MD, Jefferson Medical College (Philadelphia, PA)
Roosevelt Hospital; USPHS Hospital
Memorial Hospital for Cancer and Allied Diseases
Weill Medical College of Cornell University
Memorial Hospital for Cancer and Allied Diseases
My clinical research interests at Memorial Hospital focus on the prevention and therapy of infectious complications of neoplastic diseases in adult and pediatric oncology patients. My efforts have been directed towards immunoprophylaxis (active immunization), chemoprophylaxis, and mechanical (barrier) methods of preventing infection as well as the chemotherapy and immunotherapy of such infections. We have performed highly informative trials with live, attenuated varicella vaccine in children with A.L.L. in remission for one year. With the collaboration of Hospital Infection Control, we have investigated outbreaks of vancomycin-resistant Enterococcus faecium and are using molecular epidemiology to track strains on adult and pediatric impatient services at MSKCC.
We are using retrospective reviews of positive blood cultures to establish the frequency and importance of different bacteria and fungi as pathogens in the setting of the immunocompromised host. As an example, we have performed studies of catheter-related sepsis due to Rhodotorula species and Malassezia furfur. Prospective studies, such as the evaluation of infections in patients with indwelling intravascular devices, have altered the manner in which we diagnose and treat such infections. Our observations have led us to propose new approaches to reduce the incidence and cost of catheter-related infections. Furthermore, we have been able to determine which patients will benefit most from specific types of catheters and have examined the effects of increasing the frequency of flushing on the risk of infection. Finally, we have also investigated the optimal duration of therapy that is required for effective treatment of catheter-related sepsis.
Comparison of various antibiotics for empiric treatment of febrile, neutropenic patients has been an important interest of mine. Our earlier studies demonstrated that combinations of aminoglycosides and cephalosporins could be given safely in the setting of fever and neutropenia. Other studies demonstrated unanticipated risks encountered with moxalactam therapy and offered an opportunity to study the mechanism by which moxalactam prolongs the prothrombin time. More recent studies of ciprofloxacin suggest that newer combinations containing fluoroquinolones should be evaluated in febrile, neutropenic patients. Furthermore, we have attempted to define the febrile, neutropenic patient at “low-risk” by reviewing our experience with pediatric oncology patients.
Seo SK and Brown AE. Hospital-acquired fever. In: Schlossberg, David (ed). Clinical Infectious Disease. 3rd edition. New York: Cambridge University Press;2008:745-748.
Brown AE. Hospital acquired fever. D. Schlossberg ed. Current therapy of infectious disease, Mosby, Philadelphia, pp. 407-409, 2001. [PubMed Abstract]
Brown AE. Other corynebacteria and rhodococcus. Principles and practice of infectious diseases, GL Mandell, JE Bennett, R Dolin, eds, Churchill Livingstone, Inc., New York, 1999. [PubMed Abstract]
De Lencastre H, Brown AE, Chung M, Armstrong D, Tomasz A. Role of transposon Tn5482 in the epidemiology of vancomycin-resistant Enterococcus faecium (VRE) in the pediatric oncology unit of a New York City Hospital. Microbial. Drug Resistance. 1999; 5:113-129.[PubMed Abstract]
Mc Neeley DF, Brown AE, Noel GJ, Chung M, De Lencastre H. An investigation of vancomycin-resistant Enterococcus faecium within the pediatric service of a large urban medical center. Pediatri. Infect. Dis. J. 1998; 17:184-188.[PubMed Abstract]
Lucas KG, Brown AE, Armstrong D, Chapman D, Heller G. The identification of febrile neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis. Cancer. 1996; 77:971-978.[PubMed Abstract]
Henning KJ, De Lencastre H, Eagan J, Boone N, Brown AE, Chung M, Wollner N, Armstrong A. Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration of stool shedding and incidence of clinical infection. Pediatr. Infect. Dis. J. 1996; 15:848-854.[PubMed Abstract]
La Quaglia MP, Caldwell C, Lucas A, Corbally M, Heller G, Steinherz L, Brown AE, Groeger J, Exelby P. A prospective randomized double-blind trial of bolus urokinase in the treatment of established hickman catheter sepsis in children. J. Pediatr. Surg. 1994; 29:742-745.[PubMed Abstract]
Groeger JS, Lucas AB, Thaler HT, Friedlander-Klar H, Brown AE, Kiehn TE, Armstrong D. Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann. Intern. Med. 1993; 119:1168-1174.[PubMed Abstract]
Groeger JS, Lucas AB, Coit D, La Quaglia M, Brown AE, Turnbull A, Exelby P. A prospective randomized evaluation of the effect of silver impregnated subcutaneous cuffs for preventing tunneled chronic venous access catheter infections in cancer patients. Ann. Surg. 1993; 218:206-210.[PubMed Abstract]
Barber GR, Brown AE, Kiehn TE, Edwards FF, Armstrong D. Malassezia furfur fungemia in immunocompromised patients. Am. J. Med. 1993; 95:365-370.[PubMed Abstract]
Kiehn TE, Corey E, Brown AE, Edwards FF, Armstrong D. Sepsis due to Rhodotorula related to use of indwelling central venous catheters. Clin. Infect. Dis. 1992; 14:841-846.[PubMed Abstract]
Brown AE, Smith G. Treatment of sepsis in patients with neoplastic diseases with intravenous ciprofloxacin. Am. J. Med. 1989; 87 (5A):266S-268S.[PubMed Abstract]
Benezra D, Kiehn TE, Gold JWM, Brown AE, Turnbull ADM, Armstrong D. Prospective study of infections in indwelling central venous catheters using quantitative blood cultures. Am. J. Med. 1988; 85:495-498.[PubMed Abstract]
Barza M. Furie B, Brown AE, Furie BC. Vitamin K-dependent carboxylation defects associated with moxalactam treatment. J. Infect. Dis. 1986; 153:1166-1169.[PubMed Abstract]
Brown AE, Quesada O, Armstrong D. Minimal nephrotoxicity with cephalosporin-aminoglycoside combinations in patients with neoplastic disease. Antimicrob. Agents Chemother. 1982; 21:592-594.[PubMed Abstract]