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the tipping point: patients predisposed to clostridium difficile infection and a hospital antimicrobial stewardship programme.the incidence and severity of clostridium difficile infection (cdi) have increased in recent years. predictive models may help to identify at-risk patients before the onset of infection. early identification of high-risk patients could help antimicrobial stewardship (ams) programmes and other initiatives to better prevent c. difficile in these patients.201627742079
clostridium difficile environmental contamination within a clinical laundry facility in the usa.clostridium difficile is both a hospital and community acquired pathogen. the current study determined if c. difficile could be cultured from clinical laundry facility surfaces. a total of 240 surface samples were collected from dirty areas (n = 120), which handle soiled clinical linens, and from clean areas (n = 120), which process and fold the clean linens, within the university of washington consolidated laundry facility in 2015. sampling was done four times over the course of one year. the d ...201627744367
failure of risk-adjustment by test method for c. difficile laboratory-identified event reporting.using an algorithm including both enzyme immunoassay (eia) and nucleic acid amplification (naat) for clostridium difficile infection (cdi) diagnosis, we found that the use of naat versus eia almost doubled our hospital-onset cdi laboratory-identified (labid) event standardized infection ratio (sir). we recommend that the current risk adjustment approach be modified. infect control hosp epidemiol 2016:1-3.201727745553
an antimicrobial stewardship program based on systematic infectious disease consultation in a rehabilitation facility.objective to assess the impact of an antimicrobial stewardship program (asp) on antibiotic consumption, clostridium difficile infections (cdi), and antimicrobial resistance patterns in a rehabilitation hospital. design quasi-experimental study of the periods before (from january 2011 to june 2012) and after (from july 2012 to december 2014) asp implementation. setting 150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries. intervention beginning in july 2012, an asp was ...201727745559
the cost-efficiency and care effectiveness of probiotic administration with antibiotics to prevent hospital-acquired clostridium difficile infection.health care facility-acquired clostridium difficile infections (hcfa-cdi) have increased over the last several decades despite facilities developing protocols for prescribing probiotics with antibiotics to prevent hcfa-cdi. the literature does not consistently support this. a retrospective medical record review evaluated the care effectiveness of this practice. care effectiveness was not found; patients receiving probiotics with antibiotics were twice as likely to develop hcfa-cdi (p = .004). ex ...201627749722
thermal contrast amplification reader yielding 8-fold analytical improvement for disease detection with lateral flow assays.there is an increasing need for highly sensitive and quantitative diagnostics at the point-of-care. the lateral flow immunoassay (lfa) is one of the most widely used point-of-care diagnostic tests; however, lfas generally suffer from low sensitivity and lack of quantification. to overcome these limitations, thermal contrast amplification (tca) is a new method that is based on the laser excitation of gold nanoparticles (gnps), the most commonly used visual signature, to evoke a thermal signature. ...201627750420
distribution of clostridium difficile pcr ribotypes and high proportion of 027 and 176 in some hospitals in four south eastern european countries.while clostridium difficile epidemiology is well documented in many european countries, data are largely missing for south eastern european region. here we report the pcr ribotype distribution of 249 c. difficile isolates received for typing from six hospital settings from croatia, bosnia and herzegovina, republic of macedonia and serbia in time period from 2008 to 2015. twenty-four pcr ribotypes were detected. the majority of strains from bosnia and herzegovina and serbia belonged to pcr riboty ...201627751937
emergence and spread of moxifloxacin-resistant clostridium difficile ribotype 231 in sweden between 2006 and 2015.an aggregation of moxifloxacin-resistant clostridium difficile ribotype 231 (rt231) isolates was first identified in the county of stockholm in 2008, and by the end of 2015 isolates of rt231 had spread to 13 of 21 swedish counties. we investigated the epidemiology of c. difficile rt231 in sweden between 2006 and 2015 using whole genome sequencing (wgs) and evaluated whether its emergence could be associated with extended moxifloxacin use. we performed wgs and phylogenetic analysis of 51 c. diffi ...201627752322
new and emerging therapies for clostridium difficile infection.clostridium difficile infection has attained high prominence given its prevalence and impacts on patients and healthcare institutions. multiple new approaches to the prevention and treatment of c. difficile infection (cdi) are undergoing clinical trials.201627753689
increased rates of clostridium difficile infection and poor outcomes in patients with ibd with cytomegalovirus.clostridium difficile infection (cdi) and cytomegalovirus (cmv) reactivation are associated with disease exacerbations and poor outcomes in inflammatory bowel disease (ibd). therefore, we assessed the association between these organisms in patients with ibd and the impact on colectomy.201627755270
the use and efficacy of fecal microbiota transplantation for refractory clostridium difficile in patients with inflammatory bowel disease.clostridium difficile (cd) is an anaerobic, spore-forming bacillus that is responsible for a spectrum of gastrointestinal illness ranging from asymptomatic carriage to toxic megacolon and death. the prevalence of cd infection is increasing in both hospitalized and community-based inflammatory bowel disease populations. standard antibiotic therapy fails to cure or prevent recurrence in more than 50% of patients, thus increasing the need for alternative therapies. recently, fecal microbiota transp ...201627755271
burden of six healthcare-associated infections on european population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study.estimating the burden of healthcare-associated infections (hais) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. based on the methodology of the burden of communicable diseases in europe (bcode) project and 2011-2012 data from the european centre for disease prevention and control (ecdc) point prevalence survey (pps) of hais and antimicrobial use in european acute care hospit ...201627755545
the monoclonal antitoxin antibodies (actoxumab-bezlotoxumab) treatment facilitates normalization of the gut microbiota of mice with clostridium difficile infection.antibiotics have significant and long-lasting impacts on the intestinal microbiota and consequently reduce colonization resistance against clostridium difficile infection (cdi). standard therapy using antibiotics is associated with a high rate of disease recurrence, highlighting the need for novel treatment strategies that target toxins, the major virulence factors, rather than the organism itself. human monoclonal antibodies mk-3415a (actoxumab-bezlotoxumab) to c. difficile toxin a and toxin b, ...201627757389
the type b flagellin of hypervirulent clostridium difficile is modified with novel sulfonated peptidylamido-glycans.glycosylation of flagellins is a well recognized property of many bacterial species. in this study, we describe the structural characterization of novel flagellar glycans from a number of hypervirulent strains of c. difficile we used mass spectrometry (nano-lc-ms and ms/ms analysis) to identify a number of putative glycopeptides that carried a variety of glycoform substitutions, each of which was linked through an initial n-acetylhexosamine residue to ser or thr. detailed analysis of a lldgsstei ...201627758867
wall teichoic acids are involved in the medium-induced loss of function of the autolysin cd11 against clostridium difficile.bacterial lysins are potent antibacterial enzymes with potential applications in the treatment of bacterial infections. some lysins lose activity in the growth media of target bacteria, and the underlying mechanism remains unclear. here we use cd11, an autolysin of clostridium difficile, as a model lysin to demonstrate that the inability of this enzyme to kill c. difficile in growth medium is not associated with inhibition of the enzyme activity by medium, or the modification of the cell wall pe ...201627759081
utilization of health services among adults with recurrent clostridium difficile infection: a 12-year population-based study.background considerable efforts have been dedicated to developing strategies to prevent and treat recurrent clostridium difficile infection (rcdi); however, evidence of the impact of rcdi on patient healthcare utilization and outcomes is limited. objective to compare healthcare utilization and 1-year mortality among adults who had rcdi, nonrecurrent cdi, or no cdi. methods we performed a nested case-control study among adult kaiser foundation health plan members from september 1, 2001, through d ...201727760583
laboratory experience with the liaison analyzer in the diagnosis of clostridium difficile-associated diarrhea.chemiluminescent or enzyme-linked fluorescent immunoassays are commonly used to diagnose clostridium difficile-associated diarrhea.201627766170
fear of failure: engaging patients in antimicrobial stewardship after fecal transplantation for recurrent clostridium difficile infection. 201727766987
household transmission of clostridium difficile to family members and domestic pets.objective to determine the risk of clostridium difficile transmission from index cases with c. difficile infection (cdi) to their household contacts and domestic pets. design a prospective study from april 2011 to june 2013. setting patients with cdi from canadian tertiary care centers. participants patients with cdi, their household human contacts, and pets. methods epidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. ...201627767004
correction: importance of glutamate dehydrogenase (gdh) in clostridium difficile colonization in vivo.[this corrects the article doi: 10.1371/journal.pone.0160107.].201627768767
epidemiology and recurrence rates of clostridium difficile infections in germany: a secondary data analysis.clostridium difficile infection (cdi) is the most common cause of health-care-associated infectious diarrhea. recurrence rates are as high as 20-30% after standard treatment with metronidazole or vancomycin, and appear to be reduced for patients treated with fidaxomicin. according to the literature, the risk of cdi recurrence increases after the second relapse to 30-65%. accurate data for germany are not yet available.201627770261
rapid identification of the etiological factors causing diarrheal diseases.the main objective of this investigation was to develop and pilot a real-time polymerase chain reaction (rt-pcr) diagnostic system for rapid and simultaneous identification of pathogens with a particular emphasis on diarrheal disease diagnostics. the diarrheal diseases were selected as a target for the pilot because they constitute a primary public health priority in georgia and worldwide. the product developed by our research team "neo_pcr_diagnostics" represents an original system for the iden ...201627770538
a dna vaccine targeting tcda and tcdb induces protective immunity against clostridium difficile.clostridium difficile-associated disease (cdad) constitutes a great majority of hospital diarrhea cases in industrialized countries and is induced by two types of large toxin molecules: toxin a (tcda) and toxin b (tcdb). development of immunotherapeutic approaches, either active or passive, has seen a resurgence in recent years. studies have described vaccine plasmids that express either tcda and/or tcdb receptor binding domain (rbd). however, the effectiveness of one vector encoding both toxin ...201627770789
enteropathogen infections in canine puppies: (co-)occurrence, clinical relevance and risk factors.laboratory confirmation of the causative agent(s) of diarrhoea in puppies may allow for appropriate treatment. the presence of potential pathogens however, does not prove a causal relationship with diarrhoea. the aim of this study was to identify specific enteropathogens in ≤12 month old puppies with and without acute diarrhoea and to assess their associations with clinical signs, putative risk factors and pathogen co-occurrence. faecal samples from puppies with (n=113) and without (n=56) acute ...201627771056
determining the cause of recurrent clostridium difficile infection using whole genome sequencing.understanding the contribution of relapse and reinfection to recurrent clostridium difficile infection (cdi) has implications for therapy and infection prevention, respectively. we used whole genome sequencing to determine the relation of c. difficile strains isolated from patients with recurrent cdi at an academic medical center in the united states. thirty-five toxigenic c. difficile isolates from 16 patients with 19 recurrent cdi episodes with median time of 53.5days (range, 13-362) between e ...201727771207
ensuring the safe and effective fda regulation of fecal microbiota transplantation.scientists, policymakers, and medical professionals alike have become increasingly worried about the rise of antibiotic resistance, and the growing number of infections due to bacteria like clostridium difficile, which cause a significant number of deaths and are imposing increasing costs on our health care system. however, in the last few years, fecal microbiota transplantation (fmt), the transplantation of stool from a healthy donor into the bowel of a patient, has emerged as a startlingly eff ...201527774199
a descriptive case study of the changing nature of nurses' work: the impact of managing infectious diseases requiring isolation.methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, and clostridium difficile have increased in health care facilities worldwide. the complexity of caring for patients with infectious comorbidities has impacted nurses' daily work. a mixed-methods study at 1 community hospital in ontario, canada, demonstrated the cumulative effect of additional time spent on infection prevention and control measures resulted in trade-offs, cutting corners, and raised concerns about the ...201727776824
a population-based longitudinal study of clostridium difficile infection-related hospitalization in mid-age and older australians.clostridium difficile is the principal cause of infectious diarrhoea in hospitalized patients. we investigated the incidence and risk factors for hospitalization due to c. difficile infection (cdi) in older australians. we linked data from a population-based prospective cohort study (the 45 and up study) of 266 922 adults aged ⩾45 years recruited in new south wales, australia to hospitalization and death records for 2006-2012. we estimated the incidence of cdi hospitalization and calculated days ...201727780483
mechanisms for floor surfaces or environmental ground contamination to cause human infection: a systematic review.shoe soles have been shown to transfer infectious microorganisms to floor and ground surfaces. however, the possible modes of transmission of infectious agents from floors or ground surfaces to human contact for infection have not been systematically reviewed. a systematic review was performed on articles indexed in medical databases (medline, embase, pubmed) using a pre-defined search strategy and mesh terms (date of last search: 15 march 2016). only primary research studies in english that inv ...201727780492
insight into the 3d structure and substrate specificity of previously uncharacterized gnat superfamily acetyltransferases from pathogenic bacteria.members of the gcn5-related n-acetyltransferase (gnat) superfamily catalyze the acetylation of a wide range of small molecule and protein substrates. due to their abundance in all kingdoms of life and diversity of their functions, they are implicated in many aspects of eukaryotic and prokaryotic physiology. although numerous gnats have been identified thus far, many remain structurally and functionally uncharacterized. the elucidation of their structures and functions is critical for broadening ...201727783928
corticosteroids in the treatment of pseudomembranous colitis: a report of 3 cases.clostridium difficile associated diarrhoea has been an increasing problem in the last decade in the uk and is a cause of significant morbidity. at the most severe end of the spectrum it causes pseudomembranous colitis which has a significant associated mortality rate and can be refractory to standard treatments. here we present three cases of proven pseudomembranous colitis in which systemic corticosteroids were used as an adjunct to treatment, raising the possibility of a new treatment option f ...201227785209
proton pump inhibitors and clostridium difficile infection: are we propagating an already rapidly growing healthcare problem?proton pump inhibitors (ppis) have been associated with clostridium difficile infection (cdi) in several recent studies. the exact mechanism through which ppis may cause clostridium difficile infection is not well understood. one potential mechanism to explain this association may be that elevated gastric ph levels facilitate the growth of potentially pathogenic upper and lower gastrointestinal tract flora. although clostridium difficile spores are acid resistant, vegetative forms are susceptibl ...201327785249
[clostridium difficile infections in geriatric patients].clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in europe and north america. infections with c. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. other risk factors are proton pump inhibitors, which are taken by many elderly patients. the main virulence factors are toxins a and b. the clinical spectrum ranges from asymptomatic colonization to severe disease with abdominal complications and sepsis. the cur ...201627785569
identification of risk factors associated with clostridium difficile infection in liver transplantation recipients: a single-center analysis.clostridium difficile remains the leading cause of health care-associated infectious diarrhea, and its incidence and severity are increasing in liver transplant recipients. several known risk factors for c difficile infection (cdi) are inherently associated with liver transplantation, such as severe underlying illness, immunosuppression, abdominal surgery, and broad-spectrum antibiotic use. we conducted a single-center retrospective case control study to characterize risk factors for cdi among p ...201627788814
understanding risk perceptions and responses of the public and health care professionals toward clostridium difficile: a qualitative interpretive description study.the occurrence of clostridium difficile infection is a major health-related risk. how the public and health care professionals perceive and respond to a health-related risk is shaped by socially and contextually structured evaluations and interpretations. risk perceptions and responses are context dependent and therefore need to be understood within the context in which they are perceived and experienced.201727789069
body mass index greater than 35 is associated with severe clostridium difficile infection.obesity has been implicated in the acquisition of clostridium difficile infections (cdi), however, no study has investigated whether there is a correlation between body mass index (bmi) and cdi severity.201727790736
snp-ing out the differences: investigating differences between clostridium difficile lab strains. 201627791481
toxin profiles, pcr ribotypes and resistance patterns of clostridium difficile: a multicentre study in china, 2012-2013.a total of 178 clinical isolates of clostridium difficile were collected from five major teaching hospitals representing northern, eastern and southern china from august 2012 to july 2013. among the 178 isolates, 162 (91.0%) were toxigenic, including 66 (40.7%) toxin a-negative, toxin b-positive, 95 (58.6%) toxin a-positive, toxin b-positive and only 1 (0.6%) toxin a-, toxin b- and binary toxin-positive. twenty-nine different pcr ribotypes were identified, of which 017 (21.0%), 012 (17.3%) and n ...201627793509
[clostridium difficile infection : what is currently available for treatment?]clostridium difficile (c. difficile) is an anaerobic, gram-positive, spore-forming, toxin-secreting bacillus. it is transmitted via a fecal-oral route and can be found in 1-3 % of the healthy population. symptoms caused by c. difficile range from uncomplicated diarrhea to a toxic megacolon. the incidence, frequency of recurrence, and mortality rate of c. difficile infections (cdis) have increased significantly over the past few decades. the most important risk factor is antibiotic treatment in e ...201627796474
rasch analysis of the antimicrobial self-assessment toolkit for national health service (nhs) trusts (asat v17).the antimicrobial self-assessment toolkit for national health service (nhs) trusts (asat) was developed to evaluate hospital-based antimicrobial stewardship programmes. iterative validity investigations of the asat were used to produce a 91-item asat v17 utilizing qualitative methodology. rasch analysis was used to generate question (item) behaviour estimates and to investigate the validity of asat v17.201727798214
molecular epidemiology and antimicrobial susceptibility of clostridium difficile isolates from a university teaching hospital in china.while the developed world has seen a significant increase in the number of scientific articles on clostridium difficile infection (cdi), the developing world still lags behind on this subject due to limited laboratory capacity, low awareness, and limited surveillance of this problem. as such, cdi is considered a neglected but potentially huge problem in developing countries. the major aim of this study was to systemically evaluate the utility of several molecular typing tools for cdi, including ...201627799923
hydralazine-induced anca vasculitis in the setting of acute clostridium difficile infection.we report a rare case of hydralazine-induced anca associated glomerulonephritis with alveolar hemorrhage in the setting of acute clostridium difficile infection. a 71-year-old caucasian woman with hypertension, who was being treated with hydralazine 25 mg twice a day for six years, presented to the hospital with diarrhea, nausea, vomiting and anemia. she had acute kidney injury and urinalysis showed proteinuria, dysmorphic rbcs, and rare rbc cast. she was found to have clostridium difficile coli ...201627801920
clostridium difficile infection: associations with chemotherapy, radiation therapy, and targeting therapy treatments.although mucositis, diarrhea, and constipation as well as immunosuppression are well recognized side-effects of cancer treatment, the underlying mechanisms including changes in the composition of gut microbiota and clostridium difficile infection have not yet been thoroughly reviewed.201627804875
costs and consequences associated with misdiagnosed lower extremity cellulitis.inflammatory dermatoses of the lower extremity are often misdiagnosed as cellulitis (aka "pseudocellulitis") and treated with antibiotics and/or hospitalization. there is limited data on the cost and complications from misdiagnosed cellulitis.201627806170
identification of factors impacting recurrent clostridium difficile infection and development of a risk evaluation tool.recurrent clostridium difficile infection (rcdi) is a growing concern, yet limited data exists to clarify which patients are at highest risk.  identification of these patients may better inform decisions of those who may benefit from prophylactic intervention. the purpose of this study was to determine which factors are associated with the recurrence of clostridium difficile infection (cdi) and to develop a risk stratification tool.  methods. patients readmitted within 10 weeks of positive c. di ...201627806252
comparison of clostridium difficile ribotypes circulating in australian hospitals and communities.clostridium difficile infection (cdi) is becoming less exclusively a health care-associated cdi (ha-cdi). the incidence of community-associated cdi (ca-cdi) has increased over the past few decades. it has been postulated that asymptomatic toxigenic c. difficile (tcd)-colonized patients may play a role in the transfer of c. difficile between the hospital setting and the community. thus, to investigate the relatedness of c. difficile across the hospital and community settings, we compared the char ...201727807147
nutrition and the gut microbiome in the elderly.the gut microbiota is the assembly of microorganisms living in our intestine and their genomes are known as the microbiome. the correct composition and functionality of this microbiome is essential for maintaining a "healthy status." aging is related to changes in the gut microbiota which are frequently associated with physiological modifications of the gastrointestinal tract, as well as, to changes in dietary patterns, together with a concomitant decline in cognitive and immune function, all to ...201727808595
cost-effectiveness of histamine2 receptor antagonists versus proton pump inhibitors for stress ulcer prophylaxis in critically ill patients.to determine the cost-effectiveness of stress ulcer prophylaxis with histamine2 receptor antagonists (h2ras) versus proton pump inhibitors (ppis) in critically ill and mechanically ventilated adults.201727809338
genome sequence of clostridium paraputrificum 373-a1 isolated in chile from a patient infected with clostridium difficile.clostridium paraputrificum is a gut microbiota member reported in several cases of bacteremia and coinfections. so far, only one genome sequence of a c. paraputrificum (agr2156) isolate is available. here, we present the draft genome of c. paraputrificum strain 373-a1, isolated from stools from a patient with c. difficile infection.201627811092
evaluation and selection of bacillus species based on enzyme production, antimicrobial activity, and biofilm synthesis as direct-fed microbial candidates for poultry.social concern about misuse of antibiotics as growth promoters (agp) and generation of multidrug-resistant bacteria have restricted the dietary inclusion of antibiotics in livestock feed in several countries. direct-fed microbials (dfm) are one of the multiple alternatives commonly evaluated as substitutes of agp. sporeformer bacteria from the genus bacillus have been extensively investigated because of their extraordinary properties to form highly resistant endospores, produce antimicrobial com ...201627812526
dissemination of clostridium difficile in food and the environment: significant sources of c. difficile community-acquired infection?clostridium difficile is a significant pathogen with over 300 000 cases reported in north america annually. previously, it was thought that c. difficile was primarily a clinically associated infection. however, through the use of whole genome sequencing it has been revealed that the majority of cases are community acquired. the source of community-acquired c. difficile infections (cdi) is open to debate with foodborne being one route considered. clostridium difficile fits the criteria of a foodb ...201727813268
clostridium difficile infection due to pneumonia treatment: mortality risk models.one of the most common gastrointestinal infection after the antibiotic treatment of community or nosocomial pneumonia is caused by the anaerobic spore clostridium difficile (c. difficile). the aim of this study was to retrospectively assess mortality due to c. difficile infection (cdi) in patients treated for pneumonia. we identified 94 cases of post-pneumonia cdi out of the 217 patients with cdi. the mortality issue was addressed by creating a mortality risk models using logistic regression and ...201727815923
drug utilization review of cephalosporins in a secondary care hospital in united arab emirates.background cephalosporins are one of the most commonly used antibiotics in united arab emirates (uae). few studies have been carried out to evaluate the antibiotic utilization pattern in uae in spite of the obvious increase in cephalosporins resistance during the past decade. objective to assess the prescriptions pattern of cephalosporins among physicians at a secondary care hospital in ras al khaimah, uae. method this observational prospective study was carried out during october 2013 to april ...201627817172
a comprehensive study of costs associated with recurrent clostridium difficile infection.background clostridium difficile infection (cdi) is the most common healthcare-associated infection and is associated with considerable morbidity. recurrent cdi is a key contributing factor to this morbidity. despite an estimated 83,000 recurrences annually in the united states, there are few accurate estimates of costs associated with recurrent cdi. objective we performed this study (1) to identify the health consequences of recurrent cdi including need for repeat hospitalization, intensive car ...201727817758
clostridium difficile infection in cancer patients. 201727817939
electronic clostridium difficile infection bundle reduces time to initiation of contact precautions.the impact of computerized order-entry bundles on timing of contact precaution initiation for c. difficile infection (cdi) remains largely unexplored. implementation of an electronic cdi prevention and management bundle that included an automatic isolation component significantly reduced time to initiation of contact precautions from 33.7 to 22.4 hours. infect control hosp epidemiol 2016;242-244.201727821198
fecal microbiota transplantation by freeze-dried oral capsules for recurrent clostridium difficile infection. 201627822485
clostridium difficile associated diarrhoea: an increased problem.clostridium difficile associated diarrhoea is a major health problem that seems to be on the increase. in our study, we analyse the changes in the incidence of this infection over the last 11 years.201627823794
epidemiology and outcome of clostridium difficile infections in patients hospitalized in internal medicine: findings from the nationwide fadoi-practice study.clostridium difficile (cd) is a leading cause of diarrhoea among hospitalized patients. the objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of cd infections (cdi) in internal medicine (im) wards in italy.201627825317
effect of a national 4c antibiotic stewardship intervention on the clinical and molecular epidemiology of clostridium difficile infections in a region of scotland: a non-linear time-series analysis.whereas many antibiotics increase risk of clostridium difficile infection through dysbiosis, epidemic c difficile ribotypes characterised by multidrug resistance might depend on antibiotic selection pressures arising from population use of specific drugs. we examined the effect of a national antibiotic stewardship intervention limiting the use of 4c antibiotics (fluoroquinolones, clindamycin, co-amoxiclav, and cephalosporins) and other infection prevention and control strategies on the clinical ...201727825595
clostridium difficile infection: stewardship's lowest hanging fruit? 201727825596
influence of antibiotics and case exposure on hospital-acquired clostridium difficile infection independent of illness severity.previous studies of the association between antibiotic exposure and risk of hospital-acquired clostridium difficile-associated infection (cdi) have not fully accounted for patient severity of illness, and competing risks.201727825674
infection: modulation of clostridium difficile infection by dietary zinc. 201627826138
colon-targeted delivery of igy against clostridium difficile toxin a and b by encapsulation in chitosan-ca pectinate microbeads.this study investigated the use of a newly developed chitosan-ca pectinate microbead formulation for the colon-targeted delivery of anti-a/b toxin immunoglobulin of egg yolk (igy) to inhibit toxin binding to colon mucosa cells. the effect of the three components (pectinate, calcium chloride, and chitosan) used for the microbead production was examined with the aim of identifying the optimal levels to improve drug encapsulation efficiency, swelling ratio, and cumulative igy release rate. the opti ...201627826799
antimicrobial stewardship and environmental decontamination for the control of clostridium difficile transmission in healthcare settings.we implement an agent-based model for clostridium difficile transmission in hospitals that accounts for several processes and individual factors including environmental and antibiotic heterogeneity in order to evaluate the efficacy of various control measures aimed at reducing environmental contamination and mitigating the effects of antibiotic use on transmission. in particular, we account for local contamination levels that contribute to the probability of colonization and we account for both ...201727826877
a new lab developed real time pcr assay for direct detection of c. difficle from stool sample without dna extraction.clostridium difficile is a major cause of nosocomial antibiotic-associated infectious diarrhea and pseudomembranous colitis. detection of c. difficile by anaerobic bacterial culture and/or cytotoxicity assays has been largely replaced by rapid enzyme immunoassays (eia). however, due to the lack of sensitivity of stool eia, we developed a multiplex real-time pcr assay targeting the c. difficile toxin genes tcdb. stool samples from hospitalized pediatric patients suspected of having c. difficile-a ...201627829823
chemical and stress resistances of clostridium difficile spores and vegetative cells.clostridium difficile is a gram-positive, sporogenic and anaerobic bacterium that causes a potentially fatal colitis. c. difficile enters the body as dormant spores that germinate in the colon to form vegetative cells that secrete toxins and cause the symptoms of infection. during transit through the intestine, some vegetative cells transform into spores, which are more resistant to killing by environmental insults than the vegetative cells. understanding the inherent resistance properties of th ...201627833595
fecal calprotectin level reflects the severity of clostridium difficile infection.clostridium difficile is a significant nosocomial and community-acquired pathogen, and is the leading cause of antibiotic-induced diarrhea associated with high morbidity and mortality. given that the treatment outcome depends on the severity of c. difficile infection (cdi), we aimed to establish an efficient method of assessing severity, and focused on the stool biomarker fecal calprotectin (fc). fc directly reflects the intestinal inflammation status of a patient, and can aid in interpreting th ...201727834066
pharmacologic stress gastropathy prophylaxis may not be necessary in at-risk surgical trauma icu patients tolerating enteral nutrition.stress gastropathy is a rare complication of the intensive care unit stay with high morbidity and mortality. there are data that support the concept that patients tolerating enteral nutrition have sufficient gut blood flow to obviate the need for prophylaxis; however, no robust studies exist. this study assesses the incidence of clinically significant gastrointestinal bleeding in surgical trauma intensive care unit (sticu) patients at risk of stress gastropathy secondary to mechanical ventilatio ...201627837045
interspecies interactions between clostridium difficile and candida albicans.the facultative anaerobic polymorphic fungus candida albicans and the strictly anaerobic gram-positive bacterium clostridium difficile are two opportunistic pathogens residing in the human gut. while a few studies have focused on the prevalence of c. albicans in c. difficile-infected patients, the nature of the interactions between these two microbes has not been studied thus far. in the current study, both chemical and physical interactions between c. albicans and c. difficile were investigated ...201727840850
vesicoileal fistula and clostridium difficile colitis in a child with acute lymphoblastic leukemia. 201627842209
identification of a novel mutation at the primary dimer interface of gyra conferring fluoroquinolone resistance in clostridium difficile.the aim of this study was to determine whether alternative resistance mechanisms, other than mutation in the quinolone resistance-determining region (qrdr) of dna gyrase, could confer fluoroquinolone resistance in clostridium difficile. an in vitro-generated c. difficile mutant exhibiting increased fluoroquinolone resistance was isolated through antibiotic selection on ciprofloxacin. the qrdr of this mutant was investigated by chain-termination sequencing and was found to be devoid of mutation. ...201527842877
asymptomatic and yet c. difficile-toxin positive? prevalence and risk factors of carriers of toxigenic clostridium difficile among geriatric in-patients.clostridium difficile infections (cdi) are the most frequent cause of diarrhoea in hospitals. geriatric patients are more often affected by the condition, by a relapse and complications. therefore, a crucial question is how often colonization with toxigenic clostridium difficile strains occurs in elderly patients without diarrhoea and whether there is a "risk pattern" of colonized patients that can be defined by geriatric assessment. furthermore, the probability for those asymptomatic carriers t ...201627846818
are proton pump inhibitors associated with an increased risk of clostridium difficile infection after considering confounding variables? 201727847127
clinical conundrums in management of sepsis in the elderly.in 2012, surviving sepsis campaign came out with updated international guidelines for management of severe sepsis and septic shock. paradoxically, there are no specific guidelines for management of sepsis in the elderly, although the elderly are more predisposed to sepsis, and morbidity and mortality related to sepsis. sepsis in the elderly is, more often than not, complicated by clinical conundrums such as congestive heart failure (chf), atrial fibrillation (af), chronic kidney disease (ckd), a ...201727847897
rates of microbiologically diagnosed infection and pathogen detection in hematopoietic stem cell transplant patients.infections remain a significant cause of mortality in hematopoietic stem cell transplant patients. evaluations of causes of infection are often unrevealing, and at some sites, increasing rates of antimicrobial resistance have been noticed. we performed a retrospective analysis of infection rates and microbiologic testing yield, or percent of tests ordered to diagnose an infection, in the first 100 days of 30 allogeneic and 56 autologous stem cell transplants performed at san antonio military med ...201627849508
detection of clostridium difficile in feces of asymptomatic patients admitted to the hospital.recent evidence shows that patients asymptomatically colonized with clostridium difficile may contribute to the transmission of c. difficile in health care facilities. additionally, these patients may have a higher risk of developing c. difficile infection. the aim of this study was to compare a commercially available pcr directed to both toxin a and b (artus c. difficile qs-rgq kit ce; qiagen), an enzyme-linked fluorescent assay to glutamate dehydrogenase (gdh elfa) (vidas, biomérieux), and an ...201727852676
two novel myoviruses from the north of iraq reveal insights into clostridium difficile phage diversity and biology.bacteriophages (phages) are increasingly being explored as therapeutic agents to combat bacterial diseases, including clostridium difficile infections. therapeutic phages need to be able to efficiently target and kill a wide range of clinically relevant strains. while many phage groups have yet to be investigated in detail, those with new and useful properties can potentially be identified when phages from newly studied geographies are characterised. here, we report the isolation of c. difficile ...201627854339
characterization of the clostridium difficile volatile metabolome using comprehensive two-dimensional gas chromatography time-of-flight mass spectrometry.clostridium difficile is a bacterial pathogen capable of causing life-threatening infections of the gastrointestinal tract characterized by severe diarrhea. exposure to certain classes of antibiotics, advanced age, and prolonged hospitalizations are known risk factors for infection by this organism. anecdotally, healthcare providers have reported that they can smell c. difficile infections in their patients, and several studies have suggested that there may indeed be an olfactory signal associat ...201627855313
national age group trends in clostridium difficile infection incidence and health outcomes in united states community hospitals.prior studies have demonstrated an increase in clostridium difficile infection (cdi) incidence in the united states (u.s.) in recent years, but trends among different age groups have not been evaluated. this study describes national cdi incidence by age group over a 10-year period and mortality and hospital length of stay (los) among patients with cdi.201627855653
gleaning insights from fecal microbiota transplantation and probiotic studies for the rational design of combination microbial therapies.beneficial microorganisms hold promise for the treatment of numerous gastrointestinal diseases. the transfer of whole microbiota via fecal transplantation has already been shown to ameliorate the severity of diseases such as clostridium difficile infection, inflammatory bowel disease, and others. however, the exact mechanisms of fecal microbiota transplant efficacy and the particular strains conferring this benefit are still unclear. rationally designed combinations of microbial preparations may ...201727856521
draft genome sequence of robinsoniella peoriensis 6600698, a confounder of clostridium difficile diagnosis.robinsoniella peoriensis is a gram-positive, strictly anaerobic, spore-forming, rod-shaped organism. here, we report the draft genome of r. peoriensis 6600698, initially classified as clostridium difficile due to growth on selective agar, a fecal gdh pcr-positive result, and clinical symptoms. r. peoriensis is a potential confounder of c. difficile diagnosis.201627856584
variability in antibiotic use across ontario acute care hospitals.antibiotic stewardship is a required organizational practice for canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. we sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in ontario, canada's most populous province.201727856724
toxin a of the nosocomial pathogen clostridium difficile induces primary effects in the proteome of hep-2 cells.this study was carried out to investigate the impact of high concentrations of clostridium difficile toxin a (tcda) on the proteome of human cells. it should also be examined whether a catalytically deficient mutant (tcdanxn ) has an effect on target cells.201727860399
two clusters of fluoroquinolone and clindamycin-resistant clostridium difficile pcr ribotype 001 strain recognized by capillary electrophoresis ribotyping and multilocus variable tandem repeat analysis.to perform a retrospective analysis of the high occurrence of clostridium difficile infection in the surgical department of a czech tertiary care hospital and to identify weaknesses in c. difficile infection (cdi) prevention and control policies.201627860531
predominance of clostridium difficile ribotypes 017 and 078 among toxigenic clinical isolates in southern taiwan.ribotypes and toxin genotypes of clinical c. difficile isolates in taiwan are rarely reported. a prospective surveillance study from january 2011 to january 2013 was conducted at the medical wards of a district hospital in southern taiwan. of the first toxigenic isolates from 120 patients, 68 (56.7%) of 120 isolates possessed both tcda and tcdb. of 52 (43.3%) with tcdb and truncated tcda (tcda-/tcdb+), all were ribotype 017 and none had binary toxin or tcdc deletion. eighteen (15%) toxigenic iso ...201627861606
evidence for dual receptor-binding sites in clostridium difficile toxin a.tcda (308 kda) and tcdb (270 kda) disrupt the integrity of the intestinal epithelial barrier and provide an environment favorable for clostridium difficile colonization. recent evidence suggests that entry of tcda into cells is mediated by at least two domains. here, we report the characterization of a second receptor-binding domain (rbd2) for tcda. while both the isolated combined repetitive oligopeptides (crops) and rbd2 fragments are rapidly internalized into cells under physiologic condition ...201627861794
rethinking strategies to select antibiotic therapy in clostridium difficile infection.in recent years, clostridium difficile infection (cdi) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective components not well delineated across treatment algorithms and clinical trials. furthermore, there is little evidence linking severity at onset to ou ...201627862113
liver abscess and bacteremia caused by lactobacillus: role of probiotics? case report and review of the literature.lactobacilli are non-spore forming, lactic acid producing, gram-positive rods. they are a part of the normal gastrointestinal and genitourinary microbiota and have rarely been reported to be the cause of infections. lactobacilli species are considered non-pathogenic organisms and have been used as probiotics to prevent antibiotic associated diarrhea. there are sporadic reported cases of infections related to lactobacilli containing probiotics.201627863462
bezlotoxumab approved to prevent clostridium difficile recurrence. 201627864194
an increase in healthcare-associated clostridium difficile infection associated with use of a defective peracetic acid-based surface disinfectant.background we investigated an increase in the incidence of healthcare-associated clostridium difficile infection (cdi) that occurred following a change from a bleach disinfectant to a peracetic acid-based disinfectant. objective to evaluate the efficacy of the peracetic acid-based disinfectant. design laboratory-based product evaluation. methods the commercial peracetic acid-based product is activated on site by mixing a small volume of concentrated hydrogen peroxide and peracetic acid present i ...201727866475
evaluation of an automated room decontamination device using aerosolized peracetic acid.because manual cleaning is often suboptimal, there is increasing interest in use of automated devices for room decontamination. we demonstrated that an ultrasonic room fogging system that generates submicron droplets of peracetic acid and hydrogen peroxide eliminated clostridium difficile spores and vegetative pathogens from exposed carriers in hospital rooms and adjacent bathrooms.201727866755
efficacy of sterile fecal filtrate transfer for treating patients with clostridium difficile infection.fecal microbiota transplantation (fmt) is a highly effective therapy for recurrent clostridium difficile infection (cdi). however, transferring undefined living bacteria entails uncontrollable risks for infectious and metabolic or malignant diseases, particularly in immunocompromised patients. we investigated whether sterile fecal filtrates (containing bacterial debris, proteins, antimicrobial compounds, metabolic products, and oligonucleotides/dna), rather than intact microorganisms, are effect ...201727866880
prevalence and molecular characterization of clostridium difficile isolates from a pig slaughterhouse, pork, and humans in taiwan.clostridium difficile causes antibiotic-associated diarrhea in both humans and animals. the ribotype 078, predominant in food animals, is associated with community-acquired c. difficile infection, and c. difficile is suggested to be a foodborne pathogen. recently, the c. difficile ribotype 078 lineage emerged in patients and pigs in taiwan. this study aimed to investigate the prevalence and molecular characterization of c. difficile isolated from a pig slaughterhouse, retail meat, ready-to-eat m ...201727870984
survival and prevalence of clostridium difficile in manure compost derived from pigs.pigs, particularly piglets, have been identified as reservoir hosts of clostridium difficile. to examine the survival ability of this pathogen in pig feces-based manure compost, c. difficile spores, which were prepared to contain as few vegetative cells as possible, were artificially inoculated into pig feces and incubated at different temperatures. while c. difficile survived in the feces incubated at temperatures below 37 °c for over 30 days, cell numbers gradually decreased at thermophilic te ...201727871997
antimicrobial stewardship in hospitals: does it work and can we do it?selection of resistant pathogens by antimicrobial use is probably the most important cause of antimicrobial resistance. antimicrobial stewardship (ams) refers to a multifaceted approach to optimise prescribing. the benefits of ams programmes have been widely demonstrated in terms of reductions in antimicrobial use, mortality, clostridium difficile and other healthcare-associated infections, hospital length of stay and bacterial resistance. several kinds of interventions (i.e. restriction of drug ...201427873630
chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis.health care-associated infections (hai) have been shown to increase length of stay, the cost of care, and rates of hospital deaths (kaye and marchaim, j am geriatr soc 62(2):306-11, 2014; roberts and scott, med care 48(11):1026-35, 2010; warren and quadir, crit care med 34(8):2084-9, 2006; zimlichman and henderson, jama intern med 173(22):2039-46, 2013). importantly, infections acquired during a hospital stay have been shown to be preventable (loveday and wilson, j hosp infect 86:s1-70, 2014). i ...201627876075
diagnosis and treatment of clostridium difficile (c. diff) colitis: review of the literature and a perspective in gynecologic oncology.clostridium difficile infection (cdi) is a major cause of nosocomial diarrhea with the potential for significant morbidity and mortality. colonization in a susceptible individual, with risk factors such as prior antibiotic use, advanced age, or medical comorbidities, may result in symptomatic infection. although patients with a gynecologic malignancy may be at a higher risk of developing cdi due to an increased likelihood of having one or more risk factors, data do not consistently support the i ...201727876339
national survey of practice of faecal microbiota transplantation for clostridium difficile infection in the uk. 201727876399
the role of single-shot metronidazole in the prevention of clostridium difficile infection following ileostomy reversal surgery.symptomatic infection with clostridium difficile is strongly linked to antibiotic use and rates are higher for colorectal surgery. in february 2015, trust policy for antibiotic prophylaxis of ileostomy reversal surgery was changed from three doses of metronidazole plus cefuroxime to single-dose metronidazole, in a bid to reduce rates of clostridium difficile infection.201627878620
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