Scholars@Duke
Rachel Ann Miller

Rachel Ann Miller

Professor of Medicine
Medicine, Infectious Diseases

Selected Publications

A change of heart: Limitations of National Healthcare Safety Network (NHSN) and Society of Thoracic Surgeons (STS) surveillance strategies in identifying surgical site infections after heart transplant surgery.

Journal Article Am J Infect Control · July 2025 Surgical site infections (SSI) surveillance after heart transplantation is critical for preventing SSI. We analyzed the accuracy of 3 SSI surveillance systems: National-Healthcare-Safety-Network (NHSN), Society-of-Thoracic-Surgeons (STS), and detailed manu ... Full text Link to item Cite

The tell-tale hearts: Donor-derived invasive fungal infections among orthotopic heart transplant recipients.

Journal Article Med Mycol Case Rep · June 2025 Donor-derived invasive fungal infections among solid organ transplant recipients are rare but sometimes devastating events associated with notable morbidity and mortality. Here we describe two donor-derived fungal infections - one Candida parapsilosis comp ... Full text Link to item Cite

Coccidioidomycosis Transmission Through Solid Organ Transplantation (2013-2022): A Report of the Organ Procurement and Transplantation Network ad hoc Disease Transmission Advisory Committee.

Journal Article Transpl Infect Dis · 2025 BACKGROUND: Coccidioidomycosis is a fungal infection that poses a serious risk when transmitted through organ transplantation. We analyzed cases reported to the Organ Procurement and Transplantation Network ad hoc Disease Transmission Advisory Committee fr ... Full text Link to item Cite

Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D-/R-): Time to Reexamine Donor CMV Serostatus.

Journal Article Clin Transplant · January 2025 BACKGROUND: Early posttransplant cytomegalovirus (CMV) infections in CMV seronegative solid organ transplant recipients (SOTR) with CMV seronegative donors (D-/R-) are often attributed transfusion-transmitted CMV. The prevalence of false-negative donor CMV ... Full text Link to item Cite

Risk Factors for Invasive Surgical Site Infections Among Adult Single Liver Transplant Recipients at Duke University Hospital in the Period 2015-2020.

Journal Article Transplant Direct · December 2024 BACKGROUND: Invasive primary surgical site infections (IP-SSI) are a severe complication of liver transplant surgery. Identification of risk factors for IP-SSI is critical to IP-SSI prevention. METHODS: All adult single liver transplants performed at Duke ... Full text Open Access Link to item Cite

Hepatitis B transmission/reactivation associated with Hepatitis B core antibody and Hepatitis C nucleic acid testing positive organs: A report from the Organ Procurement and Transplantation Network Disease Transmission Advisory Committee.

Journal Article Transpl Infect Dis · November 2024 BACKGROUND: Better access to direct-acting antiviral (DAA) therapy has broadened the utilization of hepatitis C virus (HCV) nucleic acid testing (NAT) positive organs with excellent outcomes. However, DAA therapy has been associated with hepatitis B virus ... Full text Link to item Cite

Minimizing risk while maximizing opportunity: The infectious disease organ offer process survey.

Journal Article Transpl Infect Dis · October 2024 BACKGROUND: The purpose of this study was to understand how transplant infectious disease (TID) physicians assess a potential donor with known or suspected infection and describe posttransplant management. METHODS: We designed a survey of 10 organ offer sc ... Full text Link to item Cite

Real-World Experience With Maribavir for Treatment of Cytomegalovirus Infection in High-Risk Solid Organ Transplant Recipients.

Journal Article Open Forum Infect Dis · July 2024 We evaluated use of maribavir (MBV) for treatment of 15 episodes of refractory/resistant cytomegalovirus infection in 13 solid organ transplant recipients. Treatment failure due to treatment-emergent MBV resistance or early virological recurrence after MBV ... Full text Link to item Cite

Late surgical site infections among solid organ transplant recipients: an unrecognized clinical entity.

Journal Article Infect Control Hosp Epidemiol · May 24, 2024 This study identified 26 late invasive primary surgical site infection (IP-SSI) within 4-12 months of transplantation among 2073 SOT recipients at Duke University Hospital over the period 2015-2019. Thoracic organ transplants accounted for 25 late IP-SSI. ... Full text Link to item Cite

Risk factors, management, and clinical outcomes of invasive Mycoplasma and Ureaplasma infections after lung transplantation.

Journal Article Am J Transplant · April 2024 Mollicute infections, caused by Mycoplasma and Ureaplasma species, are serious complications after lung transplantation; however, understanding of the epidemiology and outcomes of these infections remains limited. We conducted a single-center retrospective ... Full text Open Access Link to item Cite

Limitations of antifungal prophylaxis in preventing invasive Candida surgical site infections after liver transplant surgery.

Journal Article Antimicrob Agents Chemother · March 6, 2024 Invasive primary Candida surgical site infections (IP-SSIs) are a common complication of liver transplantation, and targeted antifungal prophylaxis is an efficient strategy to limit their occurrence. We performed a retrospective single-center cohort study ... Full text Link to item Cite

Immunocompromised Host Pneumonia: Definitions and Diagnostic Criteria: An Official American Thoracic Society Workshop Report.

Journal Article Ann Am Thorac Soc · March 2023 Pneumonia imposes a significant clinical burden on people with immunocompromising conditions. Millions of individuals live with compromised immunity because of cytotoxic cancer treatments, biological therapies, organ transplants, inherited and acquired imm ... Full text Link to item Cite

Cytomegalovirus Therapy: Role of Letermovir in Prophylaxis and Treatment in Transplant Recipients.

Journal Article Annu Rev Med · January 27, 2023 Cytomegalovirus (CMV) is a common viral pathogen in the transplant population and is associated with significant morbidity and mortality. CMV prevention is paramount; however, selecting the best preventive strategy depends on many factors including donor-r ... Full text Link to item Cite

Epidemiology of surgical site infections after solid organ transplants in the period 2015-2019: A single-center retrospective cohort study.

Journal Article Am J Transplant · December 2022 Surgical site infections (SSI) are severe complications of solid organ transplant (SOT). This retrospective study assessed the epidemiology of and outcomes associated with invasive primary SSI (IP-SSI) occurring within 3 months of transplantation in adult ... Full text Open Access Link to item Cite

Clinical characteristics of COVID-19 in solid organ transplant recipients following COVID-19 vaccination: A multicenter case series.

Journal Article Transplant infectious disease : an official journal of the Transplantation Society · April 2022 BackgroundSolid organ transplant recipients (SOTR) have diminished humoral immune responses to COVID-19 vaccination and higher rates of COVID-19 vaccine breakthrough infection than the general population. Little is known about COVID-19 disease sev ... Full text Cite

Updates on Histoplasmosis in Solid Organ Transplantation.

Journal Article Curr Fungal Infect Rep · 2022 PURPOSE OF REVIEW: Histoplasmosis remains a challenging infection in solid organ transplantation. This review provides a topic update with emphasis on the changing Histoplasma epidemiology, along with new diagnostic and treatment innovations. RECENT FINDIN ... Full text Link to item Cite

Transplant Infectious Disease Evaluation of Cytopenias

Chapter · January 1, 2021 Cytopenias are a common occurrence in both hematopoietic stem cell and solid organ transplant recipients, particularly in the early post-transplant time period. The etiology is frequently multifactorial, reflecting the simultaneous interplay of infection, ... Full text Cite

Preventing Pulmonary Aspergillosis: Can We Breathe Easy?

Journal Article Transplantation · December 2020 Full text Cite

Surgical infection prophylaxis prior to left ventricular assist device implantation: A survey of clinical practice.

Journal Article J Card Surg · October 2020 BACKGROUND: Short duration, antimicrobial prophylaxis that includes antistaphylococcal activity is recommended at the time of left ventricular assist device (LVAD) implantation to reduce infection-related complications. There continues to be wide variabili ... Full text Link to item Cite

Update on Nocardia infections in solid-organ transplantation.

Journal Article Curr Opin Organ Transplant · August 2020 PURPOSE OF REVIEW: Nocardia is a ubiquitous pathogen associated with life-threatening opportunistic infections. Organ transplant recipients are uniquely predisposed to Nocardia infections due to their iatrogenic cell-mediated immune deficit necessary to ma ... Full text Link to item Cite

Oral and Inhaled Ribavirin Treatment for Respiratory Syncytial Virus Infection in Lung Transplant Recipients.

Journal Article Transplantation · June 2020 BACKGROUND: Respiratory syncytial virus (RSV) infection in lung transplant recipients (LTRs) causes mortality rates of 10%-20% despite antiviral therapy. Ribavirin (RBV) has been used to treat RSV-infected LTRs with limited data. METHODS: A retrospective s ... Full text Link to item Cite

Cytomegalovirus in Allogeneic Hematopoietic Transplantation: Impact on Costs and Clinical Outcomes Using a Preemptive Strategy.

Journal Article Biol Blood Marrow Transplant · March 2020 Cytomegalovirus (CMV) results in significant morbidity and mortality following hematopoietic cell transplantation (HCT). Establishing the cost and clinical impact is imperative to the selection of appropriate CMV preventative strategies. This is a retrospe ... Full text Link to item Cite

Endemic fungal infections in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.

Journal Article Clin Transplant · September 2019 These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention and management of blastomycosis, histoplasmosis, and coccidioidomycosis in the pre- and post-transplant ... Full text Link to item Cite

Donor derived HSV hepatitis in a kidney transplant recipient leading to liver fibrosis and portal hypertension.

Journal Article Transpl Infect Dis · February 2019 The unexpected transmission of donor-derived infection through organ transplantation is a rare event with current donor screening practices. In this case report we describe a probable donor-derived transmission of Herpes Simplex Virus (HSV)-2 via deceased ... Full text Link to item Cite

Dementia Reported Missing: Use of an Online Search Engine to Track Outcomes in Persons With Dementia Reported Missing.

Journal Article Alzheimer Dis Assoc Disord · 2019 BACKGROUND: Persons with dementia (PWD) reported missing are known to be at high risk for mortality. Analysis of online search engines' reports of missing PWD may show patterns in the data of this relatively common event and the broad patterns relevant to ... Full text Link to item Cite

A randomized, placebo-controlled phase I trial of live, attenuated herpes zoster vaccine in subjects with end-stage renal disease immunized prior to renal transplantation.

Journal Article Transpl Infect Dis · June 2018 BACKGROUND: Solid organ transplant recipients are at increased risk for reactivation of herpes zoster, or shingles, and have a higher frequency of serious complications including post-herpetic neuralgia. A live, attenuated shingles vaccine is effective and ... Full text Link to item Cite

A Case for Antifungal Stewardship

Journal Article Current Fungal Infection Reports · March 1, 2018 Purpose of Review: The expanding utilization of limited available antifungal agents has led to a pressing need to implement interventions to ensure appropriate usage. The global emergence of resistant, difficult-to-treat invasive fungal infections among th ... Full text Cite

High clinical suspicion of donor-derived disease leads to timely recognition and early intervention to treat solid organ transplant-transmitted lymphocytic choriomeningitis virus.

Journal Article Transpl Infect Dis · August 2017 Despite careful donor screening, unexpected donor-derived infections continue to occur in organ transplant recipients (OTRs). Lymphocytic choriomeningitis virus (LCMV) is one such transplant-transmitted infection that in previous reports has resulted in a ... Full text Link to item Cite

Unique characteristics of cryptococcosis identified after death in patients with liver cirrhosis: comparison with concurrent cohort diagnosed antemortem.

Journal Article Med Mycol · April 1, 2017 Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis fo ... Full text Link to item Cite

Current practices for treatment of respiratory syncytial virus and other non-influenza respiratory viruses in high-risk patient populations: a survey of institutions in the Midwestern Respiratory Virus Collaborative.

Journal Article Transpl Infect Dis · April 2016 BACKGROUND: The optimal treatment for respiratory syncytial virus (RSV) infection in adult immunocompromised patients is unknown. We assessed the management of RSV and other non-influenza respiratory viruses in Midwestern transplant centers. METHODS: A sur ... Full text Link to item Cite

Cryptococcosis in Patients With Cirrhosis of the Liver and Posttransplant Outcomes.

Journal Article Transplantation · October 2015 BACKGROUND: The outcomes and optimal management of cirrhotic patients who develop cryptococcosis before transplantation are not fully known. METHODS: We conducted a multicenter study involving consecutive patients with cirrhosis and cryptococcosis between ... Full text Link to item Cite

Histoplasmosis complicating tumor necrosis factor-α blocker therapy: a retrospective analysis of 98 cases.

Journal Article Clin Infect Dis · August 1, 2015 BACKGROUND: Histoplasmosis may complicate tumor necrosis factor (TNF)-α blocker therapy. Published case series provide limited guidance on disease management. We sought to determine the need for long-term antifungal therapy and the safety of resuming TNF-α ... Full text Link to item Cite

Communication gaps associated with donor-derived infections.

Journal Article Am J Transplant · January 2015 The detection and management of potential donor-derived infections is challenging, in part due to the complexity of communications between diverse labs, organ procurement organizations (OPOs), and recipient transplant centers. We sought to determine if com ... Full text Link to item Cite

Solid organ transplant donors with central nervous system infection.

Journal Article Transplantation · September 27, 2014 BACKGROUND: While donor-derived infections (DDI) remain uncommon, multiple reports describe DDI with pathogens that cause central nervous system (CNS) infection resulting in significant recipient disease. The Ad Hoc Disease Transmission Advisory Committee ... Full text Link to item Cite

Management practices and major infections after cardiac surgery.

Journal Article J Am Coll Cardiol · July 29, 2014 BACKGROUND: Infections are the most common noncardiac complication after cardiac surgery, but their incidence across a broad range of operations, as well as the management factors that shape infection risk, remain unknown. OBJECTIVES: This study sought to ... Full text Link to item Cite

Notes from the field: a cluster of lymphocytic choriomeningitis virus infections transmitted through organ transplantation - Iowa, 2013.

Journal Article MMWR Morb Mortal Wkly Rep · March 21, 2014 On April 26, 2013, the United Network for Organ Sharing reported to CDC a cluster of ill organ transplant recipients in Iowa with a common organ donor. Infection with lymphocytic choriomeningitis virus (LCMV) was suspected. LCMV is a rodent-borne virus tha ... Link to item Cite

Histoplasmosis after solid organ transplant.

Journal Article Clin Infect Dis · December 2013 BACKGROUND: To improve our understanding of risk factors, management, diagnosis, and outcomes associated with histoplasmosis after solid organ transplant (SOT), we report a large series of histoplasmosis occurring after SOT. METHODS: All cases of histoplas ... Full text Link to item Cite

Communication gaps for solid organ transplant-transmitted infections among infectious disease physicians: an Emerging Infections Network survey.

Journal Article Transpl Infect Dis · February 2013 Infectious disease (ID) physicians were surveyed concerning knowledge and management of potential transplant-transmitted infections (TTIs). On the basis of cumulative responses to 4 questions that assessed solid organ transplant-related clinical exposures ... Full text Link to item Cite

Are we managing acute knee effusion well?

Journal Article British Journal of Medical Practitioners · March 1, 2012 Background: Non-traumatic knee effusion is a common referral to the on-call Orthopaedic team. The two most common causes of this presentation are septic and crystal arthritis. Crystal-induced arthritis can easily be overlooked or misdiagnosed as septic art ... Cite

A multicenter study of histoplasmosis and blastomycosis after solid organ transplantation.

Journal Article Transpl Infect Dis · February 2012 AIM: A review of the clinical presentation, diagnosis, treatment and outcomes of 30 solid organ transplant recipients (SOTRs) with histoplasmosis or blastomycosis from 3 Midwestern academic medical centers. BACKGROUND: The endemic fungal pathogens, Histopl ... Full text Link to item Cite

A pilot study of the use of biocide-impregnated gauze as an adjunct to wound care in a burn population.

Journal Article J Burn Care Res · 2012 The aim of this study was to evaluate the use of a polyhexamethylene biguanide biocide-impregnated gauze (Kerlix™ AMD gauze dressing, Covidien d/b/a Tyco Healthcare Group LP) as an adjuvant to routine burn care and its impact on the incidence of hospital-a ... Full text Link to item Cite

American Journal of Transplantation: Foreword

Journal Article American Journal of Transplantation · December 1, 2009 Full text Cite

Older donor livers show early severe histological activity, fibrosis, and graft failure after liver transplantation for hepatitis C.

Journal Article Transplantation · August 15, 2007 BACKGROUND: In hepatitis C virus (HCV)-positive liver transplant recipients, infection of the allograft and recurrent liver disease are important problems. Increased donor age has emerged as an important variable affecting patient and graft survival; howev ... Full text Link to item Cite

A cyclosporine-based immunosuppressive regimen may be better than tacrolimus for long-term liver allograft survival in recipients transplanted for hepatitis C.

Journal Article Transplant Proc · December 2006 UNLABELLED: Rapid recurrence of severe hepatitis C (HCV) after liver transplantation is a major barrier to survival of the transplanted liver. While cyclosporine (CsA) in vitro has been shown to suppress HCV replication, an effect is not seen with tacrolim ... Full text Link to item Cite

Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study.

Journal Article Transplantation · February 15, 2006 BACKGROUND: : The efficacy of the combination of voriconazole and caspofungin when used as primary therapy for invasive aspergillosis in organ transplant recipients has not been defined. METHODS: : Transplant recipients who received voriconazole and caspof ... Full text Link to item Cite

Positive serum cryoglobulin is associated with worse outcome after liver transplantation for chronic hepatitis C.

Journal Article Transplantation · August 27, 2005 BACKGROUND: Recurrent hepatitis C virus (HCV) infection in patients after liver transplantation is an important clinical problem. Because serum cryoglobulins (CG) are known to be associated with an increased incidence of cirrhosis in nontransplant patients ... Full text Link to item Cite

Antioxidant enzyme expression in clinical isolates of Pseudomonas aeruginosa: identification of an atypical form of manganese superoxide dismutase.

Journal Article Infect Immun · December 2001 Expression of superoxide dismutases (FeSOD and MnSOD) and catalases by laboratory strains of Pseudomonas aeruginosa is modulated by exogenous factors. Whether clinical isolates behave similarly and whether antioxidant enzyme expression influences P. aerugi ... Full text Link to item Cite

Suprahepatic venacavaplasty (cavaplasty) with retrohepatic cava extension in liver transplantation: experience with first 115 cases.

Journal Article Transplantation · October 27, 2001 BACKGROUND: We first introduced the orthotopic liver transplantation utilizing cavaplasty technique in 1994. This paper describes the surgical technique and assesses the outcome of the cavaplasty OLT. METHODS: The cavaplasty procedure was used in 115 conse ... Full text Link to item Cite

Role of oxidants in microbial pathophysiology.

Journal Article Clin Microbiol Rev · January 1997 Reactive oxidant species (superoxide, hydrogen peroxide, hydroxyl radical, hypohalous acid, and nitric oxide) are involved in many of the complex interactions between the invading microorganism and its host. Regardless of the source of these compounds or w ... Full text Link to item Cite

Protease cleavage of iron-transferrin augments pyocyanin-mediated endothelial cell injury via promotion of hydroxyl radical formation.

Journal Article Infect Immun · January 1996 Although a number of bacterium- and host-derived factors have been suggested to contribute to the pathogenesis of Pseudomonas aeruginosa-associated tissue injury, the mechanism remains unclear. We have previously shown that protease modification of iron (F ... Full text Link to item Cite

Characterization of antioxidant enzymes among pseudomonas aeruginosa clinical isolates

Journal Article Journal of Investigative Medicine · January 1, 1996 Pseudomonas aeruginosa (PA) is subjected to endogenous oxidative stress from aerobic metabolism and exogenous oxidative stress as a result of exposure to oxidantproducing neutrophils. Like other bacteria, laboratory strains of PA contain anrtoxidant enzyme ... Cite

Mycobacterium tuberculosis in lung transplant recipients.

Journal Article Am J Respir Crit Care Med · July 1995 The diagnosis and treatment of Mycobacterium tuberculosis, although difficult in normal hosts, are even more complex in transplant recipients. As a result of the use of immunosuppressive agents, transplant recipients are not only predisposed to primary tub ... Full text Link to item Cite

Protease-cleaved iron-transferrin augments oxidant-mediated endothelial cell injury via hydroxyl radical formation.

Journal Article J Clin Invest · June 1995 Previous work has shown that the Pseudomonas-derived protease, pseudomonas elastase (PAE), can modify transferrin to form iron complexes capable of catalyzing the formation of hydroxyl radical (.OH) from neutrophil (PMN)-derived superoxide (.O2-) and hydro ... Full text Link to item Cite