Maria E. Aguero-Rosenfeld
· Clinical ProfessorNew York University · Pathology
Active 1988–2025
About
Maria E. Aguero-Rosenfeld, MD, is a Clinical Professor in the Department of Pathology and the Department of Medicine at NYU Grossman School of Medicine. She holds an MD degree from the University of Chile. Her professional focus includes diagnostic microbiology and infectious disease, with a particular emphasis on the evaluation and management of infectious conditions. Dr. Aguero-Rosenfeld has contributed to research on various topics such as emergency department point of care troponin testing, diagnosis and treatment of candidemia, pneumonia diagnostics, disinfection methods for patient room surfaces, and the detection of liver fluke eggs in bile duct cytology. Her work has been published in multiple scientific journals, reflecting her active engagement in advancing clinical microbiology and infectious disease diagnostics.
Selected publications
Safety, Efficiency, and Cost Conflicts in Emergency Department Point of Care Troponin Testing
Quality Management in Health Care · 2025-05-08
articleBACKGROUND AND OBJECTIVES: Assessment of acute coronary syndrome (ACS) has pressured rapid diagnostic evaluation through point of care troponins (POCT-Tns). However, POCT-Tns have demonstrated inconsistent accuracy compared to laboratory (LABT)-Tn. A POCT-Tn used inappropriately to "rule-out" ACS can lead to premature diagnostic closure. We aimed to minimize indiscriminate POCT-Tn testing, while balancing test turnaround time (TAT), institutional cost, and impact on patient time to disposition (TTD). METHODS: A quality improvement (QI) initiative from 2018 to 2022 included educational interventions and electronic health record (EHR) adaptations. We evaluated test characteristics, trended test frequency, TATs, cost, and TTD. We used statistical process control charts to evaluate changes in test frequency over time. We used the Mann-Whitney U and Wilcoxon Signed-Rank Sum test to analyze changes in TAT, TTD, and cost. RESULTS: POCT-Tn had high discordance with LAB-Tn (9.7%) and low sensitivity (52.5%). SPCs showed a significant decrease in POCT-Tn tests performed over time. LABT-Tn TATs were longer than POCT-Tn (54 vs 21 min; P < .001). Total Tn testing costs decreased by $668 827.83 annually. Compared to pre-initiative, arrival to disposition was 20 min longer for patients receiving a LABT-Tn (P < .001) and 37 min shorter for patients receiving a POCT with reflex to LABT-Tn (P < .001). CONCLUSION: POCT-Tn test characteristics may place patients at risk for missed ACS. A combined approach using education and EHR adaptations decreased use of indiscriminate POCT-Tn tests, decreased health care costs, and resulted in clinically appropriate changes in disposition times for this large cohort of ED patients.
The American Journal of Medicine · 2024-12-03 · 3 citations
articleOpen accessSenior authorCulture and other direct detection methods to diagnose human granulocytic anaplasmosis
American Journal of Clinical Pathology · 2024-09-21 · 3 citations
articleOpen access1st authorCorrespondingOBJECTIVES: We sought to assess the performance of 3 laboratory tests on blood specimens for direct detection of Anaplasma phagocytophilum, the cause of human granulocytic anaplasmosis (HGA), in patients tested at a single medical institution in New York State. METHODS: Direct tests included microscopic blood smear examination for intragranulocytic inclusions, polymerase chain reaction (PCR), and culture using the HL-60 cell line. The HGA cases testing positive by only 1 direct test were not included, unless HGA was confirmed by acute or convalescent serology using an indirect immunofluorescent assay. RESULTS: From 1997 to 2009, 71 patients with HGA were diagnosed by at least 1 of the 3 direct test methods. For the subgroup of 55 patients who were tested using all 3 methods, culture was positive for 90.9% (50/55) vs 81.8% (45/55) for PCR vs 63.6% (35/55) for blood smear (P =.002). Most cultures (79.3%) were detected as positive within 1 week of incubation. CONCLUSIONS: Although using culture to detect A phagocytophilum is likely not amenable for implementation in most hospital laboratories, in our experience, culture had the highest yield among the direct tests evaluated.
BMC Infectious Diseases · 2023-09-14 · 7 citations
reviewOpen accessSenior authorBACKGROUND: Mycoplasma hominis is a facultative anaerobic bacterium commonly present in the urogenital tract. In recent years, M. hominis has increasingly been associated with extra-urogenital tract infections, particularly in immunosuppressed patients. Detecting M. hominis in a diagnostic laboratory can be challenging due to its slow growth rate, absence of a cell wall, and the requirements of specialized media and conditions for optimal growth. Consequently, it is necessary to establish guidelines for the detection of this microorganism and to request the appropriate microbiological work-up of immunosuppressed patients. CASE PRESENTATION: We hereby present two cases of solid organ transplant patients who developed M. hominis infection. Microscopic examination of the bronchial lavage and pleural fluid showed no microorganisms. However, upon inoculating the specimens onto routine microbiology media, the organism was successfully identified and confirmation was performed using 16S rDNA sequencing. Both patients received appropriate treatment resulting in the resolution of M. hominis infection. CONCLUSIONS: The prompt detection of M. hominis in a clinical specimen can have a significant impact on patient care by allowing for early intervention and ultimately resulting in more favorable clinical outcomes, especially in transplant patients.
ClinMicroNow · 2023-08-11
other1st authorCorrespondingAbstract Borrelia species constitute a heterogeneous group of organisms that are maintained in nature in animal reservoirs and are transmitted via arthropod vectors. Borrelia species are agents of relapsing fever (RF), caused by the RF Borrelia group, and Lyme disease, caused by the Lyme borreliosis (LB) Borrelia group. A hallmark of Borrelia species is a segmented genome consisting of a linear chromosome and a mix of linear and circular plasmids. Although members of LB group of Borrelia have similar characteristics, they vary in their ability to cause disease in humans as well as in clinical manifestations. Acrodermatitis chronica atrophicans is a common late manifestation of LB in Europe. RF Borrelia can be detected in peripheral blood with blood films prepared from blood collected with EDTA. Variable major protein‐like sequences expressed is one of the most specific Borrelia burgdorferi antigens and has high significance in LB serology.
ClinMicroNow · 2023-08-11
other1st authorCorrespondingAbstract Borrelia species constitute a heterogeneous group of organisms that are maintained in nature in animal reservoirs and are transmitted via arthropod vectors. Borrelia species are agents of relapsing fever (RF), caused by the RF Borrelia group, and Lyme disease, caused by the Lyme borreliosis (LB) Borrelia group. A hallmark of Borrelia species is a segmented genome consisting of a linear chromosome and a mix of linear and circular plasmids. Although members of LB group of Borrelia have similar characteristics, they vary in their ability to cause disease in humans as well as in clinical manifestations. Acrodermatitis chronica atrophicans is a common late manifestation of LB in Europe. RF Borrelia can be detected in peripheral blood with blood films prepared from blood collected with EDTA. Variable major protein‐like sequences expressed is one of the most specific Borrelia burgdorferi antigens and has high significance in LB serology.
Diagnostic Microbiology and Infectious Disease · 2023-10-14 · 3 citations
articleSenior authorCureus · 2023-04-23 · 3 citations
articleOpen accessObjectives Immunocompromised patients, specifically those with solid organ transplants or cancer on chemotherapy, are at particularly high risk of severe pneumonia and opportunistic infections. In select patients, bronchoalveolar lavage (BAL) is performed to provide high-quality samples for analysis. We compare BioFire® FilmArray® Pneumonia Panel (BioFire Diagnostics, Salt Lake City, Utah, United States), a multiplex polymerase chain reaction (PCR) assay, with standard of care diagnostics in BAL samples from immunocompromised patients to identify opportunities for this test to affect clinical decision making. Methods Patients hospitalized with pneumonia based on clinical and radiographic findings who underwent evaluation with bronchoscopy between May 2019 to January 2020 were reviewed. Among those patients undergoing bronchoscopy, those who were immunocompromised were selected for inclusion in the study. BAL specimens submitted to the microbiology laboratory were chosen based on as part of the internal validation of the panel in comparison with sputum culture at our hospitals. We compared the outcomes of the multiplex PCR assay with traditional culture methods and evaluated the role of PCR assay in de-escalating antimicrobial therapy. Results Twenty-four patients were identified for testing with the multiplex PCR assay. Of the 24 patients, 16 were immunocompromised, all with solid or hematological malignancy or a history of organ transplant. Seventeen individual BAL samples from the 16 patients were reviewed. BAL culture results and the multiplex PCR assay were in agreement in 13 samples (76.5%). In four cases, the multiplex PCR assay identified a possible causative pathogen not detected by standard workup. The median time to de-escalation of antimicrobials was three days (interquartile range (IQR) 2-4) from the day of collection of the BAL samples. Conclusions Studies have established the additive role of multiplex PCR testing in addition to traditional diagnostic tools like sputum culture in diagnosing the etiology of pneumonia. Limited data exist specifically looking at immunocompromised patients, in whom a timely and accurate diagnosis is particularly important. There is a potential benefit for performing multiplex PCR assays as an additive diagnostic tool in BAL samples for these patients.
Open Forum Infectious Diseases · 2022-12-01
articleOpen accessSenior authorAbstract Background Candidemia is a common hospital acquired infection that is associated with significant morbidity and mortality. The optimal strategy for diagnosis remains unknown. Methods We evaluated 2 distinct diagnostic strategies in hospitalized patients with suspicion of Candida bloodstream infection, namely strategy #1 that included simultaneous blood cultures and T2Candida and strategy #2 that included blood cultures, T2Candida testing and Beta-D-glucan (BDG). We examined the consistency with which each diagnostic algorithm led to changes in antifungal prescribing, the overall rate of antifungal utilization and patients’ clinical outcomes. Flow Chart. Figure 1. Results Among 96 patients tested with strategy #1, 3 had a positive result. Of those 100% completed a 14-day antifungal course for candidemia or were on antifungals until hospital discharge. Of the 29 out 120 patients that tested positive with strategy #2, 55.2% received a complete 14-day course or were on antifungals until hospital discharge. The percentage of completed treatment increased to 75.0% and 80.0% when the threshold for BDG positivity was increased at 200 pg/ml and 500 pg/ml respectively. We observed a significant difference in the overall antifungal utilization with 268.5 days of antifungals per 1,000 patient days for strategy #1, as opposed to 371.9 days of antifungals for strategy #2, a 38.5% increase. Negative tests at both diagnostic strategies led to a similar rate of antifungal discontinuation 3 days after testing (36.8% and 37.0% for strategy #1 and #2 respectively). We did not find significant benefits in death and/or subsequent diagnosis of candidemia between the 2 diagnostic strategies. Sensitivity analyses performed based on indication for testing and severity of illness did not significantly alter results. Table 1.Characteristics of patients tested for suspicion of candidemia with the 2 diagnostic strategies. Figure 2. Duration of antifungal therapy among patients with positive BDG at different thresholds A. BDG&lt;80 pg/ml, B. BDG&lt;200 pg/ml, C. BDG&lt;500 pg/ml. Figure 3. Percentage of patients who were taken off antifungals within 3 days of testing for different BDG thresholds, BDG&lt;80 pg/ml, BDG&lt;200 pg/ml, and BDG&lt;500 pg/ml. Conclusion In summary, the addition of BDG in diagnostic algorithms for candidemia was interpreted variably by clinicians, was associated with a significant increase in antifungal utilization, and it did not appear to lead to measured clinical benefits for patients. Diagnostic strategies of common and serious infections that incorporate non-culture diagnostics need to be evaluated for added benefit. Table 2.Antifungal utilization among patients tested for suspicion of candidemia with the 2 diagnostic strategies. Table 3. Outcomes among patients tested for suspicion of candidemia with the two different diagnostic strategies. Disclosures All Authors: No reported disclosures.
International Journal of Infectious Diseases · 2021-01-12 · 29 citations
articleOpen accessSenior authorOBJECTIVES: We evaluated the value of BioFire® FilmArray® pneumonia panel in establishing a microbiological diagnosis of pneumonia. We evaluated opportunities for antimicrobial optimization from its use. METHODS: We included adult patients with pneumonia between May 2019 and January 2020. The pneumonia panel was used on high-quality sputum specimens, and the results were prospectively compared with sputum cultures and other tests performed according to standard of care. RESULTS: Seventy patients were included, sixty-nine of whom completed a 5-day antimicrobial course for pneumonia, and 14.3% died during hospitalization. There was a trend of higher rate of microbiological diagnosis among the patients with culture submitted before antimicrobial administration (9/15 vs. 20/55; p = 0.09). The panel increased the microbiological diagnosis from 29/70 to 59/70 (p < 0.001) patients. The per isolate analysis revealed an increase in the isolation of Haemophilus influenzae (p = 0.002) and Streptococcus pneumoniae (p = 0.05). On review of empiric antimicrobials, there was potential for antimicrobial optimization in 56/70 patients, including 9 bacteria among 9 patients, which were not covered by empiric treatment and another 70 antimicrobials in 49 patients that could have been stopped. CONCLUSIONS: Incorporation of the pneumonia panel in the diagnostic work-up of pneumonia substantially increased the rate of microbiological diagnosis and revealed abundant opportunities for antimicrobial optimization.
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