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Background Clostridioides difficile is an organism acquired not only in healthcare settings but also in community settings. For the past several years our hospital has performed screening tests to detect asymptomatic carriage of C. difficile. We now aim to better understand the ribotypes and degree of diversity among these C. difficile strains obtained in a systematic screening. Methods This study was performed at a 600 bed teaching affiliated hospital in Milwaukee, WI, where surveillance testing is performed in selected units upon admission and weekly thereafter using nucleic acid amplification test (NAAT; Xpert® C. difficile ; Cepheid, Sunnyvale, CA). Screening tests are obtained regardless of symptoms. NAAT positive samples underwent anaerobic cultures in C. difficile selective broth (CCMB-TAL) for 24–48 hr and then to Brucella blood agar plates (BA) for 48–72 hr to confirm C. difficile presence. PCR-ribotyping was performed as previously described by Stubbs et al. with minor modifications. The results were compared with a database containing >3,000 clinical isolates including C. difficile reference strains from the Cardiff ribotype collection. Results A total of 104 strains belonging to 93 unique patients were processed. Patients had a mean age of 60 years (range: 18 - 89) and 49% were females. Most patients were hospitalized in the hematology oncology units (55.7%) or in the solid-organ transplant step down unit (9.6%). A total of 25 different ribotypes were identified. The most common ribotype was 014/020 (23; 22%), followed by ribotype 56 (13; 12.5%), 106 (12; 11.5%), 027 (11; 10.5%), 002 (6; 5.7%), and 078/126 (5; 4.81). Regarding the timing of admission, 70 strains were obtained within 4 days from hospital admission and the remaining 34 were obtained afterwards. Both groups had ribotype 014/020 as the most frequently detected ribotype but 027 were the second most commonly detected at the time of admission (table). A total of 7 patients had more than one stool sample processed and 5 of them had discordant ribotypes at different time points. Conclusion Systematic screening tests for C. difficile carriage in a single center showed a large heterogeneity of ribotypes with the majority not being 027. Additionally, most patients tested more than once carried different ribotypes. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background We recently implemented a hospital-wide C. difficile testing algorithm and screening/isolation of C. difficile asymptomatic carriers primarily in heme-onc units. We aim to evaluate the impact of these interventions on the epidemiology of C. difficile + tests. Methods This retrospective cohort was performed in a 600-bed hospital in Milwaukee, WI, from January 1, 2016 to March 31, 2019. All clinical C. difficile tests included nucleic acid amplification (NAAT; Xpert C. difficile , Cepheid). On February 2017, all NAAT+ tests had toxin (tox) checked (Quick check complete, Alere). Testing algorithm (Figure 1) started mid 2016 until now. Screening phases included: Phase 1 (September 2016–May 2017): C. difficile screening cultures shared with units but not placed in electronic medical records (EMR). Patients + placed on enteric precautions (gown, gloves, hand hygiene). Phase 2 (May 2017–January 2018): C. difficile screening (NAAT) performed on admission and weekly thereafter, results placed in EMR, NAAT+ patients placed on enteric precautions. Phase 3 (January 2018–present): C. difficile screening (NAAT) on admission, results placed in EMR, NAAT+ patients placed on enteric precautions. Federal reporting changed to only reporting NAAT+tox+. Tests (NAAT+, NAAT+tox+, and NAAT+tox-) were analyzed using Poisson regression offsetting for log of patient-days using SAS, v9.4. Results Hospital-wide C. difficile tests decreased from 21 to 10.9 tests per 1,000 patient-days (P < 0.0001; Figure 2). This effect was seen in heme-onc units (41 to 15.7; P < 0.0001; Figure 3) and in all other units (18.9 to 9.9; P < 0.0001). All NAAT+ results decreased from 2.99 to 1.94 per 1,000 patient-days hospital wide (P < 0.0001) but remained unchanged in heme-onc units (4.6 to 3.7, P > 0.05). NAAT+tox+ results remained unchanged hospital wide and in heme-onc units (0.8 to 0.7 and 1.1 to 1.2, respectively; both P > 0.05); however, the frequency of NAAT+tox− tests decreased hospital wide (1.8 to 1.3; P = 0.0003) and in heme-onc units (3.8 to 2.4; P = 0.05). Conclusion A C. difficile testing algorithm was successful decreasing the number of C. difficile tests performed and had a hospital-wide reduction of NAAT+tox− tests. The rate of NAAT+tox+ cases in heme-onc units and hospital wide remained unchanged despite active screening and isolation in selected units. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background During 2016, our hospital experienced an outbreak with carbapenemase-producing Enterobacteriaceae (CPE) in our solid-organ transplant (SOT) population. Since this outbreak and until now, our hospital has implemented active CPE screening of patients admitted to SOT units and point prevalence surveillances in any unit with a known CPE patient. The present study evaluates the yield of these screening tests and their cost since implementation. Methods This retrospective cohort was performed in a 600-bed hospital in Milwaukee, WI. CPE screening tests were retrieved from the clinical microbiology laboratory dataset from January 2016 to April 2019. CPE tests are performed on rectal swabs or stool samples using the CDC broth enrichment method followed by MIC confirmation using Etest. CPE patients were placed on enhanced precautions (gowns, gloves, booties) and were cohorted geographically and to 1:1 nursing and nurse aid staff. Results A total of 6,684 samples belonging to 3,383 patients were processed (1.9 samples/patient). Two hundred thirty (3.44%) had carbapenem-resistant Enterobacteriaceae , although only 33 isolates (0.49%) were confirmed as either KPC (n = 31) or NDM (n = 2) positive. Out of the 3,383 patients tested, 121 were identified as carriers of carbapenem-resistant isolates but only 11 (0.32%) were CPE (KPC = 11; NDM = 2). The incidence of new CPE patients during 2016 was 0.82% but decreased to 0.28% and 0.33% in 2017 and 2018, respectively. The units with the highest number of CPE patients were the transplant intensive care unit (n = 6) and the step-down SOT unit (n = 3). Negative cultures were quoted at $8.49 per sample but culture plates with colonies increased the cost per test to $28.44. The total cost for all the 6,684 screening tests was calculated at $61,335. The cost of CPE screening per positive CPE patient identified comes up to $5,575 (not including RN collection time). Conclusion In an institution with staff and CPE patient cohorting, active screening of CPE positive patients was relatively expensive given our low -level of transmission. In the near future, we plan to stop staff and patient cohorting due to the high stress that these interventions place on our hospital staff. This might ensue in increase transmission, which will be detected by CPE screening tests. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]