2429. Whole-genome Sequencing of Healthcare-Onset C. difficile Infection (HO-CDI) Cases Shows Widespread Presence of Antimicrobial Resistance Genes

BACKGROUND: Clostridioides difficile infection (CDI) is the most common pathogen to cause healthcare-associated infections. Unlike some other bacterial pathogens antimicrobial treatment is seldom based on culture with susceptibility testing with infrequent surveillance for antimicrobial resistance. We have evaluated healthcare-onset CDI (HO-CDI) for both transmission and antimicrobial resistance emergence. METHODS: We identified cases of HO-CDI diagnosed by PCR within a 3 month period (October 1/2018–December 31/2018) at University of Virginia Health System with overlapping stays in the same inpatient units with other HO-CDI. Chart review of all cases was performed. C. difficile was cultured from stool, then DNA was extracted and underwent sequencing on Illumina Miseq platform. Antimicrobial resistance genes were screened using NCBI’s AMRFinder tool from the de-novo assembled contigs using SPAdes. All the C. difficile isolates underwent antibiotic susceptibility testing. RESULTS: Eleven patients were identified with overlapping stays from 5 units. Mean age was 64 years and 63.6% were female. 36.3% of cases were severe CDI with one case of fulminant CDI. There was one recurrence within 90 days (9.1%). Patients were treated with PO vancomycin (72.7%) or IV metronidazole and PO vancomycin (27.3%), none were treated with metronidazole alone. None of the hospital strains were genetically related. There were two isolates with binary toxin gene (cdtB), one ribotype 027 (CD196) and one ribotype 078 (M120). Ninety-one percent of isolates had vanG-like gene cluster and vanZ1 originally identified in Enterococcus sp. erm(B), tet(M), and cfr(C) genes were also detected in several strains. All isolates were susceptible to vancomycin, metronidazole, and tigecycline. There was one strain with moxifloxacin resistance associated with the presence of erm(B) gene. None of the isolates were susceptible to clindamycin. CONCLUSION: There were no widely circulating clones or direct transmissions found in this small sample of HO-CDI cases at our hospital. Like others have we demonstrate carriage of many vanG/Z genes without conferring phenotypic resistance to vancomycin. The origin and function of Van genes in C. difficile could be an area of future research. DISCLOSURES: All authors: No reported disclosures.