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clostridium difficile infection: a review of current and emerging therapies.clostridium difficile (c. difficile) infection (cdi) is the most common cause of -healthcare-associated infections in us hospitals. the epidemic strain nap1/bi/ribotype 027 accounts for outbreaks worldwide, with increasing mortality and severity. cdi is acquired from an endogenous source or from spores in the environment, most easily acquired during the hospital stay. the use of antimicrobials disrupts the intestinal microflora enabling c. difficile to proliferate in the colon and produce toxins ...201727065726
new role for fda-approved drugs in combating antibiotic-resistant bacteria.antibiotic resistance in medically relevant bacterial pathogens, coupled with a paucity of novel antimicrobial discoveries, represents a pressing global crisis. traditional drug discovery is an inefficient and costly process; however, systematic screening of food and drug administration (fda)-approved therapeutics for other indications in humans offers a rapid alternative approach. in this study, we screened a library of 780 fda-approved drugs to identify molecules that rendered raw 264.7 murine ...201627067323
vancomycin-resistant enterococcus co-colonization rates with methicillin-resistant staphylococcus aureus and clostridium difficile in critically ill veterans.a prospective study was conducted to identify risk factors for vancomycin-resistant enterococcus, including co-colonization with methicillin-resistant staphylococcus aureus and clostridium difficile infection in patients admitted to the intensive care unit in 2 veterans affairs facilities. methicillin-resistant staphylococcus aureus and clostridium difficile infection co-colonization were significant risk factors for vancomycin-resistant enterococcus colonization. further studies are needed to i ...201627067517
the clostridium difficile dlt pathway is controlled by the extracytoplasmic function sigma factor σv in response to lysozyme.clostridium difficile (also known as peptoclostridium difficile) is a major nosocomial pathogen and a leading cause of antibiotic-associated diarrhea throughout the world. colonization of the intestinal tract is necessary for c. difficile to cause disease. host-produced antimicrobial proteins (amps), such as lysozyme, are present in the intestinal tract and can deter colonization by many bacterial pathogens, and yet c. difficile is able to survive in the colon in the presence of these amps. our ...201627068095
in-use evaluation of peracetic acid for high-level disinfection of endoscopes.many high-level disinfectants have been used for disinfection of endoscopes such as 2% glutaraldehyde (ga), 0.55% ortho-phthalaldehyde (opa), and peracetic acid (paa). both ga and opa are widely used in disinfection of endoscopes and have been previously discussed, but there is little research on the practical use of paa as an endoscope disinfectant. an experimental model of a flexible gastrointestinal endoscope being contaminated with 9 strains of microorganism was designed. after the cleaning ...201727070796
a pilot study to assess bacterial and toxin reduction in patients with clostridium difficile infection given fidaxomicin or vancomycin.to assess the effect of fidaxomicin and vancomycin on clostridium difficile toxins and correlation with clinical and microbiologic outcomes.201627071986
the effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation.the widespread use of antibiotics in the past 80 years has saved millions of human lives, facilitated technological progress and killed incalculable numbers of microbes, both pathogenic and commensal. human-associated microbes perform an array of important functions, and we are now just beginning to understand the ways in which antibiotics have reshaped their ecology and the functional consequences of these changes. mounting evidence shows that antibiotics influence the function of the immune sy ...201627074706
possible interplay between hospital and community transmission of a novel clostridium difficile sequence type 295 recognized by next-generation sequencing.objective to use next-generation sequencing (ngs) analysis to enhance epidemiological information to identify and resolve a clostridium difficile outbreak and to evaluate its effectiveness beyond the capacity of current standard pcr ribotyping. methods ngs analysis was performed as part of prospective surveillance of all detected c. difficile isolates at a university hospital. an outbreak of a novel c. difficile sequence type (st)-295 was identified in a hospital and a community hostel for homel ...201627074865
design and purification of subunit vaccines for prevention of clostridium difficile infection.clostridium difficile is a gram-positive bacterium responsible for a large proportion of nosocomial infections in the developed world. c. difficile secretes toxins a and b (tcda and tcdb) and both toxins act synergistically to induce a spectrum of pathological responses in infected individuals ranging from pseudomembranous colitis to c. difficile-associated diarrhea. toxins a and b have been actively investigated as components of prophylactic vaccine as well as targets for therapeutic interventi ...201627076142
the design of a clostridium difficile carbohydrate-based vaccine.clostridium difficile vaccines composed of surface polysaccharides (pss) have the potential to simultaneously control infection and colonization levels in humans. hot water-phenol treatment of c. difficile biomass can extricate water-soluble ps-i and ps-ii; and water- and phenol-soluble ps-iii. c. difficile vaccines based on ps-ii have attracted the most attention due its facile purification and ubiquitous expression by c. difficile ribotypes. anti ps-ii antibodies recognize both c. difficile ve ...201627076143
a novel fic (filamentation induced by camp) protein from clostridium difficile reveals an inhibitory motif-independent adenylylation/ampylation mechanism.filamentation induced by camp (fic) domain proteins have been shown to catalyze the transfer of the amp moiety from atp onto a protein target. this type of post-translational modification was recently shown to play a crucial role in pathogenicity mediated by two bacterial virulence factors. herein we characterize a novel fic domain protein that we identified from the human pathogen clostridium difficile the crystal structure shows that the protein adopts a classical all-helical fic fold, which b ...201627076635
safety, immunogenicity and dose response of vla84, a new vaccine candidate against clostridium difficile, in healthy volunteers.clostridium difficile infection (cdi) is the leading cause of antibiotic-associated diarrhoea and colitis and the most common pathogen of health care-associated infections. in the us, cdi causes approximately half a million infections and close to 30,000 deaths. despite antibiotic treatment of c. difficile associated diarrhoea, the disease is complicated by its recurrence in up to 30% of patients.201627079932
evaluation of a new molecular method illumigene for detection of clostridium difficile associated diarrhoea. 201627080791
"clostridium difficile associated pseudomembranous colitis: an under-recognized threat" - scenario from a tertiary care hospital. 201627080803
outcomes in children with clostridium difficile infection: results from a nationwide survey.hospital- and population-based studies demonstrate an increasing incidence of clostridium difficile infection (cdi) in adults and children; although pediatric cdi outcomes are incompletely understood. we analysed united states national hospital discharge survey (nhds) data to study cdi in hospitalized children.201627081152
recurrent clostridium difficile infection associates with distinct bile acid and microbiome profiles.the healthy microbiome protects against the development of clostridium difficile infection (cdi), which typically develops following antibiotics. the microbiome metabolises primary to secondary bile acids, a process if disrupted by antibiotics, may be critical for the initiation of cdi.201627086647
successful fecal microbiota transplantation as an initial therapy for clostridium difficile infection on an outpatient basis.a 64-year-old woman developed diarrhea after taking clindamycin for a dental infection. we diagnosed her with clostridium difficile infection (cdi) and performed fecal microbiota transplantation (fmt) as the initial therapy using colonoscopy on an outpatient basis. the frequency of her bowel movements decreased from 10 times per day to two times per day three days after the procedure. the key component of fmt is to restructure the protective microbiome of the natural intestinal flora. we conside ...201627086820
should asymptomatic bacteriuria be systematically treated in kidney transplant recipients? results from a randomized controlled trial.the indication of antimicrobial treatment for asymptomatic bacteriuria (ab) after kidney transplantation (kt) remains controversial. between january 2011 and december 2013 112 kt recipients that developed ≥1 episode of ab beyond the second month post-transplantation were included in this open-label trial. participants were randomized (1:1 ratio) to the treatment group (systematic antimicrobial therapy for all episodes of ab occurring up to 24 months post-transplantation [53 patients]) or control ...201627088545
importation, antibiotics, and clostridium difficile infection in veteran long-term care: a multilevel case-control study.although clinical factors affecting a person's susceptibility to clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings.201627088642
national variability and appropriateness of surgical antibiotic prophylaxis in us children's hospitals.appropriate use of surgical antibiotic prophylaxis (ap) reduces surgical site infection rates, but prior data suggest variability in use patterns.201627088649
metal ion activation of clostridium sordellii lethal toxin and clostridium difficile toxin b.lethal toxin from clostridium sordellii (tcsl) and toxin b from clostridium difficile (tcdb) belong to the family of the "large clostridial glycosylating toxins." these toxins mono-o-glucosylate low molecular weight gtpases of the rho and ras families by exploiting udp-glucose as a hexose donor. tcsl is casually involved in the toxic shock syndrome and the gas gangrene. tcdb-together with toxin a (tcda)-is causative for the pseudomembranous colitis (pmc). here, we present evidence for the in vit ...201627089365
synthesis and antimicrobial evaluation of amixicile-based inhibitors of the pyruvate-ferredoxin oxidoreductases of anaerobic bacteria and epsilonproteobacteria.amixicile is a promising derivative of nitazoxanide (an antiparasitic therapeutic) developed to treat systemic infections caused by anaerobic bacteria, anaerobic parasites, and members of the epsilonproteobacteria (campylobacter and helicobacter). amixicile selectively inhibits pyruvate-ferredoxin oxidoreductase (pfor) and related enzymes by inhibiting the function of the vitamin b1 cofactor (thiamine pyrophosphate) by a novel mechanism. here, we interrogate the amixicile scaffold, guided by doc ...201627090174
effect of fidaxomicin versus vancomycin on susceptibility to intestinal colonization with vancomycin-resistant enterococci and klebsiella pneumoniae in mice.the use of oral vancomycin or metronidazole for treatment of clostridium difficile infection (cdi) may promote colonization by health care-associated pathogens due to disruption of the intestinal microbiota. because the macrocyclic antibiotic fidaxomicin causes less alteration of the intestinal microbiota than vancomycin, we hypothesized that it would not lead to a loss of colonization resistance to vancomycin-resistant enterococci (vre) and extended-spectrum-β-lactamase-producing klebsiella pne ...201627090175
microbiome mediation of infections in the cancer setting.infections encountered in the cancer setting may arise from intensive cancer treatments or may result from the cancer itself, leading to risk of infections through immune compromise, disruption of anatomic barriers, and exposure to nosocomial (hospital-acquired) pathogens. consequently, cancer-related infections are unique and epidemiologically distinct from those in other patient populations and may be particularly challenging for clinicians to treat. there is increasing evidence that the micro ...201627090860
molecular and epidemiologic study of clostridium difficile reveals unusual heterogeneity in clinical strains circulating in different regions in portugal.clostridium difficile infection (cdi) represents a great healthcare burden in developed countries. the emergence of the epidemic pcr ribotype (rt) 027 and its acquired fluoroquinolones resistance have accentuated the need for an active surveillance of cdi. here we report the first countrywide study of cdi in portugal with the characterization of 498 c. difficile clinical isolates from 20 hospitals in four regions in portugal regarding rt, virulence factors and antimicrobial susceptibility. we id ...201627091093
postoperative antimicrobials after lung transplantation and the development of multidrug-resistant bacterial and clostridium difficile infections: an analysis of 500 non-cystic fibrosis lung transplant patients.broad-spectrum antimicrobials are given prophylactically post-transplant, although these agents are a risk factor for multidrug-resistant (mdr) infections and clostridium difficile infection (cdi). this study aimed to determine whether an association exists between the duration of antimicrobials given early post-transplant and the development of mdr infections or cdi.201627091109
do piperacillin/tazobactam and other antibiotics with inhibitory activity against clostridium difficile reduce the risk for acquisition of c. difficile colonization?systemic antibiotics vary widely in in vitro activity against clostridium difficile. some agents with activity against c. difficile (e.g., piperacillin/tazobactam) inhibit establishment of colonization in mice. we tested the hypothesis that piperacillin/tazobactam and other agents with activity against c. difficile achieve sufficient concentrations in the intestinal tract to inhibit colonization in patients.201627091232
ulcerative colitis patients with clostridium difficile are at increased risk of death, colectomy, and postoperative complications: a population-based inception cohort study.clostridium difficile (c. difficile) may worsen the prognosis of ulcerative colitis (uc). the objectives of this study were to: (i) validate the international classification of diseases-10 (icd-10) code for c. difficile; (ii) determine the risk of c. difficile infection after diagnosis of uc; (iii) evaluate the effect of c. difficile infection on the risk of colectomy; and (iv) assess the association between c. difficile and postoperative complications.201627091322
multivalent display of minimal clostridium difficile glycan epitopes mimics antigenic properties of larger glycans.synthetic cell-surface glycans are promising vaccine candidates against clostridium difficile. the complexity of large, highly antigenic and immunogenic glycans is a synthetic challenge. less complex antigens providing similar immune responses are desirable for vaccine development. based on molecular-level glycan-antibody interaction analyses, we here demonstrate that the c. difficile surface polysaccharide-i (ps-i) can be resembled by multivalent display of minimal disaccharide epitopes on a sy ...201627091615
clinical outcomes of acid suppressive therapy use in hematology/oncology patients at an academic medical center.acid suppressive therapy (ast)-namely, proton pump inhibitors (ppis) and histamine-2 receptor antagonists (h2ras)-is routinely prescribed to hospitalized patients for stress ulcer prophylaxis (sup).201627091869
stress ulcer prophylaxis with a proton pump inhibitor versus placebo in critically ill patients (sup-icu trial): study protocol for a randomised controlled trial.critically ill patients in the intensive care unit (icu) are at risk of clinically important gastrointestinal bleeding, and acid suppressants are frequently used prophylactically. however, stress ulcer prophylaxis may increase the risk of serious adverse events and, additionally, the quantity and quality of evidence supporting the use of stress ulcer prophylaxis is low. the aim of the sup-icu trial is to assess the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in ad ...201627093939
diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to clostridium difficile.diarrhoea is common in intensive care unit (icu) patients, with a reported prevalence of 15-38%. many factors may cause diarrhoea, including clostridium difficile, drugs (e.g. laxatives, antibiotics) and enteral feeds. diarrhoea impacts on patient dignity, increases nursing workload and healthcare costs, and exacerbates morbidity through dermal injury, impaired enteral uptake and subsequent fluid imbalance. we analysed a cohort of 9331 consecutive patients admitted to a mixed general intensive c ...201627094447
sporulation properties and antimicrobial susceptibility in endemic and rare clostridium difficile pcr ribotypes.increased sporulation and antibiotic resistance have been proposed to be associated with certain clostridium difficile epidemic strains such as pcr ribotype 027. in this study we examined these properties in another widespread pcr ribotype, 014/020, in comparison to prevalent pcr ribotype 002 and a group of rarely represented pcr ribotypes. highest sporulation was observed in 014/020 strains at 24 h, while after 72 h pcr ribotype 002 and rare pcr ribotypes formed higher total number of spores. p ...201627095618
fecal microbiota transplantation: a review of emerging indications beyond relapsing clostridium difficile toxin colitis.the symbiotic relationship between gut microbiota and humans has been forged over many millennia. this relationship has evolved to establish an intimate partnership that we are only beginning to understand. gut microbiota were once considered pathogenic, but the concept of gut microbiota and their influence in human health is undergoing a major paradigm shift, as there is mounting evidence of their impact in the homeostasis of intestinal development, metabolic activities, and the immune system. ...201527099570
the burden of clostridium difficile infection: estimates of the incidence of cdi from u.s. administrative databases.many administrative data sources are available to study the epidemiology of infectious diseases, including clostridium difficile infection (cdi), but few publications have compared cdi event rates across databases using similar methodology. we used comparable methods with multiple administrative databases to compare the incidence of cdi in older and younger persons in the united states.201627102582
fecal transplantation using a nasoenteric tube during an initial episode of severe clostridium difficile infection.the incidence of clostridium difficile infection is increasing worldwide, and its severity and resulting mortality are also on the rise. metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains. furthermore, antibiotic therapy results in recurrence rates of at least 20%. fecal transplantation may be a feasible treatment option for recurrent c. difficile infection; moreover, it may be an early treatme ...201627104013
recurrence and death after clostridium difficile infection: gender-dependant influence of proton pump inhibitor therapy.to determine whether patients with a pre-existing ppi treatment had a higher risk of poor evolution (recurrence or death) when diagnosed with a toxicogenic clostridium difficile digestive infection.201627104118
bacterial intestinal superinfections in inflammatory bowel diseases beyond clostridum difficile.besides genetics and environmental factors, intestinal microbiota seem to play a major role in the pathogenesis of inflammatory bowel diseases. for many decades, it has been said that some enteropathogens may even trigger both inflammatory bowel disease development and disease flares. for this reason, stool testing had been performed in inflammatory bowel disease flares but current guidelines only recommend to rule out clostridium difficile infection and there is no clear advice for other entero ...201627104824
risk factors for clostridium difficile infection in hospitalized patients with community-acquired pneumonia.clostridium difficile infection (cdi) is strongly associated with anti-biotic treatment, and community-acquired pneumonia (cap) is the leading indication for anti-biotic prescription in hospitals. this study assessed the incidence of and risk factors for cdi in a cohort of patients hospitalized with cap.201627105657
corrigendum to "length of stay and mortality due to clostridium difficile infection acquired in the intensive care unit" journal of critical care (2013) 28, 335-340. 201627107495
epidemiology of clostridium difficile infections in australia: enhanced surveillance to evaluate time trends and severity of illness in victoria, 2010-2014.with epidemic strains of clostridium difficile posing a substantial healthcare burden internationally, there is a need for longitudinal evaluation of clostridium difficile infection (cdi) events in australia.201627107622
the role of clostridium difficile in the paediatric and neonatal gut - a narrative review.clostridium difficile is an important nosocomial pathogen in adults. its significance in children is less well defined, but cases of c. difficile infection (cdi) appear to be increasingly prevalent in paediatric patients. this review aims to summarize reported clostridium difficile carriage rates across children of different age groups, appraise the relationship between cdi and factors such as method of delivery, type of infant feed, antibiotic use, and co-morbidities, and review factors affecti ...201627107991
immune responses induced by clostridium difficile.the spectrum of clostridium difficile infections is highly variable, ranging from asymptomatic carriage to fatal colitis depending on the strain virulence and on the host, its gut microbiota and its immune response. after disruption of the gut microbiota, c. difficile pathogenesis can be divided into three steps: 1) contamination by spores and their germination; 2) multiplication of vegetative cells and intestinal colonization using colonization factors; 3) production of the toxins tcda and tcdb ...201627108093
a novel method for imaging the pharmacological effects of antibiotic treatment on clostridium difficile.clostridium difficile is a significant cause of nosocomial-acquired infection that results in severe diarrhea and can lead to mortality. treatment options for c. difficile infection (cdi) are limited, however, new antibiotics are being developed. current methods for determining efficacy of experimental antibiotics on c. difficile involve antibiotic killing rates and do not give insight into the drug's pharmacologic effects. considering this, we hypothesized that by using scanning electron micros ...201627108094
determination of the extent of clostridium difficile colonisation and toxin accumulation in sows and neonatal piglets.clostridium difficile is an important spore-forming, opportunistic pathogen in animal husbandry and health care. in pig farming, only neonatal piglets are affected, and diarrhoea and necrotising lesions are common symptoms leading to dehydration and in some cases death. this study aimed at the assessment of the quantitative development of c. difficile colonisation in neonatal piglets by determining the shedding of spores and c. difficile toxins a (tcda) and b (tcdb) concentrations in sow (n = 5- ...201627108595
efficacy and mechanisms of action of fecal microbiota transplantation in ulcerative colitis: pitfalls and promises from a first meta-analysis.inflammatory bowel disease (ibd) is the results of a chronic inflammatory process deriving from disequilibrium between self-microbiota composition and immune response.201627109966
active surveillance and isolation of asymptomatic carriers of clostridium difficile at hospital admission: containing what lies under the waterline. 201627111468
effect of detecting and isolating clostridium difficile carriers at hospital admission on the incidence of c difficile infections: a quasi-experimental controlled study.clostridium difficile infection (cdi) is a major cause of health care-associated infection worldwide, and new preventive strategies are urgently needed. current control measures do not target asymptomatic carriers, despite evidence that they can contaminate the hospital environment and health care workers' hands and potentially transmit c difficile to other patients.201627111806
uk renal registry 18th annual report: chapter 12 epidemiology of reported infections amongst patients receiving dialysis for established renal failure in england 2013 to 2014: a joint report from public health england and the uk renal registry.from 1st may 2013 to 30th april 2014 there were 35 episodes of methicillin resistant staphylococcus aureus (mrsa) bacteraemia in established renal failure patients on dialysis. this is now fairly stable year-on-year equating to a rate of 0.15 episodes per 100 dialysis patient years, following an initial decline in rates from 4.0 episodes per 100 dialysis patient years in 2005 when reporting began. methicillin sensitive staphylococcus aureus (mssa) bacteraemia rates were slightly higher this year ...201627116291
nqo1-knockout mice are highly sensitive to clostridium difficile toxin a-induced enteritis.clostridium difficile toxin a causes acute gut inflammation in animals and humans. it is known to downregulate the tight junctions between colonic epithelial cells, allowing luminal contents to access body tissues and trigger acute immune responses. however, it is not yet known whether this loss of the barrier function is a critical factor in the progression of toxin a-induced pseudomembranous colitis. we previously showed that nadh:quinone oxidoreductase 1 (nqo1) ko (knockout) mice spontaneousl ...201627116994
epidemiology, diagnosis, and management of clostridium difficile infection in patients with inflammatory bowel disease.clostridium difficile infection (cdi) is a major source of morbidity and mortality for the u.s. health care system and frequently complicates the course of inflammatory bowel disease (ibd). patients with ibd are more likely to be colonized with c. difficile and develop active infection than the general population. they are also more likely to have severe cdi and develop subsequent complications such as ibd flare, colectomy, or death. even after successful initial treatment and recovery, recurren ...201627120571
dynamics of the fecal microbiome in patients with recurrent and nonrecurrent clostridium difficile infection.recurrent clostridium difficile infection (cdi) remains problematic, with up to 30 % of individuals diagnosed with primary cdi experiencing at least one episode of recurrence. the success of microbial-based therapeutics, such as fecal microbiota transplantation, for the treatment of recurrent cdi underscores the importance of restoring the microbiota. however, few studies have looked at the microbial factors that contribute to the development of recurrent disease. here we compare microbial chang ...201627121861
developing a clinical prediction rule for first hospital-onset clostridium difficile infections: a retrospective observational study.background the healthcare burden of hospital-acquired clostridium difficile infection (cdi) demands attention and calls for a solution. identifying patients' risk of developing a primary nosocomial cdi is a critical first step in reducing the development of new cases of cdi. objective to derive a clinical prediction rule that can predict a patient's risk of acquiring a primary cdi. design retrospective cohort study. setting large tertiary healthcare center. patients total of 61,482 subjects aged ...201627123975
repeat clostridium difficile pcr testing after a negative result. 201627124907
[chronic salmonella typhimurium diarrhea in an immunocompetent patient].chronic diarrhea caused by infection in immunocompetent patients is an infrequent condition in developed countries, although certain pathogens,generally parasites (giardia lamblia, isospora belli,cryptosporidium, cyclospora, strongyloides, ameba,trichuris and schistosoma) and some bacteria (aeromonas,plesiomonas, campylobacter, clostridium difficile, salmonella or mycobacterium tuberculosis)can cause persistent diarrhea.we present the case of a patient who showed salmonella typhimurium in his st ...201627125610
durable coexistence of donor and recipient strains after fecal microbiota transplantation.fecal microbiota transplantation (fmt) has shown efficacy in treating recurrent clostridium difficile infection and is increasingly being applied to other gastrointestinal disorders, yet the fate of native and introduced microbial strains remains largely unknown. to quantify the extent of donor microbiota colonization, we monitored strain populations in fecal samples from a recent fmt study on metabolic syndrome patients using single-nucleotide variants in metagenomes. we found extensive coexist ...201627126044
getting to a man's heart through his colon.a 69-year-old man presented with a progressively enlarging pulsatile mass in the left side of his chest. because of a history of an ischemic cardiomyopathy, he had been randomized in 2003 to undergo coronary artery bypass grafting with a dor procedure, as part of the surgical treatment for ischemic heart failure (stich) trial. our patient's imaging studies, including a thoracic computed tomogram and transthoracic echocardiogram, were now of concern for left ventricular pseudoaneurysm. he was tak ...201627127437
fecal microbiota transplantation using upper gastrointestinal tract for the treatment of refractory or severe complicated clostridium difficile infection in elderly patients in poor medical condition: the first study in an asian country.background and aims. fecal microbiota transplantation (fmt) is a highly effective treatment option for refractory clostridium difficile infection (cdi). fmt may be challenging in patients with a low performance status, because of their poor medical condition. the aims of this study were to describe our experience treating patients in poor medical condition with refractory or severe complicated cdi using fmt via the upper gi tract route. methods. this study was a retrospective review of seven eld ...201627127501
impact of microbiology cascade reporting on antibiotic de-escalation in cefazolin-susceptible gram-negative bacteremia.cascade reporting (cr) involves reporting the susceptibilities of broad-spectrum agents only when the organism is resistant to more narrow-spectrum agents. the purpose of this study is to evaluate the impact of cr on antibiotic de-escalation practices and to characterize the impact of cr on clinical outcomes. cr rules were implemented in the microbiology laboratory at atlantic health system (ahs) in june 2013. a retrospective chart review was conducted at two community teaching hospitals in adul ...201627130036
clostridium difficile clade 5 in australia: antimicrobial susceptibility profiling of pcr ribotypes of human and animal origin.increasing reports of genetic overlap between animal and human sources of clostridium difficile necessitate an understanding of antimicrobial susceptibility and resistance in these populations. in this study, we sought to investigate the in vitro activities of 13 antimicrobials against a unique collection of clade 5 c. difficile isolates of australian animal and human origin.201627130808
reducing health care-associated infections by implementing a novel all hands on deck approach for hand hygiene compliance.hand hygiene is a key intervention for preventing health care-associated infections; however, maintaining high compliance is a challenge, and accurate measurement of compliance can be difficult. a novel program that engaged all health care personnel to measure compliance and provide real-time interventions overcame many barriers for compliance measurement and proved effective for sustaining high compliance and reducing health care-associated infections.201627131129
effectiveness of ultraviolet devices and hydrogen peroxide systems for terminal room decontamination: focus on clinical trials.over the last decade, substantial scientific evidence has accumulated that indicates contamination of environmental surfaces in hospital rooms plays an important role in the transmission of key health care-associated pathogens (eg, methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, clostridium difficile, acinetobacter spp). for example, a patient admitted to a room previously occupied by a patient colonized or infected with one of these pathogens has a higher risk for ...201627131140
occupational health risks associated with the use of germicides in health care.environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities, including methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococcus, clostridium difficile, norovirus, and multidrug-resistant gram-negative bacilli. for this reason, routine disinfection of environmental surfaces in patient rooms is recommended. in addition, decontamination of shared medical devices between use by different patients is also recommended. environmental ...201627131141
impact of standard test protocols on sporicidal efficacy.there has been an increase in the availability of commercial sporicidal formulations. any comparison of sporicidal data from the literature is hampered by the number of different standard tests available and the use of diverse test conditions including bacterial strains and endospore preparation.201627133281
fecal microbiota transplant for clostridium difficile infection in older adults.the objective of this study was to describe the safety of fecal microbiota transplant (fmt) for clostridium difficile infection (cdi) among older adults.201627134658
clostridium difficile infection in patients with inflammatory bowel disease.clostridium difficile infection (cdi) is now the leading cause of nosocomial infection. there has been an upsurge of cdi in patients with inflammatory bowel disease (ibd). ibd patients with cdi have increased morbidity and mortality. the establishment, proliferation, and recurrence of cdi in ibd patients form a complex interplay of microbial, environmental, and host-susceptibility factors. different risk factors have been found predisposing ibd patients to cdi. vancomycin performs better than me ...201627137789
the epidemiological and clinical analysis of clostridium difficile infections in patients hospitalized due to the infection at the department of infectious diseases in bytom.clostridium difficile infections are becoming a more serious problem as hospital-acquired infections and the consequence of common antibiotic therapy, also on an out-patient basis.201527139349
ecological effect of solithromycin on normal human oropharyngeal and intestinal microbiota.solithromycin is a new fluoroketolide. the purpose of the present study was to investigate the effect of orally administered solithromycin on the human oropharyngeal and intestinal microbiota. thirteen healthy volunteers (median age, 27.3 years) received oral solithromycin at 800 mg on day 1 followed by 400 mg daily on days 2 to 7. fecal and saliva samples were collected at baseline and on days 2, 5, 7, 9, 14, and 21 for pharmacokinetic and microbiological analyses. plasma samples were collected ...201627139483
effect of passive immunotherapy against clostridium difficile infection: a systematic review and meta-analysis.this systematic review aimed to determine the effect of antibody therapy against clostridium difficile infection (cdi) using meta-analysis. in total, 28 studies (animals - 12; human - 17) were identified from the database on the basis of inclusion criteria; then selected studies were systematically reviewed and statistically analyzed. in animal experiments, the pooled relative risk of eight potential studies suggested that the antibody treatment could reduce the risk of cdi. however, the methodo ...201627140414
point-prevalence survey of healthcare-associated infections in beijing, china: a survey and analysis in 2014.point-prevalence studies can identify priorities for infection control.201627140419
efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials.the relative efficacy and safety of proton pump inhibitors (ppis) compared to histamine-2-receptor antagonists (h2ras) should guide their use in reducing bleeding risk in the critically ill.201627142116
discovery and development of kibdelomycin, a new class of broad-spectrum antibiotics targeting the clinically proven bacterial type ii topoisomerase.kibdelomycin is a complex novel antibiotic, discovered by applying a highly sophisticated chemical-genetic staphylococcus aureus fitness test (saft) approach, that inhibits the clinically established bacterial targets, gyrase and topoisomerase iv. it exhibits broad-spectrum antibacterial activity against aerobic bacteria including mrsa and acinetobacter baumannii. it is slowly bactericidal and has a low frequency of resistance. in an anaerobic environment, it exhibits narrow-spectrum activity an ...201627143131
transplanting a microbial organ: the good, the bad, and the unknown.fecal microbiota transplantation (fmt) has received increased attention as a therapy for correcting intestinal dysbiosis and restoring a state of health in patients suffering from either recalcitrant infection by clostridium difficile or more complex disease states, such as inflammatory bowel disease (ibd). the "gut microbial organ" from the donor that is used in these transplants may serve to transfer genetic material between donor and recipient via virus-like particles, specifically bacterioph ...201627143392
risk factors for recurrent clostridium difficile infection in pediatric inpatients.the purpose of this study was to identify the risk factors during the incident clostridium difficile infection (cdi) episode, associated with developing recurrent cdi within 60 days, among hospitalized children that may be amenable to intervention.201627146969
detection of 23 gastrointestinal pathogens among children who present with diarrhea.in the era of widespread rotavirus vaccine use, toxigenic clostridium difficile, diarrheagenic escherichia coli, and viruses (particularly norovirus) are commonly detected among children with infectious gastroenteritis in the united states by using a multipathogen molecular panel.201627147712
extended perioperative antibiotic coverage in conjunction with intraoperative bile cultures decreases infectious complications after pancreaticoduodenectomy.background. bile contamination from the digestive tract is a well-known risk factor for postoperative complications. despite the literature concerning prevalence of bacterobilia and fungobilia in patients with biliary pathologies, there are no specific recommendations for perioperative antimicrobial coverage for biliary/pancreatic procedures. we evaluated the effect of at least 72 hours of perioperative broad spectrum antibiotic coverage on outcomes of pancreaticoduodenectomy (pd). materials and ...201627147813
screening of bifidobacteria and lactobacilli able to antagonize the cytotoxic effect of clostridium difficile upon intestinal epithelial ht29 monolayer.clostridium difficile is an opportunistic pathogen inhabiting the human gut, often being the aetiological agent of infections after a microbiota dysbiosis following, for example, an antibiotic treatment. c. difficile infections (cdi) constitute a growing health problem with increasing rates of morbidity and mortality at groups of risk, such as elderly and hospitalized patients, but also in populations traditionally considered low-risk. this could be related to the occurrence of virulent strains ...201627148250
long-term changes of bacterial and viral compositions in the intestine of a recovered clostridium difficile patient after fecal microbiota transplantation.fecal microbiota transplantation (fmt) is an effective treatment for recurrent clostridium difficile infections (rcdis). however, long-term effects on the patients' gut microbiota and the role of viruses remain to be elucidated. here, we characterized bacterial and viral microbiota in the feces of a cured rcdi patient at various time points until 4.5 yr post-fmt compared with the stool donor. feces were subjected to dna sequencing to characterize bacteria and double-stranded dna (dsdna) viruses ...201627148577
bacteria-mediated hypoxia-specific delivery of nanoparticles for tumors imaging and therapy.the hypoxia region in a solid tumor has been recognized as a complex microenvironment revealing very low oxygen concentration and deficient nutrients. the hypoxic environment reduces the susceptibility of the cancer cells to anticancer drugs, low response of free radicals, and less proliferation of cancer cells in the center of the solid tumors. however, the reduced oxygen surroundings provide an appreciable habitat for anaerobic bacteria to colonize. here, we present the bacteria-mediated targe ...201627148804
rifaximin for the treatment of irritable bowel syndrome - a drug safety evaluation.irritable bowel syndrome is a functional gastrointestinal disorder with a multifactorial etiology. alterations of intestinal motility and immunity, gut-brain interactions, as well as gut microbiota dysbiosis contribute to the development of irritable bowel syndrome. therefore, gut microbiota modulation by non-absorbable antibiotics is a therapeutic option in patients with ibs.201627149541
production of the ramoplanin activity analogue by double gene inactivation.glycopeptides such as vancomycin and telavancin are essential for treating infections caused by gram-positive bacteria. but the dwindling availability of new antibiotics and the emergence of resistant bacteria are making effective antibiotic treatment increasingly difficult. ramoplanin, an inhibitor of bacterial cell wall biosynthesis, is a highly effective antibiotic against a wide range of gram-positive bacteria, including methicillin-resistant staphylococcus aureus, vancomycin-intermediate re ...201627149627
high mobility group box1 protein is involved in acute inflammation induced by clostridium difficile toxin a.high mobility group box1 (hmgb1), as a damage-associated inflammatory factor, contributes to the pathogenesis of numerous chronic inflammatory and autoimmune diseases. in this study, we explored the role of hmgb1 in cdi (clostridium difficile infection) by in vivo and in vitro experiments. our results showed that hmgb1 might play an important role in the acute inflammatory responses to c. difficile toxin a (tcda), affect early inflammatory factors, and induce inflammation via the hmgb1-tlr4 path ...201627151296
fecal transplantation indications in ulcerative colitis. preliminary study.fecal microbiota transplantation is used with success in persistent (more than two episodes) clostridium difficile infection; it has also gained importance and started to be used in inflammatory bowel disease. there are theoretical arguments that justify its use in ulcerative colitis or crohn's disease. based on our clinical cases we tried to evaluate the indications of fecal microbiota transplantation young patients with ulcerative colitis and multiple relapses, in which biological or immunosup ...201627152073
fecal transplantation: any real hope for inflammatory bowel disease?fecal microbiota transplant (fmt) has emerged as an important treatment for antibiotic resistant or recurrent clostridium difficile infection. there has been a great deal of media coverage of the efficacy of fmt, and patients with inflammatory bowel disease (ibd) understandably wonder if this approach would also work for them. there are also instructions on 'do it yourself' fmt therapy on the web. it is important to understand whether there is evidence that this approach is effective in ibd so t ...201627152872
clostridium difficile toxins a and b: insights into pathogenic properties and extraintestinal effects.clostridium difficile infection (cdi) has significant clinical impact especially on the elderly and/or immunocompromised patients. the pathogenicity of clostridium difficile is mainly mediated by two exotoxins: toxin a (tcda) and toxin b (tcdb). these toxins primarily disrupt the cytoskeletal structure and the tight junctions of target cells causing cell rounding and ultimately cell death. detectable c. difficile toxemia is strongly associated with fulminant disease. however, besides the well-kn ...201627153087
the challenge of clostridium difficile infection.clostridium difficile infection is a major problem in the united states, resulting in significant morbidity, mortality, and financial costs to the health care system. this commentary provides an update regarding the epidemiology, diagnosis, current recommended management, and challenges surrounding c. difficile infection.201627154892
clostridium difficile ribotype 176 - a predictor for high mortality and risk of nosocomial spread?the objective of this survey was to determine the incidence of clostridium difficile infections (cdi) at the department of infectious diseases, bulovka hospital, and to evaluate clinical and epidemiological data on cdi patients together with a detailed molecular characterisation of c. difficile isolates. the patient outcomes were correlated to causative c. difficile pcr-ribotype.201627155489
clostridium difficile associated diarrhea.clostridium difficile associated diarrhea (cdad) is increasingly important in primary care, and associated with high cost, significant morbidity and mortality. as the preferred treatment for different groups of patients varies considerably, it is important to stratify cdad patients into mild versus severe and uncomplicated versus complicated. while treatment with either metronidazole or oral vancomycin cures a majority of patients, and despite improvement in early diagnosis and therapy, recurren ...201627156262
clostridium difficile infection.infection of the colon with the gram-positive bacterium clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. c. difficile is the leading cause of health-care-associated infective diarrhoea. the life cycle of c. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. the primary mediators of inflamma ...201627158839
how to manipulate the microbiota: fecal microbiota transplantation.fecal microbiota transplantation (fmt) is a rather straightforward therapy that manipulates the human gastrointestinal (gi) microbiota, by which a healthy donor microbiota is transferred into an existing but disturbed microbial ecosystem. this is a natural process that occurs already at birth; infants are rapidly colonized by a specific microbial community, the composition of which strongly depends on the mode of delivery and which therefore most likely originates from the mother (palmer et al. ...201627161356
impact of microbial derived secondary bile acids on colonization resistance against clostridium difficile in the gastrointestinal tract.clostridium difficile is an anaerobic, gram positive, spore-forming bacillus that is the leading cause of nosocomial gastroenteritis. clostridium difficile infection (cdi) is associated with increasing morbidity and mortality, consequently posing an urgent threat to public health. recurrence of cdi after successful treatment with antibiotics is high, thus necessitating discovery of novel therapeutics against this pathogen. susceptibility to cdi is associated with alterations in the gut microbiot ...201627163871
infection: targeting asymptomatic carriers of clostridium difficile infection. 201627165512
predominance and high antibiotic resistance of the emerging clostridium difficile genotypes napcr1 and nap9 in a costa rican hospital over a 2-year period without outbreaks.clostridium difficile is the major causative agent of nosocomial antibiotic-associated diarrhea. in a 2009 outbreak of c. difficile-associated diarrhea that was recorded in a major costa rican hospital, the hypervirulent nap1 strain (45%) predominated together with a local genotype variant (napcr1, 31%). both strains were fluoroquinolone-resistant and the napcr1 genotype, in addition, was resistant to clindamycin and rifampicin. we now report on the genotypes and antibiotic susceptibilities of 6 ...201627165560
pseudomembranous colitis secondary to methicillin-resistant staphylococcus aureus (mrsa).a 37-year-old woman with a history of type ii diabetes and crohn's disease, status postcholecystectomy, presented with a >2-week history of cramping abdominal pain, nausea, non-bloody/non-bilious emesis and, later, diarrhoea. a flexible sigmoidoscopy was performed, revealing that 'a segmental pseudomembrane was found from rectum to sigmoid colon'. clostridium difficile pcr on the stool was repeated twice and resulted negative both times. a food history prior to onset of symptoms was consistent w ...201627165998
gut microbiota composition and clostridium difficile infection in hospitalized elderly individuals: a metagenomic study.the gut microbiota composition of elderly hospitalized patients with clostridium difficile infection (cdi) exposed to previous antibiotic treatment is still poorly investigated. the aim of this study was to compare the microbiota composition by means of 16s rrna microbial profiling among three groups of hospitalized elderly patients (age ≥ 65) under standard diet including 25 cdi-positive (cdi group), 29 cdi-negative exposed to antibiotic treatment (ab+ group) and 30 cdi-negative subjects not on ...201627166072
endogenous il-17 as a factor determining the severity of clostridium difficile infection in mice.clostridium difficile infection (cdi) is a toxin-mediated intestinal disease. toxin a, toxin b and binary toxin are believed to be responsible for the pathogenesis of cdi, which is characterized by massive infiltration of neutrophils at the infected intestinal mucosa. il-17 is one of the cytokines that play critical roles in several inflammatory and immunological diseases through various actions, including promoting neutrophil recruitment. the aim of this study was to examine the role of this cy ...201627166143
pseudomembranous colitis: not always clostridium difficile.although clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for c difficile or if presumed c difficile infection does not respond to treatment. histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause.201627168512
[fecal microbiota transplantation].fecal microbiota transplantation (fmt) is a therapeutic method, in which the fecal microflora from healthy donors is transmitted to the patient to restore the healthy microbial composition of the gut. in the recent years, there is a growing interest in the therapeutic potential of fmt in various diseases. the standard fmt protocols do not exist. procedures of fmt vary in several aspects such as donor selection, preparation of fecal material, preparation of the recipient and administration way. f ...201627172442
n-3 and n-6 fatty acid changes in the erythrocyte membranes of patients with 658240251 clostridium difficile infection.the implications of circulating essential fatty acids (fa) on the inflammatory risk profile and clinical outcome are still unclear. in order to gain a deeper understanding of the role of polyunsaturated fatty acids (pufa) in the pathogenesis of acute infection, we analyzed the fa content in red blood cell (rbc) membranes of patients with clostridium difficile infection (cdi) and controls. we prospectively studied 60 patients including 30 patients with cdi and 30 controls to assess lipid concentr ...201627172707
structural and functional changes within the gut microbiota and susceptibility to clostridium difficile infection.alteration of the gut microbial community structure and function through antibiotic use increases susceptibility to colonization by clostridium difficile and other enteric pathogens. however, the mechanisms that mediate colonization resistance remain elusive. as the leading definable cause of infectious diarrhea, toxigenic c. difficile represents a burden for patients and health care systems, underscoring the need for better diagnostics and treatment strategies. next-generation sequence data has ...201627180006
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