Publications

isolation of viruses from clinical specimens in microtitre plates with cells inoculated in suspension.	virus isolation is essential for the provision of a full diagnostic virology service. present methods are time consuming, expensive and relatively inflexible for routine use. our objective was to audit our existing virus isolation system and to develop a sensitive, flexible virus isolation system which could be adapted for use in a busy routine laboratory which is required to provide a service for a wide range of clinical situations. we carried out a pilot study which compared conventional rolle ...	1996	9002075
nosocomial infections and nosocomial pneumonia.	nosocomial infections are a major source of revenue loss, morbidity, and even mortality to surgical patients. this review presents current issues regarding nosocomial infections and nosocomial pneumonias. this study is a literature review that presents material on nosocomial infections in general and details regarding clostridium difficile and vancomycin-resistant enterococcus infections. nosocomial infections, including pneumonias, are serious medical complications, and prevention by strict adh ...	1996	9003688
effect of lactulose on short-chain fatty acids and lactate production and on the growth of faecal flora, with special reference to clostridium difficile.	lactulose exerts a beneficial effect on hepatic encephalopathy by decreasing toxic short-chain (ic4-nc6) fatty acid (isobutyrate, butyrate, isovalerate, valerate, isocaproate and caproate) production. however, the precise mechanism by which lactulose exerts this effect remains uncertain. this study investigated the effect of lactulose on faecal flora, particularly clostridium difficile, which produces mostly ic4-nc6 fatty acids. an in-vitro faecal incubation system was used to estimate how lactu ...	1997	9003750
in vitro activity of meropenem compared to nine other antimicrobial agents: importance of its stability when used in agar dilution systems.	the antibacterial activity of meropenem was tested against 426 clinical isolates representing a wide range of aerobic and anaerobic species. the in vitro activity of meropenem was compared with that of iminpenem, ceftazidime, cefotaxime, ciprofloxacin, piperacillin and tobramycin against aerobic isolates, and also compared with that of imipenem, metronidazole, cefoxitin, clindamycin and piperacillin against the anaerobic isolates. meropenem exhibited an extended spectrum of activity with low min ...	1996	9007956
clostridium difficile colitis presenting as an acute abdomen: case report and review of the literature.	pseudomembranous colitis associated with clostridium difficile rarely manifests as an acute abdomen and even more rarely as an acute abdomen without abnormal radiologic studies. the following is a case report of a 52-year-old white man who had an acute abdomen without abnormal radiologic studies, and was given a final diagnosis of c difficile colitis. surgery was averted only by the ability to do an expeditious flexible sigmoidoscopy with the visualization of pseudomembranes. diagnosis was later ...	1997	9010377
non-clostridium difficile nosocomial diarrhea in the intensive care unit.	it is assumed that most cases of nosocomial diarrhea are due to clostridium difficile because of the widespread use of broad-spectrum antibiotic agents. enteral tube feedings are another important cause of hospital-acquired diarrhea, especially in intensive care units (icus). we report the results of a recent survey of patients in the icu with nosocomial diarrhea and describe an illustrative case. we conclude on the basis of this and a previous larger study that c. difficile diarrhea is very unc ...	1997	9013225
clostridium difficile colitis--diagnosis and therapy.	clostridium difficile is a gram-positive bacillus which had been identified as the source of potent exotoxins: toxin a and toxin b. c. difficile infection usually follows antibiotic therapy and results from unrestrained growth of pathogenic strains of c. difficile in the colon. typical clinical findings include: diarrhoea with blood and mucus, fever, abdominal pain, nausea, loss of body weight. in the past the diagnosis was based on positive result of stool culture but now several tests are avai ...	1996	9020528
survival of anti-clostridium difficile bovine immunoglobulin concentrate in the human gastrointestinal tract.	to be therapeutically active, oral hyperimmune bovine immunoglobulin concentrate (bic) must survive its passage through the intestinal tract. this led us to study the gastrointestinal stability of orally administered bic directed against clostridium difficile toxins (bic-c. difficile). bic-c. difficile was stable at neutral ph in vitro but was degraded at low ph, particularly in the presence of pepsin. healthy volunteers (n = 6) took bic-c. difficile (45 or 8 g) as a single oral dose. total bovi ...	1997	9021173
il-2 signaling controls actin organization through rho-like protein family, phosphatidylinositol 3-kinase, and protein kinase c-zeta.	il-2 and il-4 induce proliferation of ts1 alpha beta cells. activation of the zeta isoform of protein kinase c is an important step in il-2-, but not il-4-mediated proliferation. in addition, protein kinase c-zeta is implicated in il-2-mediated actin organization. given the established involvement of the rho family of small guanine nucleotide-binding proteins in organization of actin structures, we analyze the possible relationships between rho and protein kinase c-zeta. using the rho-like prote ...	1997	9029085
[perioperative managements for postoperative severe infections in compromised host].	the incidence of postoperative infections, especially due to multi-drug resistant strains such as pseudomonas sp., enterococcus sp., and methicillin resistant staphylococcus aureus (mrsa), is high in compromised hosts. among them, respiratory infection, catheter sepsis, and drug-associated enteritis are frequently observed and respiratory infection is liable to fall into serious illness. these infections have characteristics in causative organisms. pseudomonas aeruginosa or mrsa are frequently i ...	1996	9032782
hospital-acquired clostridium difficile diarrhoea and herd immunity.	clostridium difficile diarrhoea represents a significant health-service burden. we recently experienced an outbreak of c difficile diarrhoea associated with increased use of cefotaxime. the question we pose in this paper is how did the introduction and withdrawal of a single antibiotic so greatly affect rates of c difficile diarrhoea? other antibiotics had nearly as high a risk of causing diarrhoea as cefotaxime, and the majority of patients never received cefotaxime. we believe that such outbre ...	1997	9033485
predicting clostridium difficile stool cytotoxin results in hospitalized patients with diarrhea.	to validate a model for the prediction of clostridium difficile cytotoxin assay results, and to identify a subgroup of patients with a very low likelihood of c. difficile-associated disease in whom the yield of routine cytotoxin testing is low.	1997	9034947
positive regulation of clostridium difficile toxins.	the toxigenic element of clostridium difficile vpi 10463 contains a small open reading frame (orf) immediately upstream of the toxin b gene (g. a. hammond and j. l. johnson, microb. pathog. 19:203-213, 1995). the deduced amino acid sequence of the orf, which we have designated txer, encodes a 22-kda protein which contains a helix-turn-helix motif with sequence identity to dna binding regulatory proteins. we used a dna fragment containing the c. difficile toxin a repeating units (aru) as a report ...	1997	9038324
glucosylation of small gtp-binding rho proteins disrupts endothelial barrier function.	the endothelial cytoskeleton is important for the regulation of endothelial barrier function. small gtp-binding rho proteins play a central role in the organization of the microfilament system. clostridium difficile toxin b (tcdb) inactivates rho proteins by glucosylation at thr-37. we used tcdb as a probe to study the role of rho proteins in the regulation of endothelial barrier function. tcdb time (50-170 min) and dose (10-100 ng/ml) dependently increased the hydraulic conductivity of cultured ...	1997	9038900
low albumin gradient ascites complicating severe pseudomembranous colitis.	pseudomembranous colitis (pmc) is a frequently severe, sometimes fatal iatrogenic disease that is antibiotic-associated in almost all cases. the most common clinical features of pmc include abdominal pain, watery diarrhea, fever, leukocytosis, hypoalbuminemia, and hypovolemia. ascites, not considered a well-known feature of pmc, is fairly common, based on a review of the english language literature but has not been characterized fully. this case report describes 5 patients with pmc who presented ...	1997	9041262
yield from stool testing of pediatric inpatients.	to quantify the yield from stool testing in pediatric inpatients and to identify criteria to test stool more deliberately without sacrificing diagnostic sensitivity.	1997	9041868
arbitrary primed pcr rules out clostridium difficile cross-infection among patients in a haematology unit.	eight out of 20 (40%) patients with haematological malignancies hospitalized in the same unit of our hospital from 24 january to 24 april 1995, suffered from diarrhoea due to clostridium difficile. the c. difficile isolates were characterized by serotyping and by arbitrary primed polymerase chain reaction (ap-pcr) using three different 10-mer oligonucleotides. it was found by serotyping that five patients had non-typeable isolates and three had serogroup h isolates. the ap-pcr typed all the isol ...	1997	9049815
surgical aspects of clostridium difficile colitis.	there has been a marked increase in the number of surgical patients developing clostridium difficile colitis. the epidemiology, pathogenesis, diagnosis and management of c. difficile infection were reviewed from a surgical perspective.	1997	9052424
involvement of the appendix in pseudomembranous colitis.	pseudomembranous colitis (pmc) is an inflammatory disorder usually limited to the large intestine and is the consequence of antibiotic associated clostridium difficile overgrowth with production of its toxin. it has a characteristic gross and microscopic appearance. pmc-like changes, usually associated with peri-operative hypotension and with more extensive gastrointestinal tract involvement, have also been described. in neither clinical setting has pseudomembranous appendicitis been recorded. a ...	1997	9059362
bacterial toxins that target rho proteins.		1997	9062338
[ciprofloxacin and clostridium difficile associated diarrhea].		1996	9063943
a prospective randomized controlled trial of oral ciprofloxacin in acute ulcerative colitis.	the aim of this prospective, randomized, controlled trial was to evaluate the role of ciprofloxacin as an adjunct to corticosteroids in acute ulcerative colitis.	1997	9068468
transcriptional analysis of the toxigenic element of clostridium difficile.	a transcriptional analysis was undertaken for the toxigenic element of clostridium difficile in five strains which differ greatly in toxigenicity. the toxigenic element has recently been described in c. difficile strain vpi 10463 and consists of three small open reading frames in addition to the toxin a and b genes. a large, polycistronic transcript (17.5 kb) was detected, in addition to processing intermediates, and individual transcripts for toxin a, toxin b, and two of the three small open re ...	1997	9075217
[infections in pediatrics].	probability-based antibiotic therapy: in children, the risk of an unfavorable course of bacterial infections requires careful selection of the initial antibiotic prescription based on the disease state, bacterial epidemiology and the child's age. acute community acquired pneumonia: before the age of 5 years, antibiotics active against haemophilus influenzae such as amoxicillin or clavulanic acid can be given orally. in children over 5, amoxicillin or a macrolide are effective. severe ear, nose a ...	1997	9082404
characterization of polymorphisms in the toxin a and b genes of clostridium difficile.	we have used six independent polymerase chain reactions (a1-a3 and b1-b3) for amplification of the entire sequence of the two toxin genes tcda and tcdb of several clostridium difficile strains. with this approach we have detected (1) restriction site polymorphisms which are distributed all over the genes, and (2) deletions that could be found only in tcda. characteristic differences between strains were mainly focused to the 5' third of tcdb (b1 fragment) and/or the 3' third of tcda (a3 fragment ...	1997	9084148
effects of clostridium difficile toxin b on activation of rat peritoneal mast cells.	clostridium difficile toxin b that inactivates rho subfamily proteins by glucosylation, inhibited dinitrophenyl-conjugated bovine serum albumin (dnp-bsa) and phorbol 12-myristate 13-acetate (pma)-induced mast cell activation by 80 to 90% in a concentration- and time dependent manner with a delay of about 30 min. activation of mast cells by compound 48/80 and calcium ionophore a23187 was maximally inhibited by about 50%. inhibition by toxin b was observed with suspended, attached and permeabilise ...	1997	9089662
hepatobiliary transport of iga in the golden syrian hamster (mesocricetus auratus).	do hamsters, like rats, rabbits and mice, possess an hepatocyte 'iga pump' whereby circulating plasma polymeric iga (piga) is actively transported into bile, against a concentration gradient, via the polymeric ig receptor or secretory component (sc)? precipitating antisera, raised against rat igs and serum proteins, and crossreacting with their hamster homologues, detected hamster sc by immunoelectrophoresis in bile, but not serum. gel filtration of hamster bile indicated that free sc eluted bet ...	1997	9093877
effects of epidermal growth factor and clostridium difficile toxin b in a model of mucosal injury.	numerous factors have been advocated as being paramount to the development of necrotizing enterocolitis (nec) including hypoxia, abnormal bacterial flora, and by products of enteral feedings. in an effort to better understand mechanisms involved at the level of the intestinal mucosal barrier the authors have chosen the caco-2 cell line to model the neonatal intestinal epithelium. by growing caco-2 cells in transwell inserts, the authors have investigated the ability of clostridium difficile toxi ...	1997	9094010
activity of nisin against clostridium difficile.		1997	9100650
transcription analysis of the genes tcda-e of the pathogenicity locus of clostridium difficile.	to analyse the transcription pattern of the five tcda-e genes of the pathogenicity locus (paloc) of clostridium difficile a protocol was established to purify rna from strain vpi10463. transcription analysis of the five tcda-e genes showed that they were all transcribed. in the early exponential phase, a high level of tcdc and low levels of tcda,b,d,e transcripts were detectable; this was inverted in the stationary phase, suggesting that tcdc might have a negative influence on transcription of t ...	1997	9108241
localization of the glucosyltransferase activity of clostridium difficile toxin b to the n-terminal part of the holotoxin.	clostridium difficile toxin b that is one of the largest cytotoxins (270 kda) known acts on rho subfamily proteins by monoglucosylation (just, i., selzer, j., wilm, m., von eichel-streiber, c., mann, m., and aktories, k. (1995) nature 375, 500-503). by deletion analysis we identified the enzyme and cytotoxic activity of the toxin to be located at the n terminus of the holotoxin. a 63-kda fragment of toxin b covering the first 546 amino acid residues glucosylated rho, rac, and cdc42, but not ras, ...	1997	9111001
hospital-acquired clostridium difficile diarrhoea.		1997	9113038
increased substance p responses in dorsal root ganglia and intestinal macrophages during clostridium difficile toxin a enteritis in rats.	previously we reported that pretreatment of rats with the substance p (sp) antagonist cp-96,345 inhibits the enterotoxic responses following administration of toxin a from clostridium difficile into ileal loops, indicating that sp participates in the intestinal responses to this toxin. we now report that injection of toxin a into rat ileum causes a rapid increase in sp content in lumbar dorsal root ganglia (drg) and mucosal scrapings 30-60 min after toxin a administration. toxin a-mediated fluid ...	1997	9114070
recurrent clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial.	recurrent clostridium difficile diarrhea (rcdd) occurs in 20% of patients after they have received standard antibiotic treatment with vancomycin or metronidazole, but the reasons for the recurrences are largely unknown. patients receiving vancomycin or metronidazole for active c. difficile diarrhea (cdd) were referred to our study centers for treatment and a 2-month follow-up as part of a randomized placebo-controlled trial. sixty patients had rcdd (median number of episodes, 3.0; range, 2-9 epi ...	1997	9114180
use of cycloserine-cefoxitin-fructose agar and l-proline-aminopeptidase (pro discs) in the rapid identification of clostridium difficile.	the pro disc (carr-scarborough microbiologicals, inc., decatur, ga.) can be used to screen for l-proline-aminopeptidase produced by clostridium difficile grown on cycloserine-cefoxitin-fructose agar (ccfa). fifty stored isolates of c. difficile (48 toxin-positive and 2 toxin-negative isolates) and 47 fresh c. difficile isolates (39 toxin-positive and 8 toxin-negative isolates) were all pro disc positive. other clostridium species that were pro disc positive could be differentiated from c. diffic ...	1997	9114419
reactive arthritis in a patient with simultaneous parvovirus b19 infection and clostridium difficile diarrhoea.		1997	9117160
production of a complete binary toxin (actin-specific adp-ribosyltransferase) by clostridium difficile cd196.	a clostridium difficile isolate was found to produce an actin-specific adp-ribosyltransferase (cdt) homologous to the enzymatic components of clostridium perfringens iota toxin and clostridium spiroforme toxin (m. r. popoff, e. j. rubin, d. m. gill, and p. boquet, infect. immun. 56:2299-2306, 1988). the cdt locus from c. difficile cd196 was cloned and sequenced. it contained two genes (cdta and cdtb) which display organizations and sequences similar to those of the iota toxin gene. the deduced e ...	1997	9119480
the stethoscope. a potential source of nosocomial infection?	stethoscope diaphragms have been shown to harbor potentially pathogenic bacteria.	1997	9125011
[a case of pseudomembranous enterocolitis which diagnosis was delayed in the outpatient clinic].	a 71-year-old male visited our hospital because of diarrhea. at first we suspected infectious colitis and levofloxacin (300 mg/day) was administered for four days. but the diarrhea continued, so performed a barium enema after about 3 weeks from onset. round polyposis from the rectum to the sigmoid colon were found. colonoscopy was suggested to the patient, but was rejected. however diarrhea continued and fever appeared. ceftriaxone (1 g/day) and sparfloxacin (200 mg/day) were administered, but t ...	1997	9132433
pseudomembranous enterocolitis after gynecologic endoscopy.	a 21-year-old nulligravida underwent diagnostic hysteroscopy and laparoscopic potassium-titanyl-phosphate laser ablation of pelvic peritoneal endometriosis (revised american fertility score of 10) for dysmenorrhea, dyspareunia, and dyschezia. preoperatively the patient had an electrolyte bowel preparation but no antibiotic prophylaxis. six days postoperatively she developed symptoms of nausea, vomiting, and diarrhea, which were not affected by diet and over-the-counter bowel medications. examina ...	1994	9138866
role of bacterial metabolism and physiology in the pathogenesis of clostridium difficile disease.		1997	9140922
isolation of various genotypes of clostridium difficile from patients and the environment in an oncology ward.	the epidemiology of clostridium difficile-associated diarrhea (cdad) is not well defined in nonepidemic situations because precise biotyping techniques have only recently become available. arbitrarily primed polymerase chain reaction (ap-pcr) was used to determine strain identity of c. difficile isolates recovered on our oncology ward, at an incidence rate of 0.84%. twenty-one strains of c. difficile, which were grouped into 18 different ap-pcr types, were isolated from patients' specimens. fort ...	1997	9142788
prevalence of and risk factors for clostridium difficile colonization at admission to an infectious diseases ward.	a study of 240 consecutive admissions to a single hospital ward over a 6-month period was conducted to determine the prevalence of and risk factors for clostridium difficile colonization at admission. the prevalence rate of c. difficile colonization at admission was 13.3%. seventy-four percent of the patients admitted to the ward were infected with human immunodeficiency virus (hiv). multivariate analysis identified three risk factors for c. difficile colonization: clindamycin use (adjusted odds ...	1997	9142793
clostridium difficile-related necrotizing pseudomembranous enteritis in association with henoch-schonlein purpura.		1997	9144126
health care resource utilization and antimicrobial use in elderly patients with community-acquired lower respiratory tract infection who develop clostridium difficile-associated diarrhoea.	we conducted a prospective observational study on the medical management and health service resource utilization associated with the hospital care of patients with community-acquired lower respiratory tract infection. between january 1994 and june 1995, 28 such patients developed clostridium difficile-associated diarrhoea; these 28 patients were matched with 56 age-matched patients, who were used as a control group in a comparative study. progress during the first week after admission was simila ...	1997	9145829
antianaerobic activity of the ketolide ru 64004 compared to activities of four macrolides, five beta-lactams, clindamycin, and metronidazole.	agar dilution methodology (with added oxyrase in the case of the macrolide group to allow incubation without added co2) was used to compare the activity of ru 64004, a new ketolide, with the activities of erythromycin, azithromycin, clarithromycin, roxithromycin, clindamycin, amoxicillin with and without clavulanate, piperacillin with and without tazobactam, metronidazole, and imipenem against 379 anaerobes. overall, ru 64004 yielded an mic at which 50% of the isolates are inhibited (mic50) of 1 ...	1997	9145865
guidelines for the diagnosis and management of clostridium difficile-associated diarrhea and colitis. american college of gastroenterology, practice parameters committee.	guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. when data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. guidelines are in ...	1997	9149180
pseudomembranous colitis with associated fulminant ileitis in the defunctionalized limb of a jejunal-ileal bypass. report of a case.	presented is what is believed to be the first reported case of a defunctionalized limb of small intestine serving as a reservoir for clostridium difficile. because of the altered intestinal continuity, the ensuing enteritis and colitis failed to respond to nonoperative management. current treatment strategies are reviewed. surgical intervention, including restoration of normal gastrointestinal continuity, should be considered early in the hospital course of this patient population.	1997	9152196
myasthenic crisis: clinical features, mortality, complications, and risk factors for prolonged intubation.	we retrospectively reviewed the hospital records of 53 patients admitted for 73 episodes of myasthenic crisis at columbia-presbyterian medical center over a period of 12 years, from 1983 to 1994. median age at the onset of first crisis was 55 (range, 20 to 82), the ratio of women to men was 2:1, and the median interval from onset of symptoms to first crisis was 8 months. infection (usually pneumonia or upper respiratory infection) was the most common precipitating factor (38%), followed by no ob ...	1997	9153452
vancomycin-resistant enterococci in stool specimens submitted for clostridium difficile cytotoxin assay.	the prevalence of, and clinical risk factors associated with, vancomycin-resistant enterococcal colonization were investigated in patients suspected of having clostridium difficile infection. stools submitted for c difficile cytotoxin testing were screened for vancomycin-resistant enterococci (vre). isolates were speciated and characterized further by antibiotic susceptibility testing, dna fingerprinting, and dna:dna hybridization for detection of specific vancomycin resistance genes. of the 79 ...	1997	9154478
banana flakes control diarrhea in enterally fed patients.	diarrhea occurs frequently in the critically ill tube-fed population and may result from a multitude of causes. despite the availability of antidiarrheal medications, diarrhea associated with enteral feedings remains a problem for clinicians and for the patients affected by it. we tested the hypothesis that administration of banana flakes would control diarrhea in critically ill patients receiving enteral feedings. thirty-one patients with diarrhea and receiving enteral feedings were randomized ...	1997	9155405
risk of diarrhoea, clostridium difficile and cefotaxime in the elderly.	clostridium difficile diarrhoea is an increasingly important nosocomial infection. clostridium difficile infection is associated with antibiotic use. the elderly are at greatest risk. we reported an outbreak associated with the use of cefotaxime, a third-generation cephalosporin. we review the extent of this association, putative causal mechanisms and suggest an integrated approach to the control of c difficile infection which focuses on both limiting environmental contamination and reducing pat ...	1997	9161469
[clostridium difficile].		1997	9162786
etiological agents of infectious diarrhea: implications for requests for microbial culture.	gastrointestinal infections remain a frequent disease worldwide. in order to increase our knowledge of the epidemiology for our patient population, we retrospectively analyzed the results obtained for stool samples received at the clinical microbiology laboratory of the university hospital of geneva during a 4-year period. a total of 13,965 specimens from 7,124 patients (1.96 specimens per patient) were cultured, yielding 369 (2.6%) salmonella spp., 408 (2.9%) campylobacter spp., and 79 (0.6%) s ...	1997	9163457
recurrent clostridium difficile diarrhea associated with mitoxantrone and etoposide: a case report and review.	clostridium difficile colitis most commonly occurs in association with antibiotic administration and infrequently with antineoplastic agents. our patient experienced recurrent c. difficile diarrhea associated with mitoxantrone and etoposide. he received antibiotics during the 6 months, but each episode of diarrhea was preceded by at least a 6-week antibiotic-free period. in addition, antineoplastic therapy preceded each episode by 8 or 9 days. clinicians should be aware that antineoplastic drugs ...	1997	9165566
single-step polymerase chain reaction for combined gene detection and epidemiological typing in three bacterial models.	we describe a new polymerase chain reaction (pcr) for combined gene detection and epidemiological typing (cogedet), which allows bacterial typing and gene detection in a one-step assay. this assay, in which target gene-specific primers are used under low-stringency annealing conditions, was evaluated on 32 staphylococcus aureus strains using toxic shock syndrome toxin 1 (tst) primers, 30 clostridium difficile strains using toxin a (toxa) primers, and 30 escherichia coli strains using cytotoxic n ...	1997	9170276
clostridium difficile.		1997	9171711
early functional effects of clostridium difficile toxin a on human colonocytes.	previous in vitro studies have shown that clostridium difficile toxin a is able to directly affect the intestinal epithelial barrier function. the aim of this study was to examine the early effects of toxin a on mucin exocytosis and determine whether this toxin can induce the production of the chemokine interleukin 8 (il-8) from human colonic epithelial cells.	1997	9178681
bedside prediction of clostridium difficile colitis.		1997	9182463
antibacterial activity of teicoplanin against clostridium difficile.	the in vitro inhibitory action of teicoplanin, vancomycin, metronidazole and clindamycin against clinical isolates of clostridium difficile was investigated. minimum inhibitory concentrations (mics) were determined using e test. teicoplanin (mic range 0.023-0.75 microgram/ml), vancomycin (mic range 0.5-3 micrograms/ml) and metronidazole (mic range 0.19-1 microgram/ml) were all very active against the isolates examined. no resistant strains of c. difficile to those three antimicrobial agents were ...	1996	9185278
bacteroides fragilis toxin rearranges the actin cytoskeleton of ht29/c1 cells without direct proteolysis of actin or decrease in f-actin content.	enterotoxigenic strains of b. fragilis associated with childhood diarrhea produce a 20 kd zinc metalloprotease toxin (bft). bft is reported to cleave g-actin in vitro and also causes dramatic rounding and rearrangement of the f-actin cytoskeleton in human intestinal epithelial cell lines (ht29) and ht29/c1). to test the hypothesis that the proteolysis of cellular actin by bft in vivo may contribute to these alterations in morphology and cytoskeletal architecture, we assessed the f-actin content ...	1997	9186013
clostridium difficile: a microbial enigma.	nearly 150 years ago, louis pasteur introduced the world to the science of microbiology and to the fact that our environment contains microbes capable of causing disease. subsequent to these discoveries, a pandemic of health care-related staphylococcal infections nearly a century later led to the recognition of hospital-associated (nosocomial) infection. clearly such infections (nosohusial) now also afflict nursing home residents and patients who receive home health care.	1997	9188331
delayed onset of pseudomembranous colitis after rifampin therapy.	rifampin therapy is an infrequently reported cause of pseudomembranous colitis. a low index of suspicion may account for this lack of recognition. awareness of this potentially hazardous complication of rifampin therapy is encouraged, especially since increasing numbers of patients infected with the human immunodeficiency virus, who may have diarrhea from other etiologies, require rifampin therapy.	1997	9191744
dynamics of clostridium difficile infection. control using diet.	understanding the dynamics of the establishment of c. difficile within the gut is vital to effective prevention, control and therapy of disease due to this nosocomial pathogen. factors affecting the establishment of c. difficile in the gut were investigated including the role of bacterial metabolic products (bmps), the composition of colonic flora, diet, and properties of the infecting strain. concentrations of 9/12 bacterial metabolic products (bmps), both volatile and non-volatile were signifi ...	1997	9191992
intracellular transport and processing of protein toxins produced by enteric bacteria.	bacterial toxins are associated with disease in humans and animals. toxins can either be preformed in food or produced by bacteria in the intestine. there are two types of toxins: heat-labile protein toxins and heat stabile toxins. heat labile toxins are produced by bacillus cereus, clostridium perfringens, escherichia coli, and vibrio cholerae, and heat-stabile enterotoxins consisting of relatively few amino acids are produced by escherichia coli and acts by activation of guanylate cyclase. sim ...	1997	9192018
adp-ribosylating and glucosylating toxins as tools to study secretion in rbl cells.	the influence of different adp-ribosylating and glucosylating cytotoxins on stimulated protein tyrosine phosphorylation and secretion in rat basophilic leukemia (rbl) cells was studied. treatment of rbl cells with clostridium botulinum c2 toxin, which specifically adp-ribosylated monomeric g-actin and caused complete depolymerization of the actin cytoskeleton in intact cells, inhibited fc epsilon ri receptor-mediated tyrosine phosphorylation of various proteins in a time- and concentration-depen ...	1997	9193676
clostridium difficile toxin a induces the release of neutrophil chemotactic factors from rat peritoneal macrophages: role of interleukin-1beta, tumor necrosis factor alpha, and leukotrienes.	clostridium difficile produces a potent enterotoxin and cytotoxin, toxins a and b, respectively, which appear to be responsible for pseudomenbranous colitis and antibiotic-associated diarrhea. in the present study we explored the neutrophil migration evoked by toxin a in the peritoneal cavities and subcutaneous air pouches of rats and examined the role of macrophages and their inflammatory mediators in this process. toxin a causes a significant dose-dependent neutrophil influx into the peritonea ...	1997	9199444
protective immunity against clostridium difficile toxin a induced by oral immunization with a live, attenuated vibrio cholerae vector strain.	clostridium difficile causes pseudomembranous colitis through the action of rho-modifying proteins, toxins a and b. antibodies directed against c. difficile toxin a prevent or limit c. difficile-induced colitis. we engineered plasmid petr14, containing the hlyb and hlyd genes of the escherichia coli hemolysin operon, to express a fusion protein containing 720 amino acid residues from the nontoxic, receptor-binding, carboxy terminus of c. difficile toxin a and the secretion signal of e. coli hemo ...	1997	9199470
can ischemic colitis be differentiated from c difficile colitis in biopsy specimens?	pseudomembranous colitis is often caused by clostridium difficile; however, it may also be due to ischemia. to determine if any histologic features could be used to differentiate c difficile from ischemia, 49 biopsies of pseudomembranous colitis (25 from patients with c difficile colitis and 24 from patients with ischemic colitis) were coded, randomized, and evaluated for the presence of numerous variables, including the amount and distribution of mucosal necrosis, lamina propria hyalinization, ...	1997	9199649
serious clostridium difficile sepsis.		1997	9201543
rho proteins play a critical role in cell migration during the early phase of mucosal restitution.	in the intestine, several growth factors stimulate migration of epithelial cells, contributing to the maintenance of tissue integrity. the ras-like gtpase rho regulates a signal transduction pathway linking growth factor receptors to the formation of actin stress fibers and focal adhesions, presumed to be important for motility. using an in vitro wound-induced migration assay, we have examined the role of rho gtpases in the migration of iec-6 and caco-2 cells, and provide evidence that the rho g ...	1997	9202074
role of tumor necrosis factor and nitric oxide in the cytotoxic effects of clostridium difficile toxin a and toxin b on macrophages.	clostridium difficile, the bacterium involved in antibiotic-associated colitis, produces two exotoxins, toxin a (txa) and toxin b (txb). although these toxins are well recognized as being cytotoxic to several mammalian cell types, the mechanisms involved are not fully understood. the aim of the present investigation was to examine the cytotoxicity of txa and txb to peritoneal macrophages in culture and to investigate whether tumor necrosis factor-alpha (tnf-alpha) and nitric oxide (no) are invol ...	1997	9203299
[prospective study of pathogenic agents isolated from feces of patients with hiv infections].	determine the frequency of enteropathogenic agents isolated in diarrheic feces of patients with hiv infection and to compare findings with a control group (hiv + without diarrhea) in order to identify risk factors.	1997	9205468
do patients with clostridium difficile need to be isolated?		1997	9211164
[epidemic c difficile-associated diarrhea is a reality. fewer prescriptions and more soap].		1997	9213685
reactive arthritis to clostridium difficile in a child.		1997	9217461
saccharomyces boulardii for the treatment of clostridium difficile-associated colitis.	s. boulardii has been investigated in europe and the us, and preliminary reports indicate that it is safe and effective in conjunction with vancomycin or metronidazole for the treatment of cdc, predominantly in patients who develop recurrence. s. boulardii in combination with vancomycin or metronidazole has not been shown to be more effective than either of these agents alone for treatment of a first episode of cdc. in addition, s. boulardii has not been studied in immunocompromised patients who ...	1997	9220059
the involvement of macrophage-derived tumour necrosis factor and lipoxygenase products on the neutrophil recruitment induced by clostridium difficile toxin b.	clostridium difficile (cd) toxins appear to mediate the inflammatory response in pseudomembranous colitis and/or colitis associated with the use of antibiotics. in contrast to cd toxin a (txa), cd toxin b (txb) has been reported not to promote fluid secretion or morphological damage in rabbits and hamsters and also does not induce neutrophil chemotaxis in vitro. however, txb is about 1000 times more potent than txa in stimulating the release of tumour necrosis factor-alpha (tnf-alpha) by culture ...	1997	9227329
delineation of the catalytic domain of clostridium difficile toxin b-10463 to an enzymatically active n-terminal 467 amino acid fragment.	in an attempt to directly approach the postulated toxic domain of clostridium difficile's tcdb-10463, eight subclones of different size and locations in the n-terminal third of the toxin were generated. expression of these toxin fragments was checked in western blots and the enzymatic activity of the expressed proteins was analyzed by glucosylating ras related small gtp-binding proteins. two polypeptides of 875 aa (tcdbc1-3) and 557 aa (tcdbc1-h) glucosylated their targets rho, rac and cdc42 wit ...	1997	9228777
escherichia coli cytotoxic necrotizing factor 1 (cnf1), a toxin that activates the rho gtpase.	cytotoxic necrotizing factor 1 (cnf1), a 110-kda protein toxin from pathogenic escherichia coli induces actin reorganization into stress fibers and retraction fibers in human epithelial cultured cells allowing them to spread. cnf1 is acting in the cytosol since microinjection of the toxin into hep-2 cells mimics the effects of the externally applied cnf1. incubation in vitro of cnf1 with recombinant small gtpases induces a modification of rho (but not of rac, cdc42, ras, or rab6) as demonstrated ...	1997	9235957
multivalent binding of toxin a from clostridium difficile to carbohydrate receptors.	a specific monoclonal antibody against toxin a from clostridium difficile was generated that did not show thermolabile binding. nonspecific murine monoclonal antibodies bound toxin a at 4 degrees c, but less effectively at 37 degrees c. nonspecific human monoclonal antibodies did not bind to toxin a at 4 degrees c. cytotoxic properties of purified toxin a were not inhibited by bandeiraea simplicifolia lectin. this points to a carbohydrate moiety on the cell surface and a multivalent nonspecific ...	1994	9237345
clostridium difficile--associated diseases: comparison of symptomatic infection versus carriage on the basis of risk factors, toxin production, and genotyping results.		1997	9243055
pleural empyema due to clostridium difficile and clostridium cadaveris.		1997	9243057
surveillance for antimicrobial resistance in enterococci.	to describe antimicrobial resistance patterns of enterococcus species in auckland.	1997	9251710
enhancement of bismuth antibacterial activity with lipophilic thiol chelators.	the antibacterial properties of bismuth are greatly enhanced when bismuth is combined with certain lipophilic thiol compounds. antibacterial activity was enhanced from 25- to 300-fold by the following seven different thiols, in order of decreasing synergy: 1,3-propanedithiol, dimercaprol (bal), dithiothreitol, 3-mercapto-2-butanol, beta-mercaptoethanol, 1-monothioglycerol, and mercaptoethylamine. the dithiols produced the greatest synergy with bismuth at optimum bismuth-thiol molar ratios of fro ...	1997	9257744
immobilization of reducing sugars as toxin binding agents.	a simple and economical procedure for the attachment of reducing sugars to aminated solid supports has been developed. reaction of the amino groups on the solid support with p-nitrophenyl chloroformate, followed by 1,6-hexanediamine, yields a chain-extended amine to which reducing sugars can be attached while remaining accessible to macromolecules. immobilization of the reducing sugars involves a simple incubation followed by trapping of the resulting glycosylamine with acetic anhydride and reco ...	1997	9258442
drug-induced clostridium difficile-associated disease.	clostridium difficile is a spore-forming anaerobe that resides in the colon and is capable of producing gastrointestinal disease in humans. factors such as previous exposure to antibacterials and some antineoplastic agents have been reported to promote the overgrowth of c. difficile, with subsequent liberation of potent exotoxins that induce inflammation in the colonic mucosa. colonisation rates vary, and are higher during infancy and hospitalisation, compared with healthy adults. although many ...	1997	9258629
complications by age in primary pediatric renal transplant recipients.	we asked whether pediatric renal transplant recipients, subgrouped by age, differed in the percentage and number of hospital readmissions and in the incidence of infectious complications post transplant. between 1 august 1985 and 31 october 1993, a total of 164 patients < 18 years of age underwent primary transplants, with cyclosporine-based immunosuppression, at the university of minnesota. the percentage of readmissions (p = ns), the mean number of readmissions (p = ns), and the length of hosp ...	1997	9260233
surveillance of nosocomial infections in geriatric patients.	prospective surveillance of hospital-acquired infections was undertaken in the geriatric ward of the university hospital, utrecht, the netherlands. the medical records of 300 patients were studied for the presence of nosocomial infections using the criteria defined by the centers for disease control (cdc), atlanta, georgia, usa. data were collected from patients with and without infection, which allowed for the analysis of risk factors for nosocomial infection. in 100 out of 300 patients (33.3%) ...	1997	9261757
the effect of enteric bacterial toxins on the catecholamine levels of the rabbit.	the rabbit catecholamine responses to bacterial toxins commonly found in sudden infant death syndrome (sids) victims were studied as part of a proposed animal model for sids. six bacterial toxins commonly isolated from sids baby feces and a comparison endotoxin were injected intravenously (i.v.) and intraluminarily (i.l.) to determine their effects on catecholamine levels. i.v. injected toxins clearly altered catecholamine levels causing sharp rises in adrenaline and noradrenaline levels and at ...	1997	9271018
involvement of rho family proteins in prostaglandin f2 alpha-induced phospholipase d activation in the osteoblast-like cell line mc3t3-e1.	to examine the role of rho family proteins in prostaglandin f2 alpha (pgf2 alpha)-mediated phospholipase d (pld) activation of osteoblast-like cell line mc3t3-e1 cells, we used toxin-b from clostridium difficile, which inhibits rho family proteins by monoglucosylation. pretreatment of [3h]myristic acid-labeled mc3t3-e1 cells with toxin b induced rounding-up of the cells and inhibited the pgf2 alpha-induced pld activation by 60%, but not the phospholipase c (plc) activation. cytochalasin d also i ...	1997	9271785
hemolytic-uremic syndrome associated with pseudomembranous colitis caused by clostridium difficile.		1997	9274852
il-11 inhibits clostridium difficile toxin a enterotoxicity in rat ileum.	interleukin-11 (il-11) is a stromal cell-derived cytokine with several biological activities against hematopoietic cells. recent results indicated that il-11 reduced mucosal damage in animal models of colitis. this study aimed to explore the action of recombinant human il-11 (rhil-11) on the intestinal effects of clostridium difficile toxin a, an inflammatory enterotoxin, and cholera toxin, a noninflammatory enterotoxin in rat ileum. we administered rhil-11 subcutaneously to rats before injectio ...	1997	9277411
exosporial membrane plasticity of clostridium sporogenes and clostridium difficile.	this investigation examines the morphological alterations of the exosporial membranes of clostridium sporogenes atcc 3584 and clostridium difficile atcc 43594 and 9689 endospores in relation to their possible function during germination in the attachment/colonization process of these pathogenic bacteria. there is no reported function for the exosporial membrane, nor exosporial appendages, of clostridial endospores. advances in high resolution, scanning electron microscopy (sem) permit the examin ...	1997	9281845
[clostridium difficile associated diarrhea in cephalosporin administration: experiences of the swiss adverse drug reaction reporting system 1981-1995].	20-25% of antibiotics-associated diarrhea cases are caused by infection with toxin-producing clostridium difficile. since the advent of broad-spectrum antibiotics clostridium difficile-associated diarrhea has been observed both in ambulatory practice and as a nosocomial infection in medical and nursing institutions. clindamycin, aminopenicillins, and cephalosporines are by far the most common triggers for this infection. we reviewed all cases of clostridium difficile-associated diarrhea due to c ...	1997	9289841
recurrent clostridium difficile disease following ciprofloxacin use.		1997	9296254
comparative antianaerobic activities of the ketolides hmr 3647 (ru 66647) and hmr 3004 (ru 64004).	hmr 3647 (ru 66647) and hmr 3004 (ru 64004), two ketolides, had mics at which 50% of the strains are inhibited (mic50s) of 0.06 to 0.125 microg/ml and mic90s of 16.0 microg/ml against 352 anaerobes. mic50s and mic90s of erythromycin, azithromycin, clarithromycin, and roxithromycin were 0.5 to 2.0 microg/ml and 32.0 to >64.0 microg/ml, respectively. hmr 3647 and hmr 3004 were more active against non-bacteroides fragilis-group anaerobes (other than fusobacterium mortiferum, fusobacterium varium, a ...	1997	9303406
clostridium difficile infection in obstetric and gynecologic patients.	we reviewed hospital records of women on the obstetrics and gynecologic services with a diagnosis of antibiotic-associated diarrhea, pseudomembranous colitis, or clostridium difficile infection to better characterize the incidence and course of women with c difficile infection. cases were included if there was identification of c difficile by culture or toxin or endoscopic verification of pseudomembranous colitis. between january 1985 and june 1995, there were 74,120 admissions to the obstetrics ...	1997	9305296
clostridium difficile-associated diarrhea: epidemiology, risk factors, and infection control.	to evaluate the effectiveness of specific infection control measures on the incidence of clostridium difficile-associated diarrhea (cdad) and to identify risk factors for its development.	1997	9309434
antibody responses to clostridial infection in humans.	serum antibody responses to the major toxins produced by clostridium difficile, clostridium perfringens, clostridium septicum, clostridium tetani, and clostridium botulinum have been documented following infection. effective toxoid vaccines for tetanus and enteritis necroticans due to c. perfringens type c demonstrate the potential of antitoxin responses. although individual serum and mucosal antibody responses to c. difficile enterotoxin (toxin a) vary, one-third of patients with c. difficile d ...	1997	9310668