398. Post-Infectious Irritable Bowel Syndrome in Patients Referred to a Complicated Clostridioides difficile Clinic

BACKGROUND: Recurrence of Clostridioides difficile infection (CDI) occurs in up to 20-30% after an initial episode and up to more than half of patients with previous infection. C. difficile has also been associated with post-infectious irritable bowel syndrome (PI-IBS) following the resolution of an acute infection, complicating assessment of gastrointestinal symptoms post-CDI. The prevalence and risk factors for post-CDI IBS are not as well-defined as PI-IBS secondary to other pathogens. METHODS: In this study, we examined the electronic medical record of 67 consecutive patients referred to a Complicated C. Difficile Clinic from March 2020 to July 2021 for consideration of fecal microbiota transplantation. RESULTS: Patients were referred by primary care providers (54%), gastroenterologists (16%), hospital admitting team (19%) or others (10%). Mean age was 64 (21-93) and 51 patients (76%) were female. In 25 out of the 67 patients (37%), treatment was prescribed without documentation of a positive C. difficile assay. We found that 32.8% of patients referred to the clinic for recurrent CDI had symptoms consistent with post-CDI IBS. Patients with post-CDI IBS were generally younger in age (P = 0.03), had fewer medical comorbidities (P = < 0.001), and more often had history of anxiety (P = 0.03) than patients with a diagnosis of CDI. CONCLUSION: Our findings suggest that post-CDI IBS is prevalent, can be misdiagnosed as CDI recurrence, and may lead to inappropriate use of anti-C. difficile agents or interventions. DISCLOSURES: All Authors: No reported disclosures.