Publications

lack of association of tcdc type and binary toxin status with disease severity and outcome in toxigenic clostridium difficile.	the production of binary toxin and presence of truncating mutations in the putative toxin repressor gene, tcdc, have been associated with the increased virulence and spread of clostridium difficile, especially ribotype 027. we analysed the prevalence of binary toxin genes and tcdc mutations in 207 clinical c. difficile isolates collected between 2008-2010. the majority (83%) belonged to one of five tcdc types and 8% were ribotype 027. there was little evidence of epidemic spread but there was a ...	2011	21396957
risk and rewards of fecal transplants.		2011	21398226
moist-heat resistance, spore aging, and superdormancy in clostridium difficile.	clostridium difficile spores can survive extended heating at 71┬░c (160┬░f), a minimum temperature commonly recommended for adequate cooking of meats. to determine the extent to which higher temperatures would be more effective at killing c. difficile, we quantified (d values) the effect of moist heat at 85┬░c (145┬░f, for 0 to 30 min) on c. difficile spores and compared it to the effects at 71 and 63┬░c. fresh (1-week-old) and aged (ôëñ20-week-old) c. difficile spores from food and food animals ...	2011	21398481
genetic manipulation of clostridium difficile.	clostridium difficile is a gram-positive, spore forming, anaerobic, intestinal bacterium and is the most common cause of antibiotic-associated colitis. for many years this organism was considered genetically intractable, but in the past 10 years, multiple methods have been developed or adapted for genetic manipulation of c. difficile. this unit describes the molecular techniques used for genetic modification of this organism, including methods for gene disruption, complementation, plasmid introd ...	2011	21400677
potentially inappropriate treatment of urinary tract infections in two rhode island nursing homes.	the aim of this study was to determine the appropriateness of antibiotic initiation, selection, and duration of therapy among patients in nursing homes with results of a urinalysis showing urinary tract infection.	2011	21403040
quantitative mass spectrometry for bacterial protein toxins--a sensitive, specific, high-throughput tool for detection and diagnosis.	matrix-assisted laser-desorption time-of-flight (maldi-tof) mass spectrometry (ms) is a valuable high-throughput tool for peptide analysis. liquid chromatography electrospray ionization (lc-esi) tandem-ms provides sensitive and specific quantification of small molecules and peptides. the high analytic power of ms coupled with high-specificity substrates is ideally suited for detection and quantification of bacterial enzymatic activities. as specific examples of the ms applications in disease dia ...	2011	21403598
prevention and treatment of clostridium difficile infection.		2011	21404793
clostridium difficile infection and treatment in the pediatric inflammatory bowel disease population.	recent changes in the epidemiology of clostridium difficile infection include an increase in the incidence of c difficile-associated disease (cdad) and the identification of patients with inflammatory bowel disease (ibd) as a group at risk. in addition, the effectiveness of antimicrobial therapies has been questioned. our aim was to estimate the incidence of cdad in a pediatric ibd population and review treatment efficacy.	2011	21407116
low risk of transmission of clostridium difficile to humans at petting farms.		2011	21411249
evaluation of four different diagnostic tests to detect clostridium difficile in piglets.	clostridium difficile is emerging as pathogen in both humans and animals. in 2000 it was described as one of the causes of neonatal enteritis in piglets, and it is now the most common cause of neonatal diarrhea in the united states. in europe, c. difficile infection (cdi) in both neonatal piglets and adult sows has also been reported. diagnosis of this infection is based on detection of the bacterium c. difficile or its toxins a and b. most detection methods, however, are only validated for diag ...	2011	21411571
modified multiple-locus variable-number tandem-repeat analysis for rapid identification and typing of clostridium difficile during institutional outbreaks.	a modified multiple-locus variable-number tandem-repeat analysis (mmlva) method was validated on clostridium difficile-infected stool specimens from institutional outbreaks. the method allows simultaneous detection of toxin genes, deletions, and tandem repeats from cultured isolates or stool specimens. results were used to aid institutional outbreak investigation by identifying clusters of nap1/027.	2011	21411590
nucleotide-binding oligomerization domain 1 mediates recognition of clostridium difficile and induces neutrophil recruitment and protection against the pathogen.	clostridium difficile is a gram-positive obligate anaerobic pathogen that causes pseudomembranous colitis in antibiotics-treated individuals. however, host immune protective mechanisms against c. difficile are largely unknown. in this study, we show that c. difficile possesses potent stimulatory activity for nucleotide-binding oligomerization domain 1 (nod1), an intracellular pattern recognition molecule that senses bacterial peptidoglycan-related molecules. nod1(-/-), but not nod2(-/-), mice ex ...	2011	21411735
clostridium difficile colitis: reduced time to diagnosis in a community-based outpatient setting between 1997 and 2004.	objective: we studied antibiotic use prior to the onset of clostridium difficile colitis (cdc) and time interval between onset of gastrointestinal symptoms and diagnosis for two historical time periods with separate comparisons for inpatients and outpatients to determine whether time to diagnosis had decreased and whether previous metronidazole use is associated with cdc.method: we performed a retrospective chart review of adult patients (those 18 years or older) with positive findings on clostr ...	2007	21412481
[proton pump inhibitors and infection risk].	gastric antisecretory drugs, especially proton pump inhibitors, are among the most used drugs both in ambulatory and hospital settings, and prescription does not always follows approved indications. experimental data suggest that gastric acid inhibition and the effects of proton pump inhibitors on the immune system can promote the development of infections. in recent years a number of observational studies have found an independent association between the use of proton pump inhibitors and an inc ...	2011	21412664
the host immune response to clostridium difficile.	clostridium difficile is the most common cause of nosocomial bacterial diarrhoea in the western world. diarrhoea and colitis are caused by the actions of toxins a and b released by pathogenic strains of c. difficile. adaptive immune responses to these toxins influence the outcomes of c. difficile infection (cdi). symptomless carriers of toxinogenic c. difficile and those with a single episode of cdi without recurrence show more robust antitoxin immune responses than those with symptomatic and re ...	2011	21415200
characterization and antimicrobial susceptibility of clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in poland, 2004-2006.	this study analysed 330 clostridium difficile strains isolated from patients with c. difficile infection who were hospitalized in two university hospitals (h1 and h2) in warsaw, poland, over the period 2004-2006. strains were investigated for the presence of tcda (a), tcdb (b) and binary toxin (cdt) genes, and antimicrobial susceptibility was determined against nine agents. among the 330 c. difficile isolates, 150 (45.4?%) were classified as a(+)b(+)cdt(-), 18 (5.5?%) as a(+)b(+)cdt(+), 144 (43. ...	2011	21415206
antimicrobial photodynamic therapy in the colon: delivering a light punch to the guts?	a paper in this issue of photochemistry and photobiology by cassidy et al. describes the use of a sophisticated drug delivery vehicle prepared by the hot melt extrusion process to deliver photosensitizers to the colon. the smart vehicle protects its cargo through the acidic environment of the stomach but releases the active photosensitizers in the higher ph and anaerobic environment of the colon. the goal is to use photodynamic therapy (pdt) to destroy pathogenic microorganisms that can cause di ...	2011	21418077
increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients.	to explore the clinical impact and economic burden of hospital-acquired infections (hais) in trauma patients using a nationally representative database.	2011	21422331
[antimicrobial susceptibility of clinical isolates of aerobic gram-positive cocci and anaerobic bacteria in 2006].	the activity of antibacterial agents against aerobic gram-positive cocci (26 species, 1022 strains) and anaerobic bacteria (23 species, 184 strains) isolated from clinical specimens in 2006 at 16 clinical facilities in japan were studied using either broth microdilution or agar dilution method. the ratio of methicillin-resistant strains among staphylococcus aureus and staphylococcus epidermidis was 53.0% and 65.8%, suggesting that resistant strains were isolated at high frequency. vancomycin (vc ...	2010	21425596
decline in clostridium difficile-associated disease rates in singapore public hospitals, 2006 to 2008.		2011	21429188
an integrative review of infection prevention and control programs for multidrug-resistant organisms in acute care hospitals: a socio-ecological perspective.	the infection rates of multidrug-resistant organisms (mdro) are increasing in canada and the united states. the prevention and control of mdro infections remain an important issue in acute care hospitals. although comprehensive infection prevention and control programs have been recommended, there is little evidence to date of their effectiveness or of what aspects are most important.	2011	21429622
diversity and antimicrobial activity of pseudovibrio spp. from irish marine sponges.	to evaluate the diversity and antimicrobial activity present among pseudovibrio spp. isolated from marine sponges.	2011	21435124
geographical clustering of cases of infection with moxifloxacin-resistant clostridium difficile pcr-ribotypes 012, 017 and 046 in sweden, 2008 and 2009.	we report the results of two nationwide surveillance studies of clostridium difficile infection conducted during 2008 and 2009 in sweden. the first study aimed to identify and quantify the proportion of c. difficile isolates with decreased susceptibility to moxifloxacin, particularly those of pcr-ribotype 027. from december 2007 to september 2008, 20 of 28 regional laboratories sent 585 isolates to the swedish institute for infectious disease control for typing. a majority of the isolates (454 o ...	2011	21435322
clostridium difficile infection in patients with ulcerative colitis: investigations of risk factors and efficacy of antibiotics for steroid refractory patients.	the incidence of clostridium difficile infection (cdi) has increased throughout the world and patients with ulcerative colitis (uc) are at a high risk for cdi. potentially, cdi can exacerbate uc. therefore, knowledge on the prevalence of cdi should contribute to better management of uc patients.	2011	21435967
clostridium difficile in horses in australia--a preliminary study.	during a 24 month period from 2007 to 2009, 174 faecal specimens from horses in australia (predominantly from western australia) were tested for clostridium difficile. c. difficile was isolated from 14 (23ôçè%) of 62 diarrhoeal animals (including 10 foals) and from none of 112 healthy adult horses. these isolates were toxin profiled by pcr for toxin a, toxin b and binary toxin, and ribotyped. ten of the equine isolates were a(+)b(+)cdt(-). other toxin profiles detected were a(-)b(-)cdt(+) (one i ...	2011	21436371
use of different molecular typing methods for the study of heterogeneity within clostridium difficile toxinotypes v and iii.	clostridium difficile strains of toxinotypes iii (nôçè=ôçè13) and v (nôçè=ôçè45) were typed by agarose gel-based pcr ribotyping, capillary gel electrophoresis-based pcr ribotyping and pfge using two different restriction enzymes, smai and sacii. with conventional agarose gel-based pcr ribotyping, toxinotype iii strains were distributed among six different pcr ribotypes and toxinotype v strains into three different pcr ribotypes. capillary gel electrophoresis-based ribotyping was more discriminat ...	2011	21436374
mandatory reporting and improvements in diagnosing clostridium difficile infection: an incompatible dichotomy?	toxin enzyme immunoassays (eias) are inadequate for the diagnosis of clostridium difficile infection (cdi) when used alone. in september 2010 we replaced toxin eia with a two-step algorithm, testing first with glutamate dehydrogenase and confirming with polymerase chain reaction for toxin b gene. we compared this to the gold standard of toxigenic culture, observing a positive predictive value of 96% (laboratory prevalence of 4.7%). there was no deterioration in turnaround time but there was a de ...	2011	21439999
transient fecal shedding and limited animal-to-animal transmission of clostridium difficile by naturally infected finishing feedlot cattle.	to longitudinally assess fecal shedding and animal-to-animal transmission of clostridium difficile among finishing feedlot cattle as a risk for beef carcass contamination, we tested 186 ± 12 steers (mean ± standard deviation; 1,369 samples) in an experimental feedlot facility during the finishing period and at harvest. clostridium difficile was isolated from 12.9% of steers on arrival (24/186; 0 to 33% among five suppliers). shedding decreased to undetectable levels a week later (0%; p < 0.001), ...	2011	21441320
prophage-stimulated toxin production in clostridium difficile nap1/027 lysogens.	tcda and tcdb exotoxins are the main virulence factors of clostridium difficile, one of the most deadly nosocomial pathogens. recent data suggest that prophages can influence the regulation of toxin expression. here we present the characterization of ?cd38-2, a pac-type temperate siphoviridae phage that stimulates toxin expression when introduced as a prophage into c. difficile. host range analysis showed that ?cd38-2 was able to infect 99/207 isolates of c. difficile representing 11 different p ...	2011	21441508
approach to fecal incontinence and constipation in older hospitalized patients.	although constipation and fecal incontinence are commonly encountered in older hospitalized patients, there is a paucity of clinical studies in this field. in this article we discuss the approach to and management of patients with these problems based on evidence and studies performed on patients in the ambulatory care setting, nursing home setting, and our experience. our recommendations are applicable to older hospitalized patients. successful management of these patients depends on identifyin ...	2011	21441765
emerging therapies for clostridium difficile infections.	introduction: clostridium difficile infection (cdi) is the leading identifiable gastrointestinal disease in healthcare institutions, but the response rates to the two standard therapies for cdi are declining and so innovative therapies are being developed for cdi. the purpose of this paper is to review the data on the efficacy and safety of emerging therapies for cdi and assess their potential for effectiveness based on the clinical phase of development and marketing challenges. areas covered: e ...	2011	21443387
clostridium difficile infection in patients with cancer.	patients with cancer undergoing chemotherapy often have diarrhea, which may result from their treatment or clostridium difficile infection (cdi). cdi diarrhea is an important diagnosis that can be missed if nurses are not vigilant in their assessments. treatment for cdi diarrhea is different than that of chemotherapy- or radiation-induced diarrhea. if cdi diarrhea is not treated, it can become life threatening in some patients.	2011	21444289
the repetitive oligopeptide sequences modulate cytopathic potency but are not crucial for cellular uptake of clostridium difficile toxin a.	the pathogenicity of clostridium difficile is primarily linked to secretion of the intracellular acting toxins a (tcda) and b (tcdb) which monoglucosylate and thereby inactivate rho gtpases of host cells. although the molecular mode of action of tcda and tcdb is well understood, far less is known about toxin binding and uptake. it is acknowledged that the c-terminally combined repetitive oligopeptides (crops) of the toxins function as receptor binding domain. the current study evaluates the role ...	2011	21445253
[clostridium difficile-associated diarrhea: causes and relationship to reactive arthritis].	we present a patient treated with methotrexate (mtx] for rheumatoid arthritis, in whom clostridium difficile-associated colitis has developed, without preceding antibiotic treatment. two weeks later, the patient was admitted with knee arthritis. reactive arthritis was diagnosed and treated successfully with the naproxen. the article discusses risk factors for clostridium difficile-associated diarrhea [cdad] other than antibiotics, and the relation of this pathogen to the development of reactive ...	2011	21449161
modifications of commercial toxigenic clostridium difficile pcr resulting in improved economy and workflow efficiency.	expense inherent to molecular diagnostics may prevent laboratories from utilizing real-time pcr for clostridium difficile infection. frozen master mix and overnight aliquot modifications of the bd geneohm cdiff assay failed to impact performance indices compared to the package insert protocol (p = 0.31), provided accurate results, and decreased reagent expenditure.	2011	21450967
infection prevention and control practices related to clostridium difficile infection in canadian acute and long-term care institutions.	clostridium difficile is an important pathogen in canadian health care facilities, and infection prevention and control (ipc) practices are crucial to reducing c difficile infections (cdis). we performed a cross-sectional study to identify cdi-related ipc practices in canadian health care facilities.	2011	21458680
clostridium difficile at a community hospital in the bronx, new york: incidence prevalence and risk factors from 2006 to 2008.	the rate of clostridium difficile has increased over the last decade. this study was undertaken to determine the incidence, prevalence, and risk factors for infection at a 460-bed community hospital in the bronx, new york.	2011	21458681
implications for vancomycin-resistant enterococcus colonization associated with clostridium difficile infections.	vancomycin-resistant enterococcus (vre) colonization of the gastrointestinal tract shares similar risk factors with clostridium difficile infection. we sought to elucidate the prevalence and risk factors of vre colonization associated with c difficile infection.	2011	21458682
efficacy of "sporicidal" wipes against clostridium difficile.	hospital-acquired infections associated with clostridium difficile cause severe morbidity and mortality. the current control of c difficile endospores with liquid sporicides might have limited efficacy in the health care environment. sporicidal wipes might offer additional control of surface bioburden and are now increasingly used, although there is little information about their efficacy against spores in practice.	2011	21458683
an investigation of the subtype diversity of clinical isolates of irish clostridium difficile ribotypes 027 and 078 by repetitive-extragenic palindromic pcr.	a repetitive-extragenic palindromic pcr (rep-pcr) subtyping method (diversilab) in conjunction with ribotyping, toxinotyping and antimicrobial-susceptibility testing was used to detect subtypes within clostridium difficile ribotypes 027 and 078. clinical isolates of ribotypes 027 (toxinotype iii) (n?=?30) and 078 (toxinotype v) (n?=?23) were provided by health-care facilities across the republic of ireland over 2 months in 2006 and 1 month in 2009. ribotype 027 isolates were significantly more r ...	2011	21459905
use of the loop-mediated isothermal amplification method for identification of pcr ribotype 027 clostridium difficile.	the loop-mediated isothermal amplification (lamp) assay detecting the slpa gene of slpa sequence type gc8 (slpa-gc8) was established for the identification of a hypervirulent clostridium difficile strain, pcr ribotype 027. of 107 isolates examined, 27 belonging to pcr ribotype 027 were all positive for the lamp assay. the remaining 80 isolates were typed into 47 different pcr ribotypes other than type 027, and were negative for the lamp assay with the exception of two isolates. the sensitivity a ...	2011	21459906
binary toxin locus analysis in clostridium difficile.	the objective of this study was to compare full binary toxin loci (cdtloc) sequences from a collection of clostridium difficile isolates in an effort to further understand the regulation of the binary toxin (cdtab) and its putative regulator (cdtr). sequences from different ribotypes and toxinotypes were analysed phylogenetically and for polymorphisms, non-sense mutations, promoter features and signal sequences. expression of cdta, which was also representative of cdtb expression, was measured b ...	2011	21459907
effectiveness of routine patient bathing to decrease the burden of spores on the skin of patients with clostridium difficile infection.	for 74 patients with clostridium difficile infection, the quality and frequency of bathing was often limited because of such factors as the presence of devices, decreased mobility, and pain. routine bathing practices had limited efficacy in decreasing the burden of spores on skin; however, showers were more effective than bed baths.	2011	21460475
development and validation of a clostridium difficile infection risk prediction model.	to develop and validate a risk prediction model that could identify patients at high risk for clostridium difficile infection (cdi) before they develop disease.	2011	21460487
comparison of the burdens of hospital-onset, healthcare facility-associated clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant staphylococcus aureus in community hospitals.	we sought to determine the burden of nosocomial clostridium difficile infection in comparison to other healthcare-associated infections (hais) in community hospitals participating in an infection control network. our data suggest that c. difficile has replaced mrsa as the most common etiology of hai in community hospitals in the southeastern united states.	2011	21460491
evaluation of hospital room assignment and acquisition of clostridium difficile infection.	clostridium difficile spores persist in hospital environments for an extended period. we evaluated whether admission to a room previously occupied by a patient with c. difficile infection (cdi) increased the risk of acquiring cdi.	2011	21460503
the role of the environment in transmission of clostridium difficile infection in healthcare facilities.		2011	21460504
multihospital outbreak of clostridium difficile ribotype 027 infection: epidemiology and analysis of control measures.	to report a large outbreak of clostridium difficile infection (cdi; ribotype 027) between june 2007 and august 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.	2011	21460505
comparison of clinical severity score indices for clostridium difficile infection.	to compare 8 severity score indices for clostridium difficile infection (cdi).	2011	21460506
impact of chlorhexidine bathing on hospital-acquired infections among general medical patients.	a paucity of data exists regarding the effectiveness of daily chlorhexidine gluconate (chg) bathing in non-intensive care unit (icu) settings.	2011	21460508
prevention of clostridium difficile infections: efficacious and high-quality probiotics can produce the expected effect when used appropriately.		2011	21468077
clostridium difficile isolates with increased sporulation: emergence of pcr ribotype 002 in hong kong.	we identified a predominant clone of clostridium difficile pcr ribotype 002, which was associated with an increased sporulation frequency. in 2009, 3,528 stool samples from 2,440 patients were tested for toxigenic c. difficile in a healthcare region in hong kong. a total of 345 toxigenic strains from 307 (13.3%) patients were found. ribotype 002 was the predominant ribotype, which constituted 35 samples from 29 (9.4%) patients. the mean sporulation frequency of ribotype 002 was 20.2%, which was ...	2011	21468685
clostridium difficile infection: a new threat on our doorstep.		2011	21470079
australasian society for infectious diseases guidelines for the diagnosis and treatment of clostridium difficile infection.	clostridium difficile is the most common cause of health care-associated and antibiotic-associated diarrhoea. these guidelines are intended to provide advice to clinicians on the clinical assessment, diagnosis and management of c. difficile infection (cdi). hypervirulent strains of c. difficile, including pcr ribotype 027 strains recently identified in australia, have been associated elsewhere with epidemic spread and high rates of severe disease and death. diagnostic tests include stool culture ...	2011	21470086
severe infection with clostridium difficile pcr ribotype 027 acquired in melbourne, australia.	we report the first recognised case of infection with clostridium difficile pcr ribotype 027 acquired in australia. this pathogen has caused significant morbidity and mortality in widespread hospital-based outbreaks in the northern hemisphere. clinicians need to be aware of the clinical picture, limitations of diagnostic tests, availability of further testing for epidemic strains, new therapeutic approaches, and in-hospital control strategies for this infection.	2011	21470090
intravenous tigecycline in the treatment of severe recurrent clostridium difficile colitis.		2011	21470094
characterization of cases of clostridium difficile infection (cdi) presenting at an emergency room: molecular and clinical features differentiate community-onset hospital-associated and community-associated cdi in a tertiary care hospital.	definition of community-onset, hospital-acquired clostridium difficile infection (co-ha-cdi) is difficult in patients presenting with diarrhea at hospitals or outpatient clinics, especially 4 to 12 weeks after the last discharge. we performed c. difficile stool culture for 272 diarrheic patients visiting the emergency room (er) between january 2006 and june 2010. c. difficile was isolated from 36 cases (13.2%), and isolation rates increased year by year, from 10.1% in 2008 to 12.4% in 2009 and 1 ...	2011	21471341
efficacy of decontaminants and disinfectants against clostridium difficile.	clostridium difficile is a common nosocomial pathogen transmitted mainly via its spores. these spores can remain viable on contaminated surfaces for several months and are resistant to most commonly used cleaning agents. thus, effective decontamination of the environment is essential in preventing the transmission of c. difficile in healthcare establishments. however, this emphasis on decontamination must also be extended to laboratories due to risk of exposure of staff to potentially virulent s ...	2011	21474613
therapeutic potential of egg yolk antibodies for treating clostridium difficile infection.	herein we present evidence for the therapeutic potential of colonization factor (cf)-specific egg yolk antibodies for potentially treating acute and recurring c. difficile infection (cdi) in humans. the study involved cloning, expressing as 6 x his-tagged-proteins in e. coli, and ni-affinity purifying three previously identified cf (flic, flid, and cwp84) from c. difficile. the recombinant cf antigens were then used to immunize leghorn chickens and cf-specific igy antibodies were prepared from t ...	2011	21474614
defining criteria to interpret multi-locus variable number tandem repeat analysis to aid clostridium difficile outbreak investigation.	pulsed field gel electrophoresis (pfge) is currently the north american standard for surveillance for c. difficile but lacks discriminatory power to aid outbreak investigation. a further limitation to pfge is the high baseline rate of the epidemic north american pulsotype (nap) 1 strain in hospitals. multi-locus variable number of tandem repeats analysis (mlva) appears to have superior discriminatory power but criteria to define clonality have not been set. we conducted surveillance for toxin-po ...	2011	21474615
progesterone analogs influence germination of clostridium sordellii and clostridium difficile spores in vitro.	clostridium sordellii and clostridium difficile are closely related anaerobic gram-positive, spore-forming human pathogens. c. sordellii and c. difficile form spores that are believed to be the infectious form of these bacteria. these spores return to toxin-producing vegetative cells upon binding to small molecule germinants. the endogenous compounds that regulate clostridial spore germination are not fully understood. while c. sordellii spores require three structurally distinct amino acids to ...	2011	21478359
immunization with bacillus spores expressing toxin a peptide repeats protects against infection with clostridium difficile strains producing toxins a and b.	clostridium difficile is a leading cause of nosocomial infection in the developed world. two toxins, a and b, produced by most strains of c. difficile are implicated as virulence factors, yet only recently has the requirement of these for infection been investigated by genetic manipulation. current vaccine strategies are focused mostly on parenteral delivery of toxoids. in this work, we have used bacterial spores (bacillus subtilis) as a delivery vehicle to evaluate the carboxy-terminal repeat d ...	2011	21482682
c-di-gmp turn-over in clostridium difficile is controlled by a plethora of diguanylate cyclases and phosphodiesterases.	clostridium difficile infections have become a major healthcare concern in the last decade during which the emergence of new strains has underscored this bacterium's capacity to cause persistent epidemics. c-di-gmp is a bacterial second messenger regulating diverse bacterial phenotypes, notably motility and biofilm formation, in proteobacteria such as vibrio cholerae, pseudomonas aeruginosa, and salmonella. c-di-gmp is synthesized by diguanylate cyclases (dgcs) that contain a conserved ggdef dom ...	2011	21483756
review of proton pump inhibitors for the initial treatment of heartburn: is there a dose ceiling effect?	proton pump inhibitors (ppis) are widely used in clinical practice. however, concerns have been expressed about their long-term use, particularly with regard to bone health, clostridium difficile infections, and drug interactions with platelet aggregation inhibitors. there has been limited guidance for clinicians concerning appropriate dose selection of ppis for the initial treatment of heartburn. this review explored whether published clinical trials provide evidence of a ceiling above which hi ...	2011	21484335
bacterial enteritis in dogs and cats: diagnosis, therapy, and zoonotic potential.	a variety of bacteria are known or suspected of being able to cause enteritis in dogs and cats. campylobacter spp, clostridium difficile, clostridium perfringens, and salmonella spp are most commonly implicated, but many other organisms are likely involved. poor understanding of the intestinal microflora and the fact that many, if not all, of these microorganisms can also be found in healthy individuals complicates testing, thereby affecting the use of specific treatments and assessment of poten ...	2011	21486637
rapid diagnosis of clostridium difficile infection by multiplex real-time pcr.	the gold standards for the diagnosis of clostridium difficile infections (cdis) are the cytotoxicity assay and the toxigenic culture. however, both methods are time-consuming and the results are not available before 24-48 h. we developed and evaluated a multiplex in-house real-time polymerase chain reaction (pcr) assay for the simultaneous detection of toxigenic strains of c. difficile and the presumptive identification of the epidemic nap1/027/bi strain from stools. amplifications were performe ...	2011	21487764
assessing the efficacy of different microfibre cloths at removing surface micro-organisms associated with healthcare-associated infections.	this study investigated the ability of 10 different microfibre cloths to remove microbial contamination from three surfaces commonly found in hospital settings (stainless steel, furniture laminate and ceramic tile), under controlled laboratory conditions. tests were conducted using organisms known to cause healthcare-associated infections, i.e. meticillin-resistant staphylococcus aureus (mrsa), clostridium difficile (in spore form) and escherichia coli. for all the cloths tested, there was signi ...	2011	21501897
treatment of refractory and recurrent clostridium difficile infection.	the incidence of clostridium difficile infection (cdi) has increased since 2000, with greater numbers of severe cases reported, in part due to the emergence of a hypervirulent strain. initial therapy with metronidazole is still recommended for mild to moderate cdi, but vancomycin is recommended for first-line therapy of severe cdi. colectomy could be life-saving for some patients with severe disease that does not respond to maximal medical therapy. recurrent cdi is a challenge to treat; no singl ...	2011	21502971
recognition of clostridium difficile pcr-ribotypes 001, 027 and 126/078 using an extended maldi-tof ms system.	during the last decade, clostridium difficile infection (cdi) increased markedly inside as well as outside of hospitals. in association with the occurrence of new hypervirulent c. difficile strains, cdi became more important. until now typing of c. difficile strains has been enabled by pcr-ribotyping. however, this method is restricted to specialized laboratories combined with high maintenance cost. therefore, we tested maldi-tof mass spectrometry for typing of c. difficile to provide a fast met ...	2011	21503840
evaluation of linezolid for the treatment of clostridium difficile infection caused by epidemic strains using an in vitro human gut model.	objectives therapeutic options in clostridium difficile infection (cdi) are limited. we examined linezolid activity in vitro and potential therapeutic efficacy using a gut model of cdi. methods mics were determined by agar incorporation for 118 diverse c. difficile faecal isolates, including epidemic strains and strains with reduced susceptibility to metronidazole. cdi was established in two gut model experiments using c. difficile epidemic strains (ribotypes 027 and 106) and linezolid was dosed ...	2011	21504940
epidemiology and control of clostridium difficile infections in healthcare settings: an update.	purpose of review: the epidemiology of clostridium difficile infections (cdis) has dramatically changed over the last decade in both north america and europe. the objectives of this review are to highlight the recent epidemiological data and to provide an overview of the current knowledge of infection control measures. recent findings: since 2003, many countries have reported increased incidence of cdi and outbreaks of severe cases of cdi. this trend is assumed to be due, in part, to the emergen ...	2011	21505332
infectious diseases in the critically ill patients.	infection is common in the critically ill and often results due to the severity of the patient's illness. recent data suggest 51% of intensive care unit (icu) patients are infected, and 71% receive antimicrobial therapy. bacterial infection is the primary concern, although some fungal infections are opportunistic. infection more than doubles the icu mortality rate, and the costs associated with infection may be as high as 40% of total icu expenditures. there are many contemporary antimicrobial r ...	2011	21507873
fourteen-genome comparison identifies dna markers for severe-disease-associated strains of clostridium difficile.	clostridium difficile is a common cause of infectious diarrhea in hospitalized patients. a severe and increased incidence of c. difficile infection (cdi) is associated predominantly with the nap1 strain; however, the existence of other severe-disease-associated (sda) strains and the extensive genetic diversity across c. difficile complicate reliable detection and diagnosis. comparative genome analysis of 14 sequenced genomes, including those of a subset of nap1 isolates, allowed the assessment o ...	2011	21508155
proton pump inhibitors in rheumatic diseases: clinical practice, drug interactions, bone fractures and risk of infections.	platelet activation and aggregation are key elements of the pathogenesis of acute coronary syndromes, of endothelial damage in chronic inflammatory and connective tissue disease (i.e. systemic sclerosis-ssc). patients affected by chronic inflammatory diseases as well as by connective tissue diseases such as systemic sclerosis, often have the need to take anti-platelet therapy (e.g. asa or clopidogrel). current consensus recommendations state that patients prescribed clopidogrel plus aspirin shou ...	2011	21509344
two case reports of clostridium difficile bacteremia, one with the epidemic nap-1 strain.	clostridium difficile bacteremia is rare. here, we report two cases of c. difficile bacteremia in patients with significant underlying gastrointestinal pathology. in one case, the bacteremia was caused by the north american pulsed-field gel electrophoresis (pfge) type 1 (nap-1) strain, which is responsible for recent outbreaks of c. difficile infections of increased severity.	2011	21509425
susceptibility of hamsters to infection by historic and epidemic bi clostridium difficile strains during daily administration of three fluoroquinolones.	background: the recent epidemic of clostridium difficile infection (cdi) has been attributed largely to the rea strain group bi (aka nap1/027). current isolates of the bi group differ from historic non-epidemic bi strains in that they have developed resistance to the newer fluoroquinolone (fq), moxifloxacin. the acquisition of moxifloxacin resistance has been associated with the rise in frequency of cdi caused by these isolates. in order to explore the effect of fq resistance on cdi we compared ...	2011	21511046
genetic characterisation of clinical isolates of clostridium difficile using an optimised rapd protocol and pcr ribotyping reveals strain diversity between two tertiary referral trusts in the west midlands, uk.	epidemiological investigations of clostridium difficile often focus on differences between separate geographical areas. in this investigation, two populations of c. difficile recovered from separate tertiary referral trusts within the west midlands, uk, were characterised using both pcr ribotyping and an optimised rapd protocol. the pcr ribotyping and rapd methodologies identified differences between the two c. difficile populations, both in the prevalence and the diversity of types identified. ...	2011	21511887
scottish antimicrobial prescribing group (sapg): development and impact of the scottish national antimicrobial stewardship programme.	in 2008, the scottish management of antimicrobial resistance action plan (scotmarap) was published by the scottish government. one of the key actions was initiation of the scottish antimicrobial prescribing group (sapg), hosted within the scottish medicines consortium, to take forward national implementation of the key recommendations of this action plan. the primary objective of sapg is to co-ordinate and deliver a national framework or programme of work for antimicrobial stewardship. this prog ...	2011	21515030
clostridium difficile pcr ribotype 176 in the czech republic and poland.		2011	21515161
systematic review of measurement and adjustment for colonization pressure in studies of methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, and clostridium difficile acquisition.	colonization pressure is an important infection control metric. the aim of this study was to describe the definition and measurement of and adjustment for colonization pressure in nosocomial-acquisition risk factor studies of methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), and clostridium difficile.	2011	21515979
clostridium difficile infection in a department of veterans affairs long-term care facility.	in a veterans affairs medical center, 39% of healthcare facility-onset, healthcare facility-associated clostridium difficile infections had their onset in the affiliated long-term care facility (ltcf). eighty-five percent of ltcf-onset patients had been transferred from the hospital within the past month. delays in diagnosis and treatment were common for ltcf-onset patients.	2011	21515985
toxin a-negative, toxin b-positive clostridium difficile infection diagnosed by polymerase chain reaction.		2011	21515990
increased health burden associated with clostridium difficile diarrhoea in patients with inflammatory bowel disease.	background clostridium difficile (c. difficile) infection in hospitals in developed countries continues to be a major public health hazard despite increased control measures including review of antibiotic policies and hygiene measures. patients with colitis are thought to be particularly vulnerable to c. difficile associated diarrhoea (cdad). identifying the clinical burden among hospitalised patients admitted with inflammatory bowel disease is an essential first step towards identifying and tr ...	2011	21517920
lipopolysaccharide binding protein, interleukin-6 and c-reactive protein in acute gastrointestinal infections: value as biomarkers to reduce unnecessary antibiotic therapy.	aim: several new biomarkers, such as lipopolysaccharide binding protein (lbp) and interleukin-6 (il-6), have the potential to determine the severity and outcome of infectious diseases. lbp and il-6 serum levels have not been reported in patients with gastrointestinal infections. the aim of this study was to compare established markers of infection with new markers, such as lbp and il-6, in patients with acute gastrointestinal infections method: lbp, c-reactive protein (crp), white blood cell cou ...	2011	21523403
rectal prolapse in a child: an unusual presentation of clostridium difficile-associated pseudomembranous colitis.	pseudomembranous colitis after short-course antibiotics is rare in children. we report a 14-month-old girl who presented with rectal prolapse complicated with clostridium difficile-associated pseudomembranous colitis after a 4-day course of oral cefuroxime for treatment of acute otitis media. abdominal sonogram showed a pelvic mass, and computed tomography revealed thickened wall of the rectum. sigmoidoscopy demonstrated discrete yellowish plaques adherent to an edematous mucosa. stool cultures ...	2011	21524633
evaluation of a loop-mediated isothermal amplification (lamp) assay for the diagnosis of clostridium difficile infections.	a new assay (illumigene c. difficile, meridian bioscience), based on original loop-mediated isothermal amplification (lamp) was evaluated on 472 unformed stools from patients suspected of c. difficile infection. compared to the toxigenic culture, the sensitivity, specificity, positive and negative predictive values were 91.8%, 99.1%, 91.8% and 99.1% for the illumigene c. difficile assay and 69.4%, 100%, 100%, and 96.6% for the cytotoxicity assay, respectively.	2011	21525213
the 3d structure of thuricin cd, a two-component bacteriocin with cysteine sulfur to α-carbon cross-links.	thuricin cd is an antimicrobial factor that consists of two peptides, trn-α and trn-β, that exhibit synergistic activity against drug resistant strains of clostridium difficile. trn-α and trn-β each possess three sulfur to α-carbon thioether bridges for which the stereochemistry is unknown. this report presents the three-dimensional solution structures of trn-α and trn-β. structure calculations were performed for the eight possible stereoisomers of each peptide based on the same nmr data. the st ...	2011	21526839
the analysis of para-cresol production and tolerance in clostridium difficile 027 and 012 strains.	abstract:	2011	21527013
detection of clostridium difficile in animals: comparison of real-time pcr assays with the culture method.	clostridium difficile has emerged as pathogen or commensal in food animals and overlap between isolates from animals, retail meat and humans suggests that animals may be a c. difficile reservoir. for direct detection of variant c. difficile strains in fecal samples of symptomatic and asymptomatic animals, we developed and validated a new taqman real-time pcr (tmrtpcr) targeting tcda, tcdb and cdtb genes. we compared it with enrichment culture method and with two real-time pcr assays brtpcr and p ...	2011	21527548
providers' beliefs and behaviors regarding antibiotic prescribing and antibiotic resistance in persons with spinal cord injury or disorder.	persons with spinal cord injury or disorder (sci/d) are at increased risk for antibiotic resistance because of recurrent infections and subsequent use of antibiotics. however, there are no studies focused on providers who care for these patients and their perceptions regarding antibiotic use and resistance.	2011	21528622
epidemiology of clostridium difficile and vancomycin-resistant enterococcus colonization in patients on a spinal cord injury unit.	patients with spinal cord injury (sci) are at risk of acquiring colonization with clostridium difficile and vancomycin-resistant enterococcus (vre) due to prolonged hospitalization and frequent antimicrobial use. we examined the frequency of stool, skin, and environmental contamination with c. difficile and vre in hospitalized patients with scl.	2011	21528623
clostridium difficile infection in humans and animals, differences and similarities.	clostridium difficile is well known as the most common cause of nosocomial infections in human patients. in recent years a change in epidemiology towards an increase in incidence and severity of disease, not only inside the hospital, but also in the community, is reported. c. difficile is increasingly recognized in veterinary medicine as well and is now considered the most important cause of neonatal diarrhea in swine in north america. research on the presence of c. difficile in production and c ...	2011	21530110
roles of cysteine proteases cwp84 and cwp13 in biogenesis of the cell wall of clostridium difficile.	clostridium difficile expresses a number of cell wall proteins, including the abundant s-layer proteins hmw slp and lmw slp. these proteins are generated by post-translational cleavage of the precursor slpa by the cysteine protease cwp84. here we compare the phenotypes of c. difficile strains containing insertional mutations in either cwp84 or its paralog cwp13 and complemented with plasmids expressing wild-type or mutant forms of their genes. we show that the presence of uncleaved slpa in the c ...	2011	21531808
the clostridium difficile cell wall protein cwpv is antigenically variable between strains, but exhibits conserved aggregation-promoting function.	clostridium difficile is the main cause of antibiotic-associated diarrhea, leading to significant morbidity and mortality and putting considerable economic pressure on healthcare systems. current knowledge of the molecular basis of pathogenesis is limited primarily to the activities and regulation of two major toxins. in contrast, little is known of mechanisms used in colonization of the enteric system. c. difficile expresses a proteinaceous array on its cell surface known as the s-layer, consis ...	2011	21533071
effect of lactobacillus acidophilus & epidermal growth factor on experimentally induced clostridium difficile infection.	background & objectives : clostridium difficile-associated disease (cdad) remains an important nosocomial ailment. antimicrobial therapy used for cdad gives inconsistent results. this experimental study was planned to investigate the beneficial effects of lactobacillus acidophilus and epidermal growth factor (egf) for cdad management. methods: among 10 groups of balb/c mice (6 in each), group 1 served as controls receiving no inoculum. animals in groups 2-10 received c. difficile, those in group ...	2011	21537099
clostridium difficile infection in non-hiv-immunocompromised patients and in hiv-infected patients.	clostridium difficile infection is a common cause of morbidity in patients with hiv infection and in patients with non-hiv immune deficiency. the frequency of c. difficile-associated diarrhea (cdad) seen in these two patient populations has been attributed to immune deficiency, as well as to increased exposure to hospital environments and antibiotic therapy, both of which are major risk factors for cdad. this article reviews recent data useful in the evaluation, treatment, and prevention of c. d ...	2011	21541693
effectiveness of a novel ozone-based system for the rapid high-level disinfection of health care spaces and surfaces.	background: vapor-based fumigant systems for disinfection of health care surfaces and spaces is an evolving technology. a new system (asepticsure) uses an ozone-based process to create a highly reactive oxidative vapor with broad and high-level antimicrobial properties. methods: ozone gas at 50-500 ppm was combined with 3% hydrogen peroxide vapor in a test chamber and upscaled in rooms measuring 82 m(3) and 90 m(3) in area. test organisms included methicillin-resistant staphylococcus aureus, van ...	2011	21546123
intestinal lactoflora in estonian and norwegian patients with antibiotic associated diarrhea.	the disruption of intestinal microbiota is an important risk factor for the development of clostridium difficile caused antibiotic associated diarrhea (aad). the role of intestinal lactoflora in protection against c. difficile is unclear. fecal samples (n = 74) from aad patients were investigated for c. difficile and lactobacilli by culture and real-time pcr. lactobacilli were identified by enterobacterial repetitive intergenic consensus pcr (eric-pcr) and sequencing of 16s rrna. in c. difficile ...	2011	21549208
a complicated case of tacrolimus-induced rapid remission after cesarean section in the early third trimester for refractory severe ulcerative colitis flaring in the initial period of gestation.	a 36-year-old woman who had been diagnosed with ulcerative colitis at the age of 17 years was referred to our hospital because of severe abdominal pain and repeated bloody diarrhea that persisted during pregnancy despite combination therapy with high-dose corticosteroids and weekly granulocyte and monocyte adsorptive apheresis (gma). she underwent combination therapy consisting of high-dose corticosteroids, intensive gma (two sessions per week) and vancomycin, which was used to eradicate clostri ...	2011	21552436
prevalence and clinical course of clostridium difficile infection in a tertiary-care hospital: a retrospective analysis.	the spectrum of clostridium difficile-associated diarrhea (cdad) is changing. apart from antibiotic use, other risk factors such as use of proton pump inhibitors (ppi) and immunosuppressive agents, intensive care unit (icu) stay and inflammatory bowel disease are being recognized. we retrospectively analyzed data on patients whose stool samples were tested for c. difficile toxin (cdt) by enzyme linked immunosorbent assay between june 2006 and may 2008. demographic and clinical data, and risk fac ...	2011	21553102