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Background The estimated prevalence of Clostridioides difficile infection (CDI) in several South Asian countries is 10.5%, similar to that in North America and Europe. However, the epidemiology of CDI in Bangladesh is unknown. We aimed to assess the prevalence of CDI and assess hospital environmental contamination of toxigenic C. difficile in Bangladesh. Methods This was a prospective observational cohort study at two large tertiary care centers in Dhaka, Bangladesh, conducted from January 2017 to December 2017. Stool samples were collected from hospitalized adults with diarrhea (≥3 loose stools in a 24-hour period) and antimicrobial exposure within the past 30 days. Hospital environmental samples were collected by swabbing surfaces of common areas in the hospital. All samples underwent toxigenic culture. C. difficile isolates were tested for toxins A and B and PCR-ribotyped. Results Of 204 stool samples collected, 16 (7.8%) were positive for toxigenic C. difficile. Patients with CDI shared a room with significantly more patients (Table 1). Of 392 environmental samples, 48 (12.2%) were positive for toxigenic C. difficile, which was more common in patient care vs. nonpatient care areas (14.4% vs. 7.8%, P = 0.057). Twelve clinical stool isolates and 42 environmental isolates were ribotyped. Ribotypes identified in stool isolates were F017 (50%), FP053-163 (17%), FP435 (17%), F106 (8%), and F014-020 (8%). With the exception of FP435, these were also the most common ribotypes in environmental isolates: F017 (24%), FP053-163 (12%), F106 (26%), and F014-020 (10%). Conclusion For the first time, we report the prevalence of CDI and ribotypes in at risk patients in Bangladesh. Rates and ribotypes are similar to other resource-rich or resource-limited countries. Table 1: Demographic Data for All Stool Samples Variable No toxigenic C. difficile (n = 188) Toxigenic C. difficile (n = 16) P Female sex, n (%) 77 (41) 9 (56) 0.234 Age, years, median (IQR) 46 (32–58) 39 (25–53) 0.212 Hospital A, n (%) 149 (79) 13 (81) >0.99 Length of prior hospital stay, days, median (IQR) 13 (7–23) 14 (8–32) 0.798 Duration of previous antibiotics, days, median (IQR) 10 (7–17) 12 (6–20) 0.687 Number of patients in the same room, median (IQR) 13 (7–19) 19 (14–20) 0.009 Disclosures K. W. Garey, Merck & Co.: Grant Investigator, Grant recipient.

471. Prevalence and Characteristics of Clostridioides difficile Infection in Bangladesh