1635A Retrospective Study Comparing Outcomes of Present on Admission Clostridium difficile Infection (CDI) vs Non-present on Admission CDI at a Tertiary-care Hospital in Detroit

Background. The aim of this study was to compare hospital-onset (Non-POA) CDI discharges to community-onset (POA) CDI discharges in order to assess the healthcare burden of hospital acquired CDI. Methods. A retrospective chart review of patients diagnosed with CDI was conducted at a tertiary-care hospital in Detroit between January 2011 and December 2012. CDI Patients were classified as present-on-admission (POA) if they were primarily admitted with CDI or tested positive for CDI 48 hours prior and/or 48 hours after admission. Non-present-on-admission (Non-POA) patients were defined as being tested positive for CDI 48 hours after admission. Collected data included demographics, admission source, comorbidities, and length-of-stay (LOS). Thirty-day readmissions due to all causes including recurrent CDI as well as 30day mortality rates were calculated and compared between POA and Non-POA CDI discharges. Results. The cohort included 710 patients with POA CDI and 602 patients with Non-POA CDI. Although the mean age of POA group was not significantly different from the mean age of Non-POA group (61 ± 19 vs 61 ± 18, p = .95), Non-POA patients were more likely to be admitted with a rapidly fatal condition compared to POA patients (49 % vs 42%, p = .022). On the other hand, POA patients were more likely to be admitted from home compared to Non-POA patients (76% vs 70%, p= .015). The median LOS for Non-POA patients was significantly higher than that for POA patients (16 days, interquartile range {IQR} [10 – 27] vs 5 days, IQR [3 – 10], p < .001). Although not statistically significant, 30-day readmissions due to CDI recurrence in the POA group were higher than that in the Non-POA group (5% vs 3%, p = .09). The median time to readmission for POA patients was significantly higher than that for Non-POA patients (53 days, IQR [17 – 199] vs 34 days, IQR [11 – 137], p = .003). Thirty-day mortality rate of Non-POACDI patients was higher than that of POA CDI patients (11.5 % vs 6%, p < .001). Conclusion. Given the high morbidity and mortality rates among patients with hospital-onset CDI (Non-POA), efforts should focus on prevention strategies including regular surveillance, antimicrobial stewardship and quality improvement programs. Disclosures. K. Kaye, Cubist Pharmaceuticals: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Grant recipient and Speaker honorarium