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[the most common acute gastrointestinal infections].acute gastrointestinal infections and diarrhea with vomiting as its main presentation are a frequently encountered entity in an outpatient setting. due to a mostly self-limiting disease course a diagnostic work-up is often futile. viral infections caused by noro- or rotavirus are most frequent, while bacterial infections are second line due to high hygienic standards in developed countries. in an inpatient setting and after a precedent antibiotic treatment one should think of clostridium diffici ...201526463905
regulation of clostridium difficile spore formation by the spoiiq and spoiiia proteins.sporulation is an ancient developmental process that involves the formation of a highly resistant endospore within a larger mother cell. in the model organism bacillus subtilis, sporulation-specific sigma factors activate compartment-specific transcriptional programs that drive spore morphogenesis. σg activity in the forespore depends on the formation of a secretion complex, known as the "feeding tube," that bridges the mother cell and forespore and maintains forespore integrity. even though the ...201526465937
clostridium difficile screening in cirrhosis: one for all, or some for one? 201526467702
the effect of polydextrose and probiotic lactobacilli in a clostridium difficile-infected human colonic model.clostridium difficile is a natural resident of the intestinal microbiota; however, it becomes harmful when the normal intestinal microbiota is disrupted, and overgrowth and toxin production occurs. the toxins can cause bloating and diarrhoea, which may cause severe disease and have the potential to cause outbreaks in hospitals and other healthcare settings. normally, antibiotic agents are used for treatment, although for some of the patients, these treatments provide only a temporary relief with ...201526468159
a gut odyssey: the impact of the microbiota on clostridium difficile spore formation and germination. 201526468647
scientific evidence for the use of current traditional systemic therapies in patients with hidradenitis suppurativa.traditional systemic therapies are frequently prescribed for the treatment of hidradenitis suppurativa (hs). clinicians consider antibiotics, retinoids, antiandrogens, immunosuppressants, and less common treatment, such as fumarates, in the management of hs. different classes of medications have been selected to treat hs based on their ability to target various pathways of the condition. concerns about infection, such as infection with clostridium difficile, necessitates switching therapy or sho ...201526470615
universal vs risk factor screening for methicillin-resistant staphylococcus aureus in a large multicenter tertiary care facility in canada.objective to assess the clinical effectiveness of a universal screening program compared with a risk factor-based program in reducing the rates of nosocomial methicillin-resistant staphylococcus aureus (mrsa) among admitted patients at the ottawa hospital. design quasi-experimental study. setting ottawa hospital, a multicenter tertiary care facility with 3 main campuses, approximately 47,000 admissions per year, and 1,200 beds. methods from january 1, 2006 through december 31, 2007 (24 months), ...201626470820
evaluating risk factors for clostridium difficile infection in adult and pediatric hematopoietic cell transplant recipients.although hematopoietic cell transplant (hct) recipients are routinely exposed to classic risk factors for clostridium difficile infection (cdi), few studies have assessed cdi risk in these high-risk patients, and data are especially lacking for pediatric hct recipients. we aimed to determine incidence and risk factors for cdi in adult and pediatric allogeneic hct recipients.201526473030
a qualitative analysis of implementation of antimicrobial stewardship at 3 academic hospitals: understanding the key influences on success.inappropriate use of antimicrobials is linked to the development and spread of drug-resistant pathogens and is associated with increased morbidity, mortality, lengths of hospital stay, and health care costs. "antimicrobial stewardship" is the umbrella term for an evidence-based knowledge translation strategy involving comprehensive quality improvement activities to optimize the use of antimicrobials, improve patient outcomes, reduce the development of antimicrobial resistance and hospital-acquir ...201726478585
gastroenterologist perceptions of faecal microbiota transplantation.to explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation (fmt).201526478682
risk factors and outcomes for bloodstream infections secondary to clostridium difficile infection.we determined the incidence, risk factors, and outcomes of bloodstream infections (bsi) subsequent to clostridium difficile infection (cdi). we performed a retrospective study of all patients with definite diagnosis of cdi admitted from january 2014 to december 2014 in two large hospitals in rome. two groups of patients were analyzed: those with cdi and subsequent bsi (cdi/bsi(+)) and those with cdi and no evidence of primary bsi (cdi/bsi(-)). data about clinical features, microbiology, treatmen ...201526482315
clinical characteristics and risk factors for community-acquired clostridium difficile infection: a retrospective, case-control study in a tertiary care hospital in japan.the epidemiology of clostridium difficile infection (cdi) has changed in the past decade. the incidence, prevalence, and severity of community-acquired cdi (ca-cdi) have increased. however, the epidemiology of ca-cdi in japan has not been investigated. to evaluate the clinical characteristics and risk factors for ca-cdi in japan, we conducted a retrospective, case-control study of ca-cdi at the national hospital organization tokyo medical center between january 2010 and december 2014. two age- a ...201526482373
from the hospital to the home--the rise and rise of clostridium difficile infection.clostridium difficile infection (cdi) has emerged as a serious worldwide public health threat. although c. difficile has always been a cause of diarrhoeal disease in patients presenting to general practice, the rates of community-associated cdi (ca cdi) have increased.201526484484
hospital-onset clostridium difficile infection among solid organ transplant recipients.clostridium difficile infection (cdi) is a considerable health issue in the united states and represents the most common healthcare-associated infection. solid organ transplant recipients are at increased risk of cdi, which can affect both graft and patient survival. however, little is known about the impact of cdi on health services utilization posttransplantation. we examined hospital-onset cdi from 2012 to 2014 among transplant recipients in the university healthsystem consortium, which inclu ...201526484839
ursodeoxycholic acid inhibits clostridium difficile spore germination and vegetative growth, and prevents the recurrence of ileal pouchitis associated with the infection.to test whether ursodeoxycholic acid (udca) is inhibitory to clostridium difficile and can be used in the treatment of c. difficile-associated ileal pouchitis.201626485102
[the hunt for the toxicant from clostridium difficile]. 201526485133
clostridium difficile infection after subarachnoid hemorrhage: a nationwide analysis.clostridium difficile infection (cdi) is an important cause of hospital-acquired morbidity and mortality.201626485334
transmission of clostridium difficile during hospitalization for allogeneic stem cell transplant.objective to determine the role of unit-based transmission that accounts for cases of early clostridium difficile infection (cdi) during hospitalization for allogeneic stem cell transplant. setting stem cell transplant unit at a tertiary care cancer center. methods serially collected stool from patients admitted for transplant was screened for toxigenic c. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. in addition, isolates retrieved from cases of ...201626486102
evaluating the use of the case mix index for risk adjustment of healthcare-associated infection data: an illustration using clostridium difficile infection data from the national healthcare safety network.background case mix index (cmi) has been used as a facility-level indicator of patient disease severity. we sought to evaluate the potential for cmi to be used for risk adjustment of national healthcare safety network (nhsn) healthcare-associated infection (hai) data. methods nhsn facility-wide laboratory-identified clostridium difficile infection event data from 2012 were merged with the fiscal year 2012 inpatient prospective payment system (ipps) impact file by cms certification number (ccn) t ...201626486597
interactions between the gastrointestinal microbiome and clostridium difficile.antibiotics have significant and long-lasting effects on the intestinal microbiota and consequently reduce colonization resistance against pathogens, including clostridium difficile. by altering the community structure of the gut microbiome, antibiotics alter the intestinal metabolome, which includes both host- and microbe-derived metabolites. the mechanisms by which antibiotics reduce colonization resistance against c. difficile are unknown yet important for development of preventative and ther ...201526488281
predominance of clostridium difficile ribotypes 012, 027 and 046 in a university hospital in chile, 2012.in a 1-year survey at a university hospital we found that 20·6% (81/392) of patients with antibiotic associated diarrohea where positive for c. difficile. the most common pcr ribotypes were 012 (14·8%), 027 (12·3%), 046 (12·3%) and 014/020 (9·9). the incidence rate was 2·6 cases of c. difficile infection for every 1000 outpatients.201626489717
evaluation of a bedside scoring system for predicting clinical cure and recurrence of clostridium difficile infections.the accuracy of a bedside scoring system, atlas, for predicting clinical cure and recurrence of clostridium difficile infections (cdis) was evaluated.201526490821
a rare cause of reversible renal hemosiderosis.kidney failure secondary to renal hemosiderosis has been reported in diseases with intravascular hemolysis, like paroxysmal nocturnal hemoglobinuria, and valvular heart diseases. we present here a case of hemosiderin induced acute tubular necrosis secondary to intravascular hemolysis from clostridium difficile infection with possible role of supratherapeutic inr. we discuss the pathophysiology, causes, and prognosis of acute tubular injury from hemosiderosis.201526491580
[laboratory diagnosis of clostridium difficile infection].clostridium difficile is the leading cause of nosocomial diarrhoea in developed countries, and is one of the main aetiologic agents of community diarrhea. the eruption of the hypervirulent strain bi/nap1/027 has given rise to an increase in the morbidity and mortality of c.difficile infection (cdi). this document aims to review the main clinical pictures of cdi and the laboratory diagnosis, including sampling, transport and storage of specimens, specimen processing, diagnostic procedures, antimi ...201626493356
use of probiotics in pediatric infectious diseases.we summarize current evidence and recommendations for the use of probiotics in childhood infectious diseases. probiotics may be of benefit in treating acute infectious diarrhea and reducing antibiotic-associated diarrhea. potential benefits of probiotic on prevention of traveler's diarrhea,clostridium difficile-associated diarrhea, side effects of triple therapy in helicobacter pylori eradication, necrotizing enterocolitis, acute diarrhea, acute respiratory infections and recurrent urinary tract ...201526496433
identification of a novel lipoprotein regulator of clostridium difficile spore germination.clostridium difficile is a gram-positive spore-forming pathogen and a leading cause of nosocomial diarrhea. c. difficile infections are transmitted when ingested spores germinate in the gastrointestinal tract and transform into vegetative cells. germination begins when the germinant receptor cspc detects bile salts in the gut. cspc is a subtilisin-like serine pseudoprotease that activates the related cspb serine protease through an unknown mechanism. activated cspb cleaves the pro-slec zymogen, ...201526496694
decreasing clostridium difficile health care-associated infections through use of a launderable mattress cover.the annual incidence of clostridium difficile infection (cdi) in the united states is estimated to be 330,000 cases. we evaluated the impact of using a launderable mattress and bed deck cover on the incidence of hospital-onset cdi in 2 long-term acute care hospitals (ltachs).201526498703
serum 25-hydroxyvitamin d levels are not associated with adverse outcomes in clostridium difficile infection.clostridium difficile infection (cdi) is a significant source of healthcare-associated morbidity and mortality. this study investigated whether serum 25-hydroxyvitamin d is associated with adverse outcomes from cdi. patients with cdi were prospectively enrolled. charts were reviewed and serum 25-hydroxyvitamin d was measured. the primary outcome was a composite definition of severe disease: fever (temperature >38°c), acute organ dysfunction, or serum white blood cell count >15,000 cells/µl withi ...201526500740
memory b cells encode neutralizing antibody specific for toxin b from the clostridium difficile strains vpi 10463 and nap1/bi/027 but with superior neutralization of vpi 10463 toxin b.secreted toxin b (tcdb) substantially contributes to the pathology observed during clostridium difficile infection. to be successfully incorporated into a vaccine, tcdb-based immunogens must stimulate the production of neutralizing antibody (ab)-encoding memory b cells (bmem cells). despite numerous investigations, a clear analysis of bmem cellular responses following vaccination against tcdb is lacking. b6 mice were therefore used to test the ability of a nontoxigenic c-terminal domain (ctd) fr ...201526502913
multimorbidity in elderly hospitalised patients and risk of clostridium difficile infection: a retrospective study with the cumulative illness rating scale (cirs).to identify the role of chronic comorbidities, considered together in a literature-validated index (cumulative illness rating scale, cirs), and antibiotic or proton-pump inhibitor (ppi) treatments as risk factors for hospital-acquired clostridium difficile infection (cdi) in elderly multimorbid hospitalised patients.201526503394
cadazolid does not promote intestinal colonization of vancomycin-resistant enterococci in mice.the promotion of colonization with vancomycin-resistant enterococci (vre) is one potential side effect during treatment of clostridium difficile-associated diarrhea (cdad), resulting from disturbances in gut microbiota. cadazolid (cdz) is an investigational antibiotic with potent in vitro activity against c. difficile and against vre and is currently in clinical development for the treatment of cdad. we report that cdz treatment did not lead to intestinal vre overgrowth in mice.201526503650
immunogenic properties of the surface layer precursor of clostridium difficile and vaccination assays in animal models.clostridium difficile is an opportunistic pathogen causing gut inflammation generally associated with an intestinal dysbiosis due to antibiotics. several virulence factors have been identified as playing a key role in gut colonization. the surface-layer proteins, comprised of two proteins, the high molecular weight slpa (hmw-slp) and the low molecular weight slpa (lmw-slp), are the most abundant proteins on the c. difficile surface. these two proteins are derived from the cwp84-mediated cleavage ...201626505926
clinical significance of direct cytotoxicity and toxigenic culture in clostridium difficile infection.clostridium difficile infection (cdi) is the leading cause of hospital-acquired diarrhoea in developed countries. although an optimal diagnosis is crucial, laboratory diagnostics remain challenging. currently, the reference methods are direct cytotoxicity assay and toxigenic culture; however there is controversy in the interpretation of discordant results of these tests.201626505927
molecular characterization and antimicrobial susceptibility of clostridium difficile isolated from rabbits raised for meat production.clostridium difficile is an important cause of enteric disease in humans and animals. recent studies demonstrated a genetic overlap between c. difficile isolated from animals and humans suggesting animals as possible reservoir for human pathogenic strains. this study was a preliminary investigation on the occurrence of c. difficile in rabbits raised in industrial holdings for food production and aimed to characterise isolates and estimate their antimicrobial susceptibility. c. difficile isolates ...201526507420
defective mutations within the translocation domain of clostridium difficile toxin b impair disease pathogenesis.the clostridium difficile toxin b is one of the main virulence factors and plays an important role in the pathogenesis of c. difficile infection (cdi). we recently revealed crucial residues in the translocation domain of tcdb for the pore formation and toxin translocation. in this study, we investigated the effects of mutating a critical site involved in pore formation, leu-1106, to residues that differ in size and polarity (phe, ala, cys, asp). we observed a broad range of effects on tcdb funct ...201626507679
association between outpatient antibiotic prescribing practices and community-associated clostridium difficile infection.background.  antibiotic use predisposes patients to clostridium difficile infections (cdi), and approximately 32% of these infections are community-associated (ca) cdi. the population-level impact of antibiotic use on adult ca-cdi rates is not well described. methods.  we used 2011 active population- and laboratory-based surveillance data from 9 us geographic locations to identify adult ca-cdi cases, defined as c difficile-positive stool specimens (by toxin or molecular assay) collected from out ...201526509182
obesity is independently associated with infection in hospitalised patients with end-stage liver disease.infection is the most common cause of mortality in end-stage liver disease (esld). the impact of obesity on infection risk in esld is not established.201526510540
an update on clostridium difficile toxinotyping.toxinotyping is a pcr-restriction fragment length polymorphism (rflp)-based method for differentiation of clostridium difficile strains according to the changes in the pathogenicity locus (paloc), a region coding for toxins a and b. toxinotypes are a heterogenous group of strains that are important in the development of molecular diagnostic tests and vaccines and are a good basis for c. difficile phylogenetic studies. here we describe an overview of the 34 currently known toxinotypes (i to xxxiv ...201626511734
clinical utility of laboratory detection of clostridium difficile strain bi/nap1/027.clostridium difficile strain bi/nap1/027 is associated with increased c. difficile infection (cdi) rates and severity, and the efficacy of some cdi therapies may be strain dependent. although cultured c. difficile isolates can be reliably subtyped by various methods, the long turnaround times, high cost, and limited availability of strain typing preclude their routine use. nucleic acid amplification tests identify bi/nap1/027 rapidly from stool, but the emergence of closely related strains compr ...201626511742
differential outcome of an antimicrobial stewardship audit and feedback program in two intensive care units: a controlled interrupted time series study.antimicrobial decision making in intensive care units (icus) is challenging. unnecessary antimicrobials contribute to the development of resistant pathogens, clostridium difficile infection and drug related adverse events. however, inadequate antimicrobial therapy is associated with mortality in critically ill patients. antimicrobial stewardship programs are increasingly being implemented to improve antimicrobial prescribing, but the optimal approach in the icu setting is unknown. we assessed th ...201526511839
natural history of elderly-onset ulcerative colitis: results from a territory-wide inflammatory bowel disease registry.data on the natural history of elderly-onset ulcerative colitis [uc] are limited. we aimed to investigate clinical features and outcomes of patients with elderly-onset uc.201626512132
single fluorophore melting curve analysis for detection of hypervirulent clostridium difficile.this study demonstrates a novel detection assay able to identify and subtype strains of clostridium difficile. primers carefully designed for melting curve analysis amplify dna from three c. difficile genes, tcdb, tcdc and cdtb, during quantitative (q)pcr. the tcdb gene allows for confirmation of organism presence, whilst the tcdc and cdtb genes allow for differentiation of virulence status, as deletions in the tcdc gene and the concurrent presence of the cdtb gene, which produces binary toxin, ...201626516039
clinical and microbiologic assessment of cases of pediatric community-associated clostridium difficile infection reveals opportunities for improved testing decisions.most children with clostridium difficile infection (cdi) experience community onset of cdi symptoms.201626517329
oral teicoplanin for successful treatment of severe refractory clostridium difficile infection.clostridium difficile is the leading cause of hospital-acquired diarrhoea. there is no defined protocol for treating severe clostridium difficile infection (cdi) refractory to vancomycin or vancomycin and metronidazole combination therapy. the aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory cdi treated with oral teicoplanin.201526517480
hiv-related opportunistic infections are still relevant in 2015.the incidence of hiv-related opportunistic infections (ois) has declined in the united states with the increasing use of effective antiretroviral therapy for the treatment of hiv infection. however, the absolute number of patients with ois remains high and there continues to be considerable associated mortality. oi guidelines from the national institutes of health, centers for disease control and prevention, and infectious diseases society of america continue to be updated on a regular basis, se ...201526518395
donor species richness determines faecal microbiota transplantation success in inflammatory bowel disease.faecal microbiota transplantation is a successful therapy for patients with refractory clostridium difficile infections. it has also been suggested as a treatment option for inflammatory bowel disease, given the role of the intestinal microbiota in this disease. we assessed the impact of faecal microbiota transplantation in patients with inflammatory bowel disease and studied predictors of clinical (non-)response in microbial profiles of donors and patients.201626519463
the analysis of the occurrence of nosocomial infections in the neurosurgical ward in the district hospital from 2003-2012.the patients in the neurosurgical ward are exposed to many risk factors causing nosocomial infections. these factors are related to operations, invasive diagnosing and monitoring of the nervous system and mechanical support of vital functions. therefore, the objective of the undertaken studies was to assess the prevalence and structure of the healthcare-associated infections (hai) in patients hospitalized in the neurosurgical ward in the st. lukas district hospital in tarnów.201526519848
analysis of norovirus outbreaks reveals the need for timely and extended microbiological testing.norovirus outbreaks in hospitals remain a substantial threat despite many recommendations for prevention published recently.201526520593
an assessment of the aga and ccfa quality indicators in a sample of patients diagnosed with inflammatory bowel disease.inflammatory bowel disease (ibd) is a chronic relapsing disease characterized by activation of the mucosal immune system and inflammation of the gastrointestinal tract. management of ibd places a significant burden on the health care system because of the complexity of treatment, variability in patient outcomes, and chronic nature of the disease.201526521118
impact of clostridium difficile-associated diarrhea on acute care length of stay, hospital costs, and readmission: a multicenter retrospective study of inpatients, 2009-2011.the recent epidemiologic changes of clostridium difficile-associated diarrhea (cdad) have resulted in substantial economic burden to u.s. acute care hospitals. past studies evaluating cdad-attributable costs have been geographically and demographically limited. here, we describe cdad-attributable burden in inpatients, overall, and in vulnerable subpopulations from the premier hospital database, a large, diverse cohort with a wide range of high-risk subgroups.201526521932
clostridium difficile secreted pro-pro endopeptidase ppep-1 (zmp1/cd2830) modulates adhesion through cleavage of the collagen binding protein cd2831.the clostridium difficile cd2830 gene product is a secreted metalloprotease, named pro-pro endopeptidase (ppep-1). ppep-1 cleaves c. difficile cell surface proteins (e.g. cd2831). here, we confirmed that ppep-1 has a unique preference for prolines surrounding the scissile bond. moreover, we show that it exhibits a high preference for an asparagine at the p2 position and hydrophobic residues at the p3 position. using a ppep-1 knockout c. difficile strain, we demonstrate that the removal of the co ...201526522134
fluoroquinolone and macrolide exposure predict clostridium difficile infection with the highly fluoroquinolone- and macrolide-resistant epidemic c. difficile strain bi/nap1/027.antibiotics have been shown to influence the risk of infection with specific clostridium difficile strains as well as the risk of c. difficile infection (cdi). we performed a retrospective case-control study of patients infected with the epidemic bi/nap1/027 strain in a u.s. hospital following recognition of increased cdi severity and culture of stools positive by c. difficile toxin immunoassay. between 2005 and 2007, 72% (103/143) of patients with first-episode cdis were infected with the bi st ...201526525793
acute infectious and inflammatory enterocolitides.infectious and inflammatory enterocolitides can present with an acute abdomen. the most common entities are ulcerative colitis, crohn disease, and clostridium difficile colitis. this article reviews the clinical and imaging findings of patients who present acutely with infectious and inflammatory enterocolitides. the acute abdomen can be defined as the sudden onset (generally <24 hours) of severe localized or generalized abdominal pain that prompts the patient to seek immediate medical assistanc ...201526526437
diagnostic accuracy of loop-mediated isothermal amplification in detection of clostridium difficile in stool samples: a meta-analysis.clostridium difficile infection (cdi) remains a diagnostic challenge for clinicians. more recently, loop-mediated isothermal amplification (lamp) has become readily available for the diagnosis of cdi, and many studies have investigated the usefulness of lamp for rapid and accurate diagnosis of cdi. however, the overall diagnostic accuracy of lamp for cdi remains unclear. in this meta-analysis, our aim was to establish the overall diagnostic accuracy of lamp in detection of clostridium difficile ...201526528332
administration of defined microbiota is protective in a murine salmonella infection model.salmonella typhimurium is a major cause of diarrhea and causes significant morbidity and mortality worldwide, and perturbations of the gut microbiota are known to increase susceptibility to enteric infections. the purpose of this study was to investigate whether a microbial ecosystem therapeutic (met-1) consisting of 33 bacterial strains, isolated from human stool and previously used to cure patients with recurrent clostridium difficile infection, could also protect against s. typhimurium diseas ...201526531327
healthcare associated infections. impact and costs of diagnosis and management of clostridium difficile infections (cdi). the experience of a university hospital in rome. 201526532060
health-economic evaluation of clostridium difficile infection (cdi) and epidemiology in england and merseyside. 201526533270
the cost of treating recurrent clostridium difficile infection in patients attending infectious disease clinics at four hospitals in sweden. 201526533275
economic evaluation of fecal microbiota transplantation for the treatment of recurrent clostridium difficile infection in australia. 201526533526
hospital-based clostridium difficile infection surveillance reveals high proportions of pcr ribotypes 027 and 176 in different areas of poland, 2011 to 2013.as part of the european clostridium difficile infections (cdi) surveillance network (ecdis-net), which aims to build capacity for cdi surveillance in europe, we constructed a new network of hospital-based laboratories in poland. we performed a survey in 13 randomly selected hospital-laboratories in different sites of the country to determine their annual cdi incidence rates from 2011 to 2013. information on c. difficile laboratory diagnostic testing and indications for testing was also collected ...201526536049
bugs and guts: practical applications of probiotics for gastrointestinal disorders in children.probiotics are foods or products that contain live microorganisms that benefit the host when administered. in this clinical review, we evaluate the literature associated with using probiotics in common pediatric gastrointestinal disorders, focusing specifically on antibiotic-associated diarrhea, acute gastroenteritis, clostridium difficile infection (cdi), colic, inflammatory bowel disease, and functional gastrointestinal diseases. meta-analysis of several randomized controlled trials have confi ...201526538058
outcomes of clostridium difficile infection in pediatric solid organ transplant recipients.the incidence of clostridium difficile infection (cdi) is increasing in the pediatric population. pediatric recipients of solid organ transplantation (sot) may be at a higher risk for cdi in part because of chemotherapy and prolonged hospitalization.201626538348
multidisciplinary performance improvement team for reducing health care-associated clostridium difficile infection.clostridium difficile is the most frequent cause of health care-associated diarrhea and is a significant cause of morbidity and mortality. it is also associated with a considerable financial burden. a concerted multidisciplinary approach is required for prevention.201626541068
neomycin and bacitracin reduce the intestinal permeability in mice and increase the expression of some tight-junction proteins.tight-junction (tj) proteins regulate paracellular permeability. gut permeability can be modulated by commensal microbiota. manipulation of the gut microbiota with antibiotics like bacitracin and neomycin turned out to be useful for the treatment of diarrhoea induced by clostridium difficile or chemotherapy drugs.201526541656
molecular characterization of nosocomial clostridium difficile infection in pediatric ward in iran.clostridium difficile is recognized as a major cause of nosocomial acquired antibiotic-associated diarrhea and pseudomembranous colitis. it is a significant financial burden on modern healthcare resources. this study aimed to assess the molecular characterization of c. difficile strains isolated from children under 5 years old suffered from nosocomial diarrhea. one hundred diarrheic and 130 non-diarrheic fecal samples were collected from pediatrics less than 5 years old. samples were cultured an ...201526543762
investigation of clostridium difficile interspecies relatedness using multilocus sequence typing, multilocus variable-number tandem-repeat analysis and antimicrobial susceptibility testing.multilocus sequence typing (mlst), multilocus variable-number tandem-repeat analysis (mlva) and antimicrobial susceptibility were performed on 37 animal and human c. difficile isolates belonging to 15 different pcr-ribotypes in order to investigate the relatedness of human and animal isolates and to identify possible transmission routes. mlva identified a total of 21 different types while mlst only distinguished 12 types. identical c. difficile strains were detected in the same animal species fo ...201526545846
antibiotic prophylaxis and risk of clostridium difficile infection after coronary artery bypass graft surgery.antibiotic use, particularly type and duration, is a crucial modifiable risk factor for clostridium difficile. cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48 hours or less (vs ≤24 hours for noncardiac surgery), with increasing vancomycin use. we aimed to study associations between antibiotic prophylaxis (duration/vancomycin use) and c difficile among patients undergoing coronary artery bypass grafting.201626545971
inactivation of clostridium difficile spores by microwave irradiation.spores are a potent agent for clostridium difficile transmission. therefore, factors inhibiting spores have been of continued interest. in the present study, we investigated the influence of microwave irradiation in addition to conductive heating for c. difficile spore inactivation in aqueous suspension. the spores of 15 c. difficile isolates from different host origins were exposed to conductive heating and microwave irradiation. the complete inhibition of spore viability at 10(7) cfu/ml was en ...201626546732
small molecules take a big step against clostridium difficile.effective treatment of clostridium difficile infections demands a shift away from antibiotics towards toxin-neutralizing agents. work by bender et al., using a drug that attenuates toxin action in vivo without affecting bacterial survival, demonstrates the exciting potential of small molecules as a new modality in the fight against c. difficile.201526547239
evaluation of a clostridium difficile infection management policy with clinical pharmacy and medical microbiology involvement at a major canadian teaching hospital.clostridium difficile infection (cdi) represents a spectrum of disease and is a significant concern for healthcare institutions. our study objective was to assess whether implementation of a regional cdi management policy with clinical pharmacy and medical microbiology and infection control involvement would lead to an improvement in concordance in prescribing practices to an evidence-based cdi disease severity assessment and pharmacological treatment algorithm.201526547905
[utility of a simultaneous detection kit for glutamate dehydrogenase and toxin a/b with toxigenic culture in the diagnosis and treatment of clostridium difficile infection].we examined how doctors evaluate the results of c. diff quik chek complete (complete) in the diagnosis and treatment of clostridium difficile infection (cdi). a total of 887 stool samples submitted from 2012 to 2013 were examined with complete. requested specimens among samples with discrepant results were inoculated onto ccma plates and incubated under anaerobic conditions for 48 h, then retested by complete if positive culture results were obtained. of the 887 specimens, 198 (22.3%) were gluta ...201526548233
clostridium difficile infection and intestinal microbiota interactions.clostridium difficile remains the leading cause of healthcare-associated diarrhoea and outbreaks continue to occur worldwide. aside from nosocomial c. difficile infection, the bacterium is also increasingly important as a community pathogen. furthermore, asymptomatic carriage of c. difficile in neonates, adults and animals is also well recognised. the investigation of the gut's microbial communities, in both healthy subjects and patients suffering c. difficile infection (cdi), provides findings ...201526549493
a whole new ball game: stem cell-derived epithelia in the study of host-microbe interactions.recent advances in developmental and stem cell biology have resulted in techniques that enable the generation and maintenance of complex epithelium in vitro. while these models have been utilized to study host development and disease, a renewed appreciation of host-microbe interactions has sparked interest in employing these new techniques to study microbes at the epithelial interface. here we review the current advances in host-microbe interactions that have resulted from experiments using thes ...201626549696
cost analysis of hospitalized clostridium difficile-associated diarrhea (cdad).clostridium difficile-associated diarrhea (cdad) causes heavy financial burden on healthcare systems worldwide. as with all hospital-acquired infections, prolonged hospital stays are the main cost driver. previous cost studies only include hospital billing data and compare the length of stay in contrast to non-infected patients. to date, a survey of actual cost has not yet been conducted.201526550553
susceptibility of clostridium difficile isolates of varying antimicrobial resistance phenotypes to smt19969 and 11 comparators.we determined the in vitro activity of smt19969 and 11 comparators, including metronidazole, vancomycin, and fidaxomicin, against 107 c. difficile isolates of different antimicrobial resistance phenotypes. fidaxomicin and smt19969 were the most active. the fidaxomicin and smt19969 geometric mean mics were highest in ribotypes known to show multiple resistance. coresistance to linezolid and moxifloxacin was evident in ribotypes 001, 017, 027, and 356. the high-level ceftriaxone resistance in ribo ...201526552981
defining appropriate use of proton-pump inhibitors among medical inpatients.proton-pump inhibitors (ppis) are commonly used among medical inpatients, both for prophylaxis against upper gastrointestinal bleeding (ugib) and continuation of outpatient use. while ppis reduce the risk of ugib, they also appear to increase the risk of hospital-acquired pneumonia (hap) and clostridium difficile infection (cdi). depending upon the underlying risks of these conditions and the changes in those risks with ppis, use of proton-pump inhibitors may lead to a net benefit or net harm am ...201626553337
nisin is an effective inhibitor of clostridium difficile vegetative cells and spore germination.clostridium difficile is the most frequently identified enteric pathogen in patients with nosocomial antibiotic-associated diarrhoea and pseudomembranous colitis. several clinically isolated c. difficile strains are resistant to antibiotics other than metronidazole and vancomycin. recently, bacteriocins of lactic acid bacteria have been proposed as an alternative or complementary treatment. the aim of this study was to investigate the inhibitory effect of nisin, a bacteriocin produced by several ...201626555543
diagnostic testing for clostridium difficile in italian microbiological laboratories.a laboratory diagnosis survey of clostridium difficile infection (cdi) was performed in italy in 2012-2013. questionnaires from 278 healthcare settings from 15 regions of italy were collected and analysed. eighty seven percent of the laboratories declared to routinely perform cdi diagnosis, 99% of them only after the clinician's request. among the 216 laboratories providing information on the size of the hospitals in which they were located, 65 had more than 500 beds (large hospitals), while 151 ...201626555737
inhibitory effect of epigallocatechin gallate on the virulence of clostridium difficile pcr ribotype 027.clostridium difficile infection (cdi) is the most prevalent cause of health-care-associated infections. cdi-related health-care costs and deaths are both increasing annually on a global scale. c. difficile have been reported in food products in canada, europe, and the united states; however, the systematic transmission of c. difficile between humans and animals is yet to be understood. because of the limitations of current therapeutic options, there is a need for the development of new patient t ...201526556797
correction for zhang et al., toxin-mediated paracellular transport of antitoxin antibodies facilitates protection against clostridium difficile infection. 201526556881
inactivation of clostridium difficile in sewage sludge by anaerobic thermophilic digestion.there has been an increase in community-associated clostridium difficile infections with biosolids derived from wastewater treatment being identified as one potential source. the current study evaluated the efficacy of thermophilic digestion in decreasing levels of c. difficile ribotype 078 associated with sewage sludge. five isolates of c. difficile 078 were introduced (final density of 5 log cfu/g) into digested sludge and subjected to anaerobic digestion at mesophilic (36 or 42 °c) or thermop ...201626564276
safety and durability of rbx2660 (microbiota suspension) for recurrent clostridium difficile infection: results of the punch cd study.managing recurrent clostridium difficile infection (cdi) presents a significant challenge for clinicians and patients. fecal microbiota transplantation (fmt) is a highly effective therapy for recurrent cdi, yet availability of a standardized, safe, and effective product has been lacking. our aim in this study was to assess the safety and effectiveness of rbx2660 (microbiota suspension), a commercially prepared fmt drug manufactured using standardized processes and available in a ready-to-use for ...201626565008
novel therapeutic strategies for clostridium difficile infections.in recent years, clostridium difficile has become the primary cause of antibiotic-associated diarrhea and pseudomembranous colitis, resulting in long and complicated hospital stays that represent a serious burden for patients as well as health care systems. currently, conservative treatment of c. difficile infection (cdi) relies on the antibiotics vancomycin, metronidazole or fidaxomicin, or in case of multiple recurrences, fecal microbiota transplantation (fmt).201626565670
a high rate of alternative diagnoses in patients referred for presumed clostridium difficile infection.we evaluated a cohort of patients referred to our center for presumed recurrent clostridium difficile infection (cdi) to determine final diagnoses and outcomes.201626565971
fecal microbiota transplantation: current clinical efficacy and future prospects.fecal microbiota transplantation (fmt) has gained mainstream attention with its remarkable efficacy in treating recurrent clostridium difficile infection (rcdi) when there are no other effective therapies. methods of selecting donors and routes of administration vary among studies, but there are now randomized controlled trials showing efficacy of fmt in treating rcdi. ongoing trials of fmt for other disease such as inflammatory bowel disease are underway; this therapy should not be used for the ...201526566371
treatment of clostridium difficile infection in mice with vancomycin alone is as effective as treatment with vancomycin and metronidazole in combination.clostridium difficile is a major cause of nosocomial infectious diarrhoea. treatment of c. difficile infection (cdi) depends on disease severity. a combination of vancomycin and metronidazole is often recommended in severe cases. the aim of this study was to examine, in a murine model of cdi, if mice treated with a combination of vancomycin and metronidazole had a better clinical outcome than mice treated with vancomycin or metronidazole alone.201526568840
the effect of broader, directed antimicrobial prophylaxis including fungal coverage on perioperative infectious complications after radical cystectomy.radical cystectomy (rc) with urinary diversion has a significant risk of infection. in an effort to decrease the rate of infectious complications, we instituted a broader, culture-based preoperative antimicrobial regimen, including fungal coverage, and studied its effect on infectious complications after rc.201626572724
[diagnostic workup and therapy of infectious diarrhea. current standards].infectious diarrhea is very common; its severity ranges from uncomplicated, self-limiting courses to potentially life-threatening disease. a rapid diagnostic workup providing detailed information on the suspected pathogen should be performed only in patients at risk, analyzing one single stool sample for salmonella, shigella, campylobacter, and norovirus. in the presence of risk factors, such as a history of antibiotic exposure within the last 3 months, testing for clostridium difficile should b ...201526573083
neutralization of clostridium difficile toxin b mediated by engineered lactobacilli that produce single-domain antibodies.clostridium difficile is the primary cause of nosocomial antibiotic-associated diarrhea in the western world. the major virulence factors of c. difficile are two exotoxins, toxin a (tcda) and toxin b (tcdb), which cause extensive colonic inflammation and epithelial damage manifested by episodes of diarrhea. in this study, we explored the basis for an oral antitoxin strategy based on engineered lactobacillus strains expressing tcdb-neutralizing antibody fragments in the gastrointestinal tract. va ...201526573738
asymptomatic clostridium difficile colonization: epidemiology and clinical implications.the epidemiology of clostridium difficile infection (cdi) has changed over the past decades with the emergence of highly virulent strains. the role of asymptomatic c. difficile colonization as part of the clinical spectrum of cdi is complex because many risk factors are common to both disease and asymptomatic states. in this article, we review the role of asymptomatic c. difficile colonization in the progression to symptomatic cdi, describe the epidemiology of asymptomatic c. difficile colonizat ...201526573915
clostridium difficile colonization in asymptomatic infants 1 to 12 months old, admitted to a community hospital. 201626581362
application of density gradient for the isolation of the fecal microbial stool component and the potential use thereof.the idea of considering the gut microbiota as a virtual human organ has led to the concept of fecal microbiota transplantation (fmt), which has recently been extremely successful in the treatment of cases of recurrent clostridium difficile infection. administration of safe, viable, and representative fecal microbiota is crucial for fmt. to our knowledge, suitable techniques and systematic conditions for separating the fecal microbiota from stool samples have not been thoroughly investigated. in ...201526581409
development and evaluation of double locus sequence typing for molecular epidemiological investigations of clostridium difficile.despite the development of novel typing methods based on whole genome sequencing, most laboratories still rely on classical molecular methods for outbreak investigation or surveillance. reference methods for clostridium difficile include ribotyping and pulsed-field gel electrophoresis, which are band-comparing methods often difficult to establish and which require reference strain collections. here, we present the double locus sequence typing (dlst) scheme as a tool to analyse c. difficile isola ...201626581425
clinical and healthcare burden of multiple recurrences of clostridium difficile infection.clostridium difficile infection (cdi) is associated with a high risk of recurrence (rcdi). few studies have focused on multiple recurrences. to evaluate the potential of novel treatments targeting recurrence, we assessed the burden and severity of rcdi.201626582748
concomitant medical conditions and therapies preclude accurate classification of children with severe or severe complicated clostridium difficile infection.severe and severe complicated clostridium difficile infections (scdi/sccdi) were retrospectively assessed in a pediatric cohort. underlying medical conditions and concomitant medical therapy preclude accurate classification of children with scdi/sccdi, using current cdi severity definitions. revised cdi definitions in children should focus on more objective, age-appropriate, and cdi-specific markers of severity.201526582882
[recent antibiotic use in german acute care hospitals - from benchmarking to improved prescribing and quality care].in view of increasing rates of bacterial resistance and clostridium difficile infections efforts to enhance appropriate and intelligent antibiotic prescribing have become important. a prerequisite is the availability of reliable antibiotic use data. so far antibiotic consumption data in this country had only a very limited coverage of acute care hospitals.201526583825
quantitative lipoproteomics in clostridium difficile reveals a role for lipoproteins in sporulation.bacterial lipoproteins are surface exposed, anchored to the membrane by s-diacylglyceryl modification of the n-terminal cysteine thiol. they play important roles in many essential cellular processes and in bacterial pathogenesis. for example, clostridium difficile is a gram-positive anaerobe that causes severe gastrointestinal disease; however, its lipoproteome remains poorly characterized. here we describe the application of metabolic tagging with alkyne-tagged lipid analogs, in combination wit ...201526584780
clarifying the management of clostridium difficile infection. 201526584845
assessment of clostridium difficile burden in patients over time with first episode infection following fidaxomicin or vancomycin.in patients with first episode clostridium difficile infection treated with vancomycin or fidaxomicin, more patients receiving fidaxomicin achieved at least 2 log10 colony-forming units/g reduction in spores at the follow-up visit (p=.02). similar to published literature, a higher proportion of patients receiving fidaxomicin demonstrated sustained clinical response.201626592763
routine detection of clostridium difficile in western australia.despite increasing infection rates, clostridium difficile is not currently routinely tested for in all diarrhoeal faecal specimens in australia. in july 2014, all diarrhoeal specimens submitted to a diagnostic laboratory in western australia were surveyed to determine the true prevalence of c. difficile. in total, 1010 diarrhoeal non-duplicate faecal specimens were received during the month. testing for c. difficile was requested, or the criteria for a c. difficile investigation were met, for 67 ...201626592987
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