25; 95% CI, 0.86–0.74; P = 0.12;). No differences were seen in the rates of 30- or 90-day recurrence between RTs. CONCLUSION: Although RT 255 is becoming increasingly common across Texas, it does not appear to be associated with more severe disease when compared with other common ribotypes. Further studies are warranted to determine contributing factors for its increasing prevalence. DISCLOSURES: All authors: No reported disclosures.