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clostridium difficile presence in spanish and belgian hospitals.clostridium difficile is recognised worldwide as the main cause of infectious bacterial antibiotic-associated diarrhoea in hospitals and other healthcare settings. the aim of this study was to first survey c. difficile prevalence during the summer of 2014 at the central university hospital of asturias (spain). by typing the isolates obtained, it was then possible to compare the ribotype distribution at the spanish hospital with results from the st luc university hospital in belgium over the same ...201627616443
antibiotic resistance.antimicrobial resistance in bacterial pathogens is a challenge that is associated with high morbidity and mortality. multidrug resistance patterns in gram-positive and -negative bacteria are difficult to treat and may even be untreatable with conventional antibiotics. there is currently a shortage of effective therapies, lack of successful prevention measures, and only a few new antibiotics, which require development of novel treatment options and alternative antimicrobial therapies. biofilms ar ...201627616769
why rifampin (rifampicin) is a key component in the antibiotic treatment of hidradenitis suppurativa: a review of rifampin's effects on bacteria, bacterial biofilms, and the human immune system.combinations of rifampin and clindamycin or rifampin, metronidazole, and moxifloxcin have been reported as effective treatments for hidradenitis suppurativa (hs) hurley stage 1 and hurley stage 2.  clinical trials suggest that for stage 1 and mild stage 2 hs, clindamycin 300 mg twice daily and rifampin 300 mg twice daily for 10 weeks can substantially abate hs in ~80% of cases and remit hs in ~50% of cases.  another study notes use of rifampin-moxifloxacin-metronidazole given for 6 weeks, dosed ...201627617596
assessment of the overall and multidrug-resistant organism bioburden on environmental surfaces in healthcare facilities.objective to determine the typical microbial bioburden (overall bacterial and multidrug-resistant organisms [mdros]) on high-touch healthcare environmental surfaces after routine or terminal cleaning. design prospective 2.5-year microbiological survey of large surface areas (>1,000 cm2). setting mdro contact-precaution rooms from 9 acute-care hospitals and 2 long-term care facilities in 4 states. participants samples from 166 rooms (113 routine cleaned and 53 terminal cleaned rooms). methods usi ...201627619507
therapeutic manipulation of the microbiota: past, present, and considerations for the future.the growing appreciation of the potential role of indigenous microbiota in disease has resulted in a concomitant interest in manipulating the microbiome for therapeutic effect. the most successful example of microbiota manipulation for treatment of a disease is in recurrent infection with the bacterial pathogen clostridium difficile.201627619640
efficacy of secondary prophylaxis with vancomycin for preventing recurrent clostridium difficile infections.patients with clostridium difficile infection (cdi) who are re-exposed to antibiotics have a high likelihood of recurrence. we aimed to determine whether oral vancomycin as secondary prophylaxis reduces the risk of recurrence in patients recently diagnosed with cdi who undergo subsequent antibiotic exposure (cdi-ae).201627619835
antibiotic treatment of hospitalized patients with pneumonia complicated by clostridium difficile infection.clostridium difficile infection (cdi) is one of the most common gastrointestinal complication after antimicrobial treatment. it is estimated that cdi after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. the aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia cdi. we addressed the issue by examining retrospectively the records of 217 patients who met the diagno ...201627620311
risk factors for recurrent clostridium difficile infections and strategies to decrease readmissions in a community hospital.currently there are no universally accepted approaches for the prevention of recurrent clostridium difficile infections (cdi) following the initial infection. several studies have identified common risk factors for the emergence of recurrent cdi. identifying patients at high risk for recurrent cdi through the assessment of risk factors at initial diagnosis could enable health care providers to optimize available treatment options. a vancomycin hydrochloride-tapered regimen may be an effective tr ...201527621508
modulation of microbiota as treatment for intestinal inflammatory disorders: an uptodate.alterations of intestinal microflora may significantly contribute to the pathogenesis of different inflammatory and autoimmune disorders. there is emerging interest on the role of selective modulation of microflora in inducing benefits in inflammatory intestinal disorders, by as probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (fmt). to summarize recent evidences on microflora modulation in main intestinal inflammatory disorders, pubmed was searched using ter ...201627621567
compared lethality rates of clostridium difficile infections at the local, regional and national levels in france. 201627621820
crystal structures of two nitroreductases from hypervirulent clostridium difficile and functionally related interactions with the antibiotic metronidazole.nitroreductases (nrs) are flavin mononucleotide (fmn)-dependent enzymes that catalyze the biotransformation of organic nitro compounds (rno2; r = alkyl, aryl) to the nitroso rn=o, hydroxylamino rnhoh, or amine rnh2 derivatives. metronidazole (mtz) is a nitro-containing antibiotic that is commonly prescribed for lower-gut infections caused by the anaerobic bacterium clostridium difficile. c. difficile infections rank number one among hospital acquired infections, and can result in diarrhea, sever ...201627623089
disparate prevalence of toxigenic and nontoxigenic clostridium difficile among distinct adult patient populations in a single institution.clostridium difficile (cd) disease remains a costly and important hospital-associated infection. although nontoxigenic cd is detected by some cd testing methods, can interfere with some detection algorithms and has been suggested as a treatment for cd disease, little is known about the relative occurrence of toxigenic and nontoxigenic cd in a single institution.we used both chromogenic and selective agar media to recover cd isolates and a molecular method to detect the toxin b gene from over 240 ...201627624898
evaluation of the performance of c. diff quik chek complete and its usefulness in a hospital setting with a high prevalence of clostridium difficile infection.rapid and accurate diagnosis of clostridium difficile infection (cdi) is crucial for patient care, infection control, and efficient surveillance. we evaluated c. diff quik chek complete (qcc; techlab), which detects glutamate dehydrogenase (gdh) antigen (qcc-ag) and toxin a/b (qcc-tox) simultaneously, and compared it to the laboratory diagnostics for cdi currently in use in a tertiary hospital setting with a high prevalence of cdi. qcc, ridascreen c. difficile toxin a/b assay (toxin eia; r-bioph ...201727625418
modulation of the surface-layer protein of clostridium difficile through cwp84 inhibition.cysteine protease cwp84 is responsible for surface-layer processing in clostridium difficile and was also shown to cleave several human extracellular matrix components in vitro. to enable the facile identification and characterization of cwp84 inhibitors, we developed a fluorogenic 10-mer peptide based on the enzyme's natural substrate slpa that is amenable for use in fret-based high-throughput screening. the design of substrate-mimetic inhibitors led to epoxysuccinate 8c, which displayed an ina ...201627626098
use of a collagen membrane to enhance the survival of primary intestinal epithelial cells.intestinal epithelial cell culture is important for biological, functional and immunological studies. since enterocytes have a short in vivo life span due to anoikis, we aimed to establish a novel and reproducible method to prolong the survival of mouse and human cells. cells were isolated following a standard procedure, and cultured on ordered-cow's collagen membranes. a prolonged cell life span was achieved; cells covered the complete surface of bio-membranes and showed a classical enterocyte ...201627626762
laparobotic duodenal diverticulectomy and choledochoduodenostomy: a case study and review of the literature.the duodenum is the second most common site for diverticulae, after the colon. they are common after the fifth decade and usually asymptomatic. ten percent of patients present with symptoms, which include abdominal pain, hemorrhage, duodenal obstruction, diverticulitis, perforation, pancreatitis, and obstructive jaundice. after a thorough search of medline we present, for the first time, a case of obstructive jaundice secondary to duodenal diverticulum compressing the common bile duct. it was ma ...201027628639
hypersensitivity reaction following administration of low-dose oral vancomycin for the treatment of clostridium difficile in a patient with normal renal function.systemic absorption of oral vancomycin for the treatment of clostridium difficile is thought to be trivial in patients without risk factors for increased systemic absorption and is often overlooked in clinical practice. a 51-year-old male elicits a suspected immunoglobulin e-mediated hypersensitivity following administration of low-dose oral vancomycin for the treatment of severe c difficile the patient had normal renal function and was administered low doses of the medication, however, had a me ...201627630210
'get in early'; biofilm and wax moth (galleria mellonella) models reveal new insights into the therapeutic potential of clostridium difficile bacteriophages.clostridium difficile infection (cdi) is a global health threat associated with high rates of morbidity and mortality. conventional antibiotic cdi therapy can result in treatment failure and recurrent infection. c. difficile produces biofilms which contribute to its virulence and impair antimicrobial activity. some bacteriophages (phages) can penetrate biofilms and thus could be developed to either replace or supplement antibiotics. here, we determined the impact of a previously optimized 4-phag ...201627630633
a recombination directionality factor controls the cell type-specific activation of σk and the fidelity of spore development in clostridium difficile.the strict anaerobe clostridium difficile is the most common cause of nosocomial diarrhea, and the oxygen-resistant spores that it forms have a central role in the infectious cycle. the late stages of sporulation require the mother cell regulatory protein σk. in bacillus subtilis, the onset of σk activity requires both excision of a prophage-like element (skinbs) inserted in the sigk gene and proteolytical removal of an inhibitory pro-sequence. importantly, the rearrangement is restricted to the ...201627631621
reprofiled anthelmintics abate hypervirulent stationary-phase clostridium difficile.prolonged use of broad-spectrum antibiotics disrupts the indigenous gut microbiota, which consequently enables toxigenic clostridium difficile species to proliferate and cause infection. the burden of c. difficile infections was exacerbated with the outbreak of hypervirulent strains that produce copious amounts of enterotoxins and spores. in recent past, membrane-active agents have generated a surge of interest due to their bactericidal property with a low propensity for resistance. in this stud ...201627633064
endoscopic delivery of fecal biotherapy in inflammatory bowel disease.the intestinal microbiome plays an important role in the pathogenesis of inflammatory bowel disease (ibd). we are able to use the microbiome as a therapeutic target with use of fecal microbiota transplantation (fmt) for cure of recurrent clostridium difficile infection. given our ability to target the dysbiotic state with fmt, its use as therapy in ibd has tremendous potential. this overview discusses the practical considerations of fmt therapy with respect to our current understanding of safety ...201627633598
pantoprazole or placebo for stress ulcer prophylaxis (pop-up): randomized double-blind exploratory study.pantoprazole is frequently administered to critically ill patients for prophylaxis against gastrointestinal bleeding. however, comparison to placebo has been inadequately evaluated, and pantoprazole has the potential to cause harm. our objective was to evaluate benefit or harm associated with pantoprazole administration.201627635481
molecular types and antimicrobial susceptibility patterns of clostridium difficile isolates in different epidemiological settings in a tertiary care center in israel.the aims of this prospective study were to examine the correlation between the molecular types and the antimicrobial susceptibility patterns of clostridium difficile isolates with the source of acquisition and the occurrence of c. difficile infections (cdi) in a tertiary center in israel. all available isolates from community-acquired (ca) cdi episodes (n=43) and matching numbers of isolates from community-onset, hospital acquired (co-ha, n=67) and ha-cdi (n=56) and 32 cases of recurrent cdi wer ...201627638350
[fecal microbiota transplantation, a novel therapy for recurrent clostridium difficile infection].clostridium difficile infection is caused by a disturbance of the gut microbiota, often resulting from the use of antibiotics. among a sub group of patients with this disorder, treatment with antibiotics is not effective. they develop a chronic, recurrent infection. such patients can be treated with a fecal microbiota transplantation (fmt), or fecal transplantation. the crucial steps for safe application of fecal transplantation are central donor selection and screening. to optimise safety and t ...201627643493
non-invasive fecal microbiota transplantation for recurrent clostridium difficile infection in a patient presenting with hypertensive disorder post interventionem.fecal microbiota transplantation has gathered much attention due to its high efficacy in resolving recurrent clostridium difficile infection. until today, it is recognized as a safe procedure without any severe side effects. patients with impaired conscious states suffering from recurrent episodes of aspiration are at increased risk by endoscopic interventions needed during standard approaches for fecal microbiota transplantation application.here, we illustrate the case of a tetraplegic patient ...201627644000
proton pump inhibitors and risk of clostridium difficile infection: a multi-country study using sequence symmetry analysis.to determine the association between incident proton pump inhibitor (ppi) use and clostridium difficile infections across multiple countries method: national data covering the total population in australia and korea, the canadian population over 65 years and a 3 million person random sample data set from taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in japan. sequence symmetry analysis was used to assess the association with ...201627645304
taking advantage of public reporting: an infection composite score to assist evaluating hospital performance for infection prevention efforts.the standardized infection ratio (sir) evaluates individual publicly reported health care-associated infections, but it may not assess overall performance.201627645403
risk factors for short- and long-term mortality in very old patients with clostridium difficile infection: a retrospective study.most cases of clostridium difficile infections (cdi) occur in patients aged 65 years and older. older age is associated with increased mortality. risk factors for mortality in patients aged 80 years and older are not well recognized.201627647625
the phosphotransfer protein cd1492 represses sporulation initiation in clostridium difficile.the formation of spores is critical for the survival of clostridium difficile outside the host gastrointestinal tract. persistence of c. difficile spores greatly contributes to the spread of c. difficile infection (cdi), and the resistance of spores to antimicrobials facilitates the relapse of infection. despite the importance of sporulation to c. difficile pathogenesis, the molecular mechanisms controlling spore formation are not well understood. the initiation of sporulation is known to be reg ...201627647869
fecal microbiota transplant in patients with clostridium difficile infection: a systematic review.fecal microbiota transplantation (fmt) restores a diverse bacterial profile to the gastrointestinal tract and may effectively treat patients with clostridium difficile infection (cdi). the objective of this systematic review was to evaluate the effectiveness of fmt in the treatment of cdi.201627648772
community- and healthcare-associated clostridium difficile infections, finland, 2008-2013(1).we evaluated incidence, case-fatality rate, and trends of community-associated (ca) and healthcare-associated (ha) clostridium difficile infections (cdis) in finland during 2008-2013. cdis were identified in the national infectious disease register, deaths in the national population information system, hospitalizations to classify infections as ca or ha in the national hospital discharge register, and genotypes in a reference laboratory. a total of 32,991 cdis were identified: 10,643 (32.3%) wer ...201627648884
a comparison of histamine receptor antagonists versus proton pump inhibitor gastrointestinal ulcer prophylaxis in kidney transplant recipients.there are several different agents that can be used for gastrointestinal (gi) ulcer prophylaxis in posttransplant recipients, such as histamine-2 receptor antagonists (h2ra) or proton pump inhibitors (ppis).201627650918
clostridium difficile infection diagnostics - evaluation of the c. diff quik chek complete assay, a rapid enzyme immunoassay for detection of toxigenic c. difficile in clinical stool samples.diagnostic testing for clostridium difficile infection (cdi) has, in recent years, seen the introduction of rapid dual-eia (enzyme immunoassay) tests combining species-specific glutamate dehydrogenase (gdh) with toxin a/b. in a prospective study, we compared the c. diff quik chek complete test to a combination of selective culture (sc) and loop-mediated isothermal amplification (lamp) of the toxin a gene. of 419 specimens, 68 were positive in sc including 62 positive in lamp (14.7%). the combine ...201627651167
tea and recurrent clostridium difficile infection.background and aims. studies have shown effects of diet on gut microbiota. we aimed to identify foods associated with recurrent clostridium difficile infection (cdi). methods. in this cross-sectional survey, consecutive patients diagnosed with cdi were identified by electronic medical records. colitis symptoms and positive clostridium difficile assay were confirmed. health-care onset-health-care facility associated cdi was excluded. food surveys were mailed to 411 patients. survey responses serv ...201627651790
what's a snp between friends: the influence of single nucleotide polymorphisms on virulence and phenotypes of clostridium difficile strain 630 and derivatives.clostridium difficile is a major cause of antibiotic induced diarrhea worldwide, responsible for significant annual mortalities and represents a considerable economic burden on healthcare systems. the two main c. difficile virulence factors are toxins a and b. isogenic toxin b mutants of 2 independently isolated erythromycin-sensitive derivatives (630e and 630δerm) of strain 630 were previously shown to exhibit substantively different phenotypes. compared to 630, strain 630e and its progeny grow ...201627652799
2016 update on medical overuse: a systematic review.overuse of medical care is an increasingly recognized problem in clinical medicine.201627654002
advances in the microbiome: applications to clostridium difficile infection.clostridium difficile is a major cause of morbidity and mortality worldwide, causing over 400,000 infections and approximately 29,000 deaths in the united states alone each year. c. difficile is the most common cause of nosocomial diarrhoea in the developed world, and, in recent years, the emergence of hyper-virulent (mainly ribotypes 027 and 078, sometimes characterised by increased toxin production), epidemic strains and an increase in the number of community-acquired infections has caused fur ...201627657145
overwhelming recurrent clostridium difficile infection after reversal of diverting loop ileostomy created for prior fulminant c. difficile colitis. 201627657564
fecal microbiota transplant in patients with recurrent clostridium difficile infection.the clinical effectiveness of fecal microbiota transplant (fmt) for the treatment of recurrent clostridium difficile infections (rcdi) has been demonstrated in randomized controlled trials. to assess the current status of fmt in germany with respect to active centers, local standards, clinical effectiveness and safety, the microtrans registry (nct02681068) was established.201627658471
role of cephalosporins in the era of clostridium difficile infection.the incidence of clostridium difficile infection (cdi) in europe has increased markedly since 2000. previous meta-analyses have suggested a strong association between cephalosporin use and cdi, and many national programmes on cdi control have focused on reducing cephalosporin usage. despite reductions in cephalosporin use, however, rates of cdi have continued to rise. this review examines the potential association of cdi with cephalosporins, and considers other factors that influence cdi risk. e ...201727659735
prevention of infection due to clostridium difficile.clostridium difficile is one of the foremost nosocomial pathogens. preventing infection is particularly challenging. effective prevention efforts typically require a multifaceted bundled approach. a variety of infection control procedures may be advantageous, including strict hand decontamination with soap and water, contact precautions, and using chlorine-containing decontamination agents. additionally, risk factor reduction can help reduce the burden of disease. the risk factor modification is ...201627660089
vaccinology gets help from chemistry.a recent report on the immunological activity of protein conjugates of synthetic lipoteicoic fragments from clostridium difficile underpins the use of these molecules for the development of a vaccine. in a recent issue of cell chemical biology, broecker et al. (2016) illustrate the utility of glycoarray-based selection of bacterial carbohydrates with the potential to become vaccine candidates.201627662251
faecal microbiota transplantation for recurring clostridium difficile infection in a patient with crohn's disease and ileorectal anastomosis.faecal microbiota transplantation (fmt) is increasingly being used to treat refractory and recurring clostridium difficile infection (cdi). although fmt appears to be safe and highly effective in patients with a preserved colon and immunocompetence, its use in patients with inflammatory bowel disease (ibd) who are on immunomodulating therapies is controversial. in particular, patients who have undergone colectomy may have different treatment responses to fmt. in this case report, we describe the ...201627664230
inappropriate clostridium difficile testing and consequent overtreatment and inaccurate publicly reported metrics.background the nationally reported metric for clostridium difficile infection (cdi) relies solely on laboratory testing, which can result in overreporting due to asymptomatic c. difficile colonization. objective to review the clinical scenarios of cases of healthcare facility-onset cdi (ho-cdi) and to determine the appropriateness of c. difficile testing on the basis of presence of symptomatic diarrhea in order to identify areas for improvement. design retrospective cohort study. setting northwe ...201627666285
dietary zinc alters the microbiota and decreases resistance to clostridium difficile infection.clostridium difficile is the most commonly reported nosocomial pathogen in the united states and is an urgent public health concern worldwide. over the past decade, incidence, severity and costs associated with c. difficile infection (cdi) have increased dramatically. cdi is most commonly initiated by antibiotic-mediated disruption of the gut microbiota; however, non-antibiotic-associated cdi cases are well documented and on the rise. this suggests that unexplored environmental, nutrient and hos ...201627668938
patients with risk factors for complications do not require longer antimicrobial therapy for complicated intra-abdominal infection.a prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. we hypothesized that patients with specific risk factors for complications also had similar outcomes. short-course patients with obesity, diabetes, or acute physiology and chronic health evaluation ii ≥15 from the stop-it trial were compared with longer duration patients. outcomes ...201627670577
the housefly musca domestica as a mechanical vector of clostridium difficile.clostridium difficile is a bacterial healthcare-associated infection that may be transferred by houseflies (musca domestica) due to their close ecological association with humans and cosmopolitan nature.201627671221
assessing the risk of hospital-acquired clostridium difficile infection with proton pump inhibitor use: a meta-analysis.background clostridium difficile is the principal infectious cause of antibiotic-associated diarrhea and accounts for 12% of hospital-acquired infections. recent literature has shown an increased risk of c. difficile infection (cdi) with proton pump inhibitor (ppi) use. objective to conduct a systematic assessment of the risk of hospital-acquired cdi following exposure to ppi. methods we searched multiple databases for studies examining the relationship between ppi and hospital-acquired cdi. poo ...201627677811
eccmid 2016: addressing the burden of recurrent clostridium difficile infections.26th european congress of clinical microbiology and infectious diseases (eccmid), 9-12th april 2016, amsterdam, the netherlands the european congress of clinical microbiology and infectious diseases (eccmid) is the annual scientific meeting of the european society of clinical microbiology. eccmid 2016, held in amsterdam, the netherlands, was attended by over 11,600 clinical microbiologists and infectious disease physicians from more than 120 countries. the congress offered an essential opportuni ...201627679929
frizzled proteins are colonic epithelial receptors for c. difficile toxin b.clostridium difficile toxin b (tcdb) is a critical virulence factor that causes diseases associated with c. difficile infection. here we carried out crispr-cas9-mediated genome-wide screens and identified the members of the wnt receptor frizzled family (fzds) as tcdb receptors. tcdb binds to the conserved wnt-binding site known as the cysteine-rich domain (crd), with the highest affinity towards fzd1, 2 and 7. tcdb competes with wnt for binding to fzds, and its binding blocks wnt signalling. fzd ...201627680706
measuring appropriate antimicrobial use: attempts at opening the black box.indiscriminate antimicrobial use has plagued medicine since antibiotics were first introduced into clinical practice >70 years ago. infectious diseases physicians and public health officials have advocated for preservation of these life-saving drugs for many years. with rising burden of antimicrobial-resistant organisms and clostridium difficile infections, halting unnecessary antimicrobial use has become one of the largest public health concerns of our time. inappropriate antimicrobial use has ...201627682070
chemokine cxcl13 expression was up-regulated in clostridium difficile infection.clostridium difficile infection (cdi) is the leading cause of antibiotic- and healthcare-associated diarrhea. cxcl13 is a well-known cxc chemokine involved in inflammation, but its role in cdi remains unknown. in this study, serum and fecal samplings were collected from 51 cdi patients, 50 diarrhea patients without cdi and 50 healthy control subjects to determine the cxcl13 levels by enzyme-linked immunosorbent assay (elisa). besides, a mouse model of c. difficile infection was established, and ...201627685937
serendipity in refractory celiac disease: full recovery of duodenal villi and clinical symptoms after fecal microbiota transfer.treatment of refractory celiac disease type ii (rcd ii) and preventing the development of an enteropathy associated t-cell lymphoma in these patients is still difficult. in this case report, we describe a patient with rcd ii who received fecal microbiota transfer as treatment for a recurrent clostridium difficile infection, and remarkably showed a full recovery of duodenal villi and disappearance of celiac symptoms. this case suggests that altering the gut microbiota may hold promise in improvin ...201627689204
henoch schonlein purpura and clostridium difficile infection: a hematologist's point of view. 201627689213
mathematical modeling of the transmission dynamics of clostridium difficile infection and colonization in healthcare settings: a systematic review.we conducted a systematic review of mathematical models of transmission dynamic of clostridium difficile infection (cdi) in healthcare settings, to provide an overview of existing models and their assessment of different cdi control strategies.201727690247
an evaluation of food as a potential source for clostridium difficile acquisition in hospitalized patients.objective to determine whether clostridium difficile is present in the food of hospitalized patients and to estimate the risk of subsequent colonization associated with c. difficile in food. methods this was a prospective cohort study of inpatients at a university-affiliated tertiary care center, may 9, 2011-july 12, 2012. enrolled patients submitted a portion of food from each meal. patient stool specimens and/or rectal swabs were collected at enrollment, every 3 days thereafter, and at dischar ...201627691986
reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens.the purpose of this study was to determine the effectiveness of copper-impregnated composite hard surfaces and linens in an acute care hospital to reduce health care-associated infections (hais).201627692785
high prevalence of nontoxigenic clostridium difficile isolated from hospitalized and non-hospitalized individuals in rural ghana.since data about clostridium difficile infection in sub-saharan africa are scarce, we determined its epidemiology and risk factors in a cross-sectional study in eikwe, a rural community in ghana. we tested stool samples from 176 hospitalized patients with diarrhoea and from 131 asymptomatic non-hospitalized individuals for c. difficile and some other enteric pathogens. the overall prevalence rate of c. difficile was 4.9% with ribotype 084 being predominant. with 75% of the isolates, a high rate ...201627693000
clostridium difficile: a rare cause of pyogenic liver abscess.extra-intestinal infections due to clostridium difficile have been reported rarely. herein we report a case of pyogenic liver abscess from toxigenic c. difficile in an 80-year-old non-hospitalized woman with diabetes mellitus, cerebrovascular and cardiovascular diseases. the patient was admitted to the emergency department with fever and abdominal pain. there was no history of diarrhea or use of antibiotics. laboratory parameters revealed signs of inflammation and elevated ast and alt levels. ab ...201627693543
host response to clostridium difficile infection: diagnostics and detection.clostridium difficile infection (cdi) is a significant healthcare concern worldwide, and c. difficile is recognised as the most frequent aetiological agent of infectious healthcare-associated diarrhoea in hospitalised adult patients. the clinical manifestation of cdi varies from self-limited diarrhoea to life-threatening colitis. such a broad disease spectrum can be explained by the impact of host factors. currently, a complex cdi aetiology is widely accepted, acknowledging the interaction betwe ...201627693863
influence of saccharomyces boulardii cncm i-745on the gut-associated immune system.the probiotic saccharomyces boulardii cncm i-745 (also known as saccharomyces cerevisiae hansen cbs 5926; in the following s. boulardii) has proven its effectiveness in preventive and therapeutic treatment of many gastrointestinal diseases, especially diseases associated with acute diarrhea. in particular, antibiotic-associated diarrhea, clostridium difficile-associated diarrhea, traveller's diarrhea, as well as acute diarrhea due to common viral and bacterial infections in children and adults.201627695355
effect of detecting and isolating asymptomatic clostridium difficile carriers. 201627695834
effect of detecting and isolating asymptomatic clostridium difficile carriers-reply. 201627695841
clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.clostridium difficile infection (cdi) is increasingly found in children worldwide, but limited data are available from children living in southern europe. a 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in italy. data of children with community- and hospital-acquired cdi (ca-cdi and ha-cdi, respectively) seen at seven pediatric referral centers in italy were recorded retrospectively. annual infection rates/10,000 ho ...201727696233
toxin a-negative toxin b-positive ribotype 017 clostridium difficile is the dominant strain type in patients with diarrhoea attending tuberculosis hospitals in cape town, south africa.the molecular epidemiology of c. difficile strains causing disease in south africa is currently unknown. previously, multidrug resistant ribotype (rt)017 strains were those most commonly isolated from patients with diarrhoea attending groote schuur hospital in cape town, south africa. this larger study aimed to investigate the molecular epidemiology and antibiotic susceptibility profiles of c. difficile strains in the greater cape town and regional areas. c. difficile strains were isolated from ...201727696234
assessing methanobrevibacter smithii and clostridium difficile as not conventional faecal indicators in effluents of a wastewater treatment plant integrated with sludge anaerobic digestion.wastewater treatment plants (wwtp) are an important source of surface water contamination by enteric pathogens, affecting the role of environmental water as a microbial reservoir. we describe the release to the environment of certain anaerobes of human and environmental concern. the work was focused on emerging microbial targets. they are tracing, by rt-qpcr, on wwtp effluents, both liquid and solid, when an anaerobic digestion step is included. the focus is placed on clostridium spp. with the s ...201627697372
norovirus infection in solid organ transplant recipients: a single-center retrospective study.norovirus (nov) is gaining recognition as an important cause of diarrhea among solid organ transplant (sot) recipients, but existing studies have been limited by a small sample size.201627699965
nodular colitis: endoscopic image an unusual finding.an 82-year-old male with a history of high blood pressure, copd, chronic myeloid leukemia, and stage-4 chronic renal failure. admitted to hospital for lower-limb cellulitis and severe copd exacerbation, he received antibiotic therapy and bronchodilators. during his hospital stay he developed severe anemia and had an hematochezia event with no diarrhea. a complete colonoscopy found small (4-7 mm) nacreous elevated lesions, circumferential in shape, in the cecum and ascending colon with some bleed ...201627701886
role of glycosyltransferases modifying type b flagellin of emerging hypervirulent clostridium difficile lineages and their impact on motility and biofilm formation.clostridium difficile is the principal cause of nosocomial infectious diarrhea worldwide. the pathogen modifies its flagellin with either a type a or type b o-linked glycosylation system, which has a contributory role in pathogenesis. we study the functional role of glycosyltransferases modifying type b flagellin in the 023 and 027 hypervirulent c. difficile lineages by mutagenesis of five putative glycosyltransferases and biosynthetic genes. we reveal their roles in the biosynthesis of the flag ...201627703012
clearance of vancomycin-resistant enterococcus concomitant with administration of a microbiota-based drug targeted at recurrent clostridium difficile infection.background.  vancomycin-resistant enterococcus (vre) is a major healthcare-associated pathogen and a well known complication among transplant and immunocompromised patients. we report on stool vre clearance in a post hoc analysis of the phase 2 punch cd study assessing a microbiota-based drug for recurrent clostridium difficile infection (cdi). methods.  a total of 34 patients enrolled in the punch cd study received 1 or 2 doses of rbx2660 (microbiota suspension). patients were requested to volu ...201627703995
impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on clostridium difficile infection incidence among hematology-oncology patients.objective to evaluate the impact of no-touch terminal room no-touch disinfection using ultraviolet wavelength c germicidal irradiation (uvgi) on c. difficile infection (cdi) rates on inpatient units with persistently high rates of cdi despite infection control measures. design interrupted time-series analysis with a comparison arm. setting 3 adult hematology-oncology units in a large, tertiary-care hospital. methods we conducted a 12-month prospective valuation of uvgi. rooms of patients with cd ...201727707423
short- and long-term effects of oral vancomycin on the human intestinal microbiota.oral vancomycin remains the mainstay of therapy for severe infections produced by clostridium difficile, the most prevalent cause of healthcare-associated infectious diarrhoea in developed countries. however, its short- and long-term effects on the human intestinal microbiota remain largely unknown.201727707993
in vitro antibacterial activity of rhodanine derivatives against pathogenic clinical isolates.bacterial infections present a serious challenge to healthcare practitioners due to the emergence of resistance to numerous conventional antibacterial drugs. therefore, new bacterial targets and new antimicrobials are unmet medical needs. rhodanine derivatives have been shown to possess potent antimicrobial activity via a novel mechanism. however, their potential use as antibacterials has not been fully examined. in this study, we determined the spectrum of activity of seven rhodanine derivative ...201627711156
gut eradication of vim-1 producing st9 klebsiella oxytoca after fecal microbiota transplantation for diarrhea caused by a clostridium difficile hypervirulent r027 strain.we report the fecal carriage eradication of a vim-1-producing st9 klebsiella oxytoca strain in a pluripathological 84-year-old woman after fecal microbiota transplantation to control relapsing r027 hypervirulent clostridium difficile infections. the donor was her son, in which the absence of fecal carbapenemase-producing bacteria was corroborated.201627712927
characterization of the adherence of clostridium difficile spores: the integrity of the outermost layer affects adherence properties of spores of the epidemic strain r20291 to components of the intestinal mucosa.clostridium difficile is the causative agent of the most frequently reported nosocomial diarrhea worldwide. the high incidence of recurrent infection is the main clinical challenge of c. difficile infections (cdi). formation of c. difficile spores of the epidemic strain r20291 has been shown to be essential for recurrent infection and transmission of the disease in a mouse model. however, the underlying mechanisms of how these spores persist in the colonic environment remains unclear. in this wo ...201627713865
crystal structure and dna binding activity of a padr family transcription regulator from hypervirulent clostridium difficile r20291.clostridium difficile is a spore-forming obligate anaerobe that can remain viable for extended periods, even in the presence of antibiotics, which contributes to the persistence of this bacterium as a human pathogen during host-to-host transmission and in hospital environments. we examined the structure and function of a gene product with the locus tag cdr20291_0991 (cdpadr1) as part of our broader goal aimed at elucidating transcription regulatory mechanisms involved in virulence and antibiotic ...201627716049
longitudinal survey of clostridium difficile presence and gut microbiota composition in a belgian nursing home.increasing age, several co-morbidities, environmental contamination, antibiotic exposure and other intestinal perturbations appear to be the greatest risk factors for c. difficile infection (cdi). therefore, elderly care home residents are considered particularly vulnerable to the infection. the main objective of this study was to evaluate and follow the prevalence of c. difficile in 23 elderly care home residents weekly during a 4-month period. a c. difficile microbiological detection scheme wa ...201627716140
rapid change of fecal microbiome and disappearance of clostridium difficile in a colonized infant after transition from breast milk to cow milk.clostridium difficile is the most common known cause of antibiotic-associated diarrhea. upon the disturbance of gut microbiota by antibiotics, c. difficile establishes growth and releases toxins a and b, which cause tissue damage in the host. the symptoms of c. difficile infection disease range from mild diarrhea to pseudomembranous colitis and toxic megacolon. interestingly, 10-50 % of infants are asymptomatic carriers of c. difficile. this longitudinal study of the c. difficile colonization in ...201627717398
the efficacy of fidaxomicin in the treatment of clostridium difficile infection in a real-world clinical setting: a spanish multi-centre retrospective cohort.the objective of this study was to evaluate the efficacy and safety of fidaxomicin in the real-life clinical setting. this was a retrospective cohort of patients with clostridium difficile infection (cdi) treated with fidaxomicin in 20 spanish hospitals between july 2013 and july 2014. clinical cure, 30-day recurrence, 30-day mortality, sustained cure, and factors associated with the failure to achieve sustained cure were analyzed. of the 72 patients in the cohort 41 (56.9 %) had a fatal underly ...201727718071
successful colonoscopic fecal microbiota transplantation for active ulcerative colitis: first report from india.forty-four-year-old male with ulcerative colitis (uc) for 11 years reported frequent relapse despite daily sulfasalazine 4 g, azathioprine 125 mg, and rectal 5-aminosalicylic acid. repeated use of corticosteroids led to cataract. at enrollment, he was passing eight stools a day with blood with a mayo score of 9 (3+1+3+2). stool was negative for ova/cysts/acid fast bacilli and clostridium difficile toxin assay. rectal biopsy showed cryptitis, crypt abscess, and crypt distortion with no inclusion ...201627718119
fecal microbiota-based therapeutics for recurrent clostridium difficile infection, ulcerative colitis and obesity.the human gut microbiome is a complex ecosystem of fundamental importance to human health. our increased understanding of gut microbial composition and functional interactions in health and disease states has spurred research efforts examining the gut microbiome as a valuable target for therapeutic intervention. this review provides updated insight into the state of the gut microbiome in recurrent clostridium difficile infection (cdi), ulcerative colitis (uc), and obesity while addressing the ra ...201627720396
more than 50% of clostridium difficile isolates from pet dogs in flagstaff, usa, carry toxigenic genotypes.nosocomial acquisition of clostridium difficile is well documented, yet recent studies have highlighted the importance of community acquired infections and identified community associated reservoirs for this pathogen. multiple studies have implicated companion pets and farm animals as possible sources of community acquired c. difficile infections in humans. to explore the potential role of pet dogs in human c. difficile infections we systematically collected canine fecal samples (n = 197) in fla ...201627723795
receipt of antibiotics in hospitalized patients and risk for clostridium difficile infection in subsequent patients who occupy the same bed.to assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for cdi in subsequent patients who occupy the same bed.201627723860
hearing the alarm.many directors of nursing will, like me, have read with interest the healthcare commission ( 2007 ) report into the outbreaks of clostridium difficile at maidstone and tunbridge wells nhs trust, kent, and, being responsible to their trust boards for infection control, will have reassessed their trusts' policies in light of its recommendations.200827724551
long-term effects on luminal and mucosal microbiota and commonly acquired taxa in faecal microbiota transplantation for recurrent clostridium difficile infection.faecal microbiota transplantation (fmt) is an effective treatment for recurrent clostridium difficile infection (rcdi). it restores the disrupted intestinal microbiota and subsequently suppresses c. difficile. the long-term stability of the intestinal microbiota and the recovery of mucosal microbiota, both of which have not been previously studied, are assessed herein. further, the specific bacteria behind the treatment efficacy are also investigated.201627724956
characterization of clostridium difficile pcr-ribotype 018: a problematic emerging type.recent surveys indicate that the majority of toxigenic clostridium difficile strains isolated in european hospitals belonged to pcr-ribotypes (rts) different from rt 027 or rt 078. among these types, rt 018 has been reported in italy and, more recently, in korea and japan. in italy, strains rt 018 have become predominant in the early 2000s, whereas the majority of strains isolated before were rt 126, a type belonging to the same lineage as the rt 078. in this study, we have found that italian st ...201627725230
selected topics in anaerobic bacteriology.alteration in the host microbiome at skin and mucosal surfaces plays a role in the function of the immune system, and may predispose immunocompromised patients to infection. because obligate anaerobes are the predominant type of bacteria present in humans at skin and mucosal surfaces, immunocompromised patients are at increased risk for serious invasive infection due to anaerobes. laboratory approaches to the diagnosis of anaerobe infections that occur due to pyogenic, polymicrobial, or toxin-pr ...201627726792
surviving between hosts: sporulation and transmission.to survive adverse conditions, some bacterial species are capable of developing into a cell type, the "spore," which exhibits minimal metabolic activity and remains viable in the presence of multiple environmental challenges. for some pathogenic bacteria, this developmental state serves as a means of survival during transmission from one host to another. spores are the highly infectious form of these bacteria. upon entrance into a host, specific signals facilitate germination into metabolically ...201627726794
the projected effectiveness of clostridium difficile vaccination as part of an integrated infection control strategy.early clinical trials of a clostridium difficile toxoid vaccine show efficacy in preventing c. difficile infection (cdi). the optimal patient group to target for vaccination programmes remains unexplored. this study performed a model-based evaluation of the effectiveness of different cdi vaccination strategies, within the context of existing infection prevention and control strategies such as antimicrobial stewardship.201627727031
semicarbazone ega inhibits uptake of diphtheria toxin into human cells and protects cells from intoxication.diphtheria toxin is a single-chain protein toxin that invades human cells by receptor-mediated endocytosis. in acidic endosomes, its translocation domain inserts into endosomal membranes and facilitates the transport of the catalytic domain (dta) from endosomal lumen into the host cell cytosol. here, dta adp-ribosylates elongation factor 2 inhibits protein synthesis and leads to cell death. the compound 4-bromobenzaldehyde n-(2,6-dimethylphenyl)semicarbazone (ega) has been previously shown to pr ...201627729638
clinical use comparison of a semiautomated pcr with fluorescent ribotyping for typing of clostridium difficile.molecular typing of clostridium difficile is performed to assess strain relatedness or place strains within an epidemiological context. different c. difficile ribotyping systems are available. however, a common strain library does not exist. we aimed to compare ribotyping results of 29 clinical c. difficile isolates by two methods: semiautomated pcr-ribotyping and fluorescent pcr-ribotyping. for certain ribotypes (n = 16/29; 55.2 %), the inter-laboratory reproducibility was consistent among mult ...201727730251
quantitative structure activity relationship (qsar) studies on nitazoxanide-based analogues against clostridium difficile in vitro.quantitative structure activity relationship (qsar) has been established between the various physiochemical parameters of a series of nitazoxanide-based analogues and its antibacterial activity against clostridium difficile. genetic function approximation (gfa) and comparative molecular field analysis (comfa) techniques were used to identify the descriptors that have influence on biological activity. the most influencing molecular descriptors identified in 2d-qsar include spatial, topological, a ...201627731829
beating the bug.nhs trusts across england are under orders from the chief nursing officer christine beasley to step up their efforts to control clostridium difficile infection rates.200727732112
'superbug supremo' to oversee random hospital inspections.a 'superbug supremo' is to be appointed to spearhead scotland's new inspectorate to scrutinise hospitals' performance in dealing with infections such as mrsa and clostridium difficile.200927732445
clostridium difficile infection in dialysis patients.clostridium difficile infection (cdi) is the most common cause of nosocomial diarrhea. patients with end-stage renal disease (esrd) may be at increased risk for cdi. patients with esrd with cdi have increased mortality, longer length of stay, and higher costs. the present studies extend these observations and address associated comorbidities, incidence of recurrence, and risk factors for mortality. we queried the united states renal data system (usrds) for patients with esrd diagnosed with cdi, ...201727737913
probiotics history.gut microbiota promotes healthy effects on the host and prevents diseases. probiotic (probios, for life) are defined as "live microorganisms which when administered in adequate amounts confer a health benefit on the host." at the beginning of 1900s louis pasteur identified the microorganisms responsible for the process of fermentation, whereas e. metchnikoff associated the enhanced longevity of bulgarian rural people to the regular consumption of fermented dairy products such as yogurt. he sugge ...201627741152
probiotics and liver disease: where are we now and where are we going?probiotics are live, nonpathogenic bacteria capable of colonizing the colonic mucosa. the most common probiotics include strains of lactobacillus or bifidobacteria, which are part of the normal gastrointestinal microbiota. initial studies of selected probiotic species have suggested potential efficacy in several gastrointestinal diseases including inflammatory bowel diseases (particularly pouchitis), antibiotic-related diarrhea, clostridium difficile toxin-induced colitis, infectious diarrhea, i ...201627741172
a clostridium difficile cell wall glycopolymer locus influences bacterial shape, polysaccharide production and virulence.clostridium difficile is a diarrheagenic pathogen associated with significant mortality and morbidity. while its glucosylating toxins are primary virulence determinants, there is increasing appreciation of important roles for non-toxin factors in c. difficile pathogenesis. cell wall glycopolymers (cwgs) influence the virulence of various pathogens. five c. difficile cwgs, including psii, have been structurally characterized, but their biosynthesis and significance in c. difficile infection is un ...201627741317
clostridium difficile infection.clostridium difficile can be cultured from the stool of 3 per cent of healthy adults but most people remain asymptomatic. clinical disease develops when normal gut flora is disrupted, usually by antibiotic exposure, thereby creating conditions that favour c. difficile proliferation in the colon. gastrointestinal diseases associated with c. difficile infection range from mild diarrhoea to fulminant colitis. some 'silent' infections present with abdominal pain and distension but little or no diarr ...201027741668
scandal-hit hospital empowers ward sisters to slash infection rates.a hospital where clostridium difficile was found to have contributed to the deaths of 90 patients has slashed infection rates by empowering ward sisters.201027741749
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