2394. Different Clostridioides difficile Ribotypes among Patients with Colonization, Initial Clinical Disease and Recurrent Clinical Disease
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall
Background: C. difficile (C.diff) is the most common cause of hospital infections with a spectrum of presentation from asymptomatic carriage to severe recurrent diarrhea. Certain C.diff ribotypes are associated with severe disease, but there is little data on ribotypes in asymptomatic carriers or severe recurrent disease. The aim of this study is to compare virulence potential of C.diff ribotypes with clinical disease severity.

Methods: This retrospective study included patients aged ≥18 years at NorthShore University HealthSystem (NUHS) from 2/1/15 to 5/30/17. Three groups of patients with positive PCR test for C. diff toxin gene were selected: 1) Asymptomatic patients positive for rectal carriage; 2) symptomatic outpatients with a single positive test (CDI); and 3) patients with recurrent CDI who underwent FMT. Clinical data were extracted from the Enterprise Database Warehouse. Isolates underwent fluorescent PCR ribotyping and were assigned to clades. Ribotypes with “high” (eg. 027 and 078) and “low” (eg. 106) virulence potential were defined as such. Virulence potential of cryptic ribotypes were considered “unknown”. We used Χ2and independent samples median tests to compare categorical and continuous variables, respectively.

Results: 129 C. diff isolates (asymptomatic, N=66; CDI, N=33; FMT, N=30) were ribotyped with 60 types identified. Median age was higher in asymptomatic patients [80.5 (IQR 70.8-90) years] compared to both CDI and FMT [69 (58-81) and 69 (51-83.5) years, respectively, p=0.004] Low virulence ribotypes were identified more frequently in asymptomatic carriers than those with CDI or FMT (22/66 vs. 8/33 vs. 1/30, respectively, p = 0.006). High virulence ribotypes were found in all groups, with highest frequency in the FMT group (23/30) vs. asymptomatic (25/67) or CDI (13/33), p=0.001).

Conclusion: Patients with severe or recurrent CDI had ribotypes associated with high virulence potential. In addition, asymptomatic carriers were more likely to have ribotypes of C.diff historically associated with a low virulence potential. Molecular C.diff typing may have a role in evaluating asymptomatic C.diff colonization versus clinical disease.

Kevin Khoury, MD1, Eugene Yen, MD2, Jennifer Grant, MD3, Se Hyuk Park, MS2, Talent Thaparee, MD4, Donna Schora, MT(ASCP)5, Becky Smith, MD6, Kamaljit Singh, MD7 and Sanchita Das, MD4, (1)Internal Medicine, Northshore University Healthsystem, Evanston, IL, (2)Gastroenterology, NorthShore University HealthSystem, Evanston, IL, (3)Infectious Disease, NorthShore University HealthSystem, Evanston, IL, (4)Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, (5)NorthShore University HealthSystem, Evanston, IL, (6)Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, (7)Pathology, Evanston Hospital/NorthShore University HealthSystem, Evanston, IL

Disclosures:

K. Khoury, None

E. Yen, None

J. Grant, None

S. H. Park, None

T. Thaparee, None

D. Schora, None

B. Smith, None

K. Singh, None

S. Das, None

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