Browsing by Author "Seidelman, Jessica L"

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    Mycobacterium avium pseudo-outbreak associated with an outpatient bronchoscopy clinic: Lessons for reprocessing.
    (Infection control and hospital epidemiology, 2019-01) Seidelman, Jessica L; Wallace, Richard J; Iakhiaeva, Elena; Vasireddy, Ravikiran; Brown-Elliott, Barbara A; McKnight, Celeste; Chen, Luke F; Smith, Terry; Lewis, Sarah S
    We identified a pseudo-outbreak of Mycobacterium avium in an outpatient bronchoscopy clinic following an increase in clinic procedure volume. We terminated the pseudo-outbreak by increasing the frequency of automated endoscope reprocessors (AER) filter changes from quarterly to monthly. Filter changing schedules should depend on use rather than fixed time intervals.
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    The host transcriptional response to Candidemia is dominated by neutrophil activation and heme biosynthesis and supports novel diagnostic approaches.
    (Genome medicine, 2021-07) Steinbrink, Julie M; Myers, Rachel A; Hua, Kaiyuan; Johnson, Melissa D; Seidelman, Jessica L; Tsalik, Ephraim L; Henao, Ricardo; Ginsburg, Geoffrey S; Woods, Christopher W; Alexander, Barbara D; McClain, Micah T

    Background

    Candidemia is one of the most common nosocomial bloodstream infections in the United States, causing significant morbidity and mortality in hospitalized patients, but the breadth of the host response to Candida infections in human patients remains poorly defined.

    Methods

    In order to better define the host response to Candida infection at the transcriptional level, we performed RNA sequencing on serial peripheral blood samples from 48 hospitalized patients with blood cultures positive for Candida species and compared them to patients with other acute viral, bacterial, and non-infectious illnesses. Regularized multinomial regression was utilized to develop pathogen class-specific gene expression classifiers.

    Results

    Candidemia triggers a unique, robust, and conserved transcriptomic response in human hosts with 1641 genes differentially upregulated compared to healthy controls. Many of these genes corresponded to components of the immune response to fungal infection, heavily weighted toward neutrophil activation, heme biosynthesis, and T cell signaling. We developed pathogen class-specific classifiers from these unique signals capable of identifying and differentiating candidemia, viral, or bacterial infection across a variety of hosts with a high degree of accuracy (auROC 0.98 for candidemia, 0.99 for viral and bacterial infection). This classifier was validated on two separate human cohorts (auROC 0.88 for viral infection and 0.87 for bacterial infection in one cohort; auROC 0.97 in another cohort) and an in vitro model (auROC 0.94 for fungal infection, 0.96 for bacterial, and 0.90 for viral infection).

    Conclusions

    Transcriptional analysis of circulating leukocytes in patients with acute Candida infections defines novel aspects of the breadth of the human immune response during candidemia and suggests promising diagnostic approaches for simultaneously differentiating multiple types of clinical illnesses in at-risk, acutely ill patients.
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    Universal masking is an effective strategy to flatten the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) healthcare worker epidemiologic curve.
    (Infection control and hospital epidemiology, 2020-12) Seidelman, Jessica L; Lewis, Sarah S; Advani, Sonali D; Akinboyo, Ibukunoluwa C; Epling, Carol; Case, Matthew; Said, Kristen; Yancey, William; Stiegel, Matthew; Schwartz, Antony; Stout, Jason; Sexton, Daniel J; Smith, Becky A
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    Using clinical decision support to improve urine testing and antibiotic utilization.
    (Infection control and hospital epidemiology, 2023-03) Yarrington, Michael E; Reynolds, Staci S; Dunkerson, Tray; McClellan, Fabienne; Polage, Christopher R; Moehring, Rebekah W; Smith, Becky A; Seidelman, Jessica L; Lewis, Sarah S; Advani, Sonali D

    Objective

    Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes.

    Methods

    This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods.

    Results

    The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion.

    Conclusion

    CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.