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Background The intestinal microbiome modulates local and systemic immune responses and may impact clinical outcomes. However, there are few studies in pediatric patients. We conducted a cross-sectional study of fecal microbiomes in hospitalized children on a single inpatient unit at Children’s Hospital at Montefiore, Bronx, New York in 2016–2017 to test the hypothesis that “high-risk” children with chronic illnesses (cancer, transplant and sickle cell disease [SCD]) have decreased microbial diversity and higher rates of asymptomatic colonization with C. difficile compared with children hospitalized on the same ward but without similar risk factors. Methods Stool was collected within 72 hours of admission from patients who provided consent and assayed for C. difficile colonization by glutamate dehydrogenase (GDH); microbiome analysis was performed by 16S rRNA sequencing. Clinical and demographic data were obtained from the EMR. Results One hundred and six unique patients provided a sample for analysis. Sixty-nine were categorized as high-risk, including 32 SCD patients. C. difficile colonization rates were 22% and 19% in the high-risk and low-risk groups, respectively, but highest in the subset of SCD patients on penicillin prophylaxis (33%). The high-risk group had a trend toward lower microbial diversity than controls, and SCD patients exhibited a diversity index greater than other high-risk patients. Antibiotic use in the last 3 months and PPI use were associated with decreased microbial diversity across the entire study population (P = 0.004, P = 0.007, respectively). Among children with SCD, those on penicillin prophylaxis had a trend toward decreased alpha diversity while folic acid was associated with increased diversity (P = 0.02). SCD patients had greater quantities of Bacteroides and Parabacteroides and fewer Escherichia and Shigella than the other cohorts. Conclusion SCD and penicillin prophylaxis might be risk factors for C. difficile colonization and intestinal dysbiosis. The implications of these findings require further, longitudinal study. Disclosures All authors: No reported disclosures.

619. Intestinal Microbiome Changes Associated with Immune Status and Clostridium difficile Colonization in Hospitalized Children