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Background C. difficile is the most common cause of hospital infections with a spectrum of presentation from asymptomatic carriage to severe recurrent diarrhea. Certain C. difficile ribotypes are associated with severe disease, but there are little data on ribotypes in asymptomatic carriers or severe recurrent disease. The aim of this study was to compare virulence potential of C.diff ribotypes with clinical disease severity. Methods This retrospective study included patients aged ≥18 years at NorthShore University HealthSystem (NUHS) from February 1, 2015 to May 30, 2017. Three groups of patients with positive PCR test for C. diff toxin gene were selected: (1) Asymptomatic patients positive for rectal carriage; (2) symptomatic outpatients with a single positive test (CDI); and (3) patients with recurrent CDI who underwent FMT. Clinical data were extracted from the Enterprise Database Warehouse. Isolates underwent fluorescent PCR ribotyping and were assigned to clades. Ribotypes with “high” (e.g., 027 and 078) and “low” (e.g., 106) virulence potential were defined as such. Virulence potential of cryptic ribotypes were considered “unknown.” We used Χ2 and independent samples median tests to compare categorical and continuous variables, respectively. Results 129 C. diff isolates (asymptomatic, N = 66; CDI, N = 33; FMT, N = 30) were ribotyped with 60 types identified. Median age was higher in asymptomatic patients [80.5 (IQR 70.8–90) years] compared with both CDI and FMT [69 (58–81) and 69 (51–83.5) years, respectively, P = 0.004] Low virulence ribotypes were identified more frequently in asymptomatic carriers than those with CDI or FMT (22/66 vs. 8/33 vs. 1/30, respectively, P = 0.006). High virulence ribotypes were found in all groups, with highest frequency in the FMT group (23/30) vs. asymptomatic (25/67) or CDI (13/33), P = 0.001). Conclusion Patients with severe or recurrent CDI had ribotypes associated with high virulence potential. In addition, asymptomatic carriers were more likely to have ribotypes of C.diff historically associated with a low virulence potential. Molecular C.diff typing may have a role in evaluating asymptomatic C.diff colonization vs. clinical disease. Disclosures All authors: No reported disclosures.

2394. Different Clostridioides difficile Ribotypes Among Patients With Colonization, Initial Clinical Disease, and Recurrent Clinical Disease