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 relate to my current role as Chief and Medical Director of Employee Health and Wellness Services at Memorial Sloan-Kettering. A major project of Employee Health and Wellness has been to evaluate the usefulness of newer methodologies such as interferon-gamma release assays among PPD-positive, BCG-vaccinated healthcare workers. In doing so, Employee Health and Wellness has been able to avoid prescribing unnecessary isoniazid (INH) treatment for latent tuberculosis infection (LTBI) in 70 percent of such employees.
Other studies have focused on the use of the varicella-zoster (VZ) FAMA testing among VZ ELISA-negative employees who have received at least two doses of the varicella vaccine. Previously, all such VZ ELISA-negative healthcare workers exposed to patients with varicella (chickenpox or shingles) were furloughed from work. Testing them with the VZ FAMA assay determined that 70 percent of these individuals are actually immune to varicella and do not need to be furloughed. This finding has had both significant practical and economic implications.
Studies assessing repetitive strain syndrome among healthcare workers and the particular needs of employees at a cancer center who are themselves cancer survivors are two additional areas of ongoing investigation
In areas outside of infectious diseases, Employee Health and Wellness has expanded its role to include the creation of the Memorial Sloan-Kettering Employee WELLNESS program. The program has grown to include assistance to employees in the following areas: tobacco cessation; nutrition/weight loss; exercise/fitness; cancer screening; integrative medicine; mental health; and work/life balance. Our Building Resilience program is dedicated to providing a community “safety net” for employees with mental health concerns. In particular, attention has been given to preventing “burnout” among professional staff as well as other employees. Two recent publications bring to the forefront the importance of recognizing such issues.
In the past, my clinical research interests at Memorial Hospital have focused on the prevention and therapy of infectious complications of neoplastic diseases in adult and pediatric oncology patients. My efforts have been directed toward 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 ALL 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 Memorial Sloan-Kettering.
We used 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 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, altered the manner in which we diagnose and treat such infections. Our observations led us to propose new approaches to reduce the incidence and cost of catheter-related infections. Furthermore, we can now 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 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.
Guest RS, Baser R, Li Y, Scardino PT, Brown AE, Kissane DW. Cancer surgeons’ distress and well-being, I: the tension between a culture of productivity and the need for self-care. Ann Surg Oncol 2011; 18:1229-1235. [PubMed Abstract]
Guest RS, Baser R, Li Y, Scardino PT, Brown AE, Kissane DW. Cancer surgeons’ distress and well-being, II: modifiable factors and the potential for organizational interventions. Ann Surg Oncol 2011; 18:1236-1142. [PubMed Abstract]
Rolando L, Schneider WJ, Steinberg S, Low S, Stiles J, Gomez L, Gershon AA, Brown AE. Varicella-zoster virus (VZV) fluorescent-antibody-to-membrane-antigen (FAMA) testing, the sensitivity of determining VZV immunity in healthcare workers, and the reduction of furlough days. Infection Control Hosp Epidemiol. 2010;31:972-974. [PubMed Abstract]
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]