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the pathogenesis of infection and immune response.an understanding of the pathogenesis of infection, and the complex and fascinating 'relationship', or interaction, between the infecting organism and the host are advantageous when caring for patients with infections/infectious diseases, particularly as many of the clinical features of infection are as a consequence of the defence mechanisms mounted by the immune system. this article aims to provide a brief overview of the pathogenesis of infection, explaining how the two branches of the immune ...201020852457
clostridium difficile: moving beyond antimicrobial therapy. 201020854648
post-esophagectomy pseudomembranous inflammation of the interposed colon.pseudomembranous colitis (pmc) usually is caused by antibiotic-related changes in colonic anaerobic microflora, leading to clostridium difficile overgrowth and overproduction of toxins. we present the first reported case of pmc affecting the intrathoracic, interposed colon of an esophagectomy patient in the absence of inflammation of the in situ colon.201020858162
the attachment, internalization, and time-dependent, intracellular distribution of clostridium difficile toxin a in porcine intestinal explants.toxin a (tcda), secreted by toxigenic strains of clostridium difficile, produces lesions typical of c. difficile-associated disease (cdad) in susceptible mammal species. porcine colon explants maintained for 2 hours with tcda developed severe lesions characterized by cell swelling, swelling of mitochondria and other organelles, distension of cytoplasmic vesicles, expansion of paracellular spaces, apoptosis, and necrosis. severity of lesions was proportional to the dosage of toxin. no lesions wer ...201120861504
'thumbprinting'. 201020862786
peptide inhibitors targeting clostridium difficile toxins a and b.clostridium difficile causes severe hospital-acquired antibiotic-associated diarrhea due to the activity of two large protein toxins. current treatments suffer from a high relapse rate and are generating resistant strains; thus new methods of dealing with these infections that target the virulence factors directly are of interest. phage display was used to identify peptides that bind to the catalytic domain of c. difficile toxin a. library screening and subsequent quantitative binding and inhibi ...201020863124
clostridium difficile spore germination: an update.endospore production is vital for the spread of clostridium difficile infection. however, in order to cause disease, these spores must germinate and return to vegetative cell growth. knowledge of germination is therefore important, with potential practical implications for routine cleaning, outbreak management and potentially in the design of new therapeutics. germination has been well studied in bacillus, but until recently there had been few studies reported in c. difficile. the role of bile s ...201020863888
update: detection of a verona integron-encoded metallo-beta-lactamase in klebsiella pneumoniae --- united states, 2010.in july 2010, cdc was notified of a patient with a carbapenem-resistant klebsiella pneumoniae strain that produced a verona integron-encoded metallo-beta-lactamase (vim) carbapenemase not reported previously among enterobacteriaceae in the united states. the patient was a woman from the united states who became ill with diarrhea during a mediterranean cruise and was hospitalized in greece, where she received a diagnosis of sepsis and clostridium difficile infection. after 12 days in two hospital ...201020864922
proteomic analysis of the insoluble subproteome of clostridium difficile strain 630.clostridium difficile, a gram-positive spore-forming anaerobe, causes infections in humans ranging from mild diarrhoeal to potentially life-threatening pseudomembranous colitis. the availability of genomic information for a range of c. difficile strains affords researchers the opportunity to better understand not only the evolution of these organisms but also their basic physiology and biochemistry. we used proteomics to characterize the insoluble subproteome of c. difficile strain 630. gel-base ...201020868380
preventing catheter-associated urinary tract infections: an executive summary of the association for professionals in infection control and epidemiology, inc, elimination guide.the association for professionals in infection control and epidemiology (apic) began publishing their series of elimination guides in 2007. since then, 9 elimination guides have been developed that cover a range of important infection prevention issues, including the prevention of catheter-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections (cautis), as well as mediastinitis surgical site surveillance. multidrug-resistant organisms, i ...201020868930
epidemiology of community-onset clostridium difficile infection in a community in the south of england.clostridium difficile infection (cdi) has traditionally been considered a hospital acquired infection but there are a rising number of infections in the community. this study estimates the prevalence of community-onset cdi (co-cdi), defined as onset of symptoms in a community setting and outside the hospital, and examines the risk factors for co-cdi in 2-64 year-olds.201020869672
quantifying interhospital patient sharing as a mechanism for infectious disease spread.assessments of infectious disease spread in hospitals seldom account for interfacility patient sharing. this is particularly important for pathogens with prolonged incubation periods or carrier states.201020874503
incidence, case fatality and genotypes causing clostridium difficile infections, finland, 2008*clin microbiol infect abstract: since 2000, the epidemiology of c. difficile infections (cdi) has changed in the us and europe. few population-based assessments of both incidence and case fatality of cdi have been performed. in this study, the finnish nationwide laboratory-based surveillance data from the year 2008 were analysed to assess the incidence and case fatality of cdi, and to detect regional differences in relation to molecular epidemiology. a total of 6201 episodes of cdi were identifi ...201020874814
clostridium difficile infections among hospitalized children, united states, 1997-2006. 201020875309
clostridium difficile knowledge in healthcare workers: conclusions in the absence of broader evaluation. 201020883611
an outbreak case of clostridium difficile-associated diarrhea among elderly inpatients of an intensive care unit of a tertiary hospital in rio de janeiro, brazil.the aim of this study was to investigate clostridium difficile-associated diarrhea (cdad) in an intensive care unit (icu) of a tertiary hospital in rio de janeiro, brazil, and to characterize epidemiologically c. difficile strains obtained from an outbreak of cdad. within almost a 4-year surveillance period, cdad incidence was determined for the first time in brazil, and a 3-fold increase was observed in the average rate of cdad, featuring an outbreak. about 80% of the patients were over 65 year ...201020884155
fulminant clostridium difficile toxic megacolon in a pediatric heart transplant recipient.patel a, gossett jj, benton t, rowell e, russell h, cham e, pahl e. fulminant clostridium difficile toxic megacolon in a pediatric heart transplant recipient.
pediatr transplantation 2010: 00: 000-000. © 2010 john wiley & sons a/s. abstract:  cd can be a cause of diarrhea in pediatric heart transplant recipients. fulminant colitis can develop in immunocompromised patients with cd and progress to toxic megacolon. we report a case of a 10-yr-old girl who developed cd diarrhea and subsequently fulm ...201020887401
analysis of prevalence, risk factors and molecular epidemiology of clostridium difficile infection in kuwait over a 3-year period.we conducted a prospective study to evaluate the prevalence and epidemiology of cdi in kuwait government hospitals over a 3-year period, january 2003 to december 2005, to determine the ribotypes responsible for cdi and to estimate the prevalence of ribotype 027. we also conducted a case-control study to identify the risk factors in our patient population. a total of 697 stool samples from patients with suspected cdi were obtained and sent to anaerobe reference laboratory, faculty of medicine, ku ...201020887795
[the microbiota and infectious diarrhea].understanding the importance of the fecal microbiota has been key in understanding the pathophysiology of some infectious diarrheas. in addition to normal protective measures of bile, gastric acid, and immune response, among others, we now know that the healthy gut flora protects us from some infectious diarrheas. antibiotic associated diarrhea (aad) is an excellent example, as antibiotics perturb the normal flora; the resulting diarrhea may be due to changes in short chain fatty acid metabolism ...201020889002
[recent advances in saccharomyces boulardii research].this review summarizes the probiotic mechanisms of action of saccharomyces boulardii (s. boulardii) against inflammatory and non-inflammatory diarrheal conditions. s. boulardii is distributed in lyophilized form in many countries and used for the prevention of diarrhea in children and adults, including clostridium difficile (c. difficile) associated infection. the main mechanisms of action of s. boulardii include inhibition of activities of bacterial pathogenic products, trophic effects on the i ...201020889007
investigation of toxin gene diversity, molecular epidemiology, and antimicrobial resistance of clostridium difficile isolated from 12 hospitals in south korea.clostridium difficile is a major cause of antibiotic-associated diarrhea. the objective of this study was to characterize clinical isolates of c. difficile obtained from various regions in korea with regard to their toxin status, molecular type, and antimicrobial susceptibility.201020890081
[antimicrobial activity of oral quinolones against clinical isolates of bifidobacterium group and clostridium difficile].administrations of antimicrobial agent influence human intestinal flora, and sometimes lead to cause clostridium difficile colitis (cdc). it has been well known that antimicrobial agents, such as clindamycin (cldm), ampicillin (abpc) and cephems, frequently cause c. difficile colitis, however, recently some respiratory quinolones, such as garenoxacin (grnx) and moxifloxacin (mflx), have paid to attention. bifidobacterium species would be highly associated with the preservation of normal intestin ...201020919497
prevalence of antimicrobial resistance and association with toxin genes in clostridium difficile in commercial swine.to estimate prevalence and determine association between antimicrobia resistance and toxin gene profile of clostridium difficile in commercial pigs at the preharvest food-safety level.201020919905
in the clinic. clostridium difficile infection.this issue provides a clinical overview of clostridium difficile infection focusing on prevention, diagnosis, treatment, practice improvement, and patient information. readers can complete the accompanying cme quiz for 1.5 credits. only acp members and individual subscribers can access the electronic features of in the clinic. non-subscribers who wish to access this issue of in the clinic can elect "pay for view." subscribers can receive 1.5 category 1 cme credits by completing the cme quiz that ...201020921540
clostridium difficile infection and liver disease.the rates of the predominantly hospital acquired infection, clostridium difficile, have increased throughout the world. several risk factors and susceptible patient populations have been identified. patients with pre-existing liver disease represent an important cohort; recent evidence suggests that clostridium difficile infection (cdi) is associated with a worse outcome and increased health care costs. this review focuses on the epidemiology, risk factors, pathogenesis, treatment options and ou ...201020922196
[epidemiology of severe clostridium difficile infections in hesse, germany in 2008-2009].clostridium difficile is a major cause of health care associated infections in industrialized countries. during the past decade, the incidence and clinical severity of c. difficile infections (cdi) have increased markedly. this increase has been associated with the emergence of a possibly highly virulent strain, the c. difficile pcr ribotype 027. we investigated the emergence of severe cdi and the associated pcr ribotypes in hesse, germany.201020922636
potential value of repeat stool testing for clostridium difficile stool toxin using enzyme immunoassay?the aim of this brief review is to summarize the literature as it relates to the potential value of repeat stool testing for clostridium difficile (c. difficile) toxin using an enzyme immunoassay (eia) for toxin a&b and also propose a potential newer algorithm for diagnosing c. difficile.201020923255
intravenous immunoglobulin for the treatment of clostridium difficile infection: a review.clostridium difficile infection (cdi) has increased sharply in incidence, mortality rate, and burden on the healthcare system over the past decade. therefore, novel treatment modalities have been developed, including intravenous immunoglobulin (ivig). the level of immune response to clostridium difficile colonization is the major determinant of the magnitude and duration of clinical manifestations. this effect is mediated predominantly by serum igg anti-toxin a antibodies. based on this finding, ...201020924675
a classification system for hospital-based infection outbreaks.outbreaks of infection within semi-closed environments such as hospitals, whether inherent in the environment (such as clostridium difficile (c.diff) or methicillin-resistant staphylococcus aureus (mrsa) or imported from the wider community (such as norwalk-like viruses (nlvs)), are difficult to manage. as part of our work on modelling such outbreaks, we have developed a classification system to describe the impact of a particular outbreak upon an organization. this classification system may the ...201020924858
spores of clostridium difficile in hospital air. 201020925506
effect of ceftobiprole on the normal human intestinal microflora.ceftobiprole is a new broad-spectrum pyrrolidinone cephem active against meticillin-resistant staphylococcus aureus, vancomycin-resistant enterococcus faecalis and gram-negative bacteria such as enterobacteriaceae and pseudomonas spp. the purpose of the present study was to investigate the effect of administration of ceftobiprole on the normal intestinal microflora. twelve healthy subjects (six males and six females) aged 20-31 years received ceftobiprole 500 mg by intravenous infusion every 8h ...201020926263
rifampin plus metronidazole for clostridium difficile infection. 201020929305
global epidemiology of clostridium difficile infection in 2010.the past decade has been characterized by an epidemic of clostridium difficile infection in north america and europe that threatens to extend to the rest of the world. the epidemic is due in part to the emergence of a previously rare and now more lethal c. difficile strain variously named group bi, ribotype 027, and north american pulsed‐field gel electrophoresis type 1.201020929364
detection of clostridium difficile infection.there has been a recent surge of interest in clostridium difficile infection, which reflects an impressive increase in the number and severity of these infections. this review addresses some of the newer methods for detection of c. difficile infection at the bedside and in the laboratory. particularly important are the new rapid diagnostic tests that detect toxigenic c. difficile using polymerase chain reaction and the combination tests that, either simultaneously or sequentially, screen for c. ...201020929365
prevention of healthcare‐associated clostridium difficile infection: what works?prevention of clostridium difficile infection has become extremely important because of increases in its incidence and severity. unfortunately, efforts at c. difficile infection prevention are hampered by lack of data to support optimal prevention methods, especially for endemic c. difficile infection. studies are needed to define the optimal prevention practices and to investigate novel prevention methods.201020929366
sequencing of superbugs seen as key to combating their spread. 201020930725
medical microbiology: a toxin contest. 201020930831
impact of clostridium difficile on inflammatory bowel disease.clostridium difficile infection (cdi) has been increasing in incidence among those with underlying inflammatory bowel disease (ibd) and is associated with substantial morbidity, the need for surgery and even mortality. the similar clinical presentation between cdi and a flare of underlying ibd makes prompt diagnosis essential to prevent deterioration which would accompany an escalation of immunosuppression in the absence of appropriate antibiotic therapy. classical risk factors (antibiotic or he ...201020932144
nosocomial infections and multidrug-resistant bacterial organisms in the pediatric intensive care unit.nosocomial infections in pediatric intensive care units (picus) caused by multidrug-resistant bacterial organisms are increasing. this review attempts to report on significant findings in the current literature related to nosocomial infections in picu settings with an international perspective. the types of nosocomial infections are addressed, including catheter-related bloodstream infections, ventilator-associated pneumonia, urinary tract infections, gastrointestinal infections and post-surgica ...201020936380
[clostridium difficile]. 201020942043
evaluation of the cepheid xpert clostridium difficile epi assay for diagnosis of clostridium difficile infection and typing of the nap1 strain at a cancer hospital.clostridium difficile is the most common cause of health care-associated diarrhea. accurate and rapid diagnosis is essential to improve patient outcome and prevent disease spread. we compared our two-step diagnostic algorithm, an enzyme immunoassay for glutamate dehydrogenase (gdh) followed by the cytotoxin neutralization test (cyt) with a turnaround time of 24 to 48 h, versus the cepheid xpert c. difficile epi assay, a pcr-based assay with a turnaround time of <1 h. in the first phase of the st ...201020943860
clostridium difficile-associated diarrhea in a tertiary care medical center.this retrospective, case-control study aimed to identify variables associated with the incidence of clostridium difficile-associated diarrhea (cdad) in acute care facilities and to specifically identify the relationship of fluoroquinolones and acid suppressive agents in the development of cdad. seventy-one symptomatic patients positive for c. difficile toxin a or b hospitalized for at least 72 hours were compared with 142 control patients hospitalized for at least 72 hours who were not positive ...201020944758
differential role of rho gtpases in intestinal epithelial barrier regulation in vitro.maintenance of intestinal epithelial barrier functions is crucial to prevent systemic contamination by microbes that penetrate from the gut lumen. gtpases of the rho-family such as rhoa, rac1, and cdc42 are known to be critically involved in the regulation of intestinal epithelial barrier functions. however, it is still unclear whether inactivation or activation of these gtpases exerts barrier protection or not. we tested the effects of rho gtpase activities on intestinal epithelial barrier func ...201120945370
in-plane parallel scanning: a microarray technology for point-of-care testing.a new microarray technology is described for rapid, inexpensive, multiplex diagnostics assays. referred to as "in-plane parallel scanning" (ipps), this technology replaces expensive laser scanning with a grid of 100-μm-wide waveguides embedded in the chip's substrate, enabling real-time quantification of molecular complex formation on the chip's surface. compared to conventional microarray technology, ipps has advantages of shorter assay time and lower instrument cost and complexity so that the ...201020945920
clostridium difficile and inflammatory bowel disease: implications for current clinical practice.clostridium difficile infection should always be included in the differential diagnosis of patients with refractory inflammatory bowel disease (ibd) symptoms, as it is well known to induce or mimic a flare of ibd. there is currently an alarming increase in the incidence of c. difficile infection in europe and north america. current epidemiologic data suggest that more virulent strains, such as c. difficile 027/nap1/bi, are emerging. testing for both c. difficile toxins a and b should be done, an ...200920948756
susceptibility of clostridium difficile toward antimicrobial agents used as feed additives for food animals.a total of 65 toxigenic clostridium difficile strains isolated from patients with antibiotic-associated diarrhea were tested for susceptibility to avilamycin, flavomycin, monensin, and salinomycin. except for flavomycin the substances showed in vitro efficacy comparable to reports of the currently most commonly used drugs for treatment of c. difficile. this indicates that these old compounds may be useful for the treatment of c. difficile infections in man and perhaps for other bacterial causes ...201020950192
the diverse sporulation characteristics of clostridium difficile clinical isolates are not associated with type.clostridium difficile causes diarrhoeal diseases ranging from asymptomatic carriage to a fulminant, relapsing, and potentially fatal colitis. endospore production plays a vital role in transmission of infection, and in order to cause disease these spores must then germinate and return to vegetative cell growth. type bi/nap1/027 strains of c. difficile have recently become highly represented among clinical isolates and are associated with increased disease severity. it has also been suggested tha ...201020950700
outcomes of emergency colectomy for fulminant clostridium difficile colitis.clostridium difficile has become increasingly a common cause of nosocomial infection with increasing antibiotic usage. recently there has been an increase in the incidence of patients undergoing colectomy for fulminant c. difficile colitis (fcdc). early surgical consultation is necessary to avoid delay in diagnosis. we present a retrospective review of the outcomes of colectomies for fcdc at our large district general hospital.201020950772
the safety of drugs used in acid-related disorders and functional gastrointestinal disorders.medicines are frequently used in the management of acid-related disorders and functional gastrointestinal disorders. with the exception of complicated peptic ulcer disease, these disorders are not associated with appreciable mortality. drug treatments have consequently been held to the highest standards of safety. some medicines have been withdrawn or restricted based on assessments and perceptions of risk. however, the risk of serious toxicity is low for most of the agents discussed in this art ...201020951916
clostridium difficile infection and inflammatory bowel disease: understanding the evolving relationship.clostridium difficile (c. difficile) infection (cdi) is the leading identifiable cause of antibiotic-associated diarrhea. while there is an alarming trend of increasing incidence and severity of cdi in the united states and europe, superimposed cdi in patients with inflammatory bowel disease (ibd) has drawn considerable attention in the gastrointestinal community. the majority of ibd patients appear to contract cdi as outpatients. c. difficile affects disease course of ibd in several ways, inclu ...201020954275
recurrent haemophagocytic syndrome in an hiv-infected patient.we describe a case of recurrent haemophagocytic syndrome (hs) in an hiv-infected patient.the first episode was associated with active human herpesvirus 8 infection and progressive kaposi's sarcoma which was successfully treated with splenectomy, foscarnet and chemotherapy. the second episode was triggered by a clostridium difficile colitis and resolved completely after treatment with metronidazole only. recurrent hs has rarely been described in adult patients out of the setting of relapsing mali ...201020954469
clostridium difficile infection in cancer patients and hematopoietic stem cell transplant recipients.clostridium difficile has become the most common bacterial cause of nosocomial diarrhea. high rates of c. difficile infection (cdi) coupled with increasing morbidity and mortality attributed to cdi have sparked a renewed interest in this disease. emergence of hypervirulent strains, rising rates of severe and recurrent infection and associated infection control challenges, and diagnostic and therapeutic dilemmas are major issues in the non-oncology population. scant data on cdi exist in the cance ...201020954878
an update on clostridium difficile infection and its management. 201020955528
reducing the incidence of clostridium difficile infections: can we do it? 201020957908
comment: the relationship between inpatient fluoroquinolone use and clostridium difficile-associated disease. 201020959498
audit of the laboratory diagnosis of clostridium difficile infection in the uk.a uk-wide audit of the laboratory diagnosis of clostridium difficile infection (cdi) was undertaken by the association of clinical pathologists and the royal college of pathologists, in conjunction with keele university. a postal questionnaire was sent out to all consultant microbiologists, with eighty responses available for analysis. there was considerable variation in laboratory practices. in particular, only 56% of laboratories gave guidance on follow-up testing of toxin-negative samples, 68 ...201020965100
mapping interactions between germinants and clostridium difficile spores.germination of clostridium difficile spores is the first required step in establishing c. difficile-associated disease (cdad). taurocholate (a bile salt) and glycine (an amino acid) have been shown to be important germinants of c. difficile spores. in the present study, we tested a series of glycine and taurocholate analogs for the ability to induce or inhibit c. difficile spore germination. testing of glycine analogs revealed that both the carboxy and amino groups are important epitopes for rec ...201020971909
recent epidemiology of clostridium difficile infection during hematopoietic stem cell transplantation.given the limited information on clostridium difficile infection (cdi) during hematopoietic stem cell transplantation (hsct), we examined the recent epidemiology of cdi in hsct recipients at our institution. during the two-yr retrospective study period (2005-2006), 361 transplants were performed: 60% allogeneic and 40% autologous. among all hospitalized patients in a non-outbreak setting, cdi rates in hsct recipients were ninefold higher than those in general patients and 1.4-fold higher than th ...201020973823
identification of a genetic locus responsible for antimicrobial peptide resistance in clostridium difficile.clostridium difficile causes chronic intestinal disease, yet little is understood about how the bacterium interacts with and survives in the host. to colonize the intestine and cause persistent disease, the bacterium must circumvent killing by host innate immune factors, such as cationic antimicrobial peptides (camps). in this study, we investigated the effect of model camps on growth and found that c. difficile is not only sensitive to these compounds but also responds to low levels of camps by ...201020974818
murine model of clostridium difficile infection with aged gnotobiotic c57bl/6 mice and a bi/nap1 strain.the increased incidence and severity of clostridium difficile infection (cdi) in older adults (age, ≥65 years) corresponds with the emergence of the bi/nap1 strain, making elucidation of the host immune response extremely important. we therefore infected germ-free c57bl/6 mice aged 7-14 months with a bi/nap1 strain and monitored the mice for response. infected mice were moribund 48-72 h after infection and developed gross and histological cecitis and colitis and elevated concentrations of kerati ...201020977342
management of clostridium difficile infection: thinking inside and outside the box.treatment of clostridium difficile infection (cdi) has relied on 2 antimicrobial agents, metronidazole and vancomycin, since the recognition of this disease entity. while effective, these "inside the box" approaches to cdi management have the disadvantage of further microbial disruption of the host indigenous microflora. "outside the box" therapies use non-antimicrobial approaches to management and are theoretically less prone to causing recurrent cdi episodes. recent advances in understanding o ...201020979491
comparison of real-time pcr techniques to cytotoxigenic culture methods for diagnosing clostridium difficile infection.in the past decade, the incidence of clostridium difficile infections (cdi) with a more severe course has increased in europe and north america. assays that are capable of rapidly diagnosing cdi are essential. two real-time pcrs (lumc and lvi) targeting c. difficile toxin genes (tcdb, and tcda and tcdb, respectively) were compared with the bd geneohm pcr (targeting the tcdb gene), using cytotoxigenic culture as a gold standard. in addition, a real-time pcr targeting the tcdc frameshift mutation ...201020980562
what is the current role of algorithmic approaches for diagnosis of clostridium difficile infection?with the recognition of several serious outbreaks of clostridium difficile infection in the industrialized world coupled with the development of new testing technologies for detection of this organism, there has been renewed interest in the laboratory diagnosis of c. difficile infection. two factors seem to have driven much of this interest. first, the recognition that immunoassays for detection of c. difficile toxins a and b, for many years the most widely used tests for c. difficile infection ...201020980568
follicular fluid high-density lipoprotein-associated sphingosine 1-phosphate (s1p) promotes human granulosa lutein cell migration via s1p receptor type 3 and small g-protein rac1.coordinated migration and progesterone production by granulosa cells is critical to the development of the corpus luteum, but the underlying mechanisms remain obscure. sphingosine 1-phosphate (s1p), which is associated with follicular fluid high-density lipoprotein (ff-hdl), was previously shown to regulate ovarian angiogenesis. we herein examined the effects of s1p and ff-hdl on the function of granulosa lutein cells. both ff-hdl and s1p induced migration of primary human granulosa lutein cells ...201020980685
risk factors for treatment failure and recurrence after metronidazole treatment for clostridium difficile-associated diarrhea.the incidence of treatment failure or recurrence of clostridium difficile-associated diarrhea (cdad) following metronidazole treatment has increased recently. we studied the treatment failure, recurrence rate, and risk factors predictive of treatment failure and recurrence after metronidazole treatment for cdad.201020981209
statewide experience with clostridium difficile colitis in academic and nonacademic medical centers (*).abstract background: clostridium difficile colitis is a nosocomial infection that can present as minor, readily treated symptoms or as fulminant colitis leading to death. risk factors for c. difficile colitis have been defined, and certain populations of hospitalized patients appear to be particularly susceptible. however, most information on c. difficile colitis is from large tertiary-care medical centers. whether the community hospital experience is similar to that of large referral centers is ...201021028991
regulatory oversight and safety of probiotic use.depending on intended use of a probiotic (drug vs. dietary supplement), regulatory requirements differ greatly. for dietary supplements, premarketing demonstration of safety and efficacy and approval by the food and drug administration are not required; only premarket notification is required. saccharomyces boulardii is a probiotic regulated as a dietary supplement intended for use by the general healthy population, not as a drug to prevent, treat, or mitigate disease. however, since recent incr ...201021029521
clostridium difficile-associated disease among patients in dhahran, saudi arabia.clostridium difficile-associated diarrhea (cdad) is an important healthcare-associated infection. however, there are no data from saudi arabia on this disease. a two-year prospective, observational study on the incidence of cdad in a hospital in saudi arabia was carried out. stool analysis for c. difficile toxins a and b was carried out by an enzyme-linked immunosorbent assay. medical and laboratory records were reviewed. of the total number of patients, there were 53.3% male and the mean age wa ...201021030314
evaluation of sporicidal activities of selected environmental surface disinfectants: carrier tests with the spores of clostridium difficile and its surrogates.the emergence of clostridium difficile as a major nosocomial pathogen points to the need for safe, effective, and fast-acting environmental sporicides for infection prevention and control. available and fast-acting sporicides are generally corrosive and unsafe for both humans and the environment.201021034981
real-time pcr and typing of clostridium difficile isolates colonizing mare-foal pairs.clostridium difficile infection can occur in the dams of sick foals, but it is unknown if mares and foals share the same isolates. in this study, c. difficile isolates from fecal samples of 11 mares paired with 11 foals were genotyped by arbitrarily primed pcr; two mares and three foals in five mare-foal pairs had diarrhea. fecal immunoassays were utilized to detect c. difficile common antigen and toxin a. quantitative real-time pcr (qpcr) systems were developed to detect genes for toxins a and ...201021035363
prevalence of clostridium difficile in retail pork.clostridium difficile was isolated from 1.8% (7/393) of retail pork samples obtained from 4 canadian provinces. five ribotypes and 3 toxinotypes were identified. three isolates were indistinguishable from the international outbreak strain ribotype 027 and were toxinotype iii. although the implications for food safety practices remain elusive, the frequency of toxigenic isolates and isolates indistinguishable from known human pathogenic strains suggests contaminated pork may be a source of c. dif ...201021037888
a homology model for clostridium difficile methionyl trna synthetase: active site analysis and docking interactions.treatment of c. difficile infection is one of the most difficult biomedical challenges. to develop novel antibacterials, researchers have been targeting bacterial molecular functions that are essential for its growth. the methionyl trna synthetase (metrs) is strictly required for protein biosynthesis and success was reported in developing antibacterials to inhibit this enzyme. the present study was aimed at building and analyzing a homology model for c. difficile metrs in the context of drug des ...201021042822
autoproteolytic cleavage mediates cytotoxicity of clostridium difficile toxin a.toxin a and toxin b from clostridium difficile are the causative agents of the antibiotic-associated pseudomembranous colitis. they are of an a/b structure type and possess inositol hexakisphosphate-inducible autoproteolytic activity to release their glucosyltransferase domain to the cytoplasm of target cells. in this study, we investigated the effect of extracellular and intracellular autoproteolytic cleavage on the function of tcda. extracellular cleavage led to functional inactivation albeit ...201021046073
interscience conference on antimicrobial agents and chemotherapy - 50th annual meeting - research on promising new agents: part 1.the 50th annual interscience conference on antimicrobial agents and chemotherapy (icaac), held in boston, included topics covering new therapeutic developments in the field of infectious disease. this conference report highlights selected presentations on research with novel antimicrobial agents. investigational drugs discussed include the dicationic porphyrin derivative xf-73 (destiny pharma), the tetracycline analog tp-434 (tetraphase pharmaceuticals), an elongation factor tu inhibitor (novart ...201021046515
[environmental contamination by clostridium difficile]. 201021046723
comparative metagenomic study of alterations to the intestinal microbiota and risk of nosocomial clostridum difficile-associated disease.this study investigated the relationship between hospital exposures, intestinal microbiota, and subsequent risk of clostridium difficile-associated disease (cdad), with use of a nested case-control design. the study included 599 patients, hospitalized from september 2006 through may 2007 in montreal, quebec, from whom fecal samples were obtained within 72 h after admission; 25 developed cdad, and 50 matched controls were selected for analysis. nonsteroidal anti-inflammatory drugs and antibiotic ...201021050115
clostridium difficile infections in patients with severe burns.with improved survival in burn patients, clostridium difficile infection (cdi) remains a significant potential complication. the incidence of, risk factors for, and outcomes of cdi in severely burned patients are poorly studied and remain unclear. this study involves retrospective case control and cohort studies using electronic medical records from february 1, 2002 to january 31, 2009 at the us department of defense's only burn unit. demographic, risk factor, and outcome data were collected for ...201021050662
inhibition of rho-kinase abrogates migration of human transitional cell carcinoma cells: results of an in vitro study.migration of cells involves a complex signaling network. the aim of the present study was to elucidate the impact of rho-kinase (rok) on g protein-coupled receptor-induced migration of human transitional cell carcinoma cells in an in vitro experimental setting.201021051874
recto-vesical fistulation complicating a faecal incontinence management product in clostridium difficile diarrhoea. 201121054743
a common polymorphism in the interleukin-8 gene promoter is associated with an increased risk for recurrent clostridium difficile infection.neutrophil recruitment coordinated by intestinal interleukin (il)-8 secretion is a key component in the pathogenesis of clostridium difficile infection (cdi). we hypothesized that a common single-nucleotide polymorphism (snp) in the -251 region of the il-8 gene promoter may be predictive of recurrent cdi.201021058913
sustained reduction in antimicrobial use and decrease in methicillin-resistant staphylococcus aureus and clostridium difficile infections following implementation of an electronic medical record at a tertiary-care teaching hospital.we evaluated the effect of implementation of an electronic medical record (emr) on the use of antimicrobial agents and on the rates of infections with clostridium difficile and methicillin-resistant staphylococcus aureus (mrsa).201021059617
the effect of hospital-acquired clostridium difficile infection on in-hospital mortality.the effects of hospital-acquired clostridium difficile infection (cdi) on patient outcomes are incompletely understood. we conducted this study to determine the independent impact of hospital-acquired cdi on in-hospital mortality after adjusting for the time-varying nature of cdi and baseline mortality risk at hospital admission.201021059973
therapeutic success of rifaximin for clostridium difficile infection refractory to metronidazole and vancomycin.we report the case of a 46-year-old white male with confirmed clostridium difficile infection for >4 weeks after fluoroquinolone therapy. the patient received two courses of metronidazole 500 mg three times daily (t.i.d.) during which time diarrhea resolved; however, symptoms recurred 14-15 days after treatment termination. he received a 2-week course of vancomycin 125 mg four times daily, with symptoms recurring 10 days after treatment conclusion. the patient then received a pulsed tapering sch ...201021060709
manganese binds to clostridium difficile fbp68 and is essential for fibronectin binding.clostridium difficile is an etiological agent of pseudomembranous colitis and antibiotic-associated diarrhea. adhesion is the crucial first step in bacterial infection. thus, in addition to toxins, the importance of colonization factors in c. difficile-associated disease is recognized. in this study, we identified fbp68, one of the colonization factors that bind to fibronectin (fn), as a manganese-binding protein (k(d) = 52.70 ± 1.97 nm). furthermore, the conformation of fbp68 changed dramatical ...201021062746
targeting selenium metabolism and selenoproteins: novel avenues for drug discovery.selenoproteins play a wide range of roles in metabolism and oxidative stress defense and are produced by organisms in all three domains of life. recent evidence has been presented that metal based cancer drugs target the selenol nucleophile of the active site selenocysteine in thioredoxin reductase isoenzymes. other metals and metalloids, such as tin, arsenic and gold, have also recently been shown to form stable complexes with hydrogen selenide, a required precursor for the synthesis of selenop ...201021069141
ischemic colitis after capecitabine plus cisplatin treatment in advanced gastric cancer.systemic chemotherapy can be complicated by colonic toxicity, which usually determines the onset of pseudomembranous colitis and, rarely, of ischemic colitis in patients with cancer. this report describes the case of a 45-year-old man with advanced gastric cancer who developed severe ischemic colitis after chemotherapy with cisplatin and capecitabine. the patient developed symptoms of gastrointestinal toxicity with abdominal pain and bloody diarrhea. he had a normal white blood cell count throug ...201121069429
anti-pseudomonal beta-lactams for the initial, empirical, treatment of febrile neutropenia: comparison of beta-lactams.several beta-lactams are recommended as single agents for the treatment of febrile neutropenia.201021069685
clostridium difficile in vegetables, canada.clostridium difficile is an important gastrointestinal pathogen of humans and animals. it has been isolated from various foods, including meat and ready-to-eat salads, and concern has been expressed regarding food as a possible source of human c. difficile infection (cdi).201021069911
antibiotic prophylaxis in variceal hemorrhage: timing, effectiveness and clostridium difficile rates.to investigate if antibiotics administered within 8 h of endoscopy reduce mortality or increase the incidence of clostridium difficile infection (cdi).201021072894
improving surveillance for pediatric clostridium difficile infection: derivation and validation of an accurate case-finding tool.the incidence of clostridium difficile infection (cdi) is increasing. multicenter studies of cdi have been limited by the lack of valid case-finding tools. to facilitate pediatric studies of cdi, we constructed a case-finding tool using administrative data.201121079527
universal phosphatase-coupled glycosyltransferase assay.a nonradioactive glycosyltransferase assay is described here. this method takes advantage of specific phosphatases that can be added into glycosyltransferase reactions to quantitatively release inorganic phosphate from the leaving groups of glycosyltransferase reactions. the released phosphate group is then detected using colorimetric malachite-based reagents. because the amount of phosphate released is directly proportional to the sugar molecule transferred in a glycosyltransferase reaction, th ...201021081508
human c. difficile infections are increasing in incidence and severity. 201021083827
pathogenic c difficile is here (and everywhere) to stay. 201121084110
clostridium difficile infection in europe: a hospital-based survey.little is known about the extent of clostridium difficile infection in europe. our aim was to obtain a more complete overview of c difficile infection in europe and build capacity for diagnosis and surveillance.201121084111
using the lived experiences of patients with clostridium difficile infection to improve care.to better understand the lived experiences and needs of patients who have clostridium difficile infection.201021086831
using the waterlow tool to predict clostridium difficile infection risk in hospital settings.c difficile is the most important cause of infectious healthcare acquired diarrhoea and risk of infection is a public concern. many acute and primary care trusts are working to further reduce rates of c difficile and targets have been set. global reduction strategies include prudent antibiotic prescribing and intensive cleaning programmes. while risk assessment tools for c difficile exist, they are not easy to use in hospital. this article introduces an inexpensive and easy to use assessment too ...201021086834
insights into the mechanism of type i dehydroquinate dehydratases from structures of reaction intermediates.the biosynthetic shikimate pathway consists of seven enzymes that catalyze sequential reactions to generate chorismate, a critical branch point in the synthesis of the aromatic amino acids. the third enzyme in the pathway, dehydroquinate dehydratase (dhqd), catalyzes the dehydration of 3-dehydroquinate to 3-dehydroshikimate. we present three crystal structures of the type i dhqd from the intestinal pathogens clostridium difficile and salmonella enterica. structures of the enzyme with substrate a ...201021087925
practice of gastroenterologists in treating flaring inflammatory bowel disease patients with clostridium difficile: antibiotics alone or combined antibiotics/immunomodulators?background:: the optimal management of clostridium difficile infection (cdi) in flaring inflammatory bowel disease (ibd) patients has not been defined. limited data suggest that coadministration of immunomodulators (im) with antibiotics (ab) results in a worse outcome. we investigated the prevalent practice among north american gastroenterologists in this scenario. methods:: a structured questionnaire presented the clinical cases of two hospitalized patients with ulcerative colitis and concomita ...201021089183
[clostridium difficile: a serious outpatient infection?].secondary to severe hospital outbreaks due to hypervirulent strains of clostridium difficile, several surveillance systems in north-america and europe observed an increase in infections due to this micro-organism, also in the outpatient setting. the case reported in the present article illustrates the fulminant presentation that a c. difficile colitis can show in a previously healthy person without prior contact with healthcare facilities. it introduces a review of some recent publications on th ...201021089556
a rare cause of chronic mesenteric ischemia from fibromuscular dysplasia: a case report.abstract:201021092091
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