883. Stool Toxin Concentrations Are Higher in Children with Baseline Severe Disease, Severe Outcomes, and Recurrence

Abstract Background In adults with C. difficile infection (CDI), higher baseline stool concentrations of toxins A and B are associated severe disease, CDI-attributable outcomes, recurrence. We evaluated whether toxin concentration predicts these presentations in children CDI. Methods performed a prospective cohort study from 2016-2019. Participants were inpatients ≤17 years old at two pediatric hospitals diarrhea positive testing who received therapy. Patients followed for 40 days after sample outcomes (intensive care unit admission, colectomy, or death, categorized as CDI primarily attributable, contributed, not contributing) recurrence (resolution by new re-initiation therapy). Baseline & measured using ultrasensitive single molecule array assay (cutoff result = 20 pg/mL). Median compared between groups Wilcoxon tests. Results enrolled 206 patients [median age 8.9 (IQR, 4.7–13.2)]. Children disease IDSA-SHEA criteria (n 39) had median A+B than those without 131) (2,912.6 vs. 500.5 pg/mL, P=0.05). Of the cohort, (19%) outcome (4 attributed to CDI, 19 contribution 17 unrelated CDI). was non-significantly primarily-attributed versus (19,473 429.1 P=0.317) (Figure 1). 197 eligible data, occurred 18 (9.1%); significantly (3,946.7 283.3 P=0.026) 2). Conclusion Higher present outcome, presentations. Quantification may be helpful identifying predicting which could help guide decisions about clinical management. Disclosures Larry K. Kociolek, MD, MSCI, Merck: Grant/Research Support Timothy J. Savage, MPH, MSc, UCB: Contract Brigham Women's Hospital Alice Banz, PhD, biomerieux: Simoa assays bioMerieux, A.B. is an employee bioMerieux Kevin W. Garey, PharmD, MS, Acurx: Support|cidara: Advisor/Consultant|cidara: Support|Paratek: Support|Seres Health: Support|Summit: Ciaran P. Kelly, n/a, Artugen: Advisor/Consultant|Facile Therapeutics: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Finch: Advisor/Consultant|First Light Biosciences: Ownership Interest|Milky Way Advisor/Consultant|Milky Support|Pfizer: Advisor/Consultant|Seres Advisor/Consultant|Summit Advisor/Consultant.