Introduction: Currently, the diagnosis of Clostridioides difficile infection(CDI) is based on stool testing for the detection of C.diff glutamate dehydrogenase antigen(Ag), C.diff toxin(A or B), and toxin gene sequences(PCR, Amplified test). The sensitivity and specificity of these tests ranges between 90-99%. The results are interpreted as Ag (+/-) Toxin (+/-) and Amplified (+/-). Based on these results, the patients are classified as having C.diff infection, C.diff carriers or C.diff negative. The subset of patients who are Ag(+)Toxin(-) and Amplified(-) are classified as C.diff carriers. To date, there are no guidelines for management of symptomatic C.diff carriers, nor is there a longitudinal follow up of these patients in the literature. Methods: A retrospective study was conducted for all the patients who were admitted for or developed diarrhea and who tested positive for C.diff Antigen (n=86) between July, 2017- June, 2018. Results: Of the 86 patients, 29 were Ag(+) Toxin(+) and 35 were Ag(+) Toxin(-) Amplified(+), these group of patients were identified as having CDI and were treated. However, a subset of patients(n=22) who were Ag(+) Toxin(-) Amplified(-) who were symptomatic, were classified as Symptomatic C.diff carriers (Table 1). The mean age of this subgroup was 59.3 years(+/- 24.2 years, SD) and it consisted of 10 males and 12 females. It is noteworthy, that 19 out of these 22 symptomatic carriers were not given any antibiotic treatment. A longitudinal follow up of this group of patients, for a period of 6-12 months revealed that 6 out of these 22 C.diff carriers went on to develop CDI and requiring multiple admissions(1-3) to the hospital. Discussion: As many as 22 out of 86 patients were identified as symptomatic C.diff carriers, and the majority of these patients (86.3%) went untreated. The prevalence of the symptomatic carrier is quite significant (25.6%) in our study population. Of the untreated symptomatic C.diff carriers, six patients(27.3%) developed subsequent CDI and required readmissions to the hospital(1-3) within 6-12 months. The cost of a single hospitalization due to a single incidence of CDI is roughly $43,000. These data suggest that symptomatic C.diff carriers should be treated with antibiotics to prevent CDI and readmission to the hospital. Additional prospective clinical studies on larger group of patients with longitudinal follow up are needed for optimum guidelines for the management of this group of patients.
Disclosures: Sandeep Verma indicated no relevant financial relationships. Denise Arrup indicated no relevant financial relationships. Rakesh Vinayek indicated no relevant financial relationships. Padmanabhan Nair: Noninvasive Biotechnologies – Advisory Committee/Board Member, CEO. Laila Phillips indicated no relevant financial relationships. Elad Firnberg indicated no relevant financial relationships. Sudhir Dutta indicated no relevant financial relationships.