*Purpose: The objective of this analysis is to determine how frequently positive Clostridioides difficile (CD) screening tests, potentially identifying up to 20% of inpatients with asymptomatic carriage, result in inappropriate treatment with oral vancomycin in solid organ transplant (SOT) recipients.

*Methods: The Xpert C. difficile assay (Cepheid), a nucleic acid amplification testing method utilizing PCR for microbial DNA of the toxin gene, was performed on peri-rectal swabs collected by the primary nurse or self-collected by patients. CD screens are performed for most newly admitted patients to identify individuals appropriate for contact isolation. Retrospective chart review of all CD screens for adult patients hospitalized between July, 2015 and Nov, 2018 was performed. Results of CD screen and any oral vancomycin use were noted, along with symptoms of clinical CD infection among a cohort of hospitalized SOT recipients.

*Results: Of the 47,076 total CD screens reviewed, 1,921 were positive and 41/329 screens in the SOT cohort were positive (4.1% vs 12.4%, p<0.01). 20.5% (395 of 1,921) of all inpatients with a positive CD screen were treated with oral vancomycin within 48hrs of swab collection. In the SOT cohort, 22% (9/41) with positive CD screens were treated with oral vancomycin within 48hrs. 56% (5/9) of SOT patients who received oral vancomycin did not have true infection (defined as documentation of diarrhea in the nursing record or the physician notes).

*Conclusions: At our institution, SOT recipients were more likely to have CD colonization detected by peri-rectal screening than the general inpatient population. SOT and non-SOT patients were treated with oral vancomycin at similar rates in response to the positive screen. Over half of the oral vancomycin use in SOT recipients was likely overtreatment, but this finding is limited by the low number of patients in this cohort.

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