2386. Mortality reduction with implementation of a standardized approach of surveillance, diagnosis and treatment of Clostridioides difficile infections.

BACKGROUND: Clostridioides difficile (C. difficile) infection is the main cause of nosocomial diarrhea in the world. In our hospital, there was no standardized protocol for diagnosis and treatment of this infection. The aim of this study was to measure the impact of implementing a multimodal strategy of active surveillance, diagnosis and treatment in the clinical outcome of patients with C. difficile infection. METHODS: Observational, retrospective, and analytical study that compared a multimodal strategy for the treatment of C. difficile infection against a traditional strategy, which consisted of treatment with either metronidazole or vancomycin with variable duration of therapy depending on the physician’s choice. The multimodal strategy consisted of active surveillance of cases of nosocomial diarrhea, timely diagnosis (<12 hours), and standard treatment with oral vancomycin for a minimum of 10 days (125 mg po qid in mild and moderate illness, and 250 mg qid in severe disease). Patients with a confirmed diagnosis of C. difficile infection (PCR- Gene Xpert Cepheid) and inflammatory diarrhea were included. The study was carried out in a third-level hospital, in the period between September 2017 and December 2018. RESULTS: In 15 month study period, 92 cases of C. difficile infection were documented. All cases were caused by strain NAP1 / B1 / 027. Twenty-three patients (25%) had mild disease, 28 (30.4%) moderate illness and 41 (44.56%) complicated illness. Thirty-four patients were evaluated with multimodal strategy and 58 according to the traditional treatment. Only 24 patients (41%) in the traditional treatment group received treatment with oral vancomycin. The clinical outcomes of patients in the multimodal strategy against patients with the tradional strategy were: clinical cure 85.3% vs 37.9% (P = 0.02), recurrence 2.9% vs 17.2% (p = < 0.05) and death 11.8% vs 44.8%(p = < 0.05), respectively. CONCLUSION: Unfortunately, in our country, there are no guidelines for the management of C. difficile infection, and in many hospitals, metronidazole is the most prescribed treatment. In this study, we documented that implementing a standardized strategy of surveillance, diagnosis and adequate treatment, reduced mortality related to C. difficile infection, recurrence, and achieved greater clinical cure. [Image: see text] DISCLOSURES: All authors: No reported disclosures.