Carey-Ann D Burnham

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

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Publications (61)236.38 Total impact

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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
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    ABSTRACT: Methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE) present major challenges (1-4).…
    Antimicrobial Agents and Chemotherapy 11/2013; · 4.57 Impact Factor
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    ABSTRACT: Little is known about strain relatedness of methicillin-resistant Staphyloccocus aureus (MRSA) isolated at serial time points from the respiratory tract of patients with cystic fibrosis (CF). To interrogate the genetic diversity of MRSA recovered in serial cultures from children with CF and correlate strain relatedness with clinical characteristics. We performed a retrospective analysis of children with CF from whom MRSA was isolated from serial respiratory cultures from 2005 to 2011. Within individual patients, relatedness of isolated strains was determined by repetitive-sequence polymerase chain reaction, and the staphylococcal cassette chromosome mec (SCCmec) type of each isolate was characterized. Medical records corresponding to the MRSA cultures were reviewed. We identified 54 CF patients with serial MRSA cultures (145 distinct cultures). Over time, 45 (83%) patients maintained the same strain type and 9 (17%) possessed at least 2 distinct strain types. A total of 91 pairs of isolates were analyzed for strain relatedness. Of these, 81 (89%) were identical and 10 (11%) were distinct strain types. One hundred seventeen (83%) isolates were SCCmec type II, 24 (17%) were SCCmec type IV, and 4 were other types not resolvable with our assay. Clinical factors, including time interval and prescription of antibiotics effective against MRSA between positive cultures, did not correlate with acquisition of a distinct MRSA strain by individual patients. Our data suggest that sustained presence of MRSA in CF patients is most commonly attributable to identical strain types. Acquisition of distinct MRSA strains in the airway is infrequent.
    The Pediatric Infectious Disease Journal 11/2013; · 3.57 Impact Factor
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    John V Mitsios, Ann M Gronowski, Carey-Ann D Burnham
    Annals of Laboratory Medicine 11/2013; 33(6):455-6. · 1.48 Impact Factor
  • Journal of clinical microbiology 11/2013; 51(11):3912. · 4.16 Impact Factor
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    ABSTRACT: Although colonization traditionally is considered a risk factor for Staphylococcus aureus infection, the relationship between contemporary S aureus colonization and infection is not well characterized. We aimed to relate the presence of colonizing and disease-causing strains of S aureus within individuals and households. In a prospective study of 163 pediatric outpatients (cases) with community-associated S aureus skin and soft tissue infections in St Louis, infection isolates were obtained from cases and colonization cultures were obtained from cases and their household contacts (n = 562). Molecular typing by repetitive sequence-based polymerase chain reaction was used to compare infecting and colonizing isolates within each case. The infecting strain from each case was compared with S aureus strains colonizing household contacts. The colonization status of cases was followed for 12 months. A total of 27 distinct strain types were identified among the 1299 S aureus isolates evaluated. Between 1 and 6 distinct strain types were detected per household. A total of 110 cases (67%) were colonized at 1 or more body sites with the infecting strain. Of the 53 cases with an infecting strain that did not match a colonizing strain, 15 (28%) had 1 or more household contacts with a colonizing strain that matched the infecting strain. Intrafamilial strain-relatedness was observed in 105 families (64%). One-third of cases were colonized with a different strain type than the strain causing the skin and soft tissue infection. Fewer than one-third of cases with discordant infecting and colonizing isolates could be linked to the strain from another household contact, suggesting acquisition from sources outside the household.
    The Journal of pediatrics 10/2013; · 4.02 Impact Factor
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    Morgan A Pence, Erin McElvania Tekippe, Carey-Ann D Burnham
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    ABSTRACT: The detection of blood stream infections is one of the most important functions of the clinical microbiology laboratory. Sepsis is a clinical emergency, and mortality increases if commencement of appropriate antimicrobial therapy is delayed. Automated blood culture systems are the most sensitive approach for detection of the causative agent of sepsis. Several laboratory methods have been developed to expedite identification of organisms directly from positive blood culture broth. The principle and analytical performance characteristics of these methods are described in this review.
    Clinics in laboratory medicine 09/2013; 33(3):651-84. · 1.17 Impact Factor
  • Article: Commentary.
    Carey-Ann D Burnham
    Clinical Chemistry 09/2013; 59(9):1308-9. · 7.15 Impact Factor

Publication Stats

255 Citations
236.38 Total Impact Points


  • 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