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disarming clostridium difficile.in this issue, puriet al. (2010) present inhibitors that prevent the autocatalytic activation of the clostridial toxin tcdb in vivo. their approach is likely to provide guidance for the development of novel drugs targeting virulence factors and thereby rendering bacterial pathogens innocuous.201021095563
rational design of inhibitors and activity-based probes targeting clostridium difficile virulence factor tcdb.clostridium difficile is a leading cause of nosocomial infections. the major virulence factors of this pathogen are the multi-domain toxins tcda and tcdb. these toxins contain a cysteine protease domain (cpd) that autoproteolytically releases a cytotoxic effector domain upon binding intracellular inositol hexakisphosphate. currently, there are no known inhibitors of this protease. here, we describe the rational design of covalent small molecule inhibitors of tcdb cpd. we identified compounds tha ...201021095570
clostridium perfringens tpel glycosylates the rac and ras subfamily proteins.clostridium perfringens tpel belongs to a family of large clostridial cytotoxins that encompasses clostridium difficile toxin a (tcda) and b (tcdb) and clostridium sordellii lethal toxin (tcsl). we report here the identification of the tpel-catalyzed modification of small gtpases. a recombinant protein (tpel1-525) derived from the tpel n-terminal catalytic domain in the presence of streptolysin o (slo) induced the rounding of vero cells and the glycosylation of cellular rac1. among several hexos ...201021098103
cyclic-di-gmp reaches out into the bacterial rna world.the ubiquitous bacterial signaling molecule bis-(3'-5')-cyclic guanosine monophosphate (c-di-gmp) has brought second messenger signaling back onto the agenda of molecular microbiologists. this is due not only to its general role in promoting biofilm formation, but also to the increasingly diverse array of effector molecules bound by c-di-gmp and of the target processes affected. effectors include diverse transcription factors and proteins that directly interact with complex cellular machineries, ...201021098727
update on clostridium difficile infection.purpose of review: this review summarizes the most recent epidemiological data and advances in research into the pathogenesis, diagnosis and treatment of clostridium difficile infection (cdi). recent findings: the epidemiology of cdi has changed with the emergence of hypervirulent strains. cdi rates have increased in the community, in children and in patients with inflammatory bowel disease. although the north american pulsed-field gel electrophoresis type 1, restriction endonuclease analysis gr ...201021099432
rapid and sensitive loop-mediated isothermal amplification test for clostridium difficile detection challenges cytotoxin b cell test and culture as gold standard.compared to the composite gold standard cytotoxin b assay and toxigenic culture, the loop-mediated isothermal amplification (lamp) test for clostridium difficile had a sensitivity and specificity of 98%, positive predictive value of 92%, and negative predictive value of >99%. a one-hour turnaround time for the lamp test provides rapid diagnosis and cost savings.201021106782
acquisition of clostridium difficile by piglets.clostridium difficile is recognized as an important cause of nosocomial diarrhoea in humans especially in association with administration of antibiotics. in pigs, c. difficile can cause neonatal enteritis and can be isolated from faeces from both diseased and healthy animals. the presented prospective study describes how soon c. difficile can be isolated from newborn piglets after normal parturition and how c. difficile spreads within a pig farm. six sows, their farrowing crates and their litter ...201021111541
[use of endorectal tube actiflo in the management of clostridium difficile colitis in icu]. 201021112728
pneumatosis coli associated with pseudomembranous colitis in a patient following colonic surgery.pneumatosis intestinalis is a rare disorder characterized by gas-filled cysts within the subserosal and/or submucosal regions of the intestinal wall. the source of this gas and its translocation across the mucosa is incompletely understood. most (85%) cases are associated with medical conditions, ranging from psychiatric through respiratory disorders to gastrointestinal-related diseases; the remaining 15% lack any recognizable cause or association. in this case report, pneumatosis coli (affectin ...201021113293
alternative therapies for clostridium difficile infections.clostridium difficile infection is a serious condition responsible for significant morbidity and mortality, especially in patients being treated with antimicrobials. increasing frequency of the infection and hypervirulent c. difficile strains have resulted in more severe disease as well as therapeutic failures with traditional treatment (metronidazole and vancomycin). to review the studies assessing nontraditional therapies for the prevention and treatment of primary or recurrent c. difficile in ...201021114394
outcome for gram-negative bacteraemia when following restrictive empirical antibiotic guidelines.restrictions in prescribing broad spectrum antimicrobials have been part of a strategy to reduce clostridium difficile cases in the uk in recent years. however, there has been little work on assessing the safety of alternative antimicrobial agents.201021115461
adenosine deaminase inhibition prevents clostridium difficile toxin a-induced enteritis in mice.toxin a (txa) is able to induce most of the classical features of clostridium difficile-associated disease in animal models. the objective of this study was to determine the effect of an inhibitor of adenosine deaminase, ehna [erythro-9-(2-hydroxy-3-nonyl)-adenine], on txa-induced enteritis in c57bl6 mice and on the gene expression of adenosine receptors. ehna (90 μmol/kg) or phosphate-buffered saline (pbs) was injected intraperitoneally (i.p.) 30 min prior to txa (50 μg) or pbs injection into t ...201021115723
reference assays for clostridium difficile infection: one or two gold standards?accurate diagnosis of clostridium difficile infection (cdi) is essential for optimal treatment, prevention and control. there are two reference assays for cdi diagnosis: the cell cytotoxicity assay (ccta) and toxigenic culture (tc). importantly, these tests actually detect different targets: ccta detects the presence of c difficile toxins (primarily toxin b, but also toxin a), whereas tc detects the presence in the stool of c difficile with the potential to produce toxin. not surprisingly studie ...201021118850
clostridium difficile infection: epidemiology, risk factors and management.the epidemiology of clostridium difficile infection (cdi) has changed over the past decade. there has been a dramatic worldwide increase in its incidence, and new cdi populations are emerging, such as those with community-acquired infection and no previous exposure to antibiotics, children, pregnant women and patients with ibd. diagnosis of cdi requires identification of c. difficile toxin a or b in diarrheal stool. the accuracy of current diagnostic tests remains inadequate and the optimal diag ...201021119612
diagnostic algorithm using a sensitive broth culture method for detection of clostridium difficile toxin from stool samples.the two-step glutamate dehydrogenase antigencytotoxicity neutralization assay algorithm has been found to be reliable for the diagnosis of toxigenic clostridium difficile. however, the high sensitivity of the screening method is compromised by the relative low sensitivity of the second step, the direct cytotoxin neutralization assay (dcna) using a fecal filtrate. the objective of the present study was to compare the dcna with an indirect cytotoxin neutralization assay (icna).200921119790
a study of the prevalence of cytotoxic and non-cytotoxic klebsiella oxytoca fecal colonization in two patient populations.klebsiella oxytoca is a cause of antibiotic-associated hemorrhagic colitis. few reports of the occurrence of k oxytoca within stool exist and there is no gold standard method for its isolation.200921119796
escherichia coli and selected veterinary and zoonotic pathogens isolated from environmental sites in companion animal veterinary hospitals in southern ontario.hospital-based infection control in veterinary medicine is emerging and the role of the environment in hospital-acquired infections (hai) in veterinary hospitals is largely unknown. this study was initiated to determine the recovery of escherichia coli and selected veterinary and zoonotic pathogens from the environments of 101 community veterinary hospitals. the proportion of hospitals with positive environmental swabs were: e. coli--92%, clostridium difficile--58%, methicillin-resistant staphyl ...201021119862
prevalence and clinical impact of endoscopic pseudomembranes in patients with inflammatory bowel disease and clostridium difficile infection.limited data suggests that pseudomembranes are uncommon in patients with inflammatory bowel disease (ibd) and c. difficile associated disease (cdad), but the reason for this is unknown. we aimed to evaluate the rate of pseudomembranes in this population, identify predictive factors for pseudomembranes' presence and assess its clinical impact.201021122505
testing standards for sporicides.sporicidal products are of considerable importance in healthcare environments due to the requirement for products that are capable of dealing with contamination with clostridium difficile spores. sporicidal testing standards to validate the claims of sporicidal activity are an important tool in the evaluation of commercial sporicides. within europe there are a number of sporicidal testing standards which are often used to validate the claims of commercial sporicides. however, the extent to which ...201021122947
comparison of two commercial molecular assays to a laboratory-developed molecular assay for diagnosis of clostridium difficile infection.we compared two commercial pcr assays, the prodesse progastro cd assay and the bd geneohm cdiff assay, with a laboratory-developed clostridium difficile toxin pcr assay with previously established performance characteristics. results of all methods were in agreement for 333 (96%) of 346 stool specimens. no significant difference in performance among the assays was found (p values, >0.05).201021123537
clostridium difficile infection rates and spectrum of disease among peripartum women at one hospital from 2003 to 2007 with molecular typing analysis of recovered clostridium difficile isolates.peripartum women are at risk for clostridium difficile infection (cdi), but the risk magnitude and clinical disease spectrum are unknown. we determined the incidence and clinical features of cdi in peripartum women in the loyola university medical center system and describe typing of c difficile isolates by restriction endonuclease analysis (rea).201021126802
bacteraemia and breast abscess: unusual extra-intestinal manifestations of clostridium difficile infection.extra-intestinal manifestations of clostridium difficile infection are uncommon. most cases are associated with gastrointestinal disease and often occur as a mixed infection with other gut flora. we report a case of breast abscess following monomicrobial c. difficile bacteraemia in a female with background chronic hepatitis c infection and alcoholic liver disease. no evidence of colitis was found. our case shows that c. difficile is indeed capable of spreading from the gastrointestinal tract.201021127155
typhlitis in children with malignancy: a single center experience.in a case-control study, medical records of all children (below 18 y of age) who were diagnosed with any malignancy between january 1988 and december 2008 were reviewed. children who developed typhlitis during the course of their malignancy were identified. age and sex-matched controls who were diagnosed with malignancy during the same time period but did not develop typhlitis were identified (1:4 ratio). the variables that were examined included underlying malignancy, chemotherapy, and final ou ...201121127432
automated surveillance of clostridium difficile infections using biosense.to determine the feasibility of using electronic laboratory and admission-discharge-transfer data from biosense, a national automated surveillance system, to apply new modified clostridium difficile infection (cdi) surveillance definitions and calculate overall and facility-specific rates of disease.201021128815
the continuing crisis in antibiotic resistance.the emergence of antibiotic resistance in bacterial pathogens is an inevitable consequence of antibiotic use. despite repeated warnings, negligent antibiotic use and poor infection-control practice have led to the continuing development of extensive resistance problems worldwide. multidrug-resistant pathogens are now characterized by their heterogeneity, increasing virulence, resistance even to reserve agents and spread within and between hospitals and the community. examples are glycopeptide-re ...201021129629
monomicrobial clostridium difficile bacteraemias and relationship to gut infection. 201021129818
thirty-day mortality of clostridium difficile infection in a uk national health service foundation trust between 2002 and 2008.few standardised data are available on mortality rates in patients with clostridium difficile infection (cdi). the literature often reports 'attributable' mortality or cannot be universally applied. we aimed to investigate the pattern and trends in all-cause mortality in a large unselected cohort of patients affected by cdi. this was done by means of a retrospective cohort study between 2002 and 2008 of all patients with positive stool toxin tests indicating cdi in one national health service (n ...201021129821
herpes simplex virus: a marker of severity in bacterial ventilator-associated pneumonia.purpose: ventilator-associated pneumonia (vap) is the most frequent nosocomial infection in intensive care units and has a high morbidity and mortality rate. it is mainly a bacterial disease, although the potential role of viruses as pathogens or copathogens in vap is under discussion. our study aims were to determine the incidence of herpes simplex virus (hsv) in the lower respiratory tract (lrt) secretions in patients with bacterial vap and to assess its potential clinical relevance. material ...201021129912
gaseous and air decontamination technologies for clostridium difficile in the healthcare environment.the recent data for hospital-acquired infections suggest that infection rates for meticillin-resistant staphylococcus aureus (mrsa) and clostridium difficile are beginning to decrease. however, while there is still pressure to maintain this trend, the resistance of c. difficile spores to standard detergents continues to present a problem for many uk hospitals trying to prevent its spread or control outbreaks. alternative disinfection technologies such as gaseous decontamination are currently bei ...201021130521
infection probability score: a predictor of clostridium difficile-associated disease onset in patients with haematological malignancy.purpose: to assess the predictive power of three systems: infection probability score, apache ii and karnofsky score for the onset of clostridium difficile-associated disease (cdad) in hematology-oncology patients. methods and sample: a retrospective pilot surveillance survey was conducted in the hematology unit of a general hospital in greece. data were collected by using an anonymous standardised case-record form. the sample consisted of 102 hospitalized patients. results: the majority of the ...201021130685
prevalence of clostridium difficile in retailed meat in the netherlands.recent reports indicate that a large proportion of community-acquired clostridium difficile infections (ca-cdi) are not linked to recent antibiotic therapy, older age, significant comorbidity or previous hospitalization. possible community sources for ca-cdi include animals and food, and therefore a surveillance study on the prevalence of c. difficile in meat was performed. samples of different meat species were collected from the retail trade and analyzed for the presence of c. difficile using ...201021131085
protective roles of cx3cr1-mediated signals in toxin a-induced enteritis through the induction of heme oxygenase-1 expression.the injection of clostridium difficile toxin a into the ileal loops caused fluid accumulation with the destruction of intestinal epithelial structure and the recruitment of neutrophils and macrophages. concomitantly, intraileal gene expression of cx3cl1/fractalkine (fkn) and its receptor, cx3cr1, was enhanced. when treated with toxin a in a similar manner, cx3cr1-deficient (cx3cr1(-/-)) mice exhibited exaggerated fluid accumulation, histopathological alterations, and neutrophil recruitment, but ...201021131421
from cosubstrate similarity to inhibitor diversity--inhibitors of adp-ribosyltransferases from kinase inhibitor screening.adp-ribosyltransferases (adp-rts) use nad(+) to transfer an adp-ribosyl group to target proteins. although some adp-rts are bacterial toxins only few inhibitors are known. here we present the development of fluorescence-based assays and a focussed library screening using kinase inhibitors as a new approach towards inhibitors of adp-rts. different screening setups were established using surrogate small molecule substrates or the quantitation of the cofactor nad(+). proof-of-principle screening ex ...201021132207
efficacy of three surface disinfectants against spores of clostridium difficile ribotype 027.the emergence of clostridium difficile ribotype 027 raised the question of sporicidal surface disinfectants are also effective against spores of c. difficile ribotype 027.201021134785
tigecycline exhibits inhibitory activity against clostridium difficile in the colon of mice and does not promote growth or toxin production.tigecycline is a broad-spectrum glycylcycline antibiotic with potent in vitro activity against clostridium difficile. we used a mouse model to test the hypothesis that tigecycline has a low propensity to promote colonization and toxin production by c. difficile due to inhibitory activity in the colon. mice (5 to 8 per group) received subcutaneous injections of tigecycline (low and high doses) alone or in combination with clindamycin for 6 days. growth of and toxin production by 3 strains of c. d ...201021135181
[entero-colitis implicated by antimicrobial agents]. 201021139357
the role of glutamate dehydrogenase for the detection of clostridium difficile in faecal samples: a meta-analysis.clostridium difficile causes a serious, occasionally fatal, hospital-acquired infection. the laboratory diagnosis of c. difficile infection (cdi) needs to be accurate to ensure optimal patient management, infection control and reliable surveillance. commercial enzyme-linked immunosorbent assays for c. difficile toxins have poor sensitivity when compared with cell culture cytotoxin assay (cta) and toxigenic culture (tc). we performed a meta-analysis of the role of glutamate dehydrogenase (gdh) in ...201021145132
critical gastrointestinal bleeding at an inpatient rehabilitation center: incidence, risk factors, and the role of gastrointestinal prophylaxis.to determine the incidence of critical gastrointestinal bleeding at an inpatient rehabilitation center, the risk factors associated with said bleeding, and the role of gastrointestinal prophylaxis.201021145522
in vitro activity and single-step mutational analysis of rifamycin sv tested against enteropathogens associated with traveler's diarrhea and clostridium difficile.rifamycin sv is a broad-spectrum, poorly absorbed antimicrobial agent that, when coupled with mmx technology, is being targeted for the oral treatment of traveler's diarrhea (td) and clostridium difficile-associated disease (cdad). rifamycin sv was tested for activity against 911 td-associated enteropathogens and 30 c. difficile isolates collected from several global surveillance studies. rifamycin sv demonstrated similar antimicrobial activity levels against the enterobacteriaceae, with mic₅₀ v ...201021149623
therapeutic transplantation of the distal gut microbiota.although it is generally accepted that the distal gut microbiota are relatively stable in healthy adult individuals, a collapse of the microbial community structure resulting from antibiotic therapy or pathogen presence can lead to gut dysfunction. however, recent findings demonstrate that it is possible to engraft new microbiota from a donor source, resulting in the restoration of gut functionality and improvement in health. this builds upon decades of case reports and series in which fecal tra ...201021150894
the risk factors of clostridium difficile colitis in colorectal surgery. 201021152130
risk factors for the development of clostridium difficile-associated colitis after colorectal cancer surgery.clostridium difficile (c. difficile)-associated colitis, a known complication of colon and rectal surgery, can increase perioperative morbidity and mortality, leading to increased hospital stay and costs. several contributing factors, including advanced age, mechanical bowel preparation, and antibiotics, have been implicated in this condition. the purpose of this study was to determine the clinical features of and factors responsible for c. difficile-associated colitis after colorectal cancer su ...201021152135
scientists probe herpes in neonates, c. difficile acquisition in children. 201021156940
the role of environmental cleaning in health care-associated infections.multidrug-resistant organisms such as methicillin-resistant staphylococcus aureus (mrsa) and toxin-producing organisms such as clostridium difficile have been a concern for over 30 years. an increasing focus is being placed on the role that an unclean environment can play in transmission. this article describes the pathogens of concern and the use of a robust environmental cleaning program to help reduce the chances for hospital-acquired infections.201121160295
toxic megacolon associated clostridium difficile colitis.toxic megacolon is a severe complication of clostridium difficile (c. difficile) colitis. as the prevalence of c. difficile colitis increases and treatments become more refractory, clinicians will encounter more patients with c. difficile associated toxic megacolon in the future. here, we review a case of toxic megacolon secondary to c. difficile colitis and review the current literature on diagnosis and management. we identify both clinical and radiologic criteria for diagnosis and discuss both ...201021160629
severe colitis associated with docetaxel use: a report of four cases.diarrhea is a common side effect of chemotherapy. pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed, albeit rarely, with certain chemotherapeutic agents. we present four cases of severe colitis in patients undergoing treatment with taxane-based chemotherapy for pancreatic, lung and breast cancer. none of them had recently received antibiotics. one patient presented with a bowel perforation and three had endoscopic findings of pseudomembranous ...201021160890
effect of probiotic lactobacillus (lacidofil® cap) for the prevention of antibiotic-associated diarrhea: a prospective, randomized, double-blind, multicenter study.antibiotic-associated diarrhea (aad) is a common complication of antibiotic use. there is growing interest in probiotics for the treatment of aad and clostridium difficile infection because of the wide availability of probiotics. the aim of this multicenter, randomized, placebo-controlled, double-blind trial was to assess the efficacy of probiotic lactobacillus (lacidofil® cap) for the prevention of aad in adults. from september 2008 to november 2009, a total of 214 patients with respiratory tra ...201021165295
fecal lactoferrin and clostridium spp. in stools of autistic children.stools from autistic and healthy children were studied for fecal lactoferrin, clostridium difficile toxins, clostridium perfringens enterotoxin and cultured for clostridium spp. elevated level of fla was demonstrated in 24.4% stools, all from boys (31.25%). no toxins were detected. clostridium spp. was isolated with similar frequency from all samples. c. perfringens were isolated significantly often from the autistic stools, intermediate sensitive strains to penicillin 19%, to clindamycin 11.3%, ...201021167951
analysis of ultra low genome conservation in clostridium difficile.microarray-based comparative genome hybridisations (cgh) and genome sequencing of clostridium difficile isolates have shown that the genomes of this species are highly variable. to further characterize their genome variation, we employed integration of data from cgh, genome sequencing and putative cellular pathways. transcontinental strain comparison using cgh data confirmed the emergence of a human-specific hypervirulent cluster. however, there was no correlation between total toxin production ...201021170335
clostridium difficile: the importance of toxin a is re-established in clostridium difficile infection. 201021171215
a comparative study of three methods to evaluate an intervention to improve empirical antibiotic therapy for acute bacterial infections in hospitalized patients.in order to limit the use of broad-spectrum antibiotics, standardized empirical therapy against acute bacterial infections has been advocated.201021171827
increasing incidence of clostridium difficile-associated diarrhea in inflammatory bowel disease.over the last decade a rise in clostridium difficile-associated diarrhea (cdad) has been observed. a higher incidence of cdad has also been suggested in patients with inflammatory bowel disease (ibd), and may be a challenging factor in the differential diagnosis of flares. it is unclear if the increase is caused by the enhanced use of immunosuppressive therapy in ibd. we investigated if cdad infection is increasing in ibd patients and evaluated outcome and possible predisposing factors.200921172241
diagnosis of clostridium difficile-associated diarrhea. 200921172260
clostridium difficile-associated disease: impact of the updated shea/idsa guidelines.clostridium difficile-associated disease (cdad) is an increasingly difficult condition to treat because of the emergence of antibiotic resistance and highly pathogenic strains of bacteria. these newly identified strains affect patients in every facet of health care, from individuals in the community to those in intensive care units and all points in between. appropriate management regarding diagnosis, infection control, pharmacotherapy, and prevention is the key to good outcomes in all patient p ...201021172764
[a case of pseudomembranous colitis in a juvenile rheumatoid arthritis patient taking methotrexate].pseudomembranous colitis is mainly caused by antibiotics and clostridium difficile infection. but conditions such as gastrointestinal surgery, antacid medication, anti-neoplastic agent or immunosuppressive agent which influences the normal flora of colon can induce colitis without the administration of any antibiotics. we experienced a 13 year-old male who was taking low-dose methotrexate for juvenile rheumatoid arthritis complained diarrhea and abdominal pain for 3 weeks. sigmoidoscopic finding ...201021173564
pseudomembranous colitis complicating ulcerative colitis.clostridium difficile toxin (cd toxin) causes antibiotic-associated colitis, or pseudomembranous colitis (pmc). although cd toxin is sometimes found in the stools of patients with ulcerative colitis (uc), uc is rarely complicated by pmc. we report herein a case of pmc complicating uc, and present a review of the literature. a 71-year-old woman was diagnosed as having uc of the left colon, and treated with prednisolone and mesalazine. later, however, lumbar spinal stenosis was also detected. afte ...201021175502
clostridium difficile: progress and challenges.there is a surge of new interest in c. difficile infection (cdi) reflecting substantial increases in cases and fatalities. the new challenges by this now old pathogen have brought renewed interest in all facets of the disease. particularly important are the role of fluoroquinolones as inducing agents, the new polymerase chain reaction test to detect toxigenic strains in stools, the important role of the nap-1 strain, recent evidence favoring oral vancomycin over metronidazole in seriously ill pa ...201021175676
clostridium difficile colonization in early infancy is accompanied by changes in intestinal microbiota composition.clostridium difficile is a major enteric pathogen responsible for antibiotic-associated diarrhea. host susceptibility to c. difficile infections results partly from inability of the intestinal microbiota to resist c. difficile colonization. during early infancy, asymptomatic colonization by c. difficile is common and the intestinal microbiota shows low complexity. thus, we investigated the potential relationship between the microbiota composition and the implantation of c. difficile in infant gu ...201021177896
rifaximin therapy for metronidazole-unresponsive clostridium difficile infection: a prospective pilot trial.background:clostridium difficile infection (cdi) is a recent epidemic in the united states, particularly in the hospital setting. oral metronidazole is standard therapy for c. difficile infection, but resistance to metronidazole is becoming a clinical challenge.methods: we evaluated the efficacy of the nonsystemic oral antibiotic rifaximin for the treatment of metronidazole-resistant c. difficile infection. twenty-five patients with c. difficile infection were enrolled in the study. all had mild ...201021180604
use of probiotics in gastrointestinal disorders: what to recommend?perturbation of bacterial microflora of the gastrointestinal (gi) tract may play an important role in the pathophysiology of some gi disorders. probiotics have been used as a treatment modality for over a century. they may restore normal bacterial microflora and effect the functioning of the gi tract by a variety of mechanisms. probiotics are not currently regulated and only few randomized controlled trials exist investigating their efficacy in different gi disorders. they are available in a var ...201021180611
contribution of a government target to controlling clostridium difficile in the nhs in england.the introduction of mandatory surveillance of clostridium difficile infection (cdi) in 2004 showed the scale of the challenge: cases in patients >64 years old reached 55,681 in 2006. the first type 027 outbreaks had been in 2005 and cdi was a headline issue. the prevention and control of cdi requires a tripartite partnership between clinicians, health service managers, and the government/department of health which needs to set standards, ensure that cdi is a priority, set targets and monitor out ...201021182972
simultaneous clostridium difficile-associated colitis and late-onset intestinal cytomegalovirus disease in a renal transplant recipient.infection remains the most common complication following renal transplantation (rt). cytomegalovirus (cmv) is one of the most important pathogens in this patient population and clostridium difficile-associated colitis (cdac) has emerged as one of the most frequent gastrointestinal complications. only few cases of simultaneous cmv enterocolitis and cdac have been reported.201021183880
efficacy and safety of ciprofloxacin for prophylaxis of polyomavirus bk virus-associated hemorrhagic cystitis in allogeneic hematopoietic stem cell transplantation recipients.polyoma virus bk-induced hemorrhagic cystitis is an important cause of morbidity after hematopoietic stem cell transplantation (hsct). fluoroquinolones have been shown in vitro to inhibit bk viral replication by direct inhibition of the bk-encoded dna gyrase. we hypothesized that extended prophylaxis with ciprofloxacin may decrease the incidence of severe (grades 3 and 4) bk virus-associated hemorrhagic cystitis (sbkhc) after hsct. we retrospectively collected patient and transplant data, as wel ...201021185389
[comparison of diagnostic methods for clostridium difficile-associated diarrhea].in order to compare different methods for the diagnosis of clostridium difficile-associated diarrhea, fecal filtrates from patients presenting symptoms compatible with this condition, were analyzed. biological activity on vero cells (biological assay), dot blot with antibodies anti-tcda and anti-tcdb, and a pcr assay for the tcdb gene, were evaluated. titles of biological assays were > or =64 for 44 out of 177 samples. nineteen samples were positive in both biological and pcr assays. the analysi ...201021186669
characterization of tiacumicin b biosynthetic gene cluster affording diversified tiacumicin analogues and revealing a tailoring dihalogenase.the rna polymerase inhibitor tiacumicin b is currently undergoing phase iii clinical trial for treatment of clostridium difficile associated diarrhea with great promise. to understand the biosynthetic logic and to lay a foundation for generating structural analogues via pathway engineering, the tiacumicin b biosynthetic gene cluster was identified and characterized from the producer dactylosporangium aurantiacum subsp. hamdenensis nrrl 18085. sequence analysis of a 110,633 bp dna region revealed ...201021186805
changing prophylactic antibiotic protocol for reducing clostridium difficile-associated diarrhoeal infections.to determine whether a change in prophylactic antibiotic protocol for orthopaedic surgeries may reduce the frequency of clostridium difficile-associated diarrhoeal infections.201021187543
first synthesis of c. difficile ps-ii cell wall polysaccharide repeating unit.clostridium difficile is the most commonly diagnosed cause of nosocomial diarrhea with increasing incidence and mortality among elderly and hospitalized patients. we report the first synthesis of the surface polysaccharide ps-ii repeating unit and its nonphosphorylated analogue, with a linker for conjugation, via a (4 + 2) convergent approach from a common ab(d)c tetrasaccharide intermediate.201021190352
increased rate of irritable bowel syndrome and functional gastrointestinal disorders after clostridium difficile infection. 201021190754
synthesis and antimicrobial evaluation of nitazoxanide-based analogues: identification of selective and broad spectrum activity.a library composed of nitazoxanide-based analogues was synthesized and assayed for increased antibacterial efficacy against the pyruvate-ferredoxin oxidoreductase (pfor) using microorganisms helicobacter pylori, campylobacter jejuni and clostridium difficile. derivatives were found to recapitulate and improve activity against these organisms and select analogues were tested for their ability to disrupt the pfor enzyme directly. the library was also screened for activity against staphylococci and ...201021191957
faecal pharmacokinetics of orally administered vancomycin in patients with suspected clostridium difficile infection.oral vancomycin (125 mg qid) is recommended as treatment of severe clostridium difficile infection (cdi). higher doses (250 or 500 mg qid) are sometimes recommended for patients with very severe cdi, without supporting clinical evidence. we wished to determine to what extent faecal levels of vancomycin vary according to diarrhoea severity and dosage, and whether it is rational to administer high-dose vancomycin to selected patients.201021192802
clostridium difficile infection in an endemic setting in the netherlands.the purpose of this investigation was to study risk factors for clostridium difficile infection (cdi) in an endemic setting. in a 34-month prospective case-control study, we compared the risk factors and clinical characteristics of all consecutively diagnosed hospitalised cdi patients (n = 93) with those of patients without diarrhoea (n = 76) and patients with non-cdi diarrhoea (n = 64). the incidence of cdi was 17.5 per 10,000 hospital admissions. c. difficile polymerase chain reaction (pcr) ri ...201021194003
use of a continuous culture fermentation system to investigate the effect of ganedenbc30 (bacillus coagulans gbi-30, 6086) supplementation on pathogen survival in the human gut microbiota.single-stage continuous fermentation systems were employed to examine the effects of ganedenbc(30) supplementation on the human gastrointestinal microbiota in relation to pathogen challenge in vitro. denaturing gradient gel electrophoresis analysis demonstrated that ganedenbc(30) supplementation modified the microbial profiles in the fermentation systems compared with controls, with profiles clustering according to treatment. overall, ganedenbc(30) supplementation did not elicit major changes in ...201021195203
systemic absorption of oral vancomycin in patients with clostridium difficile infection.oral vancomycin is utilized in the treatment of severe clostridium difficile infection (cdi). we prospectively measured serum vancomycin concentrations (svc) in patients treated with oral vancomycin. the svc was measured by immunoassay prior to, and at least 3 days after, the administration of oral vancomycin 125 mg every 6 h. patients treated with intravenous vancomycin were excluded. fifty-seven patients with a mean age of 74 y (± 18) were enrolled. there was no detectable svc in 56 patients ( ...201121198337
systematic review: clostridium difficile and inflammatory bowel disease.there is increasing concern about the apparently rising incidence and worsening outcome of clostridium difficile infection (cdi) associated with inflammatory bowel disease (ibd). we have systematically reviewed the literature to evaluate the incidence, risk factors, endoscopic features, treatment and outcome of cdi complicating ibd.201021198703
clostridium difficile infection in hospitalized children in the united states.to evaluate the trend in clostridium difficile infection (cdi) among hospitalized children in the united states and to evaluate the severity of and risk factors associated with these cases of cdi.201121199971
beyond the target pathogen: ecological effects of the hospital formulary.antibiotic therapy has the potential for intended as well as unintended consequences due to ecological effects that extend beyond the target pathogen. this review examines some of the collateral damage and collateral benefit that may occur when using antibiotic therapy.201121200181
clostridium difficile infection among children with cancer.we used data from the kids' inpatient database to examine clostridium difficile infection (cdi) among children with cancer. the cdi rate was 15 times greater among children with cancer compared with those without cancer. children with cancer accounted for 21% of all pediatric cdi cases. increased adherence to infection control recommendations is needed to address cdi in children with cancer.201121206395
[c. difficile: new bacterial species significantly more pathogenic]. 201021207759
rapid stool-based diagnosis of clostridium difficile infection by real-time pcr in a children's hospital.clostridium difficile is a major cause of nosocomial antibiotic-associated infectious diarrhea and pseudomembranous colitis. detection of c. difficile by anaerobic bacterial culture and/or cytotoxicity assays has been largely replaced by rapid enzyme immunoassays (eia). however, due to the lack of sensitivity of stool eia, we developed a multiplex real-time pcr assay targeting the c. difficile toxin genes tcda and tcdb. stool samples from hospitalized pediatric patients suspected of having c. di ...201121209161
insulin-like growth factor-1 receptor transactivation modulates the inflammatory and proliferative responses of neurotensin in human colonic epithelial cells.neurotensin (nt) is a gastrointestinal neuropeptide that modulates intestinal inflammation and healing by binding to its high-affinity receptor ntr1. the dual role of nt in inflammation and healing is demonstrated in models of colitis induced by clostridium difficile toxin a and dextran sulfate sodium, respectively, and involves nf-κb-dependent il-8 expression and egf receptor-mediated mapk activation in human colonocytes. however, the detailed signaling pathways involved in these responses rema ...201121212273
difference in the biological effects of clostridium difficile toxin b in proliferating and non-proliferating cells.toxin a (tcda) and toxin b (tcdb) from clostridium difficile are the causative agents of the c. difficile-associated diarrhea (cdad) and its severe form, the pseudomembranous colitis. tcda and tcdb both glucosylate and thereby inactivate low molecular weight gtp-binding proteins of the rho, rac, and cdc42 subfamilies. in cultured cell lines, tcdb induces actin re-organization and bi-nucleation ("cytopathic effects") and cell death ("cytotoxic effects"). in this study, the role of cell cycle prog ...201121212934
optical density cut-off values for clostridium difficile enzyme immunoassays. 201121216035
neutralization of clostridium difficile toxin a with single-domain antibodies targeting the cell receptor binding domain.clostridium difficile is a leading cause of nosocomial infection in north america and a considerable challenge to healthcare professionals in hospitals and nursing homes. the gram-positive bacterium produces two high molecular weight exotoxins, toxin a (tcda) and toxin b (tcdb), which are the major virulence factors responsible for c. difficile-associated disease and are targets for c. difficile-associated disease therapy. here, recombinant single-domain antibody fragments (v(h)hs), which specif ...201121216961
us fda grants fast-trackdesignation to sanofi pasteur's investigational clostridium difficile vaccine. 201121217176
'game changer' antibiotic and others in works for superbug. 201121217660
clostridium difficile from healthy food animals: optimized isolation and prevalence.two isolation methods were compared for isolation of clostridium difficile from food animal feces. the single alcohol shock method (ss) used selective enrichment in cycloserine-cefoxitin fructose broth supplemented with 0.1% sodium taurocholate, followed by alcohol shock and isolation on tryptic soy agar supplemented with 5% sheep blood, and cycloserine-cefoxitin fructose agar. the double alcohol shock method (ds) used alcohol shock prior to and after selective enrichment in cycloserine-cefoxiti ...201121219775
infection acquisition following intensive care unit room privatization.patients in intensive care units (icus) often acquire infections, which impose a heavy human and financial burden. the use of private rooms may reduce the acquisition of certain pathogens, but the limited evidence on this topic is inconsistent.201121220658
the ecology and pathobiology of clostridium difficile infections: an interdisciplinary challenge.clostridium difficile is a well recognized pathogen of humans and animals. although c. difficile was first identified over 70 years ago, much remains unknown in regards to the primary source of human acquisition and its pathobiology. these deficits in our knowledge have been intensified by dramatic increases in both the frequency and severity of disease in humans over the last decade. the changes in c. difficile epidemiology might be due to the emergence of a hypervirulent stain of c. difficile, ...201021223531
[epidemiological aspects of gastrointestinal infections].the aim of this study was to investigate seasonal patterns and age-associated trends of the main bacterial, viral, and parasitic enteric pathogens in southwest germany.201121225552
[rifaximin--a non-resorbable antibiotic with many indications in gastroenterology].rifaximin, a non-resorbable broadband antibiotic, was approved in germany 2 years ago for the treatment of traveller's diarrhoea caused by non-invasive enteropathogens. on account of the very good tolerance and the high efficacy against almost all enteropathogens this pharmaceutical, which has been available for 25 years, bears a high potential in many other indications which are currently under clinical investigations, including: symptomatic uncomplicated diverticular disease, clostridium diffi ...201121225568
antimicrobial stewardship for inpatient facilities.antibiotic stewardship aims to improve patient care and reduce unwanted consequences of antimicrobial overuse or misuse, including lowered efficacy, emergence of antimicrobial resistance, development of secondary infections, adverse drug reactions, increased length of hospital stay, and additional healthcare costs. recent guidelines make specific recommendations for the development of institutional programs to enhance antimicrobial stewardship. optimally, such programs should be comprehensive, m ...201121225949
bacteraemia from an unrecognized source (occult bacteraemia) occurring during clostridium difficile infection.the purpose of this investigation was to determine if disruption of the colonic epithelium during clostridium difficile infection (cdi) is associated with bacteraemia due to secondary bacterial invasion by enteric organisms.201121231808
structural determinants for membrane insertion, pore formation and translocation of clostridium difficile toxin b.clostridium difficile toxins a and b bind to eukaryotic target cells, are endocytosed and then deliver their n-terminal glucosyltransferase domain after processing into the cytosol. whereas glucosyltransferase, autoprocessing and cell-binding domains are well defined, structural features involved in toxin delivery are unknown. here, we studied structural determinants that define membrane insertion, pore formation and translocation of toxin b. deletion analyses revealed that a large region, cover ...201121231971
epidemiology and risk factors for clostridium difficile infection in children.pediatric clostridium difficile infection (cdi)-related hospitalizations are increasing. we sought to describe the epidemiology of pediatric cdi at a quaternary care hospital.201121233782
does viral gastroenteritis really increase the reports of clostridium difficile infection? 201121239080
the impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals.to determine the effect of enhanced cleaning of the near-patient environment on the isolation of hospital pathogens from the bed area and staff hands.201121242793
[incidence and characteristics of clostridium difficile infection in patients with diarrhea in a prague teaching hospital].description of basic epidemiological and clinical data of patients suffering from clostridium difficile infection (cdi). recognizing important predisposing factors and detecting complications of the disease.201021243600
primary human colonic myofibroblasts are resistant to clostridium difficile toxin a-induced, but not toxin b-induced, cell death.colonic inflammation in clostridium difficile infection is mediated by released toxins a and b. we investigated responses to c. difficile toxins a and b by isolated primary human colonic myofibroblasts, which represent a distinct subpopulation of mucosal cells that are normally located below the intestinal epithelium. following incubation with either purified toxin a or b, there was a change in myofibroblast morphology to stellate cells with processes that were immunoreactive for alpha-smooth mu ...201121245273
toll-like receptor 5 stimulation protects mice from acute clostridium difficile colitis.clostridium difficile is a spore-forming bacterium that infects the lower intestinal tract of humans and is the most common known cause of diarrhea among hospitalized patients. clostridium difficile colitis is mediated by toxins and develops during or following antibiotic administration. we have used a murine model of c. difficile infection, which reproduces the major features of the human disease, to study the effect of innate immune activation on resistance to c. difficile infection. we found ...201121245274
magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting.to determine the prevalence and economic effect of inappropriate proton pump inhibitor (ppi) use in an ambulatory care setting.201021250399
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