P-1135. Influence of Antibiotic and Laxative Use on <i>Clostridioides difficile</i> Testing in Post-Operative Children

Abstract Background Antibiotic exposure in surgical patients poses risks, contributing both to Clostridioides difficile infection (CDI) and to antibiotic associated diarrhea. While CDI may cause diarrhea, we hypothesized that negative CDT could be a proxy for non-infectious diarrhea and aimed to discern if broad-spectrum (BS) antibiotics or laxatives influenced negative CDT. Broad Spectrum Antibiotics and Laxative Use In Post-Operative Children with Negative C difficile Test Compared to Matched Controls CDT: C difficile Testing, DOT: Days of Therapy, SAAR: Standardized Antibiotic Administration Ratio Methods A matched case-control study (Jan 2013-Feb 2022) examined risk factors for negative CDT in children (2-18 years) undergoing sedated procedures with preoperative antibiotic prophylaxis at a large referral hospital. Perioperative data was merged with antibiotic and laxative data from the Electronic Medication Administration Record (eMAR). Cases with PCR-negative CDT on postoperative days 3-90 were matched with untested controls based on age, gender, year of testing, and procedure category. We assessed Days of Therapy (DOT) of antibiotics or laxatives for various periods. Results Among 14,229 children (mean age 10 ± 5.2 years) undergoing 18,705 procedures, 108 cases and 108 controls were selected. Children with negative CDT received more BS antibiotics 3 days before the test date (1000DOT/LOS = 410) than controls (1000DOT/LOS = 271; OR 1.9 (1.06 – 3.5); P =0.031). Conversely, cases received fewer laxatives postoperatively and 3 days before CDT (1000DOT/LOS =148) than controls (1000DOT/LOS = 346; OR 0.35 (0.17-0.73); P=0.005). No difference was observed in pre-operative laxative use. Conclusion Our data suggests that BS antibiotics are a more important contributor to post-operative non-infectious diarrhea in children than laxatives. Antimicrobial stewardship efforts targeting BS antibiotic use in post-operative children could mitigate diarrhea and unnecessary CDT. Disclosures Abhishek Deshpande, MD, PhD, AHRQ: Grant/Research Support|Clorox Healthcare: Grant/Research Support