Susan Whittier

New York Presbyterian Hospital, New York, New York, United States

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Publications (77)285.33 Total impact

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    ABSTRACT: Rapidly growing nontuberculous mycobacteria (RG-NTM), which can contaminate inadequately sterilized medical instruments, have been known to cause serious postsurgical skin and soft tissue infections that often are characterized by a prolonged incubation period and a disfiguring clinical course. Historically, these infections have been associated with surgical procedures performed outside the United States. The Centers for Disease Control and Prevention recently reported an outbreak of RG-NTM infections among women who underwent cosmetic surgery in the Dominican Republic. Because of the large Dominican American community in upper Manhattan, we have recently observed a number of these cases at NewYork-Presbyterian Hospital/Columbia University Medical Center. We highlight the case of a 55-year-old woman who developed a postsurgical RG-NTM infection after bilateral breast reduction in the Dominican Republic; she experienced progressive deformity of her left breast until the causative pathogen was identified 20 months after her initial surgery. To assist in the timely diagnosis and treatment of these infections, we aim to promote greater awareness among physicians who are likely to encounter such patients. We present the pathologic findings of a review of 7 cases of RG-NTM infections seen at NewYork-Presbyterian Hospital/Columbia University Medical Center and discuss the diagnostic and therapeutic challenges associated with these infections, such as prolonged incubation periods, the need for acid-fast stains and mycobacterial cultures, and the combination of surgical therapy and lengthy antibiotic courses that are often required for treatment.
    No preview · Article · Feb 2016 · Annals of Plastic Surgery
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    ABSTRACT: There is significant variation in the use of polymyxin B (PMB) and optimal dosing has not been defined. The purpose of this retrospective study was to evaluate the relationship between PMB dose and clinical outcomes. We included patients with bloodstream infections (BSIs) due to carbapenem-resistant gram-negative rods who received ≥ 48 hours of intravenous PMB. The objectives were to evaluate the association between PMB dose and 30-day mortality, clinical cure at day 7, and development of acute kidney injury (AKI). A total of 151 BSIs were included. The overall 30-day mortality was 37.8% (54 of 151) and the median PMB dose was 1.3 mg/kg/day. Receipt of PMB doses < 1.3 mg/kg/day was significantly associated with 30-day mortality (46.5% vs 26.3%; p = 0.02) and this association persisted in multivariable analysis [odds ratio (OR) 1.58; 95% confidence interval (CI) 1.05-1.81; p = 0.04]. Eighty-two percent of patients who received PMB doses < 1.3 mg/kg/day had baseline renal impairment. Clinical cure at day 7 was not significantly different between dosing groups. AKI was more common in patients receiving PMB doses ≥ 250 mg/day (66.7% vs 32.0%; p = 0.03) and this association persisted in multivariable analysis (OR 4.32; 95% CI, 1.15-16.25; p = 0.03). PMB doses < 1.3 mg/kg/day were administered primarily to patients with renal impairment and this dosing was independently associated with 30-day mortality. However, doses ≥ 250 mg/day were independently associated with AKI. These data support the use of PMB without dose reduction in the setting of renal impairment. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    No preview · Article · Aug 2015 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: We conducted an open-label crossover trial to test whether proton pump inhibitors (PPIs) affect the gastrointestinal microbiome to facilitate Clostridium difficile infection (CDI). Twelve healthy volunteers each donated 2 baseline fecal samples, 4 weeks apart (at weeks 0 and 4). They then took PPIs for 4 weeks (40 mg omeprazole, twice daily) and fecal samples were collected at week 8. Six individuals took the PPIs for an additional 4 weeks (from week 8 to 12) and fecal samples were collected from all subjects at week 12. Samples were analyzed by 16S rRNA gene sequencing. We found no significant within-individual difference in microbiome diversity when we compared changes during baseline vs changes on PPIs. There were, however, significant changes during PPI use in taxa associated with CDI (increased Enterococcaceae and Streptococcaceae, decreased Clostridiales) and taxa associated with gastrointestinal bacterial overgrowth (increased Micrococcaceae and Staphylococcaceae). In a functional analysis, there were no changes in bile acids on PPIs, but there was an increase in genes involved in bacterial invasion. These alterations could provide a mechanism by which PPIs predispose to CDI. ClinicalTrials.gov:NCT01901276. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Gastroenterology
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    ABSTRACT: OBJECT Diagnosis of ventriculostomy-related infections (VRIs) is challenging due to the lack of rapid, sensitive assays for pathogen detection. The authors report the development of a multiplex polymerase chain reaction (PCR) assay for differential diagnosis of common VRI pathogens. METHODS MassTag PCR was used to develop a multiplex assay for detection of 11 VRI pathogens. The assay was established and optimized using cloned template standards and spiked samples and was then evaluated on CSF specimens from ventricular drains. Subjects were grouped into definite VRI, possible VRI, or no VRI based on conventional microbiology, CSF evaluation, and clinical parameters. RESULTS CSF specimens were obtained from 45 subjects (median age 49 years, interquartile range 32-63 years; 51% were male). The assay detected 10-100 genome copies. It detected a pathogen in 100% (6 of 6) of definite VRI cases in which a pathogen targeted by the assay was present; these represented 67% of all definite VRIs (6 of 9). Among subjects with a possible VRI, the assay detected a pathogen in 29% (5 of 17). In subjects without overt infection the presence of a pathogen was detected in 32% of subjects (6 of 19), albeit with lower signal compared with the VRI group. CONCLUSIONS MassTag PCR enabled parallel testing of CSF specimens for 11 pathogens of VRI. The high sensitivity of PCR combined with possible device colonization, specimen contamination, and concurrent antibiotic treatments limit the clinical value of the assay, similar to other current diagnostic approaches. With further optimization, multiplex PCR may provide timely identification of multiple possible VRI pathogens and guide management, complementing classic culture approaches.
    No preview · Article · May 2015 · Journal of Neurosurgery
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    ABSTRACT: Topical mupirocin is used widely to treat skin and soft tissue infections and to eradicate nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). Few studies to date have characterized the rates of S. aureus mupirocin resistance in pediatric populations. We retrospectively studied 358 unique S. aureus isolates obtained from 249 children seen in a predominantly outpatient setting by the Division of Pediatric Dermatology at a major academic center in New York City between 1 May 2012 and 17 September 2013. Mupirocin resistance rates and the associated risk factors were determined using a logistic regression analysis. In our patient population, 19.3% of patients had mupirocin-resistant S. aureus isolates at the time of their first culture, and 22.1% of patients with S. aureus infection had a mupirocin-resistant isolate at some time during the study period. Overall, 31.3% of all S. aureus isolates collected during the study period were resistant to mupirocin. Prior mupirocin use was strongly correlated (odds ratio [OR] = 26.5; P = <0.001) with mupirocin resistance. Additional risk factors for mupirocin resistance included methicillin resistance, atopic dermatitis (AD), epidermolysis bullosa (EB), immunosuppression, and residence in northern Manhattan and the Bronx. Resistance to mupirocin is widespread in children with dermatologic complaints in the New York City area, and given the strong association with mupirocin exposure, it is likely that mupirocin use contributes to the increased resistance. Routine mupirocin testing may be important for MRSA decolonization strategies or the treatment of minor skin infections in children.
    Full-text · Article · May 2015 · Antimicrobial Agents and Chemotherapy

  • No preview · Article · May 2015 · Journal of the American Academy of Dermatology
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    ABSTRACT: Despite the growing importance of carbapenem-resistant Klebsiella pneumoniae (CRKP), the clonal relationships between CRKP and antibiotic-susceptible isolates remain unclear. We compared the genetic diversity and clinical features of CRKP, 3rd and/or 4th generation cephalosporin-resistant (Ceph-R), and susceptible K. pneumoniae causing bloodstream infections at a tertiary care hospital in New York City between January 2012 and July 2013. Drug susceptibilities were determined by Vitek2. Isolates underwent multi-locus sequence typing and PCR-sequencing of the wzi and blaKPC genes. Clinical and microbiologic data were extracted from patient records and correlated with molecular data. Among 223 patients, we identified 272 isolates. Of these, 194 were susceptible, 30 Ceph-R, and 48 CRKP and belonged to 144 sequence types (STs). Susceptible (127 STs) and Ceph-R (20 STs) isolates were highly diverse. ST258 dominated CRKP strains (12 STs; 63% ST258). There was minimal overlap in STs between resistance groups. BlaKPC-3 (30%) was restricted to ST258/wzi154, whereas blaKPC-2 (70%) included several wzi alleles. CRKP infections occurred more frequently in solid organ transplant (31%) and dialysis patients (17%). Mortality was overall high (28%) and highest in CRKP-infected patients (59%). In multivariable analyses, advanced age, comorbidities and the severity of disease were significant predictors of 30-day mortality whereas the K. pneumoniae susceptibility phenotype was not. Amongst CRKP infections we observed a borderline significant association to increased mortality with ST258 and the wzi154 allele. Although the clonal spread of ST258 continues to contribute substantially to the dissemination of CRKP, non-ST258 strains appear to be evolving. Further investigations into the mechanisms promoting CRKP diversification and the impact of clonal background on outcomes are warranted. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Full-text · Article · Apr 2015 · Journal of clinical microbiology

  • No preview · Article · Apr 2015 · Gastroenterology
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    ABSTRACT: The high sensitivity of PCR assays for diagnosing Clostridium difficile infection (CDI) has greatly reduced the need for repeat testing after a negative result. Nevertheless, a small subset of patients do test positive within 7 days of a negative test. The aim of this study was to evaluate the clinical characteristics of these patients to determine when repeat testing may be appropriate. The results of all Xpert C. difficile PCR (Cepheid, Sunnyvale CA) tests performed in the clinical microbiology laboratory at New York-Presbyterian Hospital, Columbia University Medical Center (NYPH/CUMC) from 1 May 2011 through 6 September 2013, were reviewed. A retrospective case-control study was performed, comparing patients who tested positive within 7 days of a negative test result to a random selection of 50 controls who tested negative within 7 days of a negative test result. During the study period, a total of 14,875 tests were performed, of which 1,066 were repeat tests (7.2%). Eleven of these repeat tests results were positive (1.0%). The only risk factor independently associated with repeat testing positive was history of a prior CDI (odds ratio [OR], 19.6 [95% confidence interval {CI}, 4.0 to 19.5], P < 0.001). We found that patients who test positive for C. difficile by PCR within 7 days of a negative test are more likely to have a history of CDI than are patients who test negative with repeat PCR. This finding may be due to the high rate of disease relapse or the increased likelihood of empirical therapy leading to false-negative results in these patients.
    Full-text · Article · Aug 2014 · Journal of Clinical Microbiology
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    S. Whittier · P. Della-Latta

    Full-text · Article · Apr 2014 · International Journal of Infectious Diseases
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    ABSTRACT: Extremely drug-resistant gram-negative bacilli (XDR-GNB) increasingly cause health care-associated infections (HAIs) in intensive care units (ICUs). A matched case-control (1:2) study was conducted from February 2007 to January 2010 in 16 ICUs. Case and control subjects had HAIs caused by GNB susceptible to ≤ 1 antibiotic versus ≥ 2 antibiotics, respectively. Logistic and Cox proportional hazards regression assessed risk factors for HAIs and predictors of mortality, respectively. Overall, 103 case and 195 control subjects were enrolled. An immunocompromised state (odds ratio [OR], 1.55; P = .047) and exposure to amikacin (OR, 13.81; P < .001), levofloxacin (OR, 2.05; P = .005), or trimethoprim-sulfamethoxazole (OR, 3.42; P = .009) were factors associated with XDR-GNB HAIs. Multiple factors in both case and control subjects significantly predicted increased mortality at different time intervals after HAI diagnosis. At 7 days, liver disease (hazard ratio [HR], 5.52), immunocompromised state (HR, 3.41), and bloodstream infection (HR, 2.55) predicted mortality; at 15 days, age (HR, 1.02 per year increase), liver disease (HR, 3.34), and immunocompromised state (HR, 2.03) predicted mortality; and, at 30 days, age (HR, 1.02 per 1-year increase), liver disease (HR, 3.34), immunocompromised state (HR, 2.03), and hospitalization in a medical ICU (HR, 1.85) predicted mortality. HAIs caused by XDR-GNB were associated with potentially modifiable factors. Age, liver disease, and immunocompromised state, but not XDR-GNB HAIs, were associated with mortality.
    Full-text · Article · Apr 2014 · American journal of infection control
  • Claire Gordon · Thomas Briese · Susan Whittier · Jayesh Shah · Michael Yin
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    ABSTRACT: Background: Diagnosis of ventriculostomy-related infections (VRIs) can be challenging and is based upon interpretation of clinical and cerebrospinal fluid (CSF) parameters. We developed and validated a multiplex MassTag polymerase chain reaction (PCR) assay for the rapid diagnosis of VRIs utilizing organism-specific primers. Methods: A 13-plex MassTag PCR panel was developed targeting the most common pathogens causing VRIs at our institution, as identified in a retrospective review of culture-positive ventricular device (VD) CSF specimens between 2001-2006. The panel was optimized using cloned template standards and spiked samples. The level of detection ranged from 102-104 organisms per mL. The MassTag panel was evaluated on serially collected CSF specimens sent to the clinical microbiology laboratory. A retrospective review was performed to determine CSF and clinical parameters. VD patients were grouped into (1) definite VRI, (2) possible VRI, or (3) no VRI; while non-VD patients were grouped into (1) definite central nervous system (CNS) infection, (2) possible CNS infection, or (3) no CNS infection. Contamination or colonization was defined as organism detection in a patient with no VRI or no CNS infection. Results: CSF from 128 subjects were analyzed: 49 with a VD (median age 43 years; interquartile range [IQR] 30-62 years; males 49%), and 79 without a VD (median age 45 years; IQR 21-59 years; males 49%). Among subjects with a definite VRI or CNS infection due to a pathogen on the MassTag panel, the pathogen was identified in all cases (9/9). Among subjects with a possible VRI, the MassTag panel detected >1 pathogen in 33% of samples. Among subjects with no VRI or no VD and no CNS infection, an organism, mostly gram-positive bacteria was detected in 32% and 11%, respectively, representing either contamination or VD colonization. Conclusion: The VRI MassTag panel performed well in definite VRI and CNS infection and detected potential pathogens in possible VRI cases. However, the false positive rate with Staphylococcus and Enterococcus species necessitates the need for further confirmatory testing if these organisms are detected. Nonetheless, the negative predictive value for gram-negative bacteria suggests that empiric antibiotics can be narrowed if no gram-negative bacteria are detected.
    No preview · Conference Paper · Oct 2013
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    ABSTRACT: Infections with antibiotic resistant organisms (AROs) are an important source of morbidity and mortality among infants hospitalized in the neonatal intensive care unit (NICU). To identify potential reservoirs of AROs in the NICU, active surveillance strategies have been adopted by many NICUs to detect infants colonized with AROs. However, the yield, risks, benefits, and costs of different strategies have not been fully evaluated. We conducted a retrospective study in two level III NICUs from 2004-2010 to investigate the yield of surveillance cultures obtained from infants transferred to the NICU from other hospitals. Cultures were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and antibiotic resistant gram negative rods (AR-GNR). Risk factors, selected outcomes, and laboratory costs associated with ARO-colonization were assessed. Among 1751 infants studied, the rate of colonization for MRSA, VRE, and AR-GNR was 3%, 1.7%, and 1% respectively. Age at transfer was the strongest predictor of ARO colonization; infants transferred at ≥ 7 days of life had 5.8 increased odds of ARO colonization compared with infants < 7 days of age. Transferred infants who were colonized had similar rates of mortality, ARO infection, and duration of hospitalization compared to those who were not colonized. The laboratory cost of surveillance cultures during the study period was $58,425. The rate of colonization with AROs at transfer was low particularly in infants < 7 days old. Future studies should examine the safety of targeted surveillance strategies focused on older infants.
    No preview · Article · Jun 2013 · The Pediatric Infectious Disease Journal
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    ABSTRACT: Carbapenems are increasingly needed to treat infections caused by drug-resistant gram-negative bacilli (GNB), but carbapenem resistance is increasing. We evaluated the activity of doripenem by broth microdilution against 96 extensively drug-resistant (XDR) Acinetobacter baumannii and Klebsiella pneumoniae isolates from patients with hospital-associated infections. All isolates were non-susceptible to doripenem, but ≥1 doripenem combination demonstrated synergy (fractional inhibitory concentration index: ≤0.5 for 2 agents, ≤0.75 for 3 agents) against 7 (15%) A. baumannii and 23 (48%) K. pneumoniae isolates; doripenem with rifampin and/or polymyxin B were most active. As doripenem has unique potential for use in prolonged infusions, suggested pharmacodynamic (PD) breakpoints range from 2-8 μg/mL; synergistic activity was found for higher proportions of XDR-GNB at higher PD breakpoints with doripenem with amikacin or with rifampin. The clinical utility of these observations requires further study, as treatment options for XDR-GNB infections are limited.
    No preview · Article · Apr 2013 · Diagnostic microbiology and infectious disease
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    ABSTRACT: Bordetella holmesii is an emerging opportunistic pathogen that causes respiratory disease in healthy individuals and invasive infections among patients lacking splenic function. We used 16S rRNA gene analysis to confirm B. holmesii as the cause of bacteremia in a child with sickle cell disease. Semiconductor-based draft genome sequencing provided insight into B. holmesii phylogeny and potential virulence mechanisms and also identified a toluene-4-monoxygenase locus unique among bordetellae.
    Full-text · Article · Mar 2013 · Pathogens and Disease

  • No preview · Conference Paper · Mar 2013
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    ABSTRACT: Streptococcus intermedius is a human pathogen with a propensity for abscess formation. We report a high-quality draft genome sequence of S. intermedius strain BA1, an isolate from a human epidural abscess. This sequence provides insight into the biology of S. intermedius and will aid investigations of pathogenicity.
    Full-text · Article · Jan 2013 · Genome Announcements
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    ABSTRACT: While much is known about the geographic distribution of different clonal types of methicillin-resistant Staphylococcus aureus (MRSA), few studies have assessed the molecular epidemiology of methicillin-susceptible S. aureus (MSSA), despite its continued clinical importance. In each U.S. Census region, reference laboratories collected successive MSSA isolates from patients with invasive or superficial staphylococcal infections for use in the Tigecycline Evaluation and Surveillance Trial. All isolates from the periods of 2004 to 2005 and 2009 to 2010 underwent antimicrobial susceptibility testing and characterization of their staphylococcal protein A (spa) type. Of the 708 isolates analyzed, 274 spa types were identified and divided into 15 genetic clusters. The most common clones were spa t002 (n = 63, 8.9%) and t008 (n = 56, 7.9%). While the distribution of the predominant spa types did not differ by U.S. Census region or time period, spa t008 was nearly twice as common in community skin and soft tissue infections than in nosocomial bloodstream infections (11.1% versus 5.6%, respectively; P = 0.008). Despite such differences, both community and nosocomial settings had diverse staphylococcal clonal types representing all major spa clusters. In contrast to those of MRSA, MSSA infectious isolates show wide genetic diversity without clear geographical or temporal clustering. Notably, the prevalent MSSA strains (spa t002 and spa t008) are analogous to the predominant MRSA clones, further demonstrating the importance of both lineages.
    Full-text · Article · Jan 2013 · Journal of clinical microbiology
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    ABSTRACT: Background: Bacterial vaginosis (BV) is associated with an increased risk of preterm birth (PTB) and acquisition of sexually transmitted infections. Currently, the primary clinical tool for BV diagnosis is the Amsel criteria. However, not all women with BV as determined by the "gold-standard" (Nugent score of Gram stained slides) are detected by Amsel criteria. Therefore, we investigated the characteristics of women with BV by Nugent score who were negative by Amsel criteria (A-N+). Methods: The BV-IDEAS (Bacterial Vaginosis: Improved Diagnosis by ELISA and Sequencing) cross-sectional study enrolls non-pregnant women from a racially/ethnically diverse urban clinic population to evaluate a new diagnostic test for BV and to elucidate BV risk factors. All data and clinical samples were collected during routine gynecologic visits. Presence/absence of BV by Amsel criteria and Nugent score were available for all women. Sociodemographic, medical, and behavioral characteristics of women were determined by interviewer-administered questionnaires. White and races other than black or Hispanic were combined due to small sample sizes. Chi-squared test and Fisher’s exact test were used to evaluate characteristics associated with A-N+ status. Results: Of the first 217 women enrolled in our study, 78 (36%) had Nugent score 7-10, indicating BV, and these 78 women were used in this analysis. There was a trend toward white/other women being more likely to be A-N+ compared with black women (p=0.058). Women who did not report vaginal discharge (p=0.007) or odor (p=0.024) were more likely to be A-N+. White/other women drove this association. Among white/other A-N+ women, none reported discharge or odor (p-values undefined due to zero row counts). Conclusion: While current treatments for BV have been unsuccessful in preventing PTB and other adverse sequelae, we are hopeful that future strategies will prove more effective. Reliance on Amsel criteria for the diagnosis of BV may leave some cases undetected, suggesting a need for improved classification and diagnostic strategies.
    No preview · Conference Paper · Oct 2012
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    ABSTRACT: Background: Infants hospitalized in the neonatal ICU (NICU) are at great risk of acquiring antimicrobial-resistant organisms. Predictors of endemic infant colonization with methicillin-resistant Staphylococcus aureus (MRSA) at discharge have not been studied. Methods: From May 2009 to September 2011, 1,105 infants in 4 level-III NICUs with ≥14 hospital-days had surveillance cultures of the nares and skin sites (periumbilical, axilla, and groin) obtained at NICU discharge. Swabs were processed in a central laboratory according to Clinical Laboratory and Standards Institute (CLSI) guidelines, and colonization was defined as isolation of MRSA from ≥1 swab. Demographic and clinical data were used to determine predictors of colonization. Variables found significant (P<0.2) on unadjusted analysis were entered into a generalized estimating equation with study site as a design variable. Results: Overall, 4% (range per site: 3-6%) of infants were colonized with MRSA at discharge, and the colonization rate ranged from 0.7-1.2 infants/1,000 patient-days. In all, 47 infants had 63 isolates detected: 18 (38%) nares only, 13 (28%) skin only, and 16 (34%) both sites. Only 8 infants had MRSA infections; MRSA infection was more common among infants colonized at discharge than among those who were not colonized (8.5% vs. 0.4%, respectively, P<0.01). In an adjusted multivariable model, only surgery was associated with MRSA colonization (OR: 1.90 95%CI: 1.23, 2.95). Conclusion: In this study, few infants had endemic infection or colonization with MRSA, but surveillance cultures of both nares and skin sites improved detection of MRSA colonization. Surgery increased the odds of infant colonization with MRSA at NICU discharge, which suggests that MRSA acquisition may occur when infants leave the NICU for surgical procedures or during post-surgical care. Future studies should continue to delineate routes of MRSA acquisition and the attack rate for infection following colonization.
    No preview · Conference Paper · Oct 2012

Publication Stats

2k Citations
285.33 Total Impact Points

Institutions

  • 1999-2015
    • New York Presbyterian Hospital
      • Department of Pathology
      New York, New York, United States
    • University of Washington Seattle
      • Department of Pediatrics
      Seattle, Washington, United States
  • 1998-2015
    • Columbia University
      • • College of Physicians and Surgeons
      • • Department of Pathology & Cell Biology
      New York, New York, United States
  • 1994-2014
    • Mid-Columbia Medical Center
      DLS, Oregon, United States
  • 2011
    • CUNY Graduate Center
      New York City, New York, United States
  • 2007
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
  • 2002
    • Jersey Shore University Medical Center
      Neptune City, New Jersey, United States
  • 2000
    • State University of New York Downstate Medical Center
      Brooklyn, New York, United States
  • 1995
    • Montefiore Medical Center
      • Department of Pathology
      New York, New York, United States
  • 1993-1995
    • University of North Carolina at Chapel Hill
      • Department of Pediatrics
      North Carolina, United States