Erika Viana Cardenas

All Publications

• Pediatric gastrointestinal surgical site infections: a case-control study. Infection control and hospital epidemiology Khoury, V., Viana Cardenas, E. P., Lee, G. M., Burns, J. E., Tran, J., Krishna, S., Valencia, A., Davis, W., Madhavan, G., Chao, S., Rosenthal, A., Salinas, J. L., Mathew, R. 2026: 1-9

  Abstract

  Surgical site infections (SSIs) remain a significant source of morbidity in children. Elevated standardized infection ratios (SIRs) for pediatric gastrointestinal (GI) procedures persist nationally and at our institution. We assessed pediatric-specific risk factors and the applicability of the adult SIR model.Case-control study of pediatric patients undergoing GI surgery (2019-2022) with 82 SSI cases matched 1:2 with 164 controls by prematurity, age, National Healthcare Safety Network (NHSN) procedure category and year. Data was collected via chart review; socioeconomic risk was assessed using the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Bivariate and multivariate conditional logistic regression analyses used to estimate adjusted odds ratios (aOR) with 95% confidence interval (CI).A tertiary pediatric referral center.Ages 0-21; NHSN reportable GI SSI procedures (appendix, gastric, small bowel, colon, laparotomy).Cases were more likely to speak a language other than English or Spanish aOR 4.26 (95% CI, 1.06-17.11; P = .041) compared to controls. Adult SIR risk factors such as diabetes mellitus, were not significant predictors. Cases had longer hospitalizations (median 17.5 vs 7 days) and higher 30-day readmission rates (26% vs 10%) compared to controls.These findings highlight the importance of language-concordant care and consideration of other social vulnerabilities in pediatric GI surgical care. Adult-based SIR models may not be applicable to children, highlighting the need for pediatric-specific measures that ensure equitable access to preventive care.

  View details for DOI 10.1017/ice.2026.10502

  View details for PubMedID 42482478

• Impact of stopping contact precautions on vanA plasmid transmission, Northern California, 2021-2023. Antimicrobial stewardship & healthcare epidemiology : ASHE Rodriguez-Nava, G., Grieshop, M. P., Zulli, A., Behr, A. A., Miranti, E., Tariq, W., Viana-Cardenas, E. P., Pincus, N., Banaei, N., Sampson, M., Bhatt, A. S., Salinas, J. L. 2026; 6 (1): e140

  Abstract

  To evaluate the impact of discontinuing contact precautions for vancomycin-resistant enterococci (VRE) on strain and plasmid transmission using long-read whole-genome sequencing (WGS).Before-after trial of adults with Enterococcus bloodstream infections pre-(Jan-Oct 2021) and post-(Oct-Dec 2021 and Jan-Oct 2023) discontinuation of contact precautions for VRE infections.Quaternary referral and transplant academic medical center.Hospitalized adults (≥18 yr) with E. faecalis or E. faecium bacteremia.Classical epidemiology identified potential transmissions via shared unit exposure within a 14-day window. Blood culture isolates underwent long-read WGS to assess strain and vanA plasmid relatedness. Clonal transmission was defined as <20 single-nucleotide polymorphisms. Plasmid similarity was assessed with Mash distance.Among 288 isolates from 202 patients, there was no significant difference in possible epidemiologic transmissions pre-versus postdiscontinuation (9.5% vs 8.1%; P = .679). Genomic analysis identified four clonal transmission events, two of which occurred postdiscontinuation. Among 70 vanA plasmids from 54 patients, 38 highly related plasmids formed a low-diversity cluster. The proportion of cluster plasmids was not significantly different between periods (47% vs 60%; P = .267). Postdiscontinuation, vanA-positive E. faecium ST117 was more prevalent (22/44 vs 53/75; P = .024).Discontinuation of contact precautions for VRE was not associated with increased transmission of enterococci or vanA plasmids in bloodstream infections. Transmission patterns remained largely stable, though the postdiscontinuation period showed increased prevalence of the dominant E. faecium ST117. These findings suggest limited impact of contact precautions on VRE transmission.

  View details for DOI 10.1017/ash.2026.10392

  View details for PubMedID 42130491

  View details for PubMedCentralID PMC13162067

• Use of a large language model integrated within the electronic medical record for the evaluation of surgical site infections - Northern California, 2025. Infection control and hospital epidemiology Miranti, E., Keyes, T., Ayala, A., Ambers, N., Newman, G., de Leon, E., Viana-Cardenas, E. P., Tariq, W., Sampson, M., Salinas, J. L. 2026: 1-3

  Abstract

  Our study evaluated a large language model (gpt-4o-mini) for surgical site infection (SSI) adjudication, achieving 100% sensitivity but 69.4% specificity. While reducing the manual screening workload by 66%, the agent generated many false positives, underscoring the need for refined models to improve specificity without compromising accuracy.

  View details for DOI 10.1017/ice.2026.10432

  View details for PubMedID 41972262

• Implementation of Wastewater-Based Epidemiology in a Northern California Acute Care Hospital: A Pilot Study, June-July 2024. The Journal of hospital infection Rodriguez-Nava, G., Zulli, A., Grieshop, M. P., Viana-Cardenas, E. P., Jong, S., Miranti, E., Jiang, M., Ayala, A., Sampson, M., Bhatt, A. S., Boehm, A. B., Salinas, J. L. 2026

  Abstract

  AIM: To evaluate the feasibility and performance of wastewater-based healthcare epidemiology for monitoring respiratory viruses and antimicrobial resistance genes.METHODS: We conducted a pilot study at an 800-bed academic quaternary care hospital in Northern California. Composite wastewater samples were collected weekly over three timepoints (June-July 2024) from the main hospital outflow. Droplet digital PCR was performed to quantify nucleic acids from respiratory viruses (SARS-CoV-2, influenza A, RSV) and ARGs (mecA, vanA, KPC, NDM, OXA-48, VIM). Viral levels were compared with hospital testing data and community wastewater trends. Antimicrobial resistance genes were compared with contemporaneous clinical cultures.FINDINGS: Sampling was logistically feasible but constrained by equipment size and placement limitations. Viral nucleic acid levels in hospital wastewater broadly reflected hospital testing results and community wastewater trends. By contrast, ARG levels showed limited alignment with clinical culture data. mecA levels were low despite an elevated number of MRSA cultures, while vanA and carbapenemase genes were abundant, including during weeks with no corresponding clinical cases.CONCLUSIONS: Wastewater-based healthcare epidemiology captured trends in hospital respiratory virus testing but showed limited concordance with culture-based detection of resistant bacteria. While not suited for case detection of resistant pathogens, it may serve as a system-level tool to assess the hospital resistome, antimicrobial pressures, and potential environmental transmission risks.

  View details for DOI 10.1016/j.jhin.2026.03.007

  View details for PubMedID 41864437

• Using secure artificial intelligence agents integrated within the electronic medical record for the evaluation of blood culture appropriateness-Northern California, 2025. Infection control and hospital epidemiology Rodriguez-Nava, G., Keyes, T., Ambers, N., Miranti, E., Viana-Cardenas, E. P., Tariq, W., Sampson, M. M., Salinas, J. L. 2025: 1-4

  Abstract

  We evaluated large language model (LLM)-based agents integrated with the electronic medical record to assess blood culture appropriateness. While sensitivity was high, specificity remained low. Performance was shaped by prompt phrasing, sycophantic behavior, and semantic triggers, reflecting both the potential and limitations of LLMs in real-world clinical decision support.

  View details for DOI 10.1017/ice.2025.10349

  View details for PubMedID 41216923

• A systematic literature review and bayesian meta-analysis of oral vancomycin primary prophylaxis for <i>Clostridioides difficile</i> infection in stem cell transplant patients ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY Viana-Cardenas, E., Miranti, E., Tariq, W., Rodriguez-Nava, G., Shen, S., Whitaker, E., Jiang, M., Sampson, M. M., Rezvani, A., Bhatt, A. S., Marra, A. R., Salinas, J. L. 2025; 5 (1)

  View details for DOI 10.1017/ash.2025.10179

  View details for Web of Science ID 001592539000001

• A systematic literature review and bayesian meta-analysis of oral vancomycin primary prophylaxis for Clostridioides difficile infection in stem cell transplant patients. Antimicrobial stewardship & healthcare epidemiology : ASHE Viana-Cardenas, E., Miranti, E., Tariq, W., Rodriguez-Nava, G., Shen, S., Whitaker, E., Jiang, M., Sampson, M. M., Rezvani, A., Bhatt, A. S., Marra, A. R., Salinas, J. L. 2025; 5 (1): e265

  Abstract

  Clostridioides difficile infection (CDI) is common among patients undergoing hematopoietic stem cell transplantation (HSCT). Oral vancomycin prophylaxis may effectively prevent CDI in certain populations. We investigated the effectiveness of oral vancomycin primary prophylaxis in preventing CDI in HSCT patients.We searched six databases from inception to March 21, 2025, for studies comparing the incidence of CDI in HSCT patients who received oral vancomycin primary prophylaxis versus those who did not. We built a Bayesian random-effects model for meta-analysis. The primary outcome was the incidence of CDI. Secondary outcomes included incidence of positive vancomycin-resistant Enterococcus cultures, blood stream infections, graft-vs-host disease, and length of hospital stay. We also assessed for heterogeneity and publication bias using Robust Bayesian Meta-Analyses.Six studies met inclusion criteria with a total of 1,236 patients. Four of the studies were of fair to good quality. Oral vancomycin primary prophylaxis reduced the incidence of CDI during hospitalization (OR 0.31; 95%CrI 0.16-0.59). Studies were weakly heterogeneous but had strong publication bias. Oral vancomycin primary prophylaxis reduced the odds of CDI by 12% after accounting for publication bias (OR 0.88; 95%CrI 0.32-1.16), although this reduction was not statistically significant. Secondary outcomes were similar in both groups.Oral vancomycin primary prophylaxis prevented CDI in HSCT patients without significantly affecting secondary outcomes. However, after controlling for publication bias, these findings were no longer significant. Further studies are needed to provide stronger evidence for or against this intervention, assess long-term safety, and assess potential effects on antimicrobial resistance.

  View details for DOI 10.1017/ash.2025.10179

  View details for PubMedID 41127168

  View details for PubMedCentralID PMC12538368

• Low diagnostic yield of repeat urine cultures in hospitalized patients at a tertiary center in Northern California, 2023-2024. Infection control and hospital epidemiology Miranti, E., Sampson, M. M., Shepard, J., Rodriguez-Nava, G., McIntyre, K., Viana Cardenas, E. P., Trautner, B. W., Salinas, J. L. 2025: 1-3

  Abstract

  We analyzed the diagnostic yield of repeat urine cultures in a retrospective study of adult inpatients. Most urine cultures repeated at less than 6 days provided redundant information. This was true whether the index culture was positive or negative, and whether the threshold for positivity was 10,000 or 100,000 CFU/mL.

  View details for DOI 10.1017/ice.2025.10248

  View details for PubMedID 40833079