Carey-Ann D Burnham

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (71)236.18 Total impact

  • Morgan A Pence, Carey-Ann D Burnham
    Journal of clinical microbiology. 11/2014; 52(11):3835.
  • Morgan A Pence, Carey-Ann D Burnham
    Journal of clinical microbiology. 11/2014; 52(11):4121.
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    ABSTRACT: Background: Clostridium difficile (C. difficile), vancomycin resistant Enterococcus (VRE) and methicillin resistant Staphylococcus aureus (MRSA) are multidrug resistant organisms (MDRO) and cause healthcare associated infections. Previous studies have demonstrated that these MDROs can be recovered from a variety of foods including meat and vegetables. The objective of this study was to determine if C. difficile, VRE and MRSA is present in the food of hospitalized patients. Methods: Patients admitted from May 9, 2011 to July 12, 2012 at Barnes-Jewish Hospital with no diarrhea were approached to participate. Stool/rectal swab specimens were collected on admission, weekly and discharge and cultured for C. difficile. Study subjects placed samples of food from each meal into provided sterile specimen cups. Following homogenization, all food was cultured for C. difficile. A random sampling of food was cultured for VRE and MRSA. Molecular typing was performed. Medical charts were reviewed to look for positive clinical cultures for the organism during the enrollment period. Results: 148 patients were enrolled and 910 food specimens were collected and cultured for C. difficile. 218 food specimens from 122 patients were cultured for VRE and MRSA. Two (0.2%) food samples were positive for C. difficile, two (0.9%) were positive for VRE and two (0.9%) were positive for MRSA. Types of food present based on organism were: C. difficile – vegetables, grains, and other; VRE – dairy, grain and other; MRSA – poultry, fruit, vegetable, grain, and other. The C. difficile strains typed as ribotype 001 and 027. Both MRSA strains were SCCmec type IV. None of the patients with food positive for C. difficile were colonized with C. difficile before or after the positive food specimen. None of the patients with food positive for MRSA had MRSA in a clinical culture during the admission. One patient with food positive for VRE had a positive clinical culture for VRE (VRE surveillance stool culture) 32 days after the positive food specimen. Conclusion: Recovery of MRDOs from hospital food specimens was rare. One patient with VRE recovered from food was found to have a positive VRE surveillance stool culture. Hospital food appears to be an uncommon source for acquisition of these MDROs.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Rifampin is widely utilized in treatment of prosthetic joint infections (PJI) with retained hardware caused by Staphylococcal species. However, there is little data regarding clinical outcomes. Methods: We conducted a retrospective cohort study of patients with coagulase-negative Staphylococcus (CoNS), methicillin-sensitive (MSSA), and -resistant Staphylococcus aureus(MRSA) PJI who were treated with adjunctive rifampin therapy after admission to a large tertiary care hospital from July 2005 to June 2010. The epidemiology, clinical outcomes, and risk factors for failure were examined. Treatment success was defined as no further readmissions for PJI within 1 year of the index hospitalization. Results: A total of 237 patients with MRSA (56), MSSA (69), or CoNS (112) PJI were identified during the study period. Sixty-eight patients (29%) were discharged with rifampin combination therapy. Amongst patients treated with rifampin, MSSA was isolated in 30% and MRSA isolated in 25%. Partial exchange and debridement and implant retention (DAIR) was completed in 63% of all patients. Vancomycin was the most commonly prescribed IV antibiotic (48, 71%), followed by oxacillin (9, 13%). Concurrent therapy with daptomycin (2, 2.9%) or ceftriaxone (4, 5.9%) was rarely used. Antibiotic duration averaged 51 days (range 30-106, ± 14.6). Abnormal laboratories were common (53, 78%); however, only 18 (26.5%) required a change in antibiotic therapy. The most common side effect necessitating change was rash (9, 13.2%). Significant drug-drug interactions (1) and liver toxicity (2) were rare. Three patients (4%) were lost to follow up. Complications of antibiotic use caused 9% of all readmissions and 25% of the cohort was readmitted for infection (16, 25%). Rifampin use was not associated with decreased readmission for infection (MSSA, p=0.4; MRSA p=0.5; CoNS, p=0.7). Conclusion: Rifampin has been utilized as adjunctive treatment of staphylococcal PJI in cases of retained hardware. Although well tolerated in the study population, rifampin did not reduce the risk for PJI-related readmission compared to those who did not receive rifampin.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Negative routine cultures often occur with prosthetic joint infections (PJI) despite overt signs of infection. 16s rRNA gene polymerase chain reaction (PCR) has been proposed as a diagnostic tool to help identify causative organisms among those with culture negative PJI. Methods: Joint fluid, tissue or bone was collected from patients with PJI who were admitted to Barnes-Jewish Hospital between 9/15/2012 and 4/15/2013. PJI was defined per IDSA guidelines. Patients were considered to be culture negative or positive based on the results of routine microbiological cultures after 48 hours of incubation. DNA was extracted from samples using the MoBio Bacteremia Kit. Full length amplification of the 16S rRNA gene was performed, and PCR products were visualized using agarose gel electrophoresis. If a PCR product was present, it was sequenced and compared to GenBank and RDP to assign an organism identification per CLSI standards. Control samples were performed with each run. Results: We collected 54 samples from 42 unique patients with culture-negative PJI including 28 (51.9%) hip, 18 (33.3%) knee, 7 (13.0%) shoulder, and 1 (1.9%) ankle samples. Sample types included tissue (31, 57.4%), fluid (13, 24.1%), and bone (10, 18.5%). Staphylococcus aureus-specific PCR was negative in all patients with culture negative PJI. 16s rRNA gene PCR was also negative in all patients with culture negative PJI. Samples were collected from 35 patients with culture positive PJI including 18 (51.4%) hip and 17 (48.6%) knee samples. Sample types included 25 (71.4%) tissue, 8 (22.9%) fluid, and 2 (5.7%) bone. S. aureus was isolated in 21 routine cultures. S. aureus-specific PCR correctly identified 12 (57.1%) of samples with S. aureus and incorrectly identified 1 sample. 16s rRNA gene PCR correctly identified 3 samples with S. aureus and 2 samples with Streptococcus spp. Two polymicrobial cultures were identified as mixed; 4 monomicrobial cultures were identified as mixed. Among those with positive cultures for S. aureus, PCR was more likely to be positive from tissue samples than all other tissue types (p=.03). Conclusion: 16s rRNA gene PCR proved to be unreliable diagnostic tool among patients with culture positive or negative PJI. Conclusion: 16s rRNA gene PCR proved to be an unreliable diagnostic tool for patients with culture positive and negative PJI.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection is an important cause of ventilator-associated pneumonia. As a result, empiric therapy often includes anti-staphylococcal agents. Our objective was to evaluate the GeneXpert MRSA/SA SSTI Assay (Cepheid, Sunnyvale, CA) for use in lower respiratory tract (LRT) specimens for rapid MRSA detection as a tool in antimicrobial stewardship efforts. Methods: For the validation of the assay, we included laboratory-derived (“spiked”) bronchoalveolar lavage (BAL) specimens with known quantities of MRSA (SCCmec II and IV; 102 - 105 CFU/mL) and 30 banked LRT samples. For the clinical phase, we determined if LRT samples submitted to the microbiology lab met criteria for suspected pneumonia and were collected from ventilated patients. Comparator standard-of care culture results and antibiotic utilization information were collected. Antibiotic days for vancomycin and linezolid were calculated. Results: The limit of detection for MRSA in the spiked BAL samples was 103 CFU/ml. The assay correctly detected MRSA in 9/9 frozen samples and excluded MRSA in 21/21 samples with other organisms (sensitivity 100%, specificity 100%). We screened 310 LRT specimens; 100 met study criteria. Ten samples tested positive for MRSA with rapid PCR, while 6 were positive in routine cultures. Rapid PCR correctly detected 5/6 positive and 89/94 negative MRSA specimens for a sensitivity of 83.3% (95% CI: 36.1-97.2%) and specificity of 94.7% (95% CI: 88-98.2%) with a negative predictive value of 98.9% (95% CI: 93.9-99.8%). A total of 748 vancomycin and 305 linezolid antibiotic days were associated with the enrolled specimens. Vancomycin and linezolid utilization would decrease by 68.4% and 83%, respectively, if they were discontinued 1 day after negative rapid PCR results. Conclusion: A rapid MRSA PCR test performed well against the gold standard in respiratory samples from ventilated patients with suspected pneumonia. Its implementation has the potential of reducing empiric vancomycin and linezolid utilization.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Clostridium difficile infections (CDI) are a growing concern in North America, because of their increasing incidence and severity. Using integrated approaches, we correlated pathogen genotypes and host clinical characteristics for 46 C. difficile infections in a tertiary care medical center, during a six-month interval from January to June 2010. Multi-locus sequence typing (MLST) demonstrated 21 known and two novel sequence types (STs), suggesting that the institution's C. difficile strains are genetically diverse. ST1 (which corresponds to pulsed-field gel electrophoresis strain type NAP1/ribotype 027), was the most prevalent (32.6%), 43.5% of the isolates were binary toxin gene positive, of which 75% were ST1. All strains were ciprofloxacin resistant and metronidazole susceptible, and 8.3% and 13.0% of the isolates were resistant to clindamycin and tetracycline, respectively. The corresponding resistance loci, including potential novel mutations, were identified from the whole genome sequencing (WGS) of the resistant strains. Core genome SNPs determining the phylogenetic relatedness of the 46 strains recapitulated MLST types, and provided greater inter-strain differentiation. Disease severity was greatest in patients infected with ST-1 and/or binary gene positive strains, but genome-wide SNP analysis failed to provide additional associations with CDI severity within the same STs. We conclude MLST and core genome SNP typing result in the same phylogenetic grouping of the 46 C. difficile strains collected in a single hospital. WGS also has the capacity to differentiate those strains within STs, and allows the strains comparison at individual gene level and at whole genome level.
    Journal of clinical microbiology. 10/2014;
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    ABSTRACT: Household environmental surfaces may serve as vectors for the acquisition and spread of methicillin-resistant Staphylococcus aureus (MRSA) among household members, although few studies have evaluated which objects are important reservoirs of MRSA.
    JAMA Pediatrics 09/2014; · 4.28 Impact Factor
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    ABSTRACT: The aim of this study was to identify best practice for the detection of Shiga toxin-producing Escherichia coli (STEC) in children with diarrheal illness treated at a tertiary care center: sorbitol-MacConkey (SMAC) agar culture, enzyme immunoassay (EIA) for Shiga toxin, or the use of both methodologies simultaneously. STEC were detected in 100 of 14,997 stool specimens submitted for enteric culture (0.7%), of which 65 were E. coli O157. Among E. coli O157, 57 (88%) were identified by both SMAC and EIA, 6 (9%) by SMAC alone, and 2 (3%) by EIA alone. Of the 62 individuals with diarrheal hemolytic uremic syndrome (HUS) seen at our institution during the study period, 16 (26%) had STEC isolated from culture at our institution and 15 (24%) had STEC isolated at other institutions. No STEC was recovered in 31 cases (50%). Of the HUS cases in which an STEC was isolated, 28 (90%) were attributable to E. coli O157 and 3 (10%) were attributable to non-O157 STEC. Consistent with previous studies, we have determined that a subset of E. coli O157 STEC will not be detected if an agar based method is excluded from the enteric culture workup; this has both clinical and public health implications. Best practice would be concomitant use of an agar based method and a Shiga toxin EIA, but a Shiga toxin EIA should not be considered to be an adequate stand-alone test for detection of E. coli O157 in clinical samples.
    Journal of clinical microbiology. 07/2014;
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    ABSTRACT: Direct plating of synovial fluid (SF) on agar-based media often fails to identify pathogens in septic arthritis (SA). We developed a PCR assay for the simultaneous detection of Kingella kingae and Staphylococcus aureus from SF to evaluate molecular detection in SF and to estimate the incidence of K. kingae in SA in North America. The assay was based on detection of the cpn60 gene of K. kingae and the spa gene of S. aureus in multiplex real-time PCR. K. kingae was identified in 50% of patients between 0 and 5 yr of age (n=6) but not in any patients >18 yr old (n=105). Direct plating of SF on agar-based media failed to detect K. kingae in all samples. The PCR assay was inferior to the culture-based method for S. aureus, detecting only 50% of culture-positive cases. Our findings suggest that K. kingae is a common pathogen in pediatric SA in North America, in agreement with previous reports from Europe. PCR-based assays for the detection of K. kingae may be considered in children with SA, especially in those with a high degree of clinical suspicion.
    Annals of Laboratory Medicine 07/2014; 34(4):313-6. · 1.48 Impact Factor
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    ABSTRACT: Lactobacilli are low-virulence, commensal organisms of the gastrointestinal and genitourinary tracts and are commonly used as "probiotic supplements". Herein, we describe an episode of respiratory syncytial virus (RSV) bronchiolitis with bacterial super-infection secondary to administration of Lactobacillus rhamnosus in an 11 month old female with trisomy 21.
    Journal of clinical microbiology. 06/2014;
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    ABSTRACT: Background. Clostridium difficile infection (CDI) incidence has increased dramatically over the last decade. Recent studies suggest asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We sought to identify the prevalence and risk factors for asymptomatic C. difficile carriage on admission to the hospital. Methods. Patients admitted to Barnes-Jewish Hospital without diarrhea were enrolled from June, 2010, through October, 2011. Demographics and healthcare and medication exposures 90 days prior to admission were collected. Stool specimens or rectal swabs were collected within 48 hours of admission and stored at -30(°)C until cultured. C. difficile isolates were typed and compared to isolates from patients with CDI. Results. 259 subjects enrolled had an admission stool/swab specimen. 204 (79%) were not colonized, 40(15%) had toxigenic C. difficile (TCD), and 15 (6%) had nontoxigenic C. difficile. There were no differences between TCD colonized and uncolonized subjects for age (mean 56 vs.58, p=.46), comorbidities, admission from another healthcare facility (33% vs. 24%, p=.23), or recent hospitalization (50% vs. 50%, p=.43).There were no differences in antimicrobial exposures in the 90 days prior to admission (55% vs. 56%, p= .91). Asymptomatic carriers were colonized with strains similar to strains from patients with CDI, but the relative proportions were different. Conclusions. There was a high prevalence of TCD colonization on admission. In contrast to past studies, TCD colonization was not associated with recent antimicrobial or healthcare exposures. Additional investigation is needed to determine the role of asymptomatic TCD carriers on hospital-onset CDI incidence.
    Clinical Infectious Diseases 04/2014; · 9.37 Impact Factor
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    ABSTRACT: Background. Late-onset sepsis is a major problem in neonatology, but the habitat of the pathogens before bloodstream invasion occurs is not well established. Methods. We examined prospectively collected stools from premature infants with sepsis to find pathogens that subsequently invaded their bloodstreams, and sought the same organisms in stools of infants without sepsis. Culture-based techniques were used to isolate stool bacteria that provisionally matched the bloodstream organisms, which were then genome sequenced to confirm or refute commonality. Results. Of 11 children with late-onset neonatal bloodstream infections, 7 produced at least 1 stool that contained group B Streptococcus (GBS), Serratia marcescens, or Escherichia coli before their sepsis episode with provisionally matching organisms. Of 96 overlap comparison subjects without sepsis temporally associated with these cases, 4 were colonized with provisionally matching GBS or S. marcescens. Of 175 comparisons of stools from randomly selected infants without sepsis, 1 contained a GBS (this infant had also served as an overlap comparison subject and both specimens contained provisionally matching GBS). Genome sequencing confirmed common origin of provisionally matching fecal and blood isolates. The invasive E. coli were present in all presepticemic stools since birth, but gut colonization with GBS and S. marcescens occurred closer to time of bloodstream infection. Conclusions. The neonatal gut harbors sepsis-causing pathogens, but such organisms are not inevitable members of the normal microbiota. Surveillance microbiology, decolonization, and augmented hygiene might prevent dissemination of invasive bacteria between and within premature infants.
    Clinical Infectious Diseases 03/2014; · 9.37 Impact Factor
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    ABSTRACT: In North America, widespread use of vaccines targeting Haemophilus influenzae type b and Streptococcus pneumoniae have dramatically altered the epidemiology of bacterial meningitis, while the methodology for culturing cerebrospinal fluid (CSF) specimens has remained largely unchanged. The aims of this study are twofold: first, to document the current epidemiology of bacterial meningitis at a tertiary medical center; and second, to assess the clinical utility of routinely querying for anaerobes in CSF culture. To that end, CSF cultures submitted over a 2-year period were assessed. A Brucella blood agar (BBA) plate, incubated anaerobically for 5 days, was included in the culture procedure for all CSF specimens during the second year of evaluation. In the pre-and post- implementation years, 2353 and 2302 CSF specimens were cultured, with 49 and 99 patients having positive culture results, respectively. Clinical and laboratory data for patients with positive cultures were reviewed. Anaerobic bacteria were isolated in the CSF of 33 patients post-BBA, compared to two patients pre-BBA (p=0.01). The anaerobic isolates included Bacteroides thetaiotaomicron (n=1), Propionibacterium species (n=15), and P. acnes (n=19); all were recovered on the BBA. Eight of the 35 patients from which anaerobic organisms were isolated received antimicrobial therapy. Although six of these patients had central nervous system hardware, two patients did not have a history of a neurosurgical procedure and had community-acquired anaerobic bacterial meningitis. This study demonstrates that the simple addition of anaerobically incubated BBA to the culture of CSF specimens enhances recovery of clinically significant anaerobic pathogens.
    Journal of clinical microbiology 03/2014; · 4.16 Impact Factor
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    ABSTRACT: We report a case of septic arthritis of a native knee joint due to Corynebacterium striatum, a rare and unusual cause of septic arthritis of native joints. The isolate was identified by a combination of phenotypic-, mass spectrometric- and nucleic acid-based assays, and exhibited high-level resistance to most antimicrobials.
    Journal of clinical microbiology 02/2014; · 4.16 Impact Factor
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    ABSTRACT: Propionibacterium acnes is a known cause of post-neurosurgical meningitis; however, it is rarely implicated in de novo meningitis. Herein we report a case of a 49 year-old male with de novo P. acnes meningitis with metastatic melanoma as the only identified risk factor for his infection.
    Journal of clinical microbiology 01/2014; · 4.16 Impact Factor
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    ABSTRACT: Urinary tract infections are the most common cause of E. coli bloodstream infections (BSI) but the mechanism of bloodstream invasion is poorly understood. Some clinical isolates have been observed to shield themselves with extracellular amyloid fibers called curli at physiologic temperature. We hypothesize that curli fiber assembly at 37°C promotes bacteremic progression by urinary E. coli strains. Curli expression by cultured E. coli isolates from bacteriuric patients in the presence and absence of bacteremia were compared using Western blotting following amyloid fiber disruption with hexafluoroisopropanol. At 37°C, urinary isolates from bacteremic patients were more likely to express curli than those from non-bacteremic patients [16/22 (73%) vs. 7/21 (33%); p = 0.01]. No significant difference in curli expression was observed at 30°C [86% (19/22) vs. 76% (16/21); p = 0.5]. Isolates were clonally diverse between patients, indicating that this phenotype is distributed across multiple lineages. Most same-patient urine and blood isolates were highly related, consistent with direct invasion of urinary bacteria into the bloodstream. 37°C curli expression was associated with bacteremic progression of urinary E. coli isolates in this population. These findings suggest new future diagnostic and virulence-targeting therapeutic approaches.
    PLoS ONE 01/2014; 9(1):e86009. · 3.53 Impact Factor
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    ABSTRACT: We evaluated detection of ertapenem (ETP) resistance and Klebsiella pneumoniae carbapenemase (KPC) in 47 Klebsiella pneumoniae isolates using a novel, automated microscopy system. Automated microscopy correctly classified 22/23 isolates as ETP resistant and 24/24 as ETP susceptible, and correctly classified 21/21 isolates as KPC-positive and 26/26 as KPC-negative.
    Journal of clinical microbiology 01/2014; · 4.16 Impact Factor
  • Yen-Michael S. Hsu, Carey-Ann D. Burnham
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    ABSTRACT: Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has emerged as a tool for identifying clinically relevant anaerobes. We evaluated the analytical performance characteristics of the Bruker Microflex with Biotyper 3.0 software system for identification of anaerobes, and examined the impact of direct formic acid treatment and other pre-analytical factors on MALDI-TOF MS performance. A collection of 101 anaerobic bacteria were evaluated, including Clostridium spp., Propionibacterium spp., Fusobacterium spp., Bacteroides spp., and other anaerobic bacterial of clinical relevance. The results of our study indicate that an on-target extraction with 100% formic acid improves the rate of accurate identification without introducing misidentification (p < 0.05). In addition, we modify the reporting cut-offs for the Biotyper “score” yielding acceptable identification. We found that a score of ≥1.700 can maximize the rate of identification. Of interest, MALDI-TOF MS can correctly identify anaerobes grown in suboptimal conditions, such as on selective culture media and following oxygen exposure. In conclusion, we report on a number of simple and cost effective pre- and post-analytical modifications could enhance MALDI-TOF MS identification for anaerobic bacteria.
    Diagnostic microbiology and infectious disease 01/2014; · 2.45 Impact Factor
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    ABSTRACT: The VITEK MS v2.0 MALDI-TOF mass spectrometry system's performance in identifying fastidious gram-negative bacteria was evaluated in a multicenter study. Compared with the reference method (DNA sequencing), the VITEK MS system provided an accurate, species-level identification for 96% of 226 isolates; an additional 1% were accurately identified to the genus level.
    Diagnostic microbiology and infectious disease 12/2013; · 2.45 Impact Factor

Publication Stats

297 Citations
236.18 Total Impact Points

Institutions

  • 2010–2014
    • Washington University in St. Louis
      • Department of Pathology and Immunology
      San Luis, Missouri, United States
  • 2013
    • Barnes Jewish Hospital
      San Luis, Missouri, United States
  • 2010–2013
    • University of Washington Seattle
      • • Department of Immunology
      • • Department of Pediatrics
      Seattle, WA, United States
  • 2010–2011
    • University of Texas Southwestern Medical Center
      • Department of Pathology
      Dallas, TX, United States
  • 2005–2011
    • University of Alberta
      • Department of Laboratory Medicine and Pathology
      Edmonton, Alberta, Canada