384. Assessing the Multistep Approach for <i>Clostridioides difficile</i> Infection Diagnosis

Abstract Background Clostridioides difficile infection (CDI) is a spore-forming anaerobic Gram-positive bacillus and the leading cause of nosocomial infectious diarrhea. 2017 IDSA/SHEA C. guidelines recommend multistep algorithm approach for CDI diagnosis. This entails stool testing via enzyme-linked immunosorbent assay (EIA) glutamate dehydrogenase (GDH) toxins A/B (Tox). Discordant samples are arbitrated by nucleic acid amplification test (NAAT) tcdB gene. GDH EIA has sensitivities &amp;gt;90%, while Tox ranging from 50-90%. We aimed to evaluate diagnostic performance using as gold standard. Methods performed secondary analysis an inpatient dataset collected in tertiary community health system Southern US, including 9-months incident population 2019 2020. All adults ≥ 18-years old Princeton Baptist Medical Center (Birmingham, AL) tested were included. Alere TechLab Quik Chek Complete® was used determine EIA, Alethia DNA Amplification Assay®, NAAT, discordant samples. case defined positivity GDH, or either addition positive NAAT. Retesting within same admission allowed. Results Overall, 288 tests performed. Concordant &amp; found 29 (10.1%) tests; concordant negativity 226 (78.5%). observed 33 (11.5%) all with Only 1 (3.03%) negative positive, which had The remaining 32 (96.97%) negative, 18 (56.3%) NAAT (Table 1). Performance characteristics above calculated 2). Table 1:Clostridioides distributions per ToxinTable 2:Test Conclusion Taking standard, previous descriptions literature, being highly sensitive specific. A lacking would miss over one-third cases. could potentially overdiagnose about one-fifth patients. Disclosures Authors: No reported disclosures.