Sorana Segal-Maurer

New York Hospital Queens, New York City, New York, United States

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Publications (43)208.34 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We compared the Remel Spectra™ CRE agar plate to CDC standard methodology for the isolation of carbapenem resistant Enterobacteriaceae (CRE) from 300 rectal swab specimens obtained from patients residing in a long term care facility (LTCF). Multiplex polymerase chain reaction experiments were performed on isolates to identify specific Klebsiella pneumoniae carbapenemases (KPC) and additional β-lactamases. Of 300 patients, 72 (24%) harbored CRE and were PCR positive for KPC enzymes. The Remel Spectra™ CRE plates detected KPC-type CRE in isolates from 70 of 72 patients (97.2%) while the CDC method detected CRE in 56 of 72 (77.8%). CRE identification results were available in 18 hours compared to 36 hours for the CDC method. Remel Spectra™ CRE agar plates can provide useful means for fast and reliable method for detection of KPC Type CRE and accelerated institution of appropriate infection control precautions. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Journal of clinical microbiology 06/2015; DOI:10.1128/JCM.00789-15 · 4.23 Impact Factor
  • Open Journal of Medical Microbiology 01/2015; 05(01):12-16. DOI:10.4236/ojmm.2015.51002
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    ABSTRACT: Background: HIV treatment outcomes and adverse events (AEs) may vary by gender. STaR is the first study to directly compare the safety and efficacy of the two single-tablet regimens (STRs), rilpivirine/emtricitabine/tenofovir DF (RPV/FTC/TDF) and efavirenz (EFV)/FTC/TDF. Methods: STaR was an open-label, 1:1 randomized, 96-week study in treatment-naïve HIV-1 infected subjects. The primary endpoint was the proportion of subjects with HIV-1 RNA <50 copies/mL at W48 (12% non-inferiority margin; Snapshot analysis). Post-hoc analyses included safety and efficacy by gender through W96. Results: For the primary endpoint, RPV/FTC/TDF (n=394) was non-inferior to EFV/FTC/TDF (n=392) for HIV RNA <50 copies/mL (85.8% RPV/FTC/TDF vs 81.6% EFV/FTC/TDF; difference 4.1%, 95% CI [-1.1%, 9.2%]) at W48 and also at W96 (77.9% vs 72.4%; difference 5.5%, 95% CI [-0.6%, 11.5%]) with p=0.76 for testing homogeneity of response between males and females at W96. W96 Virologic Suppression by Gender RPV/FTC/TDF EFV/FTC/TDF Strata Adjusted Diff (95% CI) Males 78.7% (288/366) 73.6% (268/364) 5.1% (-1.1% to 11.3%) Females 67.9% (19/28) 57.1% (16/28) 12.0% (-15.5% to 39.5%) For important AEs listed in the RPV and EFV prescribing information, rates of nervous system AEs were 27.0% RPV/FTC/TDF vs 48.4% EFV/FTC/TDF in males and 28.6% vs 35.7% in females with dizziness and headache being the most frequently reported; psychiatric AEs were 29.0% vs 50.3% in males and 17.9% vs 32.1% in females with abnormal dreams, anxiety, depression and insomnia being the most reported; and for rash events, 16.1% vs 23.4% in males and 10.7% vs 35.7% in females. Rates of Grade 3-4 TEAEs were 9.6% (35/366) RPV/FTC/TDF vs 16.2% (59/364) EFV/FTC/TDF in males, and 17.9% (5/28) vs 21.4% (6/28) in females. Rates of discontinuation due to AEs were 2.7% (10/366) vs 11.0% (40/364) in males and 7.1% (2/28) vs 10.7% (3/28) in females. Conclusion: Overall, treatment with RPV/FTC/TDF was non-inferior to EFV/FTC/TDF at W48 and W96. Though the number of females enrolled was small, there was no difference in rates of virologic suppression between genders. In the female subpopulation, there were lower rates of important nervous system, psychiatric, and rash AEs and lower rates of discontinuations due to AEs in the RPV/FTC/TDF arm.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Objective To study the use of ertapenem delivered in an outpatient parenteral antimicrobial therapy (OPAT) hospital-based unit setting for targeted transrectal ultrasound-guided prostate biopsy (TRUSPBx) prophylaxis in the setting of multidrug-resistant (MDR) Escherichia coli rectal colonization. E coli is the pathogen most commonly associated with post-TRUSPBx complications, and there is increasing prevalence of community-associated MDR E coli. Methods Prospective data analysis of all patients admitted to the OPAT unit for administration of intravenous antibiotics for prophylaxis for TRUSPBx over 18-month period was performed. Patients had identification of MDR E coli in rectal swab cultures and/or intolerance to available oral agents. Microbiologic data and tolerability of administered antibiotics and outcome after TRUSPBx were tabulated. Results Nine patients (median age 74 years) were referred because of antibiotic-resistant E coli from rectal swabs (all fluoroquinolone resistant, 7 MDR). All patients received ertapenem 1 g intravenously 1 day before TRUSPBx and the day of the procedure before TRUSPBx. None of the patients experienced infectious complications immediately after TRUSPBx or several weeks or months later, and no patient was lost to urologic follow-up. Conclusion Increasing worldwide reports of prostatitis, urinary tract infections, and septicemia after TRUSPBx because of MDR E coli suggest rectal screening before procedure may be useful in decreasing complications. Targeted prophylaxis in these instances is necessary. Although carbapenems are used for treatment, they are not routinely used for prophylaxis. We report successful use of ertapenem delivered in a hospital-based OPAT unit for TRUSPBx prophylaxis.
    Urology 04/2014; 83(4):710–713. DOI:10.1016/j.urology.2013.12.039 · 2.13 Impact Factor
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    ABSTRACT: Background: Hospital-based outpatient parenteral antibiotic treatment (HB-OPAT) can avoid hospitalization, optimize early discharge, and facilitate access to hospital services. We report our first-year OPAT experience. Methods: Retrospective review of patients treated in a 535-bed university-affiliated community HB-OPAT unit including demographics, referral source, diagnosis, treatment, intravenous (IV) access, adverse events (A/E), and outcome. Results: Of 318 patients, median age 60 years (range 19-94), 207 (64%) male, 244 (73%) in-patient referrals, 196 (63%) commercially insured. One-half patients had peripheral IV (PIV) access (142), 42% peripherally-inserted central catheters (PICC) (others with chemoports or midlines). Infections included: 117 complicated skin and soft tissue (37%), 82 urologic (26%), 34 orthopedic (11%), 27 septicemia and/or endocarditis (9%), 22 gastrointestinal (7%), 11 pneumonia (3%), 7 others (2%). Non-infection diagnoses in 18 patients included: thrombosis, dehydration, anemia, steroid administration, etc. Two-thirds of urologic infections were due to pyelonephritis and post-prostate biopsy septicemia. Six patients with MDR E coli rectal colonization received pre-prostate biopsy IV antibiotics. One-quarter patients had microbiologic diagnoses (56% gram-positive organisms, 44% with concurrent bacteremia). Most gram-negative infections were due to MDR E coli. Most patients (145, 43%) received daptomycin (D) (median dose 8 mg/kg/day), 106 ertapenem (Ert), and 68 ceftriaxone (CTX). Ten of 318 patients failed clinically and 9 had non-OPAT related re-hospitalization. Adverse events in 14 patients included: 8 CPK elevation (D-related, 4 required discontinuation and 4 dose reduction, all resolved), 3 rash (2 CTX, 1 Ert), 1 pancytopenia (CTX), 1 seizure (Ert). No catheter-related infections occurred. Use HB-OPAT led to $824,569 antibiotic cost savings and $1,701,987 new hospital revenue in the first year. Conclusion: Over 90% OPAT patients successfully completed treatment with few A/Es. Over 25% of infections were urologic and most due to MDR Ecoli. Case Management and Antibiotic Stewardship Program were instrumental identifying OPAT-appropriate patients and facilitating clinician “buy-in.” Dedicated Infectious Diseases clinicians and skilled OPAT nurses optimized patient outcome.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • Peter Wasserman, Sorana Segal-Maurer, David S Rubin
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    ABSTRACT: Therapeutic goals for HIV-infected patients receiving antiretroviral therapy include minimizing risk of future physical disability. Presarcopenia and sarcopenia precede age-associated physical disability. We investigated their prevalence and the predictive value of patient mid-upper arm circumference (MUAC) for them. Eighty community-dwelling patients ≥45 years old demonstrating durable viral suppression were evaluated. Sarcopenia was defined as low skeletal muscle index (SMI, skeletal muscle kg/height m(2)) and either low strength or poor performance by handgrip dynamometry and gait speed, respectively. Presarcopenia was defined as low SMI only. MUAC was interpreted according to National Health Statistics percentile. Prevalence of sarcopenia and presarcopenia was 5.0% and 20.0%, respectively. Male gender (odds ratio [OR] 10.72; P < .026), recreational psychoactive substance use (OR 5.13; P < .037), and intravenous drug use transmission category (OR 6.94; P <.0327) were associated with presarcopenia. Higher body mass index (OR 0.80; P < .0007), MUAC (OR 0.83; P < .024), and large skeletal frame (OR 0.09; P < .003) were negatively associated with presarcopenia. Finding that a participant did not have a MUAC <25th percentile on physical examination had a 90.4% negative predictive value for presarcopenia. Although sarcopenia was uncommon, presarcopenia was highly prevalent in midlife and older HIV-infected males. Determination of MUAC percentile may identify those least likely to demonstrate skeletal muscle deficit and improve patient selection for mass and function testing.
    09/2013; DOI:10.1177/2325957413495919
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    ABSTRACT: Three neonates and 5 health care workers were identified as colonized with methicillin-resistant Staphylococcus aureus (MRSA) out of 222 individuals screened during an outbreak investigation in an 18-bed neonatal intensive care unit. Two of 3 MRSA neonatal isolates demonstrated identical pulsed-field gel electrophoresis clonal patterns but no clonal association was found among isolates from the 5 employees or between employees and neonates. Increased MRSA-unrelated strain colonization among health care workers supports increased MRSA community prevalence and probable decreased utility of mass screening.
    American journal of infection control 08/2013; 41(11). DOI:10.1016/j.ajic.2013.05.017 · 2.33 Impact Factor
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    ABSTRACT: Forty-seven ESBL positive Klebsiella pneumoniae urinary tract isolates were identified in non-hospitalized patients and 79% harbored KPC and/or CTX-M β-lactamases. Approximately 90% of isolates were resistant to trimethoprim/sulfamethoxazole and levofloxacin, 40% to a carbapenem, while 92% were susceptible to polymyxin B, 87% to tigecycline, and 79 % to fosfomycin. Increased use of broader spectrum antibiotics may help to prevent their dissemination and reduce the risk of progression to invasive disease.
    Antimicrobial Agents and Chemotherapy 07/2013; DOI:10.1128/AAC.00043-13 · 4.45 Impact Factor
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    ABSTRACT: Objectives: Week 96 efficacy and safety of the non-nucleoside reverse transcriptase inhibitor (NNRTI) rilpivirine (RPV) was compared to efavirenz (EFV) in subset of 1,096 subjects who received emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in pooled data from 2 phase 3 studies.Methods: ECHO and THRIVE are double-blind, double-dummy, randomized, active-controlled, non-inferiority phase 3 studies of RPV versus EFV plus 2 NRTIs in antiretroviral-naïve adult subjects. The primary and secondary endpoints were the proportion of subjects with HIV-1 RNA <50 copies/ mL using an intent-to-treat, time to loss of virologic response (ITT-TLOVR) analysis at weeks 48 and 96, respectively. Safety, tolerability, immunologic response, adherence level, and other measures were also evaluated.Results: At week 48, noninferior efficacy of RPV+FTC/TDF over EFV+FTC/TDF was established, and at week 96 RPV+FTC/TDF remained noninferior (77% overall response rate in both groups). Through week 96, rates of virologic failure were higher in the RPV+FTC/ TDF group, with low and similar rates of virologic failure and resistance mutations occurring during the second year of follow-up. Treatment with RPV+FTC/TDF was associated with a lower rate of discontinuation due to adverse events and grade 2-4 adverse events including dizziness, abnormal dreams/nightmares, rash, and lipid abnormalities.Conclusions: The pooled ECHO and THRIVE studies demonstrated noninferiority of RPV+FTC/TDF in achieving virologic response with safety and tolerability advantages over EFV+FTC/TDF through 96 weeks. Higher rates of virologic failure in the RPV+FTC/TDF group were balanced with higher rates of discontinuations due to adverse events in the EFV+FTC/TDF group.
    HIV Clinical Trials 05/2013; 14(3):81-91. DOI:10.1310/hct1403-81 · 2.14 Impact Factor
  • Open Journal of Medical Microbiology 01/2013; 03(02):130-134. DOI:10.4236/ojmm.2013.32019
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    ABSTRACT: Coagulase-negative staphylococci (CoNS) are the main pathogens causing hospital-acquired external-ventricular-drain- (EVD-) and lumbar-drain- (LD-) associated meningitis and ventriculitis. The treatment of these infections can be challenging and may require combination of intraventricular and intravenous administration of antibiotics. Limited animal data demonstrate rapid daptomycin bactericidal activity, adequate penetration in the setting of inflamed meninges, and extended half-life in the ventricles Steenbergen et al. (2009). There are limited clinical data using daptomycin intravenously and/or intraventricularly for the treatment of central nervous system infections (CNS) Elvy et al. (2008), Stucki et al. (2007), Lee et al. (2008) and Wallace et al. (2009). We report here our experience in the treatment of an EVD-related infection.
    Case Reports in Medicine 05/2012; 2012:593578. DOI:10.1155/2012/593578
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    ABSTRACT: We have identified CTX-M group 1 β-lactamases in 87% of community-acquired Escherichia coli isolates that produce extended-spectrum β-lactamases, with the majority harboring CTX-M-15 and representing the ST131 clonal group. Seventy percent of CTX-M-bearing isolates were from urine specimens; a large proportion was nonsusceptible to levofloxacin, trimethoprim/sulfamethoxazole, and β-lactam antimicrobials. Many patients were relatively youthful (41% ≤65 years old; youngest, age 32). Patients with symptomatic bacteriuria received drugs to which the organisms were susceptible, and most had favorable outcomes. Timely recognition of such isolates could help physicians choose more appropriate antibacterial therapy.
    Diagnostic microbiology and infectious disease 03/2012; 72(3):248-52. DOI:10.1016/j.diagmicrobio.2011.11.008 · 2.57 Impact Factor
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    ABSTRACT: Central nervous system infections are frequently associated with cerebrospinal fluid shunting procedures. Although most infections associated with central nervous system shunting procedures are caused by staphylococci, enterococci, including vancomycin-resistant enterococci, are increasingly a cause of nosocomial and community-acquired infections. We report a case in which a combination of intravenous and intrathecal daptomycin successfully eradicated vancomycin-resistant Enterococcus faecium infection of a cerebrospinal fluid shunt in a 59-year-old woman. In our patient, intrathecal daptomycin at a dose of 5 mg every 3 days resulted in microbiologic improvement 6 days after the initiation of therapy without a clinically significant rise in creatine phosphokinase levels.
    Infectious Disease in Clinical Practice 01/2012; 20(6):414-415. DOI:10.1097/IPC.0b013e31824f8c67
  • Sorana Segal-Maurer, Carl Urban, David S Rubin, W Wehbeh
    Clinical Infectious Diseases 11/2011; 53(12):1301-2. DOI:10.1093/cid/cir708 · 9.42 Impact Factor
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    ABSTRACT: HIV infection leads to ongoing immune activation and inflammation within gut-associated lymphoid tissue. Host response initiates events that participate in CD4+ T cell depletion and soft-tissue wasting. Chronic immune activation is associated with disruption of organized lymphoid tissue and gut-barrier integrity, and microbial translocation that may impact whole-body energy metabolism and protein turnover. Systemic stress leading to decreased food intake and/or viral damage to endocrine tissue is associated with wasting disease in HIV-infected patients. Clinical management requires appreciation of subjective, physical, and biochemical parameters, as well as addressing factors associated with food insecurity.
    Topics in clinical nutrition 12/2010; 26(1):14–28. DOI:10.1097/TIN.0b013e318209e3a0
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    ABSTRACT: Bacteria harboring CTX-M extended-spectrum beta-lactamases (ESBLs) have been identified worldwide, with most reports coming from regions outside North America. We have identified CTX-M enzymes in 31% of ESBL-positive Escherichia coli isolates from our hospital and more than half (53%) of the isolates from associated long-term care facilities. Approximately 3/4 of all CTX-M-bearing isolates were from urine specimens, with a predominance of CTX-M-15. A large proportion of such isolates were nonsusceptible to levofloxacin, trimethoprim/sulfamethoxazole, and all beta-lactam antimicrobials with the exception of the carbapenems, requiring carbapenem therapy for acute urinary tract infection or urinary tract-related sepsis. CTX-M beta-lactamases have emerged within our location, and detection of bacteria harboring these enzymes in the clinical microbiology laboratory remains problematic because molecular methods are needed for their identification.
    Diagnostic microbiology and infectious disease 04/2010; 66(4):402-6. DOI:10.1016/j.diagmicrobio.2009.11.012 · 2.57 Impact Factor
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    ABSTRACT: There are limited safety data for high-dose and long-term daptomycin treatment (16mg/kg administered for >or=14 days). We present our experience in 61 patients. We performed a retrospective chart review for all patients treated with daptomycin at New York Hospital Queens (Flushing) from 1 January 2004 through 30 April 2007; patients were identified through a computerized hospital pharmacy database. Sixty-one patients (29 male and 32 female patients; mean age, 66.6 years) received a mean dose of 8 mg/kg of daptomycin for a median of 25 days (range, 14-82 days). Twelve patients (with bone and skin and softtissue infections) did not have an identified microbiologic isolate. Gram-positive infections included bloodstream infection with or without infective endocarditis (n = 32), skin and soft-tissue infection (n = 14), bone and joint infection (n = 9), and intra-abdominal infection (n = 5), and unidentified infection (n = 1). Prosthetic devices were removed from 11 of 20 patients. Grade 1 adverse events occurred in 22 patients and did not lead to daptomycin discontinuation. Fifty-eight patients underwent creatine phosphokinase (CPK) analysis (34 patients had paired CPK analyses at the beginning of and during therapy, and 13 patients had random CPK analysis performed during treatment). Three patients had constitutional and/or musculoskeletal symptoms accompanying CPK levels 110 times upper limit of normal (grade 3). All occurred after 24 days of treatment and improved after daptomycin treatment was discontinued. Two of 3 patients were morbidly obese (body mass index grade III). Daptomycin treatment was well tolerated at a mean dose of 8 mg/kg for a median duration of 25 days. The incidence of symptomatic CPK level elevation was within the range reported with lower doses of daptomycin and/or for shorter treatment durations.
    Clinical Infectious Diseases 07/2009; 49(2):177-80. DOI:10.1086/600039 · 9.42 Impact Factor
  • Farah Shams, Deborah Asnis, Charles Lombardi, Sorana Segal-Maurer
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    ABSTRACT: Tuberculosis (TB) is a major global health problem, and musculoskeletal TB occurs in approximately 10% of extrapulmonary cases. In this article we describe 2 cases of ankle joint tuberculous arthritis. Both of the patients were immunocompromised and presented with chronic pain and swelling. Both patients described a history of antecedent ankle trauma. The clinical presentations were consistent with chronic septic arthritis and were nonspecific as to a particular etiology. The pathology and microbiology results revealed infection with Mycobacterium tuberculosis. Tuberculous infection of bone and joint must be considered when predisposing epidemiological factors are present to avoid delay in therapy. Further exploration into the relationship of trauma to tuberculosis recrudescence is warranted. Level of Clinical Evidence: 4.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 07/2009; 48(4):452-6. DOI:10.1053/j.jfas.2009.04.004 · 0.98 Impact Factor
  • Aman Dalal, Carl Urban, Sorana Segal-Maurer
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    ABSTRACT: Corynebacterium amycolatum, a normal inhabitant of human skin, is a Gram-positive, non-spore-forming, mycolic acid-free, aerobic or facultative anaerobic bacillus. Since its description in 1988, it has only rarely been associated with infective endocarditis. This paper describes a case of infective endocarditis successfully treated by combination therapy with daptomycin and rifampicin. To the best of our knowledge, this is the first case report of C. amycolatum endocarditis from the USA successfully treated with these agents.
    Journal of Medical Microbiology 11/2008; 57(Pt 10):1299-302. DOI:10.1099/jmm.0.2008/003343-0 · 2.27 Impact Factor
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    ABSTRACT: Nine carbapenem-resistant Escherichia coli isolates harboring Klebsiella pneumoniae carbapenemase (KPC)-2 or KPC-3 enzymes were identified in patients residing in 7 distinct long-term care facilities. Cefotaxime-hydrolyzing (CTX-M)-type beta-lactamases were also documented in 3 isolates. The identification of these enzymes in patients staying in long-term care facilities should be of great concern to all components of health care systems.
    Clinical Infectious Diseases 07/2008; 46(11):e127-30. DOI:10.1086/588048 · 9.42 Impact Factor