2405. Clinical Characteristics and Prognostic Factors for Extraintestinal Infection Caused by Clostridium difficile: An Analysis of 62 Consecutive Cases

Abstract Background Whereas Clostridium difficile enterocolitis has been well studied, data regarding extraintestinal C. difficile infection remain scarce and anecdotal. We investigated characteristics and prognostic factors in patients with extraintestinal C. difficile infection at a large university hospital over a recent 20-year period. Methods We conducted a retrospective cohort study of patients at a 2,700-bed tertiary care hospital from January 1997 through December 2018 whose extraintestinal clinical specimen revealed C. difficile. Gastrointestinal (GI) disruption was defined as compromised integrity of the GI tract by abdominal surgery, perforation, malignancy, or bleeding. Patients were divided into 3 groups: group A (GI disruption with malignancy, n = 15); group B (GI disruption without malignancy, n = 23); group C (No GI disruption or malignancy, n = 24). The main outcome was 30-day all-cause mortality. Results A total of 62 patients were enrolled, and the incidence of extraintestinal C. difficile infection was 2.81 per 100,000 admissions. Median age was 56 years and 36 (58.1%) of the patients were men. Seven patients (11.3%) had confirmed C. difficile enterocolitis, and 38 patients (61.3%) had a polymicrobial infection. C. difficile bacteremia was identified in 22 patients (35.5%) and was significantly more common in group A (60.0% [9/15]) than groups B (43.5% [10/23]) or C (12.5% [3/24]) (P = 0.01). Thirty-day mortality rates were also significantly higher in group A than groups B or C (60.0% [9/15] vs. 13.0% [3/23] and 16.7% [4/24], respectively; P < 0.001) (Figure 1). C. difficile bacteremia (P = 0.16), polymicrobial infection (P = 0.91), and antimicrobial therapy for C. difficile (P = 0.48) were not significantly associated with 30-day mortality. In a multivariate analysis, group A was an independent risk factor for 30-day mortality. (adjusted odds ratio; 7.29 [95% confidence interval; 1.68–31.68], P = 0.01). Conclusion Extraintestinal C. difficile infection was not commonly associated with C. difficile enterocolitis. Extraintestinal C. difficile infection accompanied by GI disruption with malignancy was associated with significantly poorer outcomes. Disclosures All authors: No reported disclosures.