Sorana Segal-Maurer

New York Presbyterian Hospital, New York, New York, United States

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Publications (47)232.29 Total impact

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    ABSTRACT: Background: Residents of long-term care facilities (LTCFs) are at increased risk for colonization and development of infections with multidrug-resistant organisms. This study was undertaken to determine prevalence of asymptomatic rectal colonization with Clostridium difficile (and proportion of 027/NAP1/BI ribotype) or carbapenem-resistant Enterobacteriaceae (CRE) in an LTCF population. Methods: Active surveillance was performed for C difficile and CRE rectal colonization of 301 residents in a 320-bed (80-bed ventilator unit), hospital-affiliated LTCF with retrospective chart review for patient demographics and potential risk factors. Results: Over 40% of patients had airway ventilation and received enteral feeding. One-third of these patients had prior C difficile-associated infection (CDI). Asymptomatic rectal colonization with C difficile occurred in 58 patients (19.3%, one-half with NAP1+), CRE occurred in 57 patients (18.9%), and both occurred in 17 patients (5.7%). Recent CDI was significantly associated with increased risk of C difficile ± CRE colonization. Multivariate logistic regression analysis revealed presence of tracheostomy collar to be significant for C difficile colonization, mechanical ventilation to be significant for CRE colonization, and prior CDI to be significant for both C difficile and CRE colonization. Conclusions: The strong association of C difficile or CRE colonization with disruption of normal flora by mechanical ventilation, enteral feeds, and prior CDI carries important implications for infection control intervention in this population.
    No preview · Article · Jan 2016 · American journal of infection control
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    ABSTRACT: Objectives: To compare efficacy, safety, tolerability, and patient-reported outcomes between two single-tablet regimens, rilpivirine/emtricitabine/tenofovir disoproxil fumarate (RPV/FTC/TDF) and efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF), in HIV-1-infected, treatment-naive adults. Design: This was a phase 3b, 96-week, randomized, open-label, international, noninferiority trial. Methods: A total of 799 participants were randomized (1: 1) to receive RPV/FTC/TDF or EFV/FTC/TDF. The primary efficacy endpoint evaluated proportions of participants with HIV-1 RNA less than 50 copies/ml using the Snapshot algorithm. Additional assessments included CD4 cell counts, genotypic/phenotypic resistance, adverse events, patient-reported outcomes, and quality of life questionnaires. Results: At week 96, trial completion rates were 80.2% (316/394; RPV/FTC/TDF) and 74.0% (290/392; EFV/FTC/TDF). Overall, RPV/FTC/TDF was noninferior to EFV/FTC/TDF [HIV-1 RNA <50 copies/ml: 77.9 vs. 72.4%, respectively; difference-5.5; 95%CI (-0.6, 11.5); P=0.076]. RPV/FTC/TDF was significantly more efficacious compared with EFV/FTC/TDF in participants with baseline HIV-1 RNA equal to or less than 100 000 copies/ml (78.8 vs. 71.2%; P=0.046) and in those with CD4 cell count greater than 200 cells/ml (80.6 vs. 73.0%; P=0.018). There was no significant betweengroup difference in the CD4 cell count increase (278189 vs. 259191 cells/ml; P=0.17). Few participants developed resistance after week 48 (1.0% RPV/FTC/TDF; 0.3% EFV/FTC/TDF). Compared with EFV/FTC/TDF, RPV/FTC/TDF was associated with fewer adverse event-related discontinuations (3.0 vs. 11.0%; P<0.001), significantly fewer adverse events due to central nervous system issues and rash, greater improvements in patient-reported symptoms, and significant improvements in the SF-12v2 quality of life questionnaire mental health composite score (P=0.014). Conclusion: In treatment-naive, HIV-1-infected participants, 96-week RPV/FTC/TDF treatment demonstrated noninferior efficacy and better tolerability than EFV/FTC/TDF.
    No preview · Article · Jan 2016 · AIDS
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    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.
    No preview · Article · Jun 2015 · Journal of clinical microbiology
  • William Rodgers · Selma Amrane · Tony Tsai · Nishant Prasad · Sorana Segal-Maurer
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    ABSTRACT: Our study seeks to compare costs of intravenous (IV) iron infusion compared with transfusion of packed red blood cells at a large community hospital in New York City in patients with anemia. Patient data from the Outpatient Parenteral Therapy Unit roster were retrospectively reviewed. Patients receiving IV iron infusion between November 2012 and January 2014 were included. Dose and dosing schedule information were required for inclusion as well as having a blood type and antibody screen. Employees of the infusion and transfusion centers were asked to provide information about cost of intravenous iron and packed red blood cell transfusion. Twenty-two patients were eligible for inclusion with 120 visits for iron infusion. The majority of patients experienced an increase in hemoglobin measured at the last iron infusion visit. Total course doses ranged from 400 to 1,200 mg. The cost of IV iron sucrose to the Outpatient Parenteral Therapy Unit was $25.79 per 100 mg of iron. Reimbursement to the Outpatient Parenteral Therapy Unit was found to be insurance-dependent with the minimum reimbursement 110% the price of iron sucrose used added to a minimum infusion cost of $78. The cost of each unit of packed red blood cells varied between $230 and $3,510. The reimbursement for transfusion of packed red blood cells was minimal, because most transfusions occurred on an inpatient basis and reimbursement for inpatient costs occurs as a fixed sum paid by patients' insurance companies for the hospitalization, regardless of interventions taken during the hospitalization. Taking nursing costs as approximately equal, the minimum saved by our hospital center was $37,656. Intravenous iron is a very cost-effective means of increasing hemoglobin levels in anemic patients.
    No preview · Article · May 2015 · Obstetrics and Gynecology
  • Priyal Chadha · Noriel Mariano · Vincent LaBombardi · Sorana Segal-Maurer · Carl Urban

    No preview · Article · Jan 2015 · Open Journal of Medical Microbiology
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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.
    No preview · Conference Paper · Oct 2014

  • No preview · Article · Oct 2014 · Open Forum Infectious Diseases
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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.
    No preview · Article · Apr 2014 · Urology
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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.
    No preview · Conference Paper · Oct 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.
    No preview · Article · Sep 2013 · Journal of the International Association of Providers of AIDS Care
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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.
    No preview · Article · Aug 2013 · American journal of infection control
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    ABSTRACT: Forty-seven extended-spectrum-β-lactamase-positive Klebsiella pneumoniae urinary tract isolates from nonhospitalized patients were identified, and 79% harbored KPC and/or CTX-M β-lactamases. Approximately 90% of the isolates were resistant to trimethoprim-sulfamethoxazole and levofloxacin, and 40% were resistant to a carbapenem, while 92% were susceptible to polymyxin B, 87% were susceptible to tigecycline, and 79% were susceptible to fosfomycin. Increased use of broader-spectrum antibiotics may help to prevent their dissemination and reduce the risk of progression to invasive disease.
    Preview · Article · Jul 2013 · Antimicrobial Agents and Chemotherapy
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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.
    Full-text · Article · May 2013 · HIV Clinical Trials

  • No preview · Article · Jan 2013 · Open Journal of Medical Microbiology
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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.
    No preview · Article · Nov 2012 · Infectious Disease in Clinical Practice
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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.
    Full-text · Article · May 2012 · Case Reports in Medicine
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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.
    No preview · Article · Mar 2012 · Diagnostic microbiology and infectious disease
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    Sorana Segal-Maurer · Carl Urban · David S Rubin · W Wehbeh

    Preview · Article · Nov 2011 · Clinical Infectious Diseases
  • Peter Wasserman · Sorana Segal-Maurer · Wehbeh Wehbeh · David S. Rubin
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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.
    No preview · Article · Dec 2010 · Topics in clinical nutrition
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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.
    No preview · Article · Apr 2010 · Diagnostic microbiology and infectious disease

Publication Stats

1k Citations
232.29 Total Impact Points

Institutions

  • 2015
    • New York Presbyterian Hospital
      New York, New York, United States
  • 1997-2014
    • New York Hospital Queens
      New York City, New York, United States
  • 2008
    • Weill Cornell Medical College
      New York, New York, United States
  • 1998
    • Cornell University
      • Department of Medicine
      Итак, New York, United States