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in vitro activity of cb-183,315, vancomycin and metronidazole against 556 strains of clostridium difficile, 445 other intestinal anaerobes and 56 enterobacteriaceae species.mics for cb-183,315, a novel lipopeptide antibiotic, vancomycin and metronidazole were determined for intestinal anaerobes and enterobacteriaceae. the mic(90) for gram-negative anaerobes was >8192, 8192 and 4 μg/ml for cb-183,315, vancomycin and metronidazole, respectively. against enterobacteriaceae, mic(90)s were >8192 μg/ml, 1024 μg/ml and1024 μg/ml, respectively. cb-183,315 mic(90) for c. difficile was 0.5 μg/ml. its lack of activity against normal fecal organisms makes it a promising new ag ...201122183166
fecal microbiota transplantation and emerging applications.fecal microbiota transplantation (fmt) has been utilized sporadically for over 50 years. in the past few years, clostridium difficile infection (cdi) epidemics in the usa and europe have resulted in the increased use of fmt, given its high efficacy in eradicating cdi and associated symptoms. as more patients request treatment and more clinics incorporate fmt into their treatment repertoire, reports of applications outside of cdi are emerging, paving the way for the use of fmt in several idiopath ...201122183182
clostridium difficile infection: clinical spectrum and approach to management.clostridium difficile is recognized globally as an important enteric pathogen associated with considerable morbidity and mortality due to the widespread use of antibiotics. the overall incidence of c. difficile-associated diarrhea (cdad) is increasing due to the emergence of a hypervirulent strain known as nap1/bi/027. c. difficile acquisition by a host can result in a varied spectrum of clinical conditions inclusive of both colonic and extracolonic manifestations. repeated occurrence of cdad, m ...201122183580
comparative effectiveness of clostridium difficile treatments: a systematic review.background: clostridium difficile infection is increasing in incidence and severity. the optimal treatment is unknown. purpose: to determine whether, among adults with c. difficile infection, treatment with certain antibiotics compared with others results in differences in initial cure, recurrence, and harms. data sources: medline, amed, clinicaltrials.gov, and cochrane databases (search dates: inception through august 2011, limited to english-language reports); bibliography review. study se ...201122184691
need for clinicopathologic correlation of clostridium difficile colitis in view of molecular diagnosis. 201222187416
loop-mediated isothermal amplification compared to real-time pcr and enzyme immunoassay for toxigenic c. difficile detection.clostridium difficile (cd) infection is the primary cause of healthcare-associated diarrhea. while most laboratories have been using rapid antigen tests for detecting cd toxins, these have poor sensitivity; newer molecular methods offer rapid results with high test sensitivity and specificity. this study was designed to compare the performance of two molecular assays (meridian illumigene, bd geneohm) with two antigen assays (wampole quik check complete, techlab tox a/b ii) to detect toxigenic cd ...201122189114
inappropriate prescribing of proton pump inhibitors in hospitalized patients.background: proton pump inhibitors have numerous important side effects, yet they are prescribed for outpatients who do not have recognized indications. less is known with respect to prescribing for inpatients. objective: to determine the rate of inappropriate prescribing of protein pump inhibitors and to assess reasons why they are prescribed. design and participants: the study was a retrospective review of administrative data for adult hospital patients discharged from the medicine service of ...201122190465
Group VIA PLA2 (iPLA2ß) is Activated Upstream of p38 MAP Kinase in Pancreatic Islet Beta Cell Signaling.Group VIA Phospholipase A(2) (iPLA(2)ß) in pancreatic islet ß-cells participates in glucose-stimulated insulin secretion and Sarco(endo)plasmic Reticulum ATPase (SERCA) inhibitor-induced apoptosis, and both are attenuated by pharmacologic or genetic reductions in iPLA(2)ß activity and amplified by iPLA(2)ß overexpression. While exploring signaling events that occur downstream of iPLA(2)ß activation, we found that p38 MAP Kinase (MAPK) is activated by phosphorylation in INS-1 insulinoma cells and ...201122194610
clostridium difficile pouchitis after proctocolectomy with ileal pouch-anal anastomosis. 201122196625
clostridium difficile and routine cleaning - alternative options to the use of stronger chlorine-releasing disinfectants. 201122197673
cefoperazone-treated mice as an experimental platform to assess differential virulence of clostridium difficile strains.the toxin-producing bacterium c. difficile is the leading cause of antibiotic-associated colitis, with an estimated 500,000 cases c. difficile infection (cdi) each year in the u.s with a cost approaching 3 billion dollars. despite the significance of cdi, the pathogenesis of this infection is still being defined. the recent development of tractable murine models of cdi will help define the determinants of c. difficile pathogenesis in vivo. to determine if cefoperazone-treated mice could be utili ...201122198617
adenovirus-based vaccination against clostridium difficile toxin a allows for rapid humoral immunity and complete protection from toxin a lethal challenge in mice.clostridium difficile associated diarrhea (cdad) is a critical public health problem worldwide with over 300,000 cases every year in the united states alone. clearly, a potent vaccine preventing the morbidity and mortality caused by this detrimental pathogen is urgently required. however, vaccine efforts to combat c. difficile infections have been limited both in scope as well as to efficacy, as such there is not a vaccine approved for use against c. difficile to date. in this study, we have use ...201122200503
Microbiology of regressive autism.This manuscript summarizes some of our earlier work on the microbiology of autism subjects' stool specimens, as compared with stools from control subjects. Our most recent data indicating that Desulfovibrio may play an important role in regressive autism is also presented. In addition, we present information on antimicrobial susceptibility patterns of Desulfovibrio using the CLSI agar dilution susceptibility technique. In addition, we summarize data from our earlier studies showing the impact of ...201122202440
a novel agent effective against infection with clostridium difficile.n(2)-(3,4-dichlorobenzyl)-7-(2-[1-morpholinyl]ethyl)guanine (more-dcbg, 362e) is a synthetic purine that selectively inhibits the replication-specific dna polymerase of clostridium difficile (cd). more-dcbg and analogs strongly inhibited the growth of a wide variety of cd strains. when administered orally in a hamster model of cd-specific colitis, 362e was as effective as oral vancomycin, the current agent of choice for treating severe forms of the human disease.201122203600
molecular and microbiological characterization of clostridium difficile isolates from single, relapse, and re-infection cases.in this study, we investigated the correlation between the microbiological characteristics of clostridium difficile clinical isolates and the recurrence of c. difficile-associated disease (cdad). twenty c. difficile isolates recovered from 20 single infection cases and 53 isolates from 20 recurrent cases were analyzed by pulsed-field gel electrophoresis (pfge) and pcr ribotyping, and cytotoxicity, antimicrobial susceptibility and sporulation/germination rates of the isolates were examined. recur ...201122205786
Verification of Performance Specifications for a US Food and Drug Administration-Approved Molecular Microbiology Test: Clostridium difficile Cytotoxin B Using the Becton, Dickinson and Company GeneOhm Cdiff Assay.Context.-US Food and Drug Administration (FDA)-approved diagnostic tests based on molecular genetic technologies are becoming available for an increasing number of microbial pathogens. Advances in technology and lower costs have moved molecular diagnostic tests formerly performed for research purposes only into much wider use in clinical microbiology laboratories. Objective.-To provide an example of laboratory studies performed to verify the performance of an FDA-approved assay for the detecti ...201222208483
Changing incidence and clinical manifestations of Clostridium difficile-associated diarrhea detected by combination of glutamate dehydrogenase and toxin assay in Northern Taiwan.BACKGROUND/PURPOSE: The incidence of Clostridium difficile-associated diarrhea (CDAD) is increasing worldwide. Spread of an epidemic hypervirulent strain in southern Taiwan was associated with poor outcome. This prospective study evaluates the incidence and clinical manifestation of CDAD following a hospital-wide hand hygiene promotion program in a 2,200-bed teaching hospital in northern Taiwan. PATIENTS AND METHODS: From June 1, 2010 to October 31, 2010, a predefined protocol was used to active ...201122209696
Hospital-acquired Clostridium difficile infection: determinants for severe disease.Risk factors of severity (need for surgical intervention, intensive care or fatal outcome) were analysed in hospital-acquired Clostridium difficile infection (CDI) in a 777-bed community hospital. In a prospective analytical cross-sectional study, age (=65 years), sex, CDI characteristics, underlying diseases, severity of comorbidity and PCR ribotypes were tested for associations with severe CDI. In total, 133 cases of hospital-acquired CDI (mean age 74.4 years) were identified, resulting in an ...201122210266
editorial: not so nosocomial anymore: the growing threat of community-acquired clostridium difficile.clostridium difficile infection is widely accepted to be the leading cause of nosocomial infection-related morbidity and mortality, outpacing both antibiotic-resistant staphylococcus and enterococcus. the existence and prevalence of community-acquired clostridium difficile infection, on the other hand, is much less well appreciated. growing evidence now suggests that community-acquired clostridium difficile infection may account for more than a third of clostridium difficile-associated diarrhea ...201222218031
risk factors associated with clostridium difficile infection in adult oncology patients with a history of recent hospitalization for febrile neutropenia. 201222221036
clostridium difficile infection is associated with poor outcomes in end-stage renal disease.to investigate the association of clostridium difficile infection (cdi) with the outcomes of hospitalized patients with end-stage renal disease (esrd).201222222233
systems analysis of the transcriptional response of human ileocecal epithelial cells to clostridium difficile toxins and effects on cell cycle control.abstract:201222225989
characterization of shiga toxin producing (stec) and enteropathogenic escherichia coli (epec) in raw yak (poephagus grunniens) milk and milk products.thirty-one shiga toxin-producing (stec) and 6 enteropathogenic escherichia coli (epec) were isolated from 87 raw yak milk and 63 'churpi' samples. of 18 stx(1) positive isolates (48.6%), 14 carried stx(1c) (77.7%). subtyping of 28 stx(2) positive isolates (75.7%) revealed the presence of stx(2c) (9, 32.1%), stx(2d) (3, 10.7%), stx(2e) (1, 3.57%) and stx(2f) (3, 10.7%) variants. furthermore, intimin (eaea), enterohaemolysin (ehxa), autoagglutinating adhesin (saa), iha (adherence conferring protei ...201222226073
gef-h1-rhoa signaling pathway mediates lps-induced nf-κb transactivation and il-8 synthesis in endothelial cells.secretion of proinflammatory cytokines by lps activated endothelial cells contributes substantially to the pathogenesis of sepsis. however, the mechanism involved in this process is not well understood. in the present study, we determined the roles of gef-h1 (guanine-nucleotide exchange factor-h1)-rhoa signaling in lps-induced interleukin-8 (il-8, cxcl8) production in endothelial cells. first, we observed that gef-h1 expression was upregulated in a dose- and time-dependent manner as consistent w ...201222226472
gef-h1/rhoa signalling pathway mediates lipopolysaccharide-induced intercellular adhesion molecular-1 expression in endothelial cells via activation of p38 and nf-κb.the purpose of study is to investigate the effects of gef-h1/rhoa pathway in regulating intercellular adhesion molecule-1 (icam-1) expression in lipopolysaccharide (lps)-activated endothelial cells. exposure of human umbilical vein endothelial cells (huvecs) to lps induced gef-h1 and icam-1 expression in dose- and time-dependent up-regulating manners. pretreatment with clostridium difficile toxin b-10463 (tcdb-10463), an inhibitor of rho activity, reduced lps-related phosphorylation of p65 at se ...201222226621
risk of secondary cases of clostridium difficile infection among household contacts of index cases.we aimed to estimate the risk of secondary cases of clostridium difficile infection (cdi) among household contacts of index cases.201222227466
high proportion of false-positive clostridium difficile enzyme immunoassays for toxin a and b in pediatric patients.objectives. to determine the frequency of false-positive clostridium difficile toxin enzyme immunoassay (eia) results in hospitalized children and to examine potential reasons for this false positivity. design. nested case-control. setting. two tertiary care pediatric hospitals. methods. as part of a natural history study, prospectively collected eia-positive stools were cultured for toxigenic c. difficile, and characteristics of children with false-positive and true-positive eia results were ...201222227987
outcomes in community-acquired clostridium difficile infection.community-acquired clostridium difficile infection (ca-cdi) is an increasingly appreciated condition. it is being described in populations lacking traditional predisposing factors that have been previously considered at low-risk for this infection. as most studies of cdi are hospital-based, outcomes in these patients are not well known.201222229532
enveloped virus but not bacteria block il-13 responses in human cord blood t cells in vitro.infections that occur early in life may have a beneficial effect on the immune system and thereby reduce the risk of allergen sensitization and/or allergic disease. it is not yet clear to what extent specific virus and/or bacteria can mediate this effect. the purpose of this study was to assess the role of virus and bacteria in cd4(+) t cell-derived cytokine production in newborns. we compared the effects of five bacteria (staphlococcus aureus, escherichia coli, clostridium difficile, lactobacil ...201222229804
high occurrence of various clostridium difficile pcr ribotypes in pigs arriving at the slaughterhouse.background: clostridium difficile is recognized as an important cause of nosocomial diarrhoea in humans, especially in association with the administration of antibiotics. furthermore, c. difficile can not only cause neonatal enteritis in pigs but can also be found in pigs without any clinical disease symptoms. clostridium difficile had been found on pork samples destined for human consumption. however, little is known about the risk of food-borne transmission. objective: to elaborate the risk ...201222235856
clostridium difficile toxins: mediators of inflammation.clostridium difficile is a significant problem in hospital settings as the most common cause of nosocomial diarrhea worldwide. c. difficile infections (cdis) are characterized by an acute intestinal inflammatory response with neutrophil infiltration. these symptoms are primarily caused by the glucosylating toxins, tcda and tcdb. in the past decade, the frequency and severity of cdis have increased markedly due to the emergence of so-called hypervirulent strains that overproduce cytotoxic glucosy ...201222237401
effects of prebiotic-containing infant formula on gastrointestinal tolerance and fecal microbiota in a randomized controlled trial.prebiotic-containing infant formula may beneficially affect gastrointestinal tolerance and commensal microbiota composition.201222237884
clinical and laboratory characteristics of clostridium difficile infection in patients with discordant diagnostic test results.the aim of this study was to compare the clinical and laboratory characteristics of clostridium difficile infection (cdi) in patients with discordant test results for the cytotoxin assay (cyt) and pcr assays. a retrospective study from may to august 2008 and march to may 2010 was performed. cdi was diagnosed in 128 patients. pcr increased the yield of c. difficile cases by 2-fold compared to that of the cyt assay. fifty-six cases (44%) were detected by pcr only (cyt negative). forty-nine percent ...201222238444
toxic megacolon from hypervirulent clostridium difficile infection (ribotype 027) following elective total knee replacement: an emerging challenge in modern health care.we present a rare case of community acquired (presenting in hospital on the day of admission or within 48 h of admission) clostridium difficile infection (cdi) with the hypervirulent (ribotype 027) strain causing toxic megacolon in a patient, diagnosed on the third postoperative day following an elective total knee replacement. the patient did not have any of the commonly reported risk factors for cdi. the source of sepsis was initially presumed to be the operated prosthetic joint, and this caus ...201022242068
one-day point prevalence of emerging bacterial pathogens in four secondary and five tertiary care german hospitals - results from a pilot study of the german society for hospital hygiene (deutsche gesellschaft für krankenhaushygiene, dgkh).objective: data on the prevalence of emerging bacterial pathogens like extended-spectrum-lactamase-building (esbl) gram negative organisms, multiresistant pseudomonas and acinetobacter species or toxin-building clostridium difficile in german hospitals are sparse. to provide data for different regions in germany, a one-day point prevalence study with five tertiary care hospitals and four secondary care hospitals was conducted on the 10(th) of february 2010.method: for participating hospitals, th ...201122242101
inulin and fructo-oligosaccharides have divergent effects on colitis and commensal microbiota in hla-b27 transgenic rats.modulation of intestinal microbiota by non-digestible carbohydrates may reduce inflammation in inflammatory bowel disease (ibd). the aim of the present study was to assess the effects of inulin and fructo-oligosaccharides (fos) on intestinal microbiota and colitis in hla-b27 transgenic rats, a well-validated rodent model for ibd. in this study, 4-week-old rats were fed 8 g/kg body weight inulin or fos for 12 weeks, or not. faeces were collected at 4 and 16 weeks of age; and caecal samples were c ...201222243836
longitudinal study comparing the dynamics of clostridium difficile in conventional and antimicrobial free pigs at farm and slaughter.clostridium difficile is the leading cause of nosocomial diarrhea in humans and a major cause of enteritis in neonatal piglets, foals and calves. the aim of this longitudinal study was to determine and compare the prevalence, antimicrobial susceptibility, and toxinotype profiles of c. difficile isolated from pigs and their environment in the indoor conventional and outdoor antimicrobial free (abf) production systems. ten conventional and eight abf cohorts of 35 pigs each and their environment we ...201122243897
[a study of patients with clostridium difficile infection hospitalized at brno clinic of infectious diseases in 2007-2010.]background: to describe a set of patients hospitalized at the clinic of infectious diseases of the university hospital brno with clostridium difficile infection (cdi), to interpret clinical and epidemiological data, and to determine the risk factors for the disease and its complications. material and methods: a retrospective study of 284 patients with confirmed diagnosis of clostridium difficile infection hospitalized between 1 january 2007 and 31 december 2010. epidemiological, clinical and lab ...201122247031
[first experiences with faecal bacteriotherapy in the treatment of relapsing pseudomembranous colitis due to clostridium difficile].the aim was to prove the effectiveness and safety of faecal bacteriotherapy in the treatment of relapsing pseudomembranous colitis due to clostridium difficile in clinical practice.201122247032
synbiotics and probiotics in the critically ill after the propatria trial.recent clinical trials have furthered our understanding of the role of probiotic and synbiotic therapy across a variety of diverse diseases including antibiotic-associated diarrhea, clostridium difficile associated diarrhea, acute pancreatitis, ventilator-associated pneumonia, and sepsis among others. although each of these conditions has implications for critically ill patients, relatively few studies have specifically studied this vulnerable population.201222248590
epidemiology of clostridium difficile-associated disease in internal medicine wards in northern italy.clostridium difficile-associated disease (cdad) is a growing health care problem. elderly patients with multiple comorbidities and repeated hospitalization are at high risk for developing the disease. few data are available on epidemiology of cdad in italy and no studies have focused on cdad burden in internal medicine wards. we retrospectively analysed all cdad cases in four internal medicine wards of a city hospital in northern italy and reviewed the medical records of patients who developed c ...201222249916
prospective observational study comparing three different treatment regimes in patients with clostridium difficile infection.in a hospital-based, prospective cohort study, the effects of the three standard treatment regimens for mild clostridium difficile infection (cdi), oral (p.o.) metronidazole at 500 mg three times/day, intravenous (i.v.) metronidazole at 500 mg three times/day, and oral (p.o.) vancomycin at 250 mg four times/day, were compared with respect to the risk of occurrence of complications, sequelae, and all-cause death within 30 days after the date of starting treatment. differences in the incidence of ...201222252830
identification of the cellular receptor of clostridium spiroforme toxin.clostridium spiroforme produces the binary actin-adp-ribosylating toxin cst (c. spiroforme toxin), which has been proposed to be responsible for diarrhea, enterocolitis and, eventually, death especially in rabbits. here, we report on the recombinant production of the enzyme component (csta) and the binding component (cstb) of c. spiroforme toxin in bacillus megaterium. by using the recombinant toxin components we show that cst enters target cells via the lipolysis-stimulated lipoprotein receptor ...201222252869
high prevalence of clostridium difficile colonization among nursing home residents in hesse, germany.clostridium difficile is the most common cause of antibiotic-associated diarrhoea in hospitals and other healthcare facilities. the elderly are particularly susceptible and at increased risk for adverse outcome as a result of c. difficile infection. the aim of this study was to determine the prevalence of c. difficile colonization among residents of nursing homes in hesse and to compare it with the prevalence in the general population living outside long-term care facilities (ltcf). we assessed ...201222253917
clostridium difficile infection and colonization. 201222256813
health care and socioeconomic impact of falls in the elderly.background: elderly falls are associated with long hospital stays, major morbidity, and mortality. we sought to examine the fate of patients ≥75 years of age admitted after falls. methods: we reviewed all fall admissions in 2008. causes, comorbidities, injuries, procedures, mortality, readmission, and costs were analyzed. results: seven hundred eight patients ≥75 years old were admitted after a fall, with 89% being simple falls. short-term mortality was 6%. male sex, atrial fibrillation, acute m ...201222257741
rhabdomyolysis: rare complications with a difficult prognosis in the course of anticancer treatment.rhabdomyolysis refers to a number of clinical and biochemical symptoms, which result from the destruction of skeletal muscles. the following triad of symptoms is considered typical: myalgia, muscle weakness, and dark urine. the most common reasons for rhabdomyolysis in children are infections. it has also been reported that rhabdomyolysis may be caused by chemotherapy drugs. the most difficult complication of rhabdomyolysis is renal failure. the authors present a 17-year-old boy diagnosed with e ...201222258346
genomic analysis uncovers a phenotypically diverse but genetically homogeneous escherichia coli st131 clone circulating in unrelated urinary tract infections.to determine variation at the genome level in escherichia coli st131 clinical isolates previously shown to be phenotypically diverse.201222258927
clostridium difficile testing algorithms using glutamate dehydrogenase antigen and c. difficile toxin enzyme immunoassays with c. difficile nucleic acid amplification testing increase diagnostic yield in a tertiary pediatric population.we evaluated the performance of the rapid c. diff quik chek complete's glutamate dehydrogenase antigen (gdh) and toxin a/b (cdt) tests in two algorithmic approaches for a tertiary pediatric population: algorithm 1 entailed initial testing with gdh/cdt followed by loop-mediated isothermal amplification (lamp), and algorithm 2 entailed gdh/cdt followed by cytotoxicity neutralization assay (ccna) for adjudication of discrepant gdh-positive/cdt-negative results. a true positive (tp) was defined as p ...201222259201
clostridium difficile infection in older adults: a review and update on its management.background: clostridium difficile is a main cause of health care-associated infections. the incidence and severity have been increasing. elderly persons are at an increased risk of morbidity and mortality from c. difficile infection (cdi). relatively few advances have been made in the treatment of cdi since it was first identified as a cause of antibiotic-associated diarrhea more than 30 years ago. objective: this article reviews cdi and provides an update on its treatment, including recently pu ...201222260856
outbreak of abdominal distension and obstipation in a c57bl/6j experimental autoimmune encephalomyelitis study.seventy-four 9-week old female c57bl/6j mice housed in a conventional facility were manipulated to induce experimental autoimmune encephalomyelitis, among which 26 developed clinical signs including lethargy, absence of defecation, and abdominal distension. by gross necropsy examination, there was distension of the cecum and colon with fecal impaction. by histologic examination, there was severe ulcerative and proliferative typhlocolitis. fecal elisa confirmed the presence of toxins a and b of c ...201222262350
effects of adenosine a2a receptor activation and alanyl-glutamine in clostridium difficile toxin-induced ileitis in rabbits and cecitis in mice.abstract: background: severe clostridium difficile toxin-induced enteritis is characterized by exuberant intestinal tissue inflammation, epithelial disruption and diarrhea. adenosine, through its action on the adenosine a2a receptor, prevents neutrophillic adhesion and oxidative burst and inhibits inflammatory cytokine production. alanyl-glutamine enhances intestinal mucosal repair and decreases apoptosis of enterocytes. this study investigates the protection from enteritis by combination thera ...201222264229
the patient presenting with acute dysentery - a systematic review.objectives: the etiologies, clinical presentations and diagnosis of acute pathogen-specific dysentery in children and adults in industrialized and developing regions is described to help develop recommendations for therapy. methods: we conducted a systematic review of literature published between january 2000 and june 2011 to determine the frequency of occurrence of pathogen-specific dysentery. results: shigella, salmonella, and campylobacter remain the most frequent bacterial causes of dysenter ...201222266388
behaviour and target site selection of the conjugative transposon tn916 in two different strains of toxigenic clostridium difficile.the insertion sites of the conjugative transposon tn916 in the anaerobic pathogen clostridium difficile were determined using illumina solexa high-throughput dna sequencing of tn916 insertion libraries in two different clinical isolates: 630δe, an erythromycin-sensitive derivative of 630 (ribotype 012) and the ribotype 027 isolate r20291 which was responsible for a severe outbreak of c. difficile disease. a consensus fifteen base pair tn916 insertion sequence was identified which was similar in ...201222267673
structural determinants of the clostridium difficile toxin a glucosyltransferase activity.the principle virulence factors in clostridium difficile pathogenesis are tcda and tcdb, homologous glucosyltransferases capable of inactivating small gtpases within the host cell. we present crystal structures of the tcda glucosyltransferase domain (gtd) in the presence and absence of the co-substrate udp-glucose. while the enzymatic core is similar to that of tcdb, the proposed gtpase-binding surface differs significantly. we show that tcda is comparable to tcdb in its modification of rho-fa ...201222267739
hospital-acquired infections.health-acquired infection (hai) is defined as a localized or systemic condition resulting from an adverse reaction to the presence of infectious agents or its toxins. this article focuses on hais that are well studied, common, and costly (direct, indirect, and intangible). the hais reviewed are catheter-related bloodstream infection, ventilator-associated pneumonia, surgical site infection, and catheter-associated urinary tract infection. this article excludes discussion of clostridium difficile ...201222269261
fecal transplant via retention enema for refractory or recurrent clostridium difficile infection. 201222271132
loop-mediated amplification accelerated by stem primers.isothermal nucleic acid amplifications (inaats) have become an important alternative to pcr for in vitro molecular diagnostics in all fields. amongst inaats loop-mediated amplification (lamp) has gained much attention over the last decade because of the simplicity of hardware requirements. lamp demonstrates performance equivalent to that of pcr, but its application has been limited by the challenging primer design. the design of six primers in lamp requires a selection of eight priming sites wit ...201122272122
detection of toxigenic clostridium difficile: comparison of the cell culture neutralization, xpert c. difficile, xpert c. difficile/epi, and illumigene c. difficile assays.clostridium difficile is the most important cause of nosocomial diarrhea. several laboratory techniques are available to detect c. difficile toxins or the genes that encode them in fecal samples. we evaluated the xpert c. difficile and xpert c. difficile/epi (cepheid, ca) that detect the toxin b gene (tcdb) and tcdb, cdt, and a deletion in tcdc associated with the 027/nap1/bi strain, respectively, by real-time pcr, and the illumigene c. difficile (meridian bioscience, inc.) that detects the toxi ...201222278839
co-amoxiclav induces proliferation and cytotoxin production of clostridium difficile ribotype 027 in a human gut model.co-amoxiclav is widely prescribed in hospitals. although reports have suggested it may be linked to onset of clostridium difficile infection (cdi), data on the risk of cdi associated with specific antibiotics is difficult to obtain, due to confounding clinical factors. we have examined the propensity of co-amoxiclav to induce cdi using a human gut model.201222279183
lactoferrin for the prevention of post-antibiotic diarrhoea.antibiotic-associated diarrhoea (aad) is a common cause of morbidity and mortality. older individuals in long-term care facilities are particularly vulnerable due to multisystem illnesses and the prevailing conditions for nosocomial infections. lactoferrin, an antimicrobial protein in human breastmilk, was tested to determine whether it would prevent or reduce aad, including clostridium difficile in tube-fed long-term care patients. thirty patients were enrolled in a randomized double-blind stud ...201122283027
non-steroidal anti-inflammatory drugs and the risk of clostridium difficile-associated disease.several case reports have linked diclofenac, a non-steroidal anti-inflammatory drug (nsaid), with clostridium difficile associated disease (cdad). we assessed whether nsaid use in general, and diclofenac use in particular, is associated with an increased risk of cdad.201222283873
clostridium difficile infection prevention: biotherapeutics, immunologics, and vaccines.we are in the midst of a resurgence of clostridium difficile infection (cdi) in north america and europe for which morbidity and mortality are higher than ever seen. c. difficile has risen in frequency to become the most common healthcare-associated infection pathogen, exceeding methicillin-resistant staphylococcus aureus in many hospitals. protection against cdi is thought to be mediated first by the normal bacterial microbiota, supplemented by an adaptive immune antibody response directed prim ...201222284786
[adverse effects of proton pump inhibitors: should we worry about long-term exposure?].long-term treatment with proton pump inhibitors (ppi) is becoming more prevalent. although they are well tolerated in the short term, serious concerns about long-term use have arisen. recent data suggest that the latter is associated with an increased risk for osteoporotic fracture (especially vertebral), clostridium difficile infection and rebound acid hypersecretion after treatment discontinuation. acute interstitial nephritis is rare but may progress to chronic renal failure. an increased ris ...201222284952
fidaxomicin: the newest addition to the armamentarium against clostridium difficile infections.fidaxomicin, a macrolide antibiotic, was the first medication for the management of clostridium difficile infections (cdi) to be approved by the us food and drug administration in more than 20 years.201222284993
assessing colectomies due to clostridium difficile infection: increases in the community, but not in the referral center.to investigate an increase in cdi-related colectomies, electronically available data were used to identify patients who underwent colectomy and were diagnosed with clostridium difficile infection (cdi), with chart review to determine whether the colectomy was for cdi. the investigation found an increase in cdi-related colectomies for cdi not associated with the study institution. electronically available data facilitated surveillance for severe cdi.201222285711
gastric acid suppression and clostridium difficile infection: is there a causal connection? 201222289872
standardized frozen preparation for transplantation of fecal microbiota for recurrent clostridium difficile infection.while fecal microbiota transplantation (fmt) is historically known to be an effective means to treat recurrent clostridium difficile infection (cdi) refractory to standard antibiotic therapies, the procedure is rarely performed. at least some of the reasons for limited availability are those of practicality, including aesthetic concerns and costs of donor screening. the objective of this study was to overcome these barriers in our clinical fmt program.201222290405
comparative in vitro activities of lff571 against clostridium difficile and 630 other intestinal strains of aerobic and anaerobic bacteria.the in vitro activities of lff571, a novel analog of ge2270a that inhibits bacterial growth by binding with high affinity for protein synthesis elongation factor tu, fidaxomicin, and 10 other antimicrobial agents were determined against 50 strains of clostridium difficile and 630 other anaerobic and aerobic organisms of intestinal origin. lff571 possesses potent activity against c. difficile and most other gram-positive anaerobes (mic(90), ≤ 0.25 μg/ml), with the exception of bifidobacteria and ...201222290948
mathematical model of the impact of a nonantibiotic treatment for clostridium difficile on the endemic prevalence of vancomycin-resistant enterococci in a hospital setting.clostridium difficile-associated disease (cdad) is treated using antibiotics, which often leads to the emergence of antibiotic-resistant bacteria such as vancomycin-resistant enterococci (vre). this study estimated the impact of a non antibiotic treatment for cdad on vre prevalence.201222291852
prediction tools for unfavourable outcomes in clostridium difficile infection: a systematic review.identifying patients at risk for adverse outcomes of clostridium difficile infection (cdi), including recurrence and death, will become increasingly important as novel therapies emerge, which are more effective than traditional approaches but very expensive. clinical prediction rules (cprs) can improve the accuracy of medical decision-making. several cprs have been developed for cdi, but none has gained a widespread acceptance.201222291926
clostridium difficile: the anaerobe that made the grade.unlike other anaerobic bacteria of clinical importance, clostridium difficile has managed to enter into the realm of public awareness. following the trail blazed by methicillin-resistant staphylococcus aureus (mrsa), c. difficile has made the transition from being an obscure anaerobic bacterium, mainly of interest to specialist anaerobic microbiologists, to that of an infamous "superbug" responsible for outbreaks of hospital-acquired infection that commonly result in serious disease and death. t ...201222293217
cells transformed by plc-gamma 1 overexpression are highly sensitive to clostridium difficile toxin a-induced apoptosis and mitotic inhibition.phospholipase c-γl (plc-γl) expression is associated with cellular transformation. notably, plc-gamma is up-regulated in colorectal cancer tissue and breast carcinoma. because exotoxins released by clostridium botulinum have been shown to induce apoptosis and promote growth arrest in various cancer cell lines, we examined here the potential of clostridium difficile toxin a to selectively induce apoptosis in cells transformed by plc-γl overexpression. we found that plc-γl-transformed cells, but n ...201222297219
proton pump inhibitor use and recurrent clostridium difficile-associated disease: a case-control analysis matched by propensity score.clostridium difficile has been increasingly diagnosed in hospitalized patients. an association between proton pump inhibitors (ppis) use and clostridium difficile-associated disease (cdad) and between recurrent cdad has been suggested. the aim of this study is to investigate whether ppi use is associated with the development of recurrent cdad.201322298089
[segmental necrotizing colitis in a patient with e. coli o104:h4 infection].a 29-year-old man presented with abdominal cramps and bloody diarrhoea. blood tests revealed elevated c-reactive protein (21.3 mg/dl; normal range 0.01 - 0. 82 mg/dl) and white blood cells (28200/μl, normal range 4000 - 10000/μl). stool tests were negative for enteropathogenic bacteria and clostridium difficile toxins a/b. ultrasound and computed tomography showed massive swelling of the transverse colon and right colonic flexure. at endoscopy, circular necrosis of the mucosa was encountered in ...201222298100
michigan clostridium difficile hospital discharges: frequency, mortality, and charges, 2002-2008.clostridium difficile (c. difficile) causes an intestinal bacterial infection of increasing importance in michigan residents and health-care facilities. the specific burden and health-care costs of c. difficile infection (cdi) were previously unknown. we evaluated the frequency, mortality, and health-care charges of cdi from michigan hospital discharge data.201722298923
strategies for management of clostridium difficile infection in immunosuppressed patients. 201122298971
frequency of outbreak investigations in us hospitals: results of a national survey of infection preventionists.a survey of infection preventionists was conducted to determine the frequency of outbreak investigations in us hospitals.201222300590
glutamate dehydrogenase is highly conserved among clostridium difficile ribotypes.glud was highly conserved and glutamate dehydrogenase (gdh) was readily expressed in vitro by all 77 clostridium difficile ribotypes assayed. all ribotypes, including arl 002, arl 027, and arl 106, were reactive in assays that detect c. difficile gdh.201222301027
guanine-nucleotide exchange factor h1 mediates lipopolysaccharide-induced interleukin 6 and tumor necrosis factor α expression in endothelial cells via activation of nuclear factor κb.the development of sepsis is multifactorial. tissue damage and organ dysfunction may be caused not only by the microorganisms but also by the inflammatory mediators released in response to the infection. interleukin 6 (il-6) and tumor necrosis factor α (tnf-α) levels in serum are well known to be upregulated in humans with sepsis and can be used to predict outcome. using human umbilical vein endothelial cells, we analyzed the role of guanine-nucleotide exchange factor h1 (gef-h1) on lipopolysacc ...201222301607
multidrug-resistant north american pulsotype 2 clostridium difficile was the predominant toxigenic hospital-acquired strain in the province of manitoba, canada, in 2006-2007.the objective of the current study was to determine whether the antimicrobial susceptibility profile or genotype of hospital-acquired isolates of clostridium difficile differed from isolates causing community-acquired disease. five hundred diarrhoeal stool samples (one >2 ml sample per patient) from patients across manitoba, canada, in 2006-2007 that were reported as c. difficile toxin positive were cultured, resulting in 432 isolates of toxin-positive c. difficile for analysis. of these 432 iso ...201222301615
war on the spore: clostridium difficile disease among patients in a long-term acute care hospital.the transmission of clostridium difficile infection (cdi) is evident in healthcare facilities across the country and poses a risk for patients and communities. a comprehensive infection control program along with an active surveillance process was developed and implemented in a 50-bed long-term acute care hospital (ltach) in the southeastern united states. patients are admitted from surrounding hospitals, have an expected stay of at least 25 days, and are acutely ill. the majority of the patient ...201322304334
determining mortality rates attributable to clostridium difficile infection.to determine accuracy of measures of deaths attributable to clostridium difficile infection, we compared 3 measures for 2007-2008 in ontario, canada: death certificate; death within 30 days of infection; and panel review. data on death within 30 days were more feasible than panel review and more accurate than death certificate data.201222305427
mycotic abdominal aortic aneurysm caused by toxigenic clostridium difficile.extra-intestinal infections caused by clostridium difficile are uncommon. we report a case of a mycotic abdominal aortic aneurysm in an 86-year old male. tissue and pus swabs from the aneurysmal sac grew a pure growth of c. difficile. the identity of the isolate was determined by phenotypic methods and confirmed by dna sequencing. he was treated successfully with an aorta-bifemoral bypass and a 4-week course of intravenous and oral antibiotics.201222306098
phase i dose finding studies of an adjuvanted clostridium difficile toxoid vaccine.fifty healthy adult (18-55 years) and 48 elderly (≥ 65 years) volunteers were randomized to receive a candidate clostridium difficile toxoid vaccine (2 μg, 10 μg, or 50 μg) or placebo on days 0, 28, and 56. no volunteer receiving placebo seroconverted. for toxin a, seroconversion by day 56 (post-dose 2) was observed in 100% of volunteers aged 18-55 years in all dose groups and in 50%, 89%, and 100% of elderly participants in the 2 μg, 10 μg, and 50 μg dose groups, respectively. for both age grou ...201222306375
efficacy, efficiency and safety aspects of hydrogen peroxide vapour and aerosolized hydrogen peroxide room disinfection systems.this was a head-to-head comparison of two hydrogen-peroxide-based room decontamination systems.201222306442
assessment of administrative data for evaluating the shifting acquisition of clostridium difficile infection in england.little is known about the acquisition of clostridium difficile infection (cdi) and whether it represents hospital- or community-acquired infection.201222306443
a meta-analysis and systematic review on the effect of probiotics in acute diarrhea.diarrhea the second leading cause of death in childhood is caused by a variety of organisms. rehydration reduces the risk of death but it is not effective in shortening duration of disease. recently, probiotics have been recommended for prevention or treatment of gastrointestinal disorders including diarrhea. considering existing documents from different aspects, it seems that results are somehow controversial or non-conclusive. thus, we aimed to meta-analyze clinical trials to show actual benef ...201222309079
implementing automated surveillance for tracking clostridium difficile infection at multiple healthcare facilities.automated surveillance using electronically available data has been found to be accurate and save time. an automated clostridium difficile infection (cdi) surveillance algorithm was validated at 4 centers for disease control and prevention epicenter hospitals. electronic surveillance was highly sensitive, specific, and showed good to excellent agreement for hospital-onset; community-onset, study facility-associated; indeterminate; and recurrent cdi.201222314071
clostridium difficile o27 colitis: hospital-onset but community-acquired.large outbreaks of clostridium difficile (cd) associated colitis in north america and europe have been attributed to the emergence of the epidemic/toxin pcr ribotype o27 cd strain (cd027). due to the increased virulence of this epidemic strain and its propension for causing outbreaks, we performed a structured risk-assessment approach in order to determine the risks associated with the introduction of this strain within our university hospital. from february 2009 to january 2010, we identified 3 ...201222314411
discovery of lff571: an investigational agent for clostridium difficile infection.clostridium difficile (c. difficile) is a gram positive, anaerobic bacterium that infects the lumen of the large intestine and produces toxins. this results in a range of syndromes from mild diarrhea to severe toxic megacolon and death. alarmingly, the prevalence and severity of c. difficile infection are increasing; thus, associated morbidity and mortality rates are rising. 4-aminothiazolyl analogues of the antibiotic natural product ge2270 a (1) were designed, synthesized, and optimized for th ...201222315981
fidaxomicin for the treatment of clostridium difficile infections.to evaluate the pharmacology, microbiology, safety, and efficacy of fidaxomicin for treatment of clostridium difficile infections (cdi).201222318930
u.k. laboratory diagnosis of clostridium difficile infection: in a state of transition, confusion, or both? 201222321724
fidaxomicin versus vancomycin for infection with clostridium difficile in europe, canada, and the usa: a double-blind, non-inferiority, randomised controlled trial.infection with clostridium difficile is the primary infective cause of antibiotic-associated diarrhoea. we aimed to compare efficacy and safety of fidaxomicin and vancomycin to treat patients with c difficile infection in europe, canada, and the usa.201222321770
intestinal superinfections in patients with inflammatory bowel diseases.intestinal superinfections may occur in the setting of inflammatory bowel diseases (ibd), complicating the clinical picture and triggering flares of disease.201122325169
clinical and laboratory evaluation of a real-time pcr for clostridium difficile toxin a and b genes.many laboratories use enzyme immunoassays (eias) for the diagnosis of clostridium difficile infection (cdi). more recently, polymerase chain reaction (pcr)-based diagnosis has been described as a sensitive test. real-time pcr for the detection of c. difficile toxin a and b genes was evaluated. a prospective evaluation was performed on stool samples from 150 hospitalized adult patients and 141 healthy volunteers. pcr was compared to toxigenic culture (tc), direct cytotoxicity test (ctt), immunoca ...201222327373
considerations for the use of proton-pump inhibitors in older adults.to investigate current concerns regarding the use of proton-pump inhibitors (ppis) in older adults.201222330952
[molecular typing methods on clostridium difficile and their application]. 201122333093
an evaluation of repeat stool testing for clostridium difficile infection by polymerase chain reaction.to evaluate the yield of repeat stool polymerase chain reaction (pcr) testing in patients with suspected clostridium difficile infection (cdi).201222334221
detection of clostridium difficile as a routine diagnosis: comparison of real-time pcr and enzyme immunoassay. 201222338064
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