802. Proton Pump Inhibitors Increase Clostridioides difficile Disease Severity Controlling for Infecting Strains

BACKGROUND: Proton pump inhibitors (PPI) display pleotropic properties that increase the risk of poor outcomes in patients with C. difficile infection (CDI). However, clinical data on PPI and CDI outcomes is controversial perhaps due to lack of knowledge of infecting strain. The purpose of this study was to assess CDI outcomes in hospitalized patients infected with known C. difficile ribotypes based on use of PPI. METHODS: This was a multicenter study (20 hospitals) of hospitalized patients infected with one of three C. difficile ribotypes (RT027, RT106, and RT014-020). Electronic medical records were reviewed by investigators blinded to RT that collected data on PPI use along with other clinical data. A composite endpoint of disease severity, mortality and 90-day CDI recurrence was assessed based on receipt of PPI and ribotype using multivariate logistic regression. RESULTS: A total of 380 patients with CDI aged 66±17 years (Female: 59.5%; White: 70.5%) infected with RT 106 (115/380; 30.3%), RT027 (116/380; 30.5%), and RT014-020 (149/380; 39.2%) were included. One hundred and ninety-nine patients (52.4%) were given a PPI at the time of CDI diagnosis and 129 patients (66.1%) experienced either severe disease or CDI recurrence. Disease severity differed significantly between ribotypes (p< 0.05) and increased in patients given PPI (p=0.08). CDI recurrence also differed significantly among ribotypes (p< 0.05) and increased in patients given PPI. Using the composite endpoint, receipt of PPIs significantly increased the likelihood of poor outcomes (OR:1.78; 95% CI: 1.17-2.73; p=0.007) after controlling for infecting ribotype. CONCLUSION: In this multicenter study, receipt of PPIs increased the likelihood of poor outcomes in CDI patients after controlling for infecting ribotype. DISCLOSURES: Kevin W. Garey, PharmD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator)