Laura Rosenberger

Positions:

Assistant Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 2003

Eastern Mennonite University

M.D. 2008

Jefferson Medical College of Thomas Jefferson University

General Surgery Resident, Surgery

University of Virginia School of Medicine

Breast Surgical Oncology Fellow, Surgery

Memorial Sloan Kettering Cancer Center

Publications:

Association of excessive duration of antibiotic therapy for intra-abdominal infection with subsequent extra-abdominal infection and death: a study of 2,552 consecutive infections.

BACKGROUND: We hypothesized that a longer duration of antibiotic treatment for intra-abdominal infections (IAI) would be associated with an increased risk of extra-abdominal infections (EAI) and high mortality. METHODS: We reviewed all IAI occurring in a single institution between 1997 and 2010. The IAI were divided into two groups consisting of those with a subsequent EAI and those without; the data for each group were analyzed. Patients with EAI following IAI were matched in a 1:2 ratio with patients who did not develop EAI on the basis of their Acute Physiology and Chronic Health Evaluation (APACHE II) score±1 point. Statistical analyses were done with the Student t-test, χ(2) analysis, Wilcoxon rank sum test, and multi-variable analysis. RESULTS: We identified 2,552 IAI, of which 549 (21.5%) were followed by EAI. Those IAI that were followed by EAI were associated with a longer initial duration of antimicrobial therapy than were IAI without subsequent EAI (median 14 d [inter-quartile range (IQR) 10-22 d], vs. 10 d [IQR 6-15 d], respectively, p<0.01), a higher APACHE II score (16.6±0.3 vs. 11.2±0.2 points, p<0.01), and higher in-hospital mortality (17.1% vs. 5.4%, p<0.01). The rate of EAI following IAI in patients treated initially with antibiotics for 0-7 d was 13.3%, vs. 25.1% in patients treated initially for >7 d (p<0.01). A successful match was made of 469 patients with subsequent EAI to 938 patients without subsequent EAI, resulting in a mean APACHE II score of 15.2 for each group. After matching, IAI followed by EAI were associated with a longer duration of initial antimicrobial therapy than were IAI without subsequent EAI (median 14 d [9-22 d], vs. 11 d [7-16 d], respectively, p<0.01), and with a higher in-hospital mortality (14.9% vs. 9.0%, respectively, p<0.01). Logistic regression showed that days of antimicrobial therapy for IAI was an independent predictor of subsequent EAI (p<0.001). CONCLUSIONS: A longer duration of antibiotic therapy for IAI is associated with an increased risk of subsequent EAI and increased mortality.
Authors
Riccio, LM; Popovsky, KA; Hranjec, T; Politano, AD; Rosenberger, LH; Tura, KC; Sawyer, RG
MLA Citation
Riccio, Lin M., et al. “Association of excessive duration of antibiotic therapy for intra-abdominal infection with subsequent extra-abdominal infection and death: a study of 2,552 consecutive infections..” Surg Infect (Larchmt), vol. 15, no. 4, Aug. 2014, pp. 417–24. Pubmed, doi:10.1089/sur.2012.077.
URI
https://scholars.duke.edu/individual/pub1148994
PMID
24824591
Source
pubmed
Published In
Surg Infect (Larchmt)
Volume
15
Published Date
Start Page
417
End Page
424
DOI
10.1089/sur.2012.077

Intraductal papillary mucinous neoplasm (IPMN) with extra-pancreatic mucin: a case series and review of the literature.

BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized pancreatic neoplasm characterized by excessive mucin secretion by ductal epithelial cells resulting in a cystic dilation of the pancreatic duct. AIM: The objective of this study was to review Thomas Jefferson University's experience and the literature to determine the significance of extra-pancreatic mucin when associated with an IPMN. RESULTS: A retrospective analysis at our institution revealed only two cases of IPMN associated with extra-pancreatic mucin, which were classic IPMNs with rupture of the pancreatic duct and peritoneal mucin spillage. This specific finding is not previously described, although is assumed as five cases were reported in the literature with IPMN and mucin extension demonstrated by pseudomyxoma peritonei (PMP). We propose IPMN of the pancreas may be grossly compared to a mucocele of the appendix, as both are characterized by excessive secretion of mucin by ductal epithelial cells. A morbid complication of a mucocele is PMP. The presence of extra-pancreatic mucin with an IPMN could present a rare but important marker of the eventual seeding of tumor outside the primary IPMN. This has been documented with cases of iatrogenic spilling of pancreatic mucin, as well as multiple cases of IPMN associated with pseudomyxoma peritonei. CONCLUSIONS: At this time, there is scant reporting and consensus for the treatment of IPMN with extra-pancreatic mucin.
Authors
Rosenberger, LH; Stein, LH; Witkiewicz, AK; Kennedy, EP; Yeo, CJ
MLA Citation
Rosenberger, Laura H., et al. “Intraductal papillary mucinous neoplasm (IPMN) with extra-pancreatic mucin: a case series and review of the literature..” J Gastrointest Surg, vol. 16, no. 4, Apr. 2012, pp. 762–70. Pubmed, doi:10.1007/s11605-012-1823-8.
URI
https://scholars.duke.edu/individual/pub1149009
PMID
22258877
Source
pubmed
Published In
J Gastrointest Surg
Volume
16
Published Date
Start Page
762
End Page
770
DOI
10.1007/s11605-012-1823-8

Aspergillus infections in transplant and non-transplant surgical patients.

BACKGROUND: Aspergillus infections are associated commonly with immunocompromised states, such as transplantation and hematologic malignant disease. Although Aspergillus infections among patients having surgery occur primarily in transplant recipients, they are found in non-recipients of transplants, and have a mortality rate similar to that seen among transplant recipients. METHODS: We conducted a retrospective analysis of a prospective data base collected from 1996 to 2010, in which we identified patients with Aspergillus infections. We compared demographic data, co-morbidities, and outcomes in non-transplant patients with those in abdominal transplant recipients. Continuous data were evaluated with the Student t-test, and categorical data were evaluated through χ(2) analysis. RESULTS: Twenty-three patients (11 transplant patients and 12 non-transplant patients) were identified as having had Aspergillus infections. The two groups were similar with regard to their demographics and co-morbidities, with the exceptions of their scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II), of 23.6±8.1 points for transplant patients vs. 16.8±6.1 points for non-transplant patients (p=0.03); Simplified Acute Physiology Score (SAPS) of 16.6±8.3 points vs. 9.2±4.1 points, respectively (p=0.02); steroid use 91.0% vs. 25.0%, respectively (p=0.003); and percentage of infections acquired in the intensive care unit (ICU) 27.3% vs. 83.3%, respectively (p=0.01). The most common site of infection in both patient groups was the lung. The two groups showed no significant difference in the number of days from admission to treatment, hospital length of stay following treatment, or mortality. CONCLUSIONS: Although Aspergillus infections among surgical patients have been associated historically with solid-organ transplantation, our data suggest that other patients may also be susceptible to such infections, especially those in an ICU who are deemed to be critically ill. This supports the idea that critically ill surgical patients exist in an immunocompromised state. Surgical intensivists should be familiar with the diagnosis and treatment of Aspergillus infections even in the absence of an active transplant program.
Authors
Davies, S; Guidry, C; Politano, A; Rosenberger, L; McLeod, M; Hranjec, T; Sawyer, R
MLA Citation
Davies, Stephen, et al. “Aspergillus infections in transplant and non-transplant surgical patients..” Surg Infect (Larchmt), vol. 15, no. 3, June 2014, pp. 207–12. Pubmed, doi:10.1089/sur.2012.239.
URI
https://scholars.duke.edu/individual/pub1148995
PMID
24799182
Source
pubmed
Published In
Surg Infect (Larchmt)
Volume
15
Published Date
Start Page
207
End Page
212
DOI
10.1089/sur.2012.239

Jejunal tube extensions via percutaneous endoscopic gastrostomy and delayed small-bowel perforations: a case series.

Authors
Rosenberger, LH; Newhook, T; Mauro, DM; Hennessy, SA; Sawyer, RG
MLA Citation
Rosenberger, Laura H., et al. “Jejunal tube extensions via percutaneous endoscopic gastrostomy and delayed small-bowel perforations: a case series..” Gastrointest Endosc, vol. 75, no. 3, Mar. 2012, pp. 683–87. Pubmed, doi:10.1016/j.gie.2011.10.009.
URI
https://scholars.duke.edu/individual/pub1149010
PMID
22243831
Source
pubmed
Published In
Gastrointest Endosc
Volume
75
Published Date
Start Page
683
End Page
687
DOI
10.1016/j.gie.2011.10.009

Endoluminal negative-pressure therapy for preventing rectal anastomotic leaks: a pilot study in a pig model.

BACKGROUND: Anastomotic leak after rectal resection carries substantial morbidity and mortality. A diverting ileostomy is beneficial for high-risk anastomoses, but its creation and reversal carry a surgical risk in addition to that of resection itself. We sought an alternative method for managing complications of rectal anastomosis. METHODS: We developed an endoluminal negative-pressure technology with a diverting proximal sump, and hypothesized that it would close anastomotic disruptions in pigs. We performed rectal resections on pigs, with primary anastomoses and the creation of an anastomotic defect. In animals in the treatment group we inserted an endoluminal negative-pressure device and kept it at a low level of continuous suction for 5 d. No device was inserted in a control group of animals. After the 5-d period of treatment we evaluated the anastomoses in both the treatment and control groups of animals for leakage, using contrast enemas. Specimens of anastomosed rectum were evaluated histologically for mucosal integrity and for the location and density of inflammatory responses. RESULTS: Fourteen pigs were assigned to either the treatment (n=10) or control (n=4) group. Of the pigs in the treatment group, 90% had complete closure of their rectal defect, as compared with 25% of the animals in the control group (χ(2) test, p=0.04). The animals in the treatment group had only minimal mucosal and serosal inflammation, whereas those in the control group had extensive mucosal damage with associated serositis. CONCLUSIONS: Endoluminal negative-pressure therapy was well-tolerated and led to successful closure of 90% of the anastomic rectal defects in the treatment group of animals in the present study. Additional evaluation of this therapy is warranted.
Authors
Shada, AL; Rosenberger, LH; Mentrikoski, MJ; Silva, MA; Feldman, SH; Kleiner, DE
MLA Citation
Shada, Amber L., et al. “Endoluminal negative-pressure therapy for preventing rectal anastomotic leaks: a pilot study in a pig model..” Surg Infect (Larchmt), vol. 15, no. 2, Apr. 2014, pp. 123–30. Pubmed, doi:10.1089/sur.2012.198.
URI
https://scholars.duke.edu/individual/pub1148990
PMID
24476015
Source
pubmed
Published In
Surg Infect (Larchmt)
Volume
15
Published Date
Start Page
123
End Page
130
DOI
10.1089/sur.2012.198