483. Clinical Characteristics of Military Trauma Patients With Clostridium difficile Infections. (26th November 2018) - Schall, Sarah
Abstract: Background: Clostridium difficile -associated diarrhea (CDAD) is an important cause of nosocomial diarrhea with increasing morbidity, mortality, and healthcare costs. There is growing recognition that critically ill trauma patients comprise a unique at risk population. This study describes the clinical epidemiology of CDAD in military trauma patients. Methods: Through the Trauma Infectious Disease Outcomes Study (TIDOS), patients with a diagnosis of confirmed (laboratory supported) or presumptive (diarrhea with treatment for CDAD in absence of lab confirmation) CDAD (September 2009–February 2014) were analyzed. Patient demographic, injury, and infection data were evaluated. CDAD severity was defined per 2017 IDSA guidelines. Results: Of 2, 660 patients, 19 and four patients with confirmed and presumptive CDAD, respectively, were identified with an incidence of 2.76/10, 000 (95% CI: 1.75–4.15) occupied bed days. Sixteen (70%) had blast injuries, four had gunshot wounds, and threehad other injuries. Median age was 24 years (IQR 23, 31). Median injury severity score was 38 (IQR 26, 47). Severe and fulminant CDAD was diagnosed in 8 (35%) and six (26%), respectively. Patients had a median hospitalization of 12 days (IQR 9.5, 34) and threeOR visits (IQR 2, 6) prior to CDAD diagnosis. Nineteen (83%) patients were in the ICU and 17 (74%) were intubated prior to or upon diagnosis. Seventeen patients had ≥1 infection before CDAD diagnosis, largely pneumonia (47%) and skin and soft-tissue infections (47%). Most patients (96%) were on antibiotics pre-CDAD diagnosis: first generation cephalosporins (1GC; 96%), tetracyclines (87%), vancomycin (74%), carbapenems (70%), and fluoroquinolones (FQ; 57%). Five (22%) received clindamycin. Of the 2637 patients without CDAD, 91% received antimicrobials during hospitalization (86% a 1GC, 47% FQ, and 16% clindamycin). Median length of hospital stay after CDAD diagnosis was 34 days (IQR 16, 55). Treatment included only oral metronidazole in 15 patients, IV metronidazole in 2, and some combination of oral vancomycin, metronidazole, and IV metronidazole in 6. No patients died. Conclusion: Despite high rates of antimicrobial usage in this severely injured population, CDAD was uncommon. Though CDAD was severe or fulminant in >50%, no patients died. Disclosures: All authors: No reported disclosures.