Seiguer Shenoy, Erica

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Seiguer Shenoy, Erica

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Seiguer Shenoy

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Erica

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Seiguer Shenoy, Erica

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313Value of Discontinuation of Contact Precautions (CP) for Methicillin-Resistant Staphylococcus aureus (MRSA)
(Oxford University Press, 2014) Seiguer Shenoy, Erica; Lee, Hang; Cotter, Jessica; Ware, Winston; Kelbaugh, Douglas; Weil, Eric; Walensky, Rochelle; Hooper, David
Natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE): a systematic review
(BioMed Central, 2014) Seiguer Shenoy, Erica; Paras, Molly; Noubary, Farzad; Walensky, Rochelle; Hooper, David
Background: No published systematic reviews have assessed the natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE). Time to clearance of colonization has important implications for patient care and infection control policy. Methods: We performed parallel searches in OVID Medline for studies that reported the time to documented clearance of MRSA and VRE colonization in the absence of treatment, published between January 1990 and July 2012. Results: For MRSA, we screened 982 articles, identified 16 eligible studies (13 observational studies and 3 randomized controlled trials), for a total of 1,804 non-duplicated subjects. For VRE, we screened 284 articles, identified 13 eligible studies (12 observational studies and 1 randomized controlled trial), for a total of 1,936 non-duplicated subjects. Studies reported varying definitions of clearance of colonization; no study reported time of initial colonization. Studies varied in the frequency of sampling, assays used for sampling, and follow-up period. The median duration of total follow-up was 38 weeks for MRSA and 25 weeks for VRE. Based on pooled analyses, the model-estimated median time to clearance was 88 weeks after documented colonization for MRSA-colonized patients and 26 weeks for VRE-colonized patients. In a secondary analysis, clearance rates for MRSA and VRE were compared by restricting the duration of follow-up for the MRSA studies to the maximum observed time point for VRE studies (43 weeks). With this restriction, the model-fitted median time to documented clearance for MRSA would occur at 41 weeks after documented colonization, demonstrating the sensitivity of the pooled estimate to length of study follow-up. Conclusions: Few available studies report the natural history of MRSA and VRE colonization. Lack of a consistent definition of clearance, uncertainty regarding the time of initial colonization, variation in frequency of sampling for persistent colonization, assays employed and variation in duration of follow-up are limitations of the existing published literature. The heterogeneity of study characteristics limits interpretation of pooled estimates of time to clearance, however, studies included in this review suggest an increase in documented clearance over time, a result which is sensitive to duration of follow-up.
The effect of vaccination on children's physical and cognitive development in the Philippines
(Informa UK Limited, 2012) Bloom, David; Canning, David; Seiguer Shenoy, Erica
We use data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS) in the Philippines to link vaccination in the first 2 years of life with later physical and cognitive development in children. We use propensity score matching to estimate the causal effect of vaccination on child development. We find no effect of vaccination on later height or weight, but full childhood vaccination for measles, polio, Tuberculosis (TB), Diphtheria, Pertussis and Tetanus (DPT) significantly increases cognitive test scores relative to matched children who received no vaccinations. The size of the effect is large, raising test scores, on average, by about half an SD.
Ceftaroline Desensitization Procedure in a Pregnant Patient With Multiple Drug Allergies
(Oxford University Press, 2015) Kuhlen, James L.; Blumenthal, Kimberly; Sokol, Caroline; Balekian, Diana S.; Weil, Ana; Varughese, Christy A.; Seiguer Shenoy, Erica; Banerji, Aleena
Validated skin testing is lacking for many drugs, including ceftaroline. The cross-reactivity between ceftaroline and other β-lactam antibiotics is unknown. We report a case of a pregnant patient with cystic fibrosis and multiple drug allergies who required ceftaroline for methicillin-resistant Staphylococcus aureus pneumonia and underwent an uncomplicated empiric desensitization procedure.
The Impact of Reporting a Prior Penicillin Allergy on the Treatment of Methicillin-Sensitive Staphylococcus aureus Bacteremia
(Public Library of Science, 2016) Blumenthal, Kimberly; Seiguer Shenoy, Erica; Huang, Mingshu; Kuhlen, James L.; Ware, Winston A.; Parker, Robert; Walensky, Rochelle
Background: Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is a morbid infection with mortality benefit from receipt of parenteral β-lactam therapy. A substantial portion of MSSA bacteremia patients report penicillin allergy, but infrequently have true allergy. Objective: To determine the frequency and predictors of optimal and adequate therapy in patients with MSSA bacteremia. Design: Retrospective cohort. Participants: Adult inpatients with MSSA bacteremia, January 2009 through October 2013. Main Measures The primary measure was a trial of optimal therapy (OT), defined as ≥3 inpatient days or discharge on any first-line agents (nafcillin, oxacillin, cefazolin, or penicillin G, if susceptible). The secondary measure was completion of adequate therapy (AT), defined as ≥10 inpatient days or discharge on an agent appropriate for MSSA bacteremia. Data were electronically gathered with key variables manually validated through chart review. Log-binomial regression models were used to determine the frequency and predictors of outcomes. Key Results Of 456 patients, 346 (76%) received a trial of OT. Patients reporting penicillin allergy (13%) were less likely to receive OT trial than those without penicillin allergy (47% vs. 80%, p <0.001). Adjusting for other factors, penicillin allergy was the largest negative predictor of OT trial (RR 0.64 [0.49, 0.83]). Infectious Disease (ID) consultation was the largest positive predictor of OT trial across all patients (RR 1.34 [1.14, 1.57]). Allergy/Immunology consultation was the single most important predictor of OT trial among patients reporting penicillin allergy (RR 2.33 [1.44, 3.77]). Of 440 patients, 391 (89%) completed AT, with ID consultation the largest positive predictor of the outcome (RR 1.28 [1.15, 1.43]). Conclusions: Nearly 25% of patients with MSSA bacteremia did not receive OT trial and about 10% did not receive AT completion. Reported penicillin allergy reduced, and ID consult increased, the likelihood of OT. Allergy evaluation, coupled with ID consultation, may improve outcomes in MSSA bacteremic patients.
Treatment Outcomes and Adverse Drug Reactions Associated with Ceftaroline Use
(Oxford University Press, 2015) Blumenthal, Kimberly; Kuhlen, James; Weil, Ana; Varughese, Christy; Kubiak, David W.; Banerji, Aleena; Seiguer Shenoy, Erica
Real-Time Automated Surveillance for Ventilator Associated Events Using Streaming Electronic Health Data
(Oxford University Press, 2017) Seiguer Shenoy, Erica; Rosenthal, Eric; Biswal, Siddharth; Ghanta, Manohar; Ryan, Erin E; Shao, Yu-Ping; Suslak, Dolores; Swanson, Nancy; Valdery, Moura Junior; Hooper, David; Westover, M Brandon
Abstract Background: Criteria defining Ventilator Associated Events (VAEs) are objective and often available in the electronic health record (EHR) data. The use of ventilation data extracted directly from the patient’s bedside monitor to allow for real-time surveillance, however, has not been previously incorporated into electronic surveillance approaches. Here we describe validation of a system that can detect and report on VAEs hospital-wide autonomously and in real-time. Methods: We developed a secure informatics hardware and software platform to identify VAEs autonomously using streaming data. The automated process included 1) archiving and analysis of bedside physiologic monitor data to detect increases in positive end-expiratory pressure (PEEP) or FiO2 settings; 2) real-time querying of EHR data for leukopenia or leukocytosis and concurrent antibiotic initiation; and 3) retrieval and interpretation of microbiology reports for the presence of respiratory pathogens. The algorithm was validated on two 3-month periods in 2015 and 2016 as follows: 1) autonomous surveillance (AS) generated detections of three VAE subclasses: VAC, IVAC, and PVAP; 2) manual surveillance (MS) by Infection Control (IC) staff independently performed standard surveillance based on chart review, 3) senior IC staff adjudicated the gold standard for cases of AS-MS discordance. The sensitivity (Se), specificity (Sp), and positive predictive value (PPV) of the algorithm are reported. Results: The number of ventilated patients, ventilator days, and events were: 1,591/9,407/3,014. In cases with complete data, AS detected 66 VAE events identified by MS; AS detected 32 VAEs missed by MS; no MS-identified events were missed by AS. The Se, Sp, and PPV of AS and MS were: 91%/100%/100%, and 61%/100%/83%, respectively. Clinical surveillance case reports generated by AS enabled visual interpretation (figure). Conclusion: We developed a surveillance tool directly streaming bedside physiologic monitor and EHR data including ventilator settings, laboratory results, and microbiology reports, to apply the CDC’s VAE definitions on source data. This resulted in an accurate, objective, and efficient method for real-time hospital-wide surveillance. Disclosures All authors: No reported disclosures.
Synthetic DNA spike-ins (SDSIs) enable sample tracking and detection of inter-sample contamination in SARS-CoV-2 sequencing workflows
(Springer Science and Business Media LLC, 2021-12-14) Lagerborg, Kim A; Normandin, Erica; Bauer, Matthew; Adams, Gordon; Figueroa, Katherine; Loreth, Christine; Gladden-Young, Adrianne; Shaw, Bennett; Pearlman, Leah; Berenzy, Daniel; Dewey, Hannah; Kales, Susan; Dobbins, Sabrina; Seiguer Shenoy, Erica; Hooper, David; Pierce, Virginia; Zachary, Kimon; Park, Daniel; Macinnis, Bronwyn; Tewhey, Ryan; Lemieux, Jacob; Sabeti, Pardis; Reilly, Steven; Siddle, Katherine
The global spread and continued evolution of SARS-CoV-2 has driven an unprecedented surge in viral genomic surveillance. Amplicon-based sequencing methods provide a sensitive, low-cost and rapid approach but suffer a high potential for contamination, which can undermine laboratory processes and results. This challenge will only increase with expanding global production of sequences by diverse laboratories for epidemiological and clinical interpretation, as well in genomic surveillance in future outbreaks. We present SDSI+AmpSeq, an approach which uses synthetic DNA spike-ins (SDSIs) to track samples and detect inter-sample contamination through the sequencing workflow. Applying SDSIs to the ARTIC Consortium’s amplicon design, we demonstrate their utility and efficiency in a real-time investigation of a suspected hospital cluster of SARS-CoV-2 cases and across thousands of diagnostic samples at multiple laboratories. We establish that SDSI+AmpSeq provides increased confidence in genomic data by detecting and in some cases correcting for relatively common, yet previously unobserved modes of error without impacting genome recovery.