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Surveillance for soil-transmitted helminths, strongyloidiasis, cryptosporidiosis, and giardiasis was conducted in Mississippi, USA. PCR performed on 224 fecal samples for all soil-transmitted helminths and on 370 samples for only Necator americanus and Strongyloides stercoralis identified 1 S. stercoralis infection. Seroprevalences were 8.8% for Toxocara, 27.4% for Cryptosporidium, 5.7% for Giardia, and 0.2% for Strongyloides parasites.

Human parainfluenza (HPIV) is a common cause for upper respiratory tract illnesses (URTI) and lower respiratory tract illnesses (LRTI) in infants and young children. Here, we describe successful control of an HPIV type 3 (HPIV3) outbreak in a neonatal intensive care unit (NICU). NICU babies with new-onset clinical signs or symptoms of RTI and positive HPIV-3 nasopharyngeal specimen by respiratory pathogen panel (RPP) test on hospital day 14 or later were diagnosed with hospital-onset (HO) HPIV-3 infection. After 3 NICU babies were diagnosed with HO HPIV-3, an outbreak investigation was initiated on May 3, 2019, and continued for 2 incubation periods since the last identified case. Enhanced infection prevention measures were immediately implemented. All positive cases were placed in a cohort in a single pod of the NICU and were placed on contact precautions with droplet isolation precautions. Dedicated staffing and equipment were assigned. Environmental cleaning and disinfection with hospital-approved disinfectant wipes was performed daily. Visitors were restricted in the NICU. All employees entering the NICU underwent daily symptom screening for respiratory tract illness. All NICU babies were screened daily for respiratory tract illness with prompt isolation and RPP testing on positive screen. To determine the source of the HPIV3 outbreak, all HPIV3-positive specimens from the NICU and available temporally associated community-onset (CO) controls collected from non-NICU units were sent to the Centers for Disease Control and Prevention (CDC) for whole-genome sequencing (WGS) analysis. The first and last cases of HPIV-3 were diagnosed on May 1 and May 5, 2019, respectively. In total, 7 HO HPIV3 cases were reported: 1 in newborn nursery (NBN) and 6 in NICU. The case from the NBN was determined to be unrelated to the outbreak and the source was linked to a sick visitor. Of the 6 NICU babies, 5 had an LRTI and 1 had a URTI. Average time from admission to diagnosis was 71 days (range, 24–112). None had severe illnesses requiring intubation, and all had full recovery. No CO HPIV3 cases were reported from the NICU during the investigation. A maximum likelihood phylogenetic tree of HPIV3 WGS (Figure 1) showed that sequences from the 6 HO cases clustered together separately from the 3 CO controls, suggesting a single source of transmission, and 3 CO cases were not related to the HO cases or source of the outbreak. Early diagnosis and isolation of respiratory tract viral infections is important to prevent an outbreak. Successful control of outbreak in NICU requires prompt implementation of infection prevention measures with focus on symptom screening, cohorting, and disinfection practices.Funding: NoDisclosures: None

Clostridioides difficile infection (CDI) is one of the leading causes of hospital–onset infections. Clinically distinguishing true CDI versus colonization with C. difficile is challenging and often requires reliable and rapid molecular testing methods. At our academic center, we implemented a 2-step testing algorithm to help identify true CDI cases. The University of Mississippi Medical Center is a 700+ bed academic facility located in Jackson, Mississippi. Hospital-onset (HO) CDI was defined based on NHSN Laboratory Identified (LabID) event as the last positive C. difficile test result performed on a specimen using a multistep testing algorithm collected >3 calendar days after admission to the facility. HO-CDI data were collected from all inpatient units except the NICU and newborn nursery. HO-CDI outcomes were assessed based on standardized infection ratio (SIR) data. In May 2020, we implemented a 2-step testing algorithm (Figure 1). All patients with diarrhea underwent C. difficile PCR testing. Those with positive C. difficile PCR test were reflexed to undergo enzyme immunoassay (EIA) glutamate dehydrogenase antigen (Ag) testing and toxin A and B testing. The final results were reported as colonization (C. difficile PCR+/EIA Ag+/Toxin A/B−) or true CDI case (C. difficile PCR+/EIA +/Toxin A/B +) or negative (C. difficile PCR−). All patients with colonization or true infection were placed under contact isolation precautions until diarrhea resolution for 48 hours. During the preintervention period (October 2019–April 2020), 25 HO-CDI cases were reported compared to 8 cases in the postintervention period (June 2020–December 2020). A reduction in CDI SIR occurred in the postintervention period (Q3 2020–Q4 2020, SIR 0.265) compared to preintervention period (Q4 2019–Q1 2020, SIR 0.338) (Figure 2). We successfully reduced our NHSN HO-CDI SIR below the national average after implementing a 2-step testing algorithm for CDI. The 2-step testing algorithm was useful for antimicrobial stewardship to guide appropriate CDI treatment for true cases and for infection prevention to continue isolation of infected and colonized cases to reduce the spread of C. difficile spores.Funding: NoDisclosures: None

Background Human Herpes Virus 6 (HHV6) is a common childhood disease that is typically mild, however, cases where it is the causative agent of meningitis/encephalitis (ME) have been reported. The treatment for HHV6 ME consists of ganciclovir, which is associated with bone marrow suppression and renal insufficiency. While the clinical significance of the presence of HHV6 in cerebrospinal fluid (CSF) in adults has been studied, there is a paucity of research on the clinical significance of HHV6 in the CSF of children with ME. We want to determine if there is clinical significance to HHV6 positivity in the CSF of children. Methods 20 patients were included whose CSF tested positive for HHV6 on the CSF ME panel from Jan 1, 2017 to May 20, 2020. We obtained a sample of 80 patients whose CSF tested negative for every pathogen on the same CSF ME panel from the same period. Logistic regression was used based on age, sex, race/ethnicity, admission to neonatal intensive care unit (NICU)/pediatric intensive care unit (PICU), clinical presentation, and presence of abnormalities on neuroimaging to determine the propensity score matching (PSM) for each patient. (Table I) The HHV6 positive patients were matched with patients who tested negative for every pathogen on the panel at a 1:1 ratio and within a caliper size of 0.25. The odds ratio (OR) of neurological sequelae at discharge was determined by performing a logistic regression based on HHV6 status in both the group with PSM and without PSM. The length of stay between the HHV6 positive group and the control group were compared with and without PSM using Mann-Whitney U test with p Results The OR for HHV6 positivity and experiencing neurological sequelae is 1.35 with a 95% confidence interval (CI) 0.133,13.721 (p=0.799) when compared to the control group without PSM. The OR for HHV6 positivity and experiencing neurological sequelae is 1 with a 95% CI 0.063, 15.988 (p=0.549) when compared to the control group with PSM. Table I shows the neurological sequelae between the HHV6 positive group, control group without PSM and the control group with PSM. It shows the Mann-Whitney U test comparing HHV6 status to the median length of hospital stay in both unmatched- and matched cohorts. We failed to reject the null hypothesis that there was a difference in the median length of hospital stay between HHV6 positive patients and all negative patients with and without PSM. Conclusion There is no clinical significance of HHV6 detection on the CSF ME panel in children as well as no statistical significance between the median length of hospital stay among HHV6 positive patients and all negative patients. Further, 10% of the HHV6 positive patients were inappropriately started on ganciclovir. Development of a consensus statement is in place regarding releasing the result of a positive HHV6 from the ME panel only among immunocompromised children to prevent inappropriate antiviral therapy.

We report on fosfomycin susceptibility and mechanisms of resistance in clinical strains of blaKPC-positive Enterobacter sp. (n = 19). A total of 14 strains (74%) were susceptible to fosfomycin; 8 strains (42%) were positive for fosA and no strains were positive for FosA3 or FosC2. FosA presence does not appear to correlate with susceptibility.

Background Contact precautions (CP) in methicillin-resistant Staphylococcus aureus (MRSA) patients along with hand hygiene has been considered a gold standard to prevent transmission. The actual impact of these measures in reducing MRSA infections is still controversial. At our institution, we evaluated the impact of discontinuation of MRSA CP on hospital-onset (HO) and community-onset (CO) MRSA bloodstream (BSI) rates. We also analyzed consequential cost savings. Methods The University of Mississippi Medical Center is a 700+ bed academic facility located in Jackson, MS. Patients admitted to any inpatient units with diagnoses or history of MRSA infection or colonization were subjected to CP during their stay. In July 2018, we discontinued MRSA CP across all inpatient units (except neonatal intensive care unit). HO MRSA BSI rate was calculated per National Healthcare Safety Network (NHSN) laboratory-identified event. CO MRSA BSI was reported per NHSN admission prevalence rate. One-way Analysis of Variance (ANOVA) was performed to compare pre-and post-intervention data. Results There was a rise in HO MRSA BSI rate after discontinuation of CP (July 2018-March 2019) in comparison to the 9-month pre-intervention period (October 2017-June 2018); however, the difference was not statistically significant (1.79/10,000 patient-days vs. 1.2/10,000 patient-days; P = 0.056). Similarly, CO MRSA BSI prevalence rate did not show a statistically significant difference between pre- and post-intervention period (0.103 vs. 0.08; P = 0.584).The total annualized cost savings on personal protective equipment (PPE) was an estimated $193,398 post-intervention. Hand hygiene (HH) compliance was higher in post-intervention compared with pre-intervention period (83% vs. 78%, P = 0.0007). Conclusion At our institute, discontinuation of MRSA CP was associated with an insignificant rise in HO MRSA BSI rates. No impact was observed on CO MRSA BSI prevalence. We had a 34% reduction in PPE expenditure. We observed an increase in HH compliance post-discontinuation of CP, but it did not reduce MRSA BSI rates. Further studies are needed to evaluate the impact of bundling hand hygiene practices with other horizontal strategies (prevention bundles, chlorhexidine bathing, environmental disinfection practices) in prevention of MRSA infections. Disclosures All authors: No reported disclosures.

The viridans group streptococci comprise multiple species and have gained more recognition in recent years as common etiologic agents of bacterial endophthalmitis. The purpose of this study was to identify the species of human endophthalmitis isolates of viridans streptococci and to characterize their potential virulence attributes. The species of 22 endophthalmitis strains of viridans streptococci were identified by Matrix Assisted Laser Desorption Ionization Time-of-Flight. Susceptibilities to 3 antibiotics commonly used for bacterial endophthalmitis were determined. The extracellular milieu of each strain was tested for cytotoxicity of retinal pigmented epithelial cells, hemolysis of sheep erythrocytes, and protease activity using gelatin zymography. Identified species were Streptococcus mitis/oralis, S. salivarius, S. vestibularis, S. parasanguinis, S. mutans, S. constellatus, and S. gordonii. One strain of S. pseudoporcinus was also identified. All strains were sensitive to vancomycin, 77% were resistant to amikacin, and 27% had intermediate resistance to ceftazidime. Extracellular milieu from all strains except one (S. pseudoporcinus) were largely devoid of toxicity to retinal pigmented epithelial cells and sheep erythrocytes. Twelve strains, 10 of which were S. mitis/oralis, produced protease activity. Interestingly, not all of the S. mitis/oralis strains were proteolytic. These findings highlight the diversity of virulence factor production in ocular strains of the viridans streptococci not only at the group level but also at the species level.