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Emi Minejima, PharmD - USC School of Pharmacy. Los Angeles, CA, US

Emi Minejima, PharmD Emi Minejima, PharmD

Associate Professor of Clinical Pharmacy | USC School of Pharmacy

Los Angeles, CA, UNITED STATES

Emi Minejima is an expert in infectious diseases pharmacotherapy and antimicrobial stewardship.

Spotlight

Biography

Dr. Minejima joined the faculty at the University of Southern California School of Pharmacy in August 2012 as Assistant Professor of Clinical Pharmacy. She graduated from University of California-Berkeley with a BS in molecular and cell biology (2005) and from University of California-San Diego School of Pharmacy (2009). Dr. Minejima completed her postgraduate residency training in pharmacy practice and infectious disease at Huntington Hospital in Pasadena.

Her clinical practice is based at LAC+USC Medical Center where she focuses on the antimicrobial stewardship program, research and precepting pharmacy students and residents in acute care medicine and infectious disease clerkships.

Areas of Expertise (5)

Coronavirus

Development of Antimicrobial Resistance

Infectious Diseases Pharmacotherapy

Antimicrobial Stewardship

COVID-19

Education (2)

University of California-San Diego School of Pharmacy: Pharm.D. 2009

University of California-Berkeley: B.S., Molecular and Cell Biology 2005

Selected Articles (5)

Don't Get Wound Up: Revised Fluoroquinolone Breakpoints for Enterobacteriaceae and Pseudomonas aeruginosa Journal of Clinical Microbiology

Tam T. Van, Emi Minejima, Chiao An Chiu, Susan M. Butler-Wu

2019 Fluoroquinolones remain some of the more commonly prescribed antimicrobial agents in the United States, despite the wide array of reported side effects that are associated with their use. In 2019, the Clinical and Laboratory Standards Institute revised the fluoroquinolone antimicrobial susceptibility testing breakpoints for both Enterobacteriaceae and Pseudomonas aeruginosa. This breakpoint revision was deemed necessary on the basis of pharmacokinetic and pharmacodynamic analyses suggesting that the previous breakpoints were too high, in addition to the inability of the previous breakpoints to detect low-level resistance to this antibiotic class. In this minireview, we review the published data in support of this revision, as well as the potential challenges that these breakpoint revisions are likely to pose for clinical laboratories.

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Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes Clinical Infectious Diseases

Emi Minejima, Nikki Mai, Nancy Bui, Melissa Mert, Wendy J Mack, Rosemary C She, Paul Nieberg, Brad Spellberg, Annie Wong-Beringer

2019 Persistent Staphylococcus aureus bacteremia (SAB) is defined based on varying duration in literature. The primary objective was to determine the risk of poor outcomes in relation to bacteremia duration.

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Utility of qSOFA score in identifying patients at risk for poor outcome in Staphylococcus aureus bacteremia BMC Infectious Diseases

Emi Minejima, Vanessa Delayo, Mimi Lou, Pamela Ny, Paul Nieberg, Rosemary C. She & Annie Wong-Beringer

2019 The prognostic capability of the quick Sequential Organ Failure Assessment (qSOFA) bedside scoring tool is uncertain in non-ICU patients with sepsis due to bacteremia given the low number of patients previously evaluated.

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Expected Practice as a Novel Antibiotic Stewardship Intervention Open Forum Infectious Diseases

Kabir Yadav, Eriko Masuda, Emi Minejima, Brad Spellberg

2018 “Expected practice” is a recently described method to alter clinical behavior. We implemented an expected practice around short-course antibiotic therapy, which was associated with decreased antibiotic utilization for multiple bacterial infections. Thus, we describe this expected practice as a novel, simple, and inexpensive tool to enhance antibiotic stewardship.

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Prospective Trial on the Use of Trough Concentration versus Area under the Curve To Determine Therapeutic Vancomycin Dosing American Society for Microbiology Journals

Michael N. Neely, Lauren Kato, Gilmer Youn, Lironn Kraler, David Bayard, Michael van Guilder, Alan Schumitzky, Walter Yamada, Brenda Jones, Emi Minejima

2018 We hypothesized that dosing vancomycin to achieve trough concentrations of >15 mg/liter overdoses many adults compared to area under the concentration-time curve (AUC)-guided dosing. We conducted a 3-year, prospective study of vancomycin dosing, plasma concentrations, and outcomes. In year 1, nonstudy clinicians targeted trough concentrations of 10 to 20 mg/liter (infection dependent) and controlled dosing. In years 2 and 3, the study team controlled vancomycin dosing with BestDose Bayesian software to achieve a daily, steady-state AUC/MIC ratio of ≥400, with a maximum AUC value of 800 mg · h/liter, regardless of trough concentration. For Bayesian estimation of AUCs, we used trough samples in years 1 and 2 and optimally timed samples in year 3. We enrolled 252 adults who were ≥18 years old with ≥1 available vancomycin concentration. Only 19% of all trough concentrations were therapeutic versus 70% of AUCs (P < 0.0001). After enrollment, median trough concentrations by year were 14.4, 9.7, and 10.9 mg/liter (P = 0.005), with 36%, 7%, and 6% over 15 mg/liter (P < 0.0001). Bayesian AUC-guided dosing in years 2 and 3 was associated with fewer additional blood samples per subject (3.6, 2.0, and 2.4; P = 0.003), shorter therapy durations (8.2, 5.4, and 4.7 days; P = 0.03), and reduced nephrotoxicity (8%, 0%, and 2%; P = 0.01). The median inpatient stay was 20 days among nephrotoxic patients versus 6 days (P = 0.002). There was no difference in efficacy by year, with 42% of patients having microbiologically proven infections. Compared to trough concentration targets, AUC-guided, Bayesian estimation-assisted vancomycin dosing was associated with decreased nephrotoxicity, reduced per-patient blood sampling, and shorter length of therapy, without compromising efficacy. These benefits have the potential for substantial cost savings. (This study has been registered at ClinicalTrials.gov under registration no. NCT01932034.)

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