1120. Clostridium difficile Infection Risk Factors, Severity, and Outcomes in Patients Infected with NAP1/027 Strain in a Non-Epidemic Setting
Session: Poster Abstract Session: Enteric Infections
Friday, October 5, 2018
Room: S Poster Hall
Background: Evidence surrounding outcomes with the North American pulsed-field gel electrophoresis type 1 (NAP1) Clostridium difficile (CDI) strain remains conflicting. We compared risk factors, severity of illness and mortality of patients infected with NAP1 strain compared to patients with non-NAP1 strains in our multi-hospital health system.

Methods: This is a retrospective case control analysis of patients admitted to one of five hospitals (1 academic and 4 community hospitals) and diagnosed with CDI from April 2014 through July 2017. CDI definition included three or more stools per day with positive stool sample polymerase chain reaction (PCR) testing for Clostridium difficile.

Results: A total of 490 patients met inclusion, of which 155 had the NAP1 strain and 335 patients were infected with non-NAP1 strains. More patients with NAP1 were older, female, had CHF, and presented from a health care facility as opposed to from the community (all p<0.05). No difference in 90-day antibiotic class use was found. NAP1 patients had increased ICU admission (12.3 vs 6.0%, p=0.016), a shorter length of stay (10.8 vs 13.4 days, p=0.037), abnormal CT findings (p<0.023) and trend toward more ID consults (p=0.067). Per IDSA classification, 61.9% in the NAP1 CDI group had severe CDI as opposed to 49.6% in the non-NAP1 study group. (p=<0.038). There was no observed difference in inpatient mortality (7.7 vs 5.7%, p=0.381).

Conclusion: CDI caused by NAP1 strain did result in increased severity but did not result in increased mortality compared to CDI caused by non-NAP1 strains. Evidence continues to mount that while the NAP1 strain may affect severity, its effect on mortality remains in question.

Julie Nahar, MD, Infectious Disease, University of Missouri Kansas City School of Medicine, Kansas City, MO

Disclosures:

J. Nahar, None

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