404. Surveillance of <i>Clostridioides difficile</i> Burden in Hospitals Through Wastewater Analysis

Abstract Background New tools capable of dynamic assessment the varying burden Clostridioides difficile infections are required to mitigate increased patient morbidity, mortality, and health costs. Wastewater (WW)-based epidemiology (WBE) is an emerging science, enabling comprehensive, inclusive, unbiased populations, spatially temporally. We sought detect, quantify track C. across a range scales using WBE. Methods WW collected from two hospitals; Rockyview General Hospital (RGH; 600 beds) Peter Lougheed Centre (PLC; 550 both based in Calgary, were compared that municipal Treatment Plant (WWTP) Canada. DNA was extracted pellets after centrifugation. A multiplexed quantitative PCR assay used abundance 16S rRNA toxin (tcdA) genes. These then assessed as raw values or normalized ratios three fecal biomarker genes: total bacterial rRNA, human 18S Bacteroides HF183 rRNA. Kruskal-Wallis Mann-Whitney tests performed RStudio GraphPad Prism (version 9.3.1). Results Eight weekly samples RGH demonstrated significant changes levels gene tcdA over time (P=0.0004 P=0.0005, respectively, Kruskal-Wallis). Similar trends observed when copies with Over separate 13-week comparison, target greater hospital (RGH PLC) than community-based WWTP (P=0.048 P=0.012, Mann-Whitney). There no difference between PLC (P=0.896 P=0.343, genes wastewater measured by PCR. ratio against load (16S rRNA) varies markedly hospitals relative treatment plant Conclusion surveillance powerful tool can monitor real-time. This could augment infection prevention control antimicrobial stewardship programs better understand factors contribute colonization infection. Disclosures Thomas J. Louie, MD, Artugen: Advisor/Consultant|Artugen: Grant/Research Support|Crestone: Advisor/Consultant|Crestone: Support|Finch Therapeutics: Advisor/Consultant|Finch Support|Rebiotix: Advisor/Consultant|Rebiotix: Support|Seres Advisor/Consultant|Seres Support|summit plc: Advisor/Consultant|summit Support|Vedanta Biosciences: Advisor/Consultant|Vedanta Support.