Infectious Diseases:
Cedars-Sinai/UCLA Multicampus ID Fellowship
Affiliations:
Cedars-Sinai/VA GLA Internal Medicine Residency
Academic Interests:
Christopher J. Graber, MD MPH
Staff Infectious Diseases Specialist, VA Greater Los Angeles Healthcare System
Assistant Clinical Professor of Medicine, David Geffen School of Medicine at UCLA
Assistant Program Director for Academic Development, Cedars-Sinai/UCLA Multicampus Program in Infectious Diseases
Associate Program Director, Cedars-Sinai/VA Greater Los Angeles Internal Medicine Residency Program
Infectious Diseases Section, 111-F
VA Greater Los Angeles Healthcare System
11301 Wilshire Blvd
Los Angeles, CA 90073
Tel: (310) 268-3015
Fax: (310) 268-4928
Email: christopher.graber@va.gov
Academic Interests:
1. Antimicrobial stewardship and clinical outcomes associated with inpatient antibiotic use: As co-director of the VA GLA antimicrobial stewardship and outpatient parenteral antmicrobial therapy program, I work with our infectious diseases pharmacist to ensure quality in antimicrobial usage in our medical center. I have completed research projects that examine 1) the impact that the addition of ertapenem to our hospital formulary has had on broad-spectrum antimicrobial usage and susceptibilities among Enterobacteriaceae and Pseudomonas and 2) risk factors for nephrotoxicity among patients receiving vancomycin for 5 days or longer. Future research plans include determination of components of antimicrobial stewardship programs that predict quality in antimicrobial usage on a VA nationwide level.
Selected publications:
Graber CJ, Hutchings C, Dong F, Lee W, Chung JK, Tran T. Changes in antibiotic usage and susceptibility in nosocomial Enterobacteriaceae and Pseudomonas isolates following the introduction of ertapenem to hospital formulary. Epidemiology & Infection 2011; Feb 9:1-11 (Epub ahead of print).
Nicolau DP, Carmeli Y, Crank CW, Goff DA, Graber CJ, Lima AL, Goldstein EJ. Carbapenem stewardship: does ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence. International Journal of Antimicrobial Agents 2011 Oct 31 (Epub ahead of print).
Prabaker KK, Tran T, Pratummas T, Goetz MB, Graber CJ. Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans. Journal of Hospital Medicine 2011 (in press).
2. Epidemiology and treatment of Staphylococcus aureus disease: This interest builds on a research focus established in the laboratory of Henry F. Chambers, MD, at San Francisco General Hospital during my infectious diseases fellowship at the University of California-San Francisco (2004-2007), where I published papers describing the epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) infection in the city of San Francisco and in the HIV-infected host. I also published the first case of vancomycin intermediate susceptibility in a community-associated MRSA strain. Since arriving in Los Angeles, I have published a review of combination treatments for invasive MRSA infections, have an ongoing project that examines risk factors for mortality associated with MRSA bacteremia, and continue to collaborate with my colleagues in San Francisco on other projects.
Selected publications:
Nguyen HM, Graber CJ. Limitations of antibiotic options for invasive infections caused by methicillin-resistant Staphylococcus aureus: is combination treatment the answer? Journal of Antimicrobial Chemotherapy 2010;65-24-36.
Diep BA, Chambers HF, Graber CJ, Szumowski JD, Miller LG, Han LL, Chen JH, Lin F, Lin J, Phan TH, Carleton HA, McDougal LK, Tenover FC, Cohen DE, Mayer KH, Sensabaugh GF, Perdreau-Remington F. Emergence of multidrug resistant community-acquired methicillin resistant Staphylococcus aureus clone USA300 in men who have sex with men. Annals of Internal Medicine 2008; 148(4): 249-57.
Graber CJ, Wong MK, Carleton HA, Perdreau-Remington F, Haller BL, Chambers HF. Intermediate vancomycin susceptibility in a community-associated MRSA clone. Emerging Infectious Diseases 2007; 13(3): 491-3.
Graber CJ, Jacobson MA, Perdreau-Remington F, Chambers HF, Diep BA. Recurrence of skin and soft tissue infection caused by methicillin-resistant Staphylococcus aureus in a primary care HIV clinic. Journal of the Acquired Immune Deficiency Syndrome. 2008;49:231-3.
Liu C, Graber CJ, Karr M, Diep BA, Basuino L, Schwartz BS, Enright MC, O'Hanlon SJ, Thomas JC, Perdreau-Remington F, Goodman D, Gordon S, Gunthorpe H, Jacobs R, Jensen P, Leoung G, Rumack J, Chambers HF. A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004-5. Clinical Infectious Diseases 2008; 46: 1637-1646.
Schwartz BS, Graber CJ, Diep BA, Basuino L, Perdreau-Remington F, Chambers HF. Doxycycline, not minocycline, induces its own resistance in multidrug-resistant community-associated methicillin-resistant Staphylococcus aureus clone USA300. Clinical Infectious Diseases 2009;48:1483-4.
Diep BA, Stone GG, Basuino L, Graber CJ, Miller A, des Estages SA, Jones A, Palazzolo-Ballance A, Perdreau-Remington F, Sensabaugh GF, DeLeo FR, Chambers HF. The ACME and SCCmec linkage: convergence of virulence and resistance in the USA300 clone of methicillin-resistant Staphylococcus aureus. Journal of Infectious Diseases 2008; 197: 1523-1530.
3. Clinical outcomes and predictors of immune response in HIV-infected patients: My interest revolves around my experience taking care of HIV-infected veterans and can be summed up by the question: Why do some patients have a better immune response to combination antiretroviral therapy than others? I recently published an analysis of predictors of CD4 count response to antiretroviral therapy where we found that starting CD8 count was inversely correlated with CD4 response. I am also working on a project that identifies the origin of bacterial DNA translocated into the bloodstream of patients with different stages of HIV infection. I also maintain an interest in antiretroviral resistance and sequencing, a topic frequently discussed in conferences in my office prior to our Tuesday afternoon HIV clinic.
Selected publications:
Izadi N, Goetz MB, Graber CJ. Inverse correlation of initial CD8 lymphocyte count and CD4 lymphocyte response to combination antiretroviral therapy in treatment-naive HIV-infected men. Journal of the Acquired Immune Deficiency Syndrome. 2011 (in press).
4. Teaching in clinical infectious diseases, literature interpretation, and epidemiologic methods: My role in the Cedars-Sinai/UCLA Multicampus ID fellowship and the Cedars-Sinai/VA GLA internal medicine residency program is to teach trainees not only clinical problem solving in infectious diseases but also how to critically interpret the literature and use basic epidemiologic tenets to construct research projects that can be completed in the context of a fellowship or residency training program. Almost all of my research projects at VA GLA to date have involved a trainee. I also serve on the editorial panel of the Journal Club of the Infectious Diseases Society of America and publish editorial reviews of clinically relevant infectious diseases literature on a bimonthly basis.
Selected publications:.
Graber CJ, Lauring A, Chin-Hong PV. Clinical problem solving: a stitch in time. New England Journal of Medicine 2007:357:1029-34.
Paige NM, Vazirani SS, Graber CJ. The top 10 infectious diseases pitfalls that hospitalists can avoid. Journal of Hospital Medicine 2010;5:42-5.