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association between antibiotic treatment and outcomes in patients hospitalized with acute exacerbation of copd treated with systemic steroids.antibiotics are widely used in acute exacerbations of copd (ae-copd), but their additional benefit to a therapeutic regimen that already includes steroids is uncertain. we evaluated the association between antibiotic therapy and outcomes among a large cohort of patients treated with steroids who were hospitalized with ae-copd and compared the effectiveness of three commonly used antibiotic regimens.201322797691
the use of ceftaroline fosamil in methicillin-resistant staphylococcus aureus endocarditis and deep-seated mrsa infections: a retrospective case series of 10 patients.there are many limitations to the current antibiotics used for the treatment of severe methicillin-resistant staphylococcus aureus (mrsa) infections. ceftaroline is a new fifth-generation cephalosporin approved for the treatment of skin and soft tissue infections caused by mrsa and community-acquired pneumonia. we propose that ceftaroline can also be used successfully in more severe mrsa infections, including endocarditis. we conducted a retrospective chart review in a university-affiliated depa ...201322797874
toxigenic clostridium difficile pcr ribotypes from wastewater treatment plants in southern switzerland.the occurrence of clostridium difficile in nine wastewater treatment plants in the ticino canton (southern switzerland) was investigated. the samples were collected from raw sewage influents and from treated effluents. forty-seven out of 55 characterized c. difficile strains belonged to 13 different reference pcr ribotypes (009, 010, 014, 015, 039, 052, 053, 066, 070, 078, 101, 106, and 117), whereas 8 strains did not match any of those available in our libraries. the most frequently isolated ri ...201222798376
epidemiological features of clostridium difficile infection among inpatients at hamad general hospital in the state of qatar, 2006-2009.the aim of this retrospective study was to evaluate the epidemiology, clinical course and outcome of clostridium difficile infection among inpatients at hamad general hospital in qatar, from 2006 to 2009. during this period, 123 patients were diagnosed with c. difficile infection and the overall incidence was 1.6/10,000 patient days. the mean age (±sd) of patients was 50.9 ± 21.2 years. the most frequent underlying disease was hypertension 51/123 (41.5%) and 133 prescriptions of antimicrobials w ...201222800937
in vitro and in vivo characterization of cb-183,315, a novel lipopeptide antibiotic for treatment of clostridium difficile.cb-183,315 is a novel lipopeptide antibiotic structurally related to daptomycin currently in phase 3 clinical development for clostridium difficile-associated diarrhea (cdad). we report here the in vitro mechanism of action, spontaneous resistance incidence, resistance by serial passage, time-kill kinetics, postantibiotic effect, and efficacy of cb-183,315 in a hamster model of lethal infection. in vitro data showed that cb-183,315 dissipated the membrane potential of staphylococcus aureus witho ...201222802252
a canadian working group report on fecal microbial therapy: microbial ecosystems therapeutics.a working group from across canada comprised of clinician and basic scientists, epidemiologists, ethicists, health canada regulatory authorities and representatives of major funding agencies (canadian institutes of health research and the crohn's and colitis foundation of canada) met to review the current experience with fecal microbial therapy and to identify the key areas of study required to move this field forward. the report highlights the promise of fecal microbial therapy and related synt ...201222803022
long-term medical management of gastro-esophageal reflux disease: how long and when to consider surgery?gastro-esophageal reflux disease is a chronic, long standing disease. spontaneous remission of gerd is rare and conservative management including life style modification measures is unlikely to relieve symptoms. majority of patients with reflux disease require long-term acid suppressants. proton pump inhibitors are the choice of drugs in management of these patients. the end point of treatment is not clear. duration of treatment is individual based. the symptoms may be intermittent or on most da ...201222803292
second infections independently increase mortality in hospitalized patients with cirrhosis: the north american consortium for the study of end-stage liver disease (nacseld) experience.bacterial infections are an important cause of mortality in cirrhosis, but there is a paucity of multicenter studies. the aim was to define factors predisposing to infection-related mortality in hospitalized patients with cirrhosis. a prospective, cohort study of patients with cirrhosis with infections was performed at eight north american tertiary-care hepatology centers. data were collected on admission vitals, disease severity (model for endstage liver disease [meld] and sequential organ fail ...201222806618
[antimicrobial susceptibility of clinical isolates of aerobic gram-positive cocci and anaerobic bacteria in 2008].the activity of antibacterial agents against aerobic gram-positive cocci (25 genus or species, 1029 strains) and anaerobic bacteria (21 genus or species, 187 strains) isolated from clinical specimens in 2008 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 59.6% and 81.2%, suggesting that resistant strains were isolated at high frequen ...201222808693
clinical update on nursing home medicine: 2012.this article is the sixth in the series of clinical updates on nursing home care. the topics covered are management of hypertension, antidepressant medications in people with dementia, peripheral arterial disease, probiotics in prevention, and treatment of clostridium difficile-associated diarrhea, frailty, and falls.201222809554
evaluation of the diagnostic algorithm consisting of enzyme immunoassay for toxins and polymerase chain reaction, for the diagnosis of clostridium difficile-associated diarrhoea.a total of 1631 stool specimens were tested for clostridium difficile toxins a and b using an enzyme immunoassay (eia). c. difficile toxin was detected in 191 (11.7%, 191/1631) cases by eia. among the remaining 1440 cases, 102 cases in patients with either antibiotic-associated diarrhoea or hospitalized patients with unexplained leukocytosis (> 15,000/mm³) and fever (≥ 38°c) even though they did not meet the criteria for diarrhoea, were further assessed using a polymerase chain reaction (pcr) fo ...201222813084
clostridium difficile infection in the pediatric surgery population.the incidence of clostridium difficile-associated disease (cdad) in the adult population doubled in the past decade, with increasing morbidity and mortality; however, little research has been performed in the pediatric population. we characterized c difficile infection in the pediatric population, with emphasis on the surgical population.201222813801
a superior test for diagnosis of clostridium difficile-associated diarrhea in resource-limited settings.in this prospective cohort study, we investigated the prevalence of clostridium difficile-associated diarrhea (cdad) in adult patients with nosocomial diarrhea by performing enzyme immunoassay (eia) for detecting toxins a and b and polymerase chain reaction (pcr) for detecting the presence of the tcdb gene in stool samples. we determined the factors associated with cdad, and the treatment outcome of cdad from may 2010 to january 2011. a total of 175 stool samples were tested by eia and pcr. in t ...201222814157
role of fecal clostridium difficile load in discrepancies between toxin tests and pcr: is quantitation the next step in c. difficile testing?direct tests for clostridium difficile are 30-50 % more sensitive than tests for c. difficile toxins but the reasons for this discrepancy are incompletely understood. in addition to toxin degradation and strain differences, we hypothesized that c. difficile concentration could be important in determining whether toxins are detected in fecal samples. we performed standard curves on an fda-approved real-time pcr test for the c. difficile tcdb gene (xpert c. difficile/epi, cepheid) during a prospec ...201222814877
reduction in clostridium difficile infection rates after mandatory hospital public reporting: findings from a longitudinal cohort study in canada.the role of public reporting in improving hospital quality of care is controversial. reporting of hospital-acquired infection rates has been introduced in multiple health care systems, but its relationship to infection rates has been understudied. our objective was to determine whether mandatory public reporting by hospitals is associated with a reduction in hospital rates of clostridium difficile infection.201222815656
soluble plantain fibre blocks adhesion and m-cell translocation of intestinal pathogens.dietary fibres may have prebiotic effects mediated by promotion of beneficial bacteria. this study explores the possibility that soluble plant fibre may also improve health by inhibiting epithelial adhesion and translocation by pathogenic bacteria. we have focussed on soluble non-starch polysaccharide (nsp) from plantain bananas (musa spp.) which previous studies showed to be particularly effective at blocking escherichia coli epithelial adherence. in vitro and ex vivo studies assessed the abili ...201322818716
reactive arthritis: developments and challenges in diagnosis and treatment.reactive arthritis (rea) has traditionally been described as a nonseptic arthritis occurring in the joint following an extra-articular bacterial infection. this concept became clinically associated with antecedent infections of either the gastrointestinal or genitourinary tract. yet this operational definition of rea has led to diagnostic uncertainty in different clinical settings. there are several scenarios in which the rea has been complex. one is in the sapho syndrome, which shares many feat ...201222821199
impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series.evidence that hand hygiene (hh) reduces healthcare-associated infections has been available for almost two centuries. yet hh compliance among healthcare professionals continues to be low, and most efforts to improve it have failed.201222822243
a woman with community-acquired clostridium difficile infection. 201222826000
clostridium difficile outbreaks: prevention and treatment strategies.the incidence and severity of clostridium difficile infection (cdi) have increased dramatically over the past decade. its treatment, however, has largely remained the same with the exception of oral vancomycin use as a first-line agent in severe disease. from 1999 to 2004, 20,642 deaths were attributed to cdi in the united states, almost 7 times the rate of all other intestinal infections combined. worldwide, several major cdi outbreaks have occurred, and many of these were associated with the n ...201222826646
on the atp-dependent activation of the radical enzyme (r)-2-hydroxyisocaproyl-coa dehydratase.members of the 2-hydroxyacyl-coa dehydratase enzyme family catalyze the β,α-dehydration of various coa-esters in the fermentation of amino acids by clostridia. abstraction of the nonacidic β-proton of the 2-hydroxyacyl-coa compounds is achieved by the reductive generation of ketyl radicals on the substrate, which is initiated by the transfer of an electron at low redox potentials. the highly energetic electron needed on the dehydratase is donated by a [4fe-4s] cluster containing atpase, termed a ...201222827463
refractory clostridium difficile infection successfully treated with tigecycline, rifaximin, and vancomycin.the occurrence of clostridium difficile colitis is on the rise and has become more difficult to manage with standard therapy. thus, the need for alternative treatments is essential. tigecycline is a glycylcycline antibiotic that has been shown to be effective against c. difficile through several published case reports and in in vitro studies. we present a case of c. difficile colitis that failed to respond to metronidazole and oral vancomycin therapy, but improved on a combination of rifaximin, ...201222829841
utilizing rapid multiple-locus variable-number tandem-repeat analysis typing to aid control of hospital-acquired clostridium difficile infection: a multicenter study.the early identification of outbreaks is crucial for the control of clostridium difficile infection. this study aimed to determine if the number of hospital-acquired c. difficile infections could be reduced by rapidly typing c. difficile strains using multiple-locus variable-number tandem-repeat analysis (mlva) compared to typing using pcr ribotyping. a total of 16 hospitals were recruited to the study, and all periods of increased incidence (piis) of c. difficile infection were identified. the ...201222837319
epidemic clostridium difficile ribotype 027 in chile. 201222840230
laboratory diagnosis of clostridium difficile associated diarrhoea and molecular characterization of clinical isolates.we evaluated a three-step algorithm for laboratory diagnosis of clostridium difficile-associated diarrhoea (cdad). first, stool specimens were screened using an eia test for glutamate dehydrogenase detection. screen-positive specimens were tested by a rapid cytotoxintoxin a/b assay and subjected to stool culture. all cultures positive for c. difficile underwent toxigenic culture. the results showed that toxigenic culture allowed us to recover 37/156 (24.4%) stool samples harbouring toxigenic c. ...201222842600
[cleaning and disinfection in nursing homes. data on quality of structure, process and outcome in nursing homes in frankfurt am main, germany, 2011].due to the infectious disease prevention act, public health services in germany are obliged to check the infection prevention in hospitals and other medical facilities as well as in nursing homes. in frankfurt/main, germany, standardized control visits have been performed for many years. in 2011 focus was laid on cleaning and disinfection of surfaces. all 41 nursing homes were checked according to a standardized checklist covering quality of structure (i.e. staffing, hygiene concept), quality of ...201222842890
clostridium difficile carriage in healthy infants in the community: a potential reservoir for pathogenic strains.clostridium difficile has long been considered to be a nosocomial pathogen but has emerged in the community in recent years. during infancy, asymptomatic c. difficile colonization is common. however, knowledge of colonization determinants and strain characteristics is limited. we studied the dynamics of c. difficile colonization in healthy infants from the community. determinants of colonization and strain genotypes were also determined in a cohort of infants attending day nurseries.201222843784
clostridium difficile dna polymerase iiic: basis for activity of antibacterial compounds.based on the finding that aerobic gram-positive antibacterials that inhibit dna polymerase iiic (pol iiic) were potent inhibitors of the growth of anaerobic clostridium difficile (cd) strains, we chose to clone and express the gene for pol iiic from this organism. the properties of the recombinant enzyme are similar to those of related pol iiics from gram-positive aerobes, e.g. b. subtilis. inhibitors of the cd enzyme also inhibited b. subtilis pol iiic, and were competitive with respect to the ...201122844265
irinotecan (cpt-11) chemotherapy alters intestinal microbiota in tumour bearing rats.intestinal microbiota mediate toxicity of irinotecan (cpt-11) cancer therapies and cause systemic infection after cpt-11-induced loss of barrier function. the intestinal microbiota and their functions are thus potential targets for treatment to mitigate cpt-11 toxicity. however, microbiota changes during cpt-11 therapy remain poorly described. this study analysed changes in intestinal microbiota induced by cpt-11 chemotherapy. qualitative and quantitative taxonomic analyses, and functional analy ...201222844397
conformational analysis of clostridium difficile toxin b and its implications for substrate recognition.clostridium difficile (c. difficile) is an opportunistic pathogen that can cause potentially lethal hospital-acquired infections. the cellular damage that it causes is the result of two large clostridial cytotoxins: tcda and tcdb which act by glucosylating cytosolic g-proteins, mis-regulation of which induces apoptosis. tcdb is a large flexible protein that appears to undergo significant structural rearrangement upon accommodation of its substrates: udp-glucose and a rho-family gtpase. to charac ...201222844485
colonoscopic versus nasogastric fecal transplantation for the treatment of clostridium difficile infection: a review and pooled analysis.fecal microbiota transplantation (fmt) has been demonstrated to be highly effective for the treatment of recurrent clostridium difficile infection (cdi). however, the best route of administration has not been established. we present a pooled analysis of the reported cases of cdi treated with fmt via colonoscopy or nasogastric tube (ngt) to evaluate treatment efficacy.201222847629
higher rates of clostridium difficile infection among smokers.cigarette smoking has been shown to be related to inflammatory bowel disease. we investigated whether smoking affected the probability of developing clostridium difficile infection (cdi).201222848714
impact of hospital-acquired clostridium difficile.to investigate the impact of hospital-acquired clostridium difficile infection (cdi) on hospital costs and patient length of stay.201222849881
evaluation of an oral suspension of vp20621, spores of nontoxigenic clostridium difficile strain m3, in healthy subjects.vp20621, spores of nontoxigenic clostridium difficile (ntcd) strain m3, is protective against challenge with toxigenic strains in hamsters. human administration and colonization may prevent primary c. difficile infection (cdi) or recurrent cdi. healthy adult subjects 18 to 45 years old or ≥60 years old received single or multiple doses of an oral suspension of vp20621 (10(4), 10(6), or 10(8) spores) or placebo. group 4 (≥60 years old) received oral vancomycin for 5 days, followed by 14 days of v ...201222850511
modulation of toxin production by the flagellar regulon in clostridium difficile.we show in this study that toxin production in clostridium difficile is altered in cells which can no longer form flagellar filaments. the impact of inactivation of flic, cd0240, flif, flig, flim, and flhb-flir flagellar genes upon toxin levels in culture supernatants was assessed using cell-based cytotoxicity assay, proteomics, immunoassay, and immunoblotting approaches. each of these showed that toxin levels in supernatants were significantly increased in a flic mutant compared to that in the ...201222851750
repeat stool testing for clostridium difficile using enzyme immunoassay in patients with inflammatory bowel disease increases diagnostic yield.the incidence and severity of clostridium difficile infection (cdi) in patients with inflammatory bowel disease (ibd) is increasing. cdi is diagnosed by toxin enzyme immunoassay (eia) or real-time polymerase chain reaction (pcr) performed on stool samples. an earlier study evaluating eia in ibd patients with cdi suggested that more than one stool sample be tested to increase diagnostic yield. we investigated whether repeat stool testing improves diagnostic accuracy for cdi in hospitalized ibd pa ...201222852871
pediatric physicians' knowledge, attitudes, and beliefs regarding clostridium difficile-associated disease prevention, testing, and treatment. 201222854381
policy development for clostridium difficile.the advisory committee on antimicrobial resistance and healthcare associated infection (arhai) was created at the height of the incidence of clostridium difficile infection (cdi). this article describes the role of arhai in the evaluation of laboratory testing for cdi, a related consultation on the legal requirements for manufacturers of in vitro diagnostic medical devices, a cdi healthcare bundle and surveillance of cdi in children.201222855874
recommendations for surveillance priorities for healthcare-associated infections and criteria for their conduct.surveillance and feedback of results to clinical teams is central to performance improvement in managing healthcare-acquired infections. a major role of the advisory committee on antimicrobial resistance and healthcare-associated infections (arhai) is to advise on surveillance priorities. a sub-committee was set up to systematically review existing uk surveillance schemes. the following three systems were examined in detail: mandatory reporting of methicillin-resistant staphylococcus aureus (mrs ...201222855875
current challenges in antimicrobial resistance and healthcare-associated infections: role and organization of arhai.the uk government specialist advisory committee on antimicrobial resistance and healthcare-associated infections (arhai) was established in 2007. it has responsibility for providing practical and scientific advice to government on healthcare-associated infections (hcais) and to maintain the effectiveness of antimicrobial agents in the treatment and prevention of infection in man and animals. the manner in which this has been approached by arhai is described. in essence, key themes have been defi ...201222855877
improving the quality of antibiotic prescribing in the nhs by developing a new antimicrobial stewardship programme: start smart--then focus.there has been dramatic change in antibiotic use in english hospitals. data from 2004 and 2009 show that the focus on reducing fluoroquinolone and second- and third-generation cephalosporin use seems to have been heeded in nhs secondary care, and has been associated with a substantial decline in hospital clostridium difficile rates. however, there has been a substantial increase in use of co-amoxiclav, carbapenems and piperacillin/tazobactam. in primary care, antibiotic prescribing fell markedly ...201222855879
use of uv-c radiation to disinfect non-critical patient care items: a laboratory assessment of the nanoclave cabinet.the near-patient environment is often heavily contaminated, yet the decontamination of near-patient surfaces and equipment is often poor. the nanoclave cabinet produces large amounts of ultraviolet-c (uv-c) radiation (53 w/m2) and is designed to rapidly disinfect individual items of clinical equipment. controlled laboratory studies were conducted to assess its ability to eradicate a range of potential pathogens including clostridium difficile spores and adenovirus from different types of surface ...201222856652
probiotics for infectious diseases: more drugs, less dietary supplementation.according to current definitions, probiotics are live microorganisms that, when ingested in adequate quantities, exert a health benefit to the host. the action of probiotics in the host is exerted by three mechanisms: modulation of the content of gut microbiota; maintenance of the integrity of the gut barrier and prevention of bacterial translocation; and modulation of the local immune response by the gut-associated immune system. regarding their role for the prevention and treatment of infectio ...201222858373
knowledge of clostridium difficile infection among uk health-care workers: development of a knowledge assessment tool.doctors' knowledge provides the basis to support good practice in infection prevention and control. however, there exists a paucity of validated knowledge assessment tools that can be reliably employed to identify poor knowledge levels of clostridium difficile infection (cdi) within populations of doctors, preventing the effective identification of knowledge deficiencies and focused targeting of educational interventions. here, we describe a development process to validate a novel cdi knowledge ...201222859801
surveillance of infection severity: a registry study of laboratory diagnosed clostridium difficile.changing clinical impact, as virulent clones replace less virulent ones, is a feature of many pathogenic bacterial species and can be difficult to detect. consequently, innovative techniques monitoring infection severity are of potential clinical value.201222859914
comparative transcriptional analysis of clinically relevant heat stress response in clostridium difficile strain 630.clostridium difficile is considered to be one of the most important causes of health care-associated infections worldwide. in order to understand more fully the adaptive response of the organism to stressful conditions, we examined transcriptional changes resulting from a clinically relevant heat stress (41 °c versus 37 °c) in c. difficile strain 630 and identified 341 differentially expressed genes encompassing multiple cellular functional categories. while the transcriptome was relatively resi ...201222860125
is primary prevention of clostridium difficile infection possible with specific probiotics?the efficacy of probiotics for the prevention of clostridium difficile infection (cdi) is highly controversial, particularly with regard to the prevention of recurrent cdi. we hypothesize that primary prevention of cdi among patients receiving antibiotics might be a more achievable goal for probiotics than prevention in patients with previous cdi where the host flora is markedly altered.201222863358
fidaxomicin: a new option for the treatment of clostridium difficile infection.the two drugs currently recommended for the treatment of clostridium difficile infection (cdi), namely vancomycin and metronidazole, are both associated with high rates of recurrence of infection. hence there is a need for new treatment options. the novel oral macrocyclic antibiotic fidaxomicin (previously known as par-101, opt-80 and difimicin) was recently approved in the usa and in europe for the treatment of cdi. clinical trials have shown non-inferiority with regard to clinical cure when co ...201222865382
in vitro and in vivo activities of the novel ketolide rbx 14255 against clostridium difficile.the mic(90) of rbx 14255, a novel ketolide, against clostridium difficile was 4 μg/ml (mic range, 0.125 to 8 μg/ml), and this drug was found to be more potent than comparator drugs. an in vitro time-kill kinetics study of rbx 14255 showed time-dependent bacterial killing for c. difficile. furthermore, in the hamster model of c. difficile infection, rbx 14255 demonstrated greater efficacy than metronidazole and vancomycin, making it a promising candidate for c. difficile treatment.201222869573
novel management strategies in the treatment of severe clostridium difficile infection.cdi is increasing in incidence and severity. clinicians must have a low threshold to consider the diagnosis and to treat patients with the clinical syndrome and risk factors before laboratory confirmation of the diagnosis. in patients who have signs of advanced disease, escalation of care with antimicrobial strategies and multidisciplinary care including surgical consultation is necessary. furthermore, lowering the threshold for surgery compared with traditional approaches likely results in impr ...201222873036
fidaxomicin (dificid), a novel oral macrocyclic antibacterial agent for the treatment of clostridium difficile-associated diarrhea in adults. 201222876085
impact of toxigenic clostridium difficile colonization and infection among hospitalized adults at a district hospital in southern taiwan.the impact of toxigenic clostridium difficile colonization (tcdc) in hospitalized patients is not clear.201222876321
sensitivity of pathogenic and commensal bacteria from the human colon to essential oils.the microbiota of the intestinal tract plays an important role in colonic health, mediating many effects of dietary components on colonic health and during enteric infections. in the context of the increasing incidence of antibiotic resistance in gut bacteria, complementary therapies are required for the prevention and treatment of enteric infections. here we report the potential application of essential oils (eo) and pure eo compounds to improve human gut health. nerolidol, thymol, eugenol and ...201222878397
toxic megacolon from fulminant clostridium difficile infection induced by topical silver sulphadiazine.pseudomembranous colitis and toxic megacolon (tm) are well-known complications of clostridium difficile infections. systemic antibiotic is considered as the major risk factor for the development of c difficile colitis. however, topical antibiotics are rarely associated with the infection. as previously thought, the use of topical antibiotic is capable of systemic absorption in damaged and denuded skin; sufficient enough to suppress the normal bowel flora. here, we present an unusual case of tm f ...201222878997
engaging patients in the prevention of health care-associated infections: a survey of patients' awareness, knowledge, and perceptions regarding the risks and consequences of infection with methicillin-resistant staphylococcus aureus and clostridium difficile.methicillin-resistant staphylococcus aureus (mrsa) infections and clostridium difficile infections (cdi) are major health care-associated infections (hais). little is known about patients' knowledge of these hais. therefore, we surveyed patients to determine awareness, knowledge, and perceptions of mrsa infections and cdi.201322884494
burden of gastrointestinal disease in the united states: 2012 update.gastrointestinal (gi) diseases account for substantial morbidity, mortality, and cost. statistical analyses of the most recent data are necessary to guide gi research, education, and clinical practice. we estimate the burden of gi disease in the united states.201222885331
isolation and characterization of clostridium difficile toxin-specific single-domain antibodies.camelidae single-domain antibodies (vhhs) are a unique class of small binding proteins that are promising inhibitors of targets relevant to infection and immunity. with vhh selection from hyperimmunized phage display libraries now routine and the fact that vhhs possess long, extended complementarity-determining region (cdr3) loop structures that can access traditionally immunosilent epitopes, vhh-based inhibition of targets such as bacterial toxins are being explored. toxin a and toxin b are hig ...201222886255
protective role of commensals against clostridium difficile infection via an il-1β-mediated positive-feedback loop.clostridium difficile is a gram-positive obligate anaerobic pathogen that causes pseudomembranous colitis in antibiotic-treated individuals. commensal bacteria are known to have a significant role in the intestinal accumulation of c. difficile after antibiotic treatment, but little is known about how they affect host immunity during c. difficile infection. in this article, we report that c. difficile infection results in translocation of commensals across the intestinal epithelial barrier that i ...201222888139
suppression of clostridium difficile in the gastrointestinal tracts of germfree mice inoculated with a murine isolate from the family lachnospiraceae.the indigenous microbial community of the gastrointestinal (gi) tract determines susceptibility to clostridium difficile colonization and disease. previous studies have demonstrated that antibiotic-treated mice challenged with c. difficile either developed rapidly lethal c. difficile infection or were stably colonized with mild disease. the gi microbial community of animals with mild disease was dominated by members of the bacterial family lachnospiraceae, while the gut community in moribund ani ...201222890996
the rise of carbapenem-resistant acinetobacter baumannii.acinetobacter spp. are gram-negative bacteria that have become one of the most difficult pathogens to treat. the species a. baumannii, largely unknown 30 years ago, has risen to prominence particularly because of its ability to cause infections in immunocompromised patients. it is now a predominant pathogen in many hospitals as it has acquired resistance genes to virtually all antibiotics capable of treating gram-negative bacteria, including the fluoroquinolones and the cephalosporins. some memb ...201322894617
lactic acid production by streptococcus thermophilus alters clostridium difficile infection and in vitro toxin a production.antibiotic treatment to treat specific infections has the potential to effectively target the offending microbe as well as other microbes that colonize sites within a host. antibiotic-associated diarrhea (aad) is a classic example resulting from disruption of host microbial communities; 20% of patients with aad are likely to become colonized with clostridium difficile. restoration of a "normal" microbial community within the host using probiotic bacteria is one approach to circumvent aad and c. ...201722895082
modeling host-pathogen interactions: h. sapiens as a host and c. difficile as a pathogen.many complex mechanisms in immunological studies cannot be measured by experiments, but can be analyzed by mathematical simulations. using theoretical modeling techniques, general principles of host-pathogen system interactions can be explored and clinical treatment schedules can be optimized to lower the microbial toxin burden and side effects in the host system. in this study, we use a computational modeling technique that aims to explain the host-pathogen interactions and suggests how the hos ...201222899591
clinical and economic outcomes of a prospective antimicrobial stewardship program.a pre-post analysis of an antimicrobial stewardship program (asp) involving the use of data-mining software to prospectively identify cases for asp intervention was conducted.201222899745
oritavancin does not induce clostridium difficile germination and toxin production in hamsters or a human gut model.to evaluate the relative propensities of oritavancin and vancomycin to induce clostridium difficile infection (cdi) in hamster and in vitro human gut models.201222899803
an evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of clostridium difficile infection in hospital settings.to evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital clostridium difficile infection (cdi) incidence rates. a secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool.201222899806
clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with clostridium difficile 027.clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial c. difficile transmission.201222902081
empiric antibiotics pending bronchoalveolar lavage data in patients without pneumonia significantly alters the flora, but not the resistance profile, if a subsequent pneumonia develops.ventilator-associated pneumonia (vap) occurs in up to 25% of mechanically ventilated patients, with an associated mortality up to 50%. early diagnosis and appropriate empiric antibiotic coverage of vap are crucial. given the multitude of noninfectious clinical and radiographic anomalies within trauma patients, microbiology from bronchioalveolar lavage (bal) is often needed. empiric antibiotics are administered while awaiting bal culture data. little is known about the effects of these empiric an ...201322906560
in vivo selection of rifamycin-resistant clostridium difficile during rifaximin therapy.we report the selection of clostridium difficile resistant to the rifamycin class of antibiotics in a patient within 32 h of receiving rifaximin for the treatment of recurrent c. difficile diarrhea. resistance was associated with single nucleotide substitutions within rpob.201222908175
acp journal club: review: proton-pump inhibitors are associated with increased risk for clostridium difficile infection. 201222910967
utility of perirectal swab specimens for diagnosis of clostridium difficile infection.for 139 patients tested for clostridium difficile infection by polymerase chain reaction, the sensitivity, specificity, positive predictive value, and negative predictive value of testing perirectal swabs vs stool specimens were 95.7%, 100%, 100%, and 99.1%, respectively. for selected patients, perirectal swabs provide an accurate toxigenic c. difficile detection strategy.201222911648
tcdc does not significantly repress toxin expression in clostridium difficile 630δerm.in the past decade, clostridium difficile has emerged as an important gut pathogen. symptoms of c. difficile infection range from mild diarrhea to pseudomembranous colitis, sometimes resulting in colectomy or death. the main virulence factors of c. difficile are toxin a and toxin b. besides the genes encoding these toxins (tcda and tcdb), the pathogenicity locus (paloc) also contains genes encoding a sigma factor (tcdr) and a putative anti-sigma factor (tcdc). the important role of tcdr as a sig ...201222912837
molecular basis of early stages of clostridium difficile infection: germination and colonization.clostridium difficile infections (cdis) occur when antibiotic therapy disrupts the gastrointestinal flora, favoring infected c. difficile spores to germinate, outgrow, colonize and produce toxins. during cdi, c. difficile vegetative cells initiate the process of sporulation allowing a fraction of the spores to remain adhered to the intestinal surfaces. these spores, which are unaffected by antibiotic therapy commonly used for cdis, then germinate, outgrow and recolonize the host's gi tract causi ...201222913353
the continually evolving clostridium difficile species.clostridium difficile is a spore-forming gram-positive bacterium that causes chronic diarrhea and sometimes life-threatening disease mainly in elderly and hospitalized patients. the reported incidence of c. difficile infection has changed dramatically over the last decade and has been related to the emergence of distinct clonal lineages that appear more transmissible and cause more severe infection. these include pcr ribotypes 027, 017 and more recently 078. population biology studies using mult ...201222913354
"community-acquired clostridium difficile infection: an emerging entity". 201222918999
toward a structural understanding of clostridium difficile toxins a and b.clostridium difficile is a toxin-producing bacterium that is a frequent cause of hospital-acquired and antibiotic-associated diarrhea. the incidence, severity, and costs associated with c. difficile associated disease are substantial and increasing, making c. difficile a significant public health concern. the two primary toxins, tcda and tcdb, disrupt host cell function by inactivating small gtpases that regulate the actin cytoskeleton. this review will discuss the role of these two toxins in pa ...201222919620
cost-effectiveness of a modified two-step algorithm using a combined glutamate dehydrogenase/toxin enzyme immunoassay and real-time pcr for the diagnosis of clostridium difficile infection.the analytical performance and cost-effectiveness of the wampole toxin a/b eia, the c. diff. quik chek complete (cdqcc) (a combined glutamate dehydrogenase antigen/toxin enzyme immunoassay), two rt-pcr assays (progastro cd and bd geneohm) and a modified two-step algorithm using the cdqcc reflexed to rt-pcr for indeterminate results were compared. the sensitivity of the wampole toxin a/b eia, cdqcc (gdh antigen), bd geneohm and progastro cd rt-pcr were 85.4%, 95.8%, 100% and 93.8%, respectively. ...201422921803
risk factors for development of clostridium difficile infection due to bi/nap1/027 strain: a meta-analysis.to identify risk factors for the development of clostridium difficile infection (cdi) due to c. difficile bi/nap1/027 strain.201222921930
evidence of in vivo prophage induction during clostridium difficile infection.prophages contribute to the evolution and virulence of most bacterial pathogens, but their role in clostridium difficile is unclear. here we describe the isolation of four myoviridae phages, φmmp01, φmmp02, φmmp03, and φmmp04, that were recovered as free viral particles in the filter-sterilized stool supernatants of patients suffering from c. difficile infection (cdi). furthermore, identical prophages were found in the chromosomes of c. difficile isolated from the corresponding fecal samples. we ...201222923402
contribution of spores to the ability of clostridium difficile to adhere to surfaces.clostridium difficile is the commonest cause of hospital-acquired infection in the united kingdom. we characterized the abilities of 21 clinical isolates to form spores; to adhere to inorganic and organic surfaces, including stainless steel and human adenocarcinoma cells; and to germinate. the composition of culture media had a significant effect on spore formation, as significantly more spores were produced in brain heart infusion broth (student's t test; p = 0.018). the spore surface relative ...201222923404
prevalence and genotypic characterization of clostridium difficile from ruminants in switzerland.clostridium difficile is an emerging enteric pathogen of humans and animals with a known main reservoir in the intestinal tract of various warm-blooded animals. this study was carried out to evaluate the prevalence of c. difficile in 150 rectal swab samples collected from cattle and goats in switzerland. the overall prevalence of c. difficile was 6.6%. the isolates belonged to the pcr ribotypes 033, 066, 070, 003, 001 and 137. in addition, the occurrence of c. difficile in faecal samples collect ...201222925279
[treatment of refractory or recurrent clostridium difficile infection].the incidence and severity of clostridium difficile infection (cdi) has increased over the past decades. it is related to the emergence of hypervirulent strains and increased use of antibiotics. the incidence of refractory cdi to standard therapies and the risk for recurrent cdi are also increasing. current guidelines recommend the first recurrence to be treated with the same agent used for the initial episode. however, data are lacking to support any particular treatment strategy for severe ref ...201222926117
determination of serum antibodies to clostridium difficile toxin b in patients with inflammatory bowel disease.clostridium difficile infection has increased in prevalence among patients with inflammatory bowel disease (ibd). serum antibodies against c. difficile toxins have been detected in susceptible populations and may be protective; however, such antibodies have not been previously characterized in ibd patients. this study measured immunoglobulin g antibody levels to c. difficile toxin b in serum from ibd patients in remission and ibd patients in relapse. ibd patients demonstrated significantly highe ...201222933861
clostridium difficile: an emerging pathogen in children.clostridium difficile is emerging as an important enteric pathogen in children. historically considered as an asymptomatic colonizer of the gastrointestinal tract, c. difficile infection (cdi) has not been well-studied in pediatric populations. while asymptomatic carriage remains high among infants, recent epidemiological surveillance has demonstrated a rise in the prevalence of cdi in both healthcare and community settings, particularly in children 1-5 years of age. the pathogenesis of pediatri ...201222935207
twenty-three-hour stay loop ileostomy closures: a pilot study.in uk in 2010-2011, 4,463 ileostomy closures were performed (35,442 bed days) with a median inpatient stay of 5 days (hospital episode statistics data). this seems anomalous when there are reports of 23-h stay colectomies. we present our early experience of 23-h discharge for loop ileostomy closures.201322936588
enteric pathogens through life stages.enteric infections and diarrheal diseases constitute pervasive health burdens throughout the world, with rates being highest at the two ends of life. during the first 2-3 years of life, much of the disease burden may be attributed to infection with enteric pathogens including salmonella, rotavirus, and many other bacterial, viral, and protozoan organisms; however, infections due to clostridium difficile exhibit steady increases with age. still others, like campylobacter infections in industriali ...201222937528
fecal microbiota transplantation for treating recurrent clostridium difficile infection. 201222937601
improved detection of toxigenic clostridium difficile using the cepheid xpert c difficile assay and impact on c difficile infection rates in a tertiary hospital: a double-edged sword.recent recommendations suggest implementation of a 2-step diagnostic algorithm for the laboratory detection of toxigenic clostridium difficile. we found that the rate of toxigenic c difficile detection in our laboratory doubled after the introduction of an algorithm that incorporated polymerase chain reaction testing. this led to an abrupt 70% increase in the overall rate of c difficile infection in our institution.201322939418
prebiotic-non-digestible oligosaccharides preference of probiotic bifidobacteria and antimicrobial activity against clostridium difficile.bifidobacterium breve 46, bifidobacterium lactis 8:8 and bifidobacterium longum 6:18 and three reference strains b. breve ccug 24611, b. lactis jcm 10602, and bifidobacterium pseudocatenulatum jcm 1200 were examined for acid and bile tolerance, prebiotic utilization and antimicrobial activity against four clostridium difficile (cd) strains including the hypervirulent strain, pcr ribotype nap1/027. b. lactis 8:8 and b. lactis jcm 10602 exhibited a high tolerance in mrsc broth with ph 2.5 for 30 m ...201222940065
[risk factors of clostridium difficile-associated diarrhea in children].to explore the risk factors of clostridium difficile-associated diarrhea (cdad) in children.201222944235
morbidity and mortality associated with clostridium difficile ribotype 078: a case-case study.the morbidity and mortality associated with clostridium difficile ribotype 078 were examined by comparison with other known outbreak strains. a healthcare interaction within eight weeks of a positive specimen significantly increased the likelihood of ribotype 078 compared with ribotype 027. individuals with ribotype 078 also tended to come from community sources, have a hospital stay post specimen similar to ribotype 027 and a lower 30-day mortality, but these differences were not statistically ...201222947650
clostridium difficile colitis and neutropenic fever associated with docetaxel chemotherapy in a patient with advanced extramammary paget's disease.extramammary paget's disease is a rare cutaneous malignant neoplasm. previous studies indicated the efficacy of docetaxel in advanced cases. the common side effects of docetaxel are usually tolerable and seldom life-threatening. we experienced a case of severe pseudomembranous colitis and neutropenic fever that developed just after the first cycle of docetaxel chemotherapy. to the best of our knowledge, there are few reports of pseudomembranous colitis associated with docetaxel administration fo ...201222949901
evaluation of the xpert clostridium difficile assay for the diagnosis of clostridium difficile infection.infection with clostridium difficile is a growing concern because of the increasing prevalence and spread of nosocomial infections. emergence of the hypervirulent 027/nap1/bi strain is also notable. existing diagnostic methods have low sensitivity or are time-consuming. therefore, establishing a rapid and accurate microbiological diagnostic assay is needed. we evaluated the xpert c. difficile assay (xpert cd assay; cepheid, usa) to detect toxigenic c. difficile. this assay is a real-time multipl ...201222950071
prevalence and distribution of clostridium difficile pcr ribotypes in cats and dogs from animal shelters in thuringia, germany.clostridium difficile is an important cause of nosocomial diarrhoea in humans. pet animals and livestock are discussed as potential natural reservoirs and sources of infection. in this study faecal samples from dogs and cats were collected at 10 animal shelters in thuringia, germany. c. difficile was isolated from 9 out of 165 (5.5%) canine and 5 out of 135 (3.7%) feline samples. five pcr ribotypes (010, 014/020, 039, 045, slo 066) were identified. pcr ribotypes 010 and 014/020 were detected in ...201222951303
clostridium difficile detection: identification of colonization, subclinical and overt disease. 201222951306
a novel use of rectal swab to test for clostridium difficile infection by real-time pcr. 201222951884
comparison of bd geneohm cdiff and seegene seeplex ace pcr assays using toxigenic clostridium difficile culture for direct detection of tcdb from stool specimens.we evaluated the performances of 2 pcr assays (bd geneohm and seegene ace) for direct detection of tcdb from stool specimens. the concordance rate between bd and seegene was 96.3%. the sensitivities, specificities, positive predictive values (ppvs), and negative predictive values (npvs) of bd and seegene were 95.7%, 96.5%, 91.8%, and 98.2% and 90.0%, 97.1%, 92.6%, and 96.0%, respectively.201222952270
clostridium difficile spore-macrophage interactions: spore survival.clostridium difficile is the main cause of nosocomial infections including antibiotic associated diarrhea, pseudomembranous colitis and toxic megacolon. during the course of clostridium difficile infections (cdi), c. difficile undergoes sporulation and releases spores to the colonic environment. the elevated relapse rates of cdi suggest that c. difficile spores has a mechanism(s) to efficiently persist in the host colonic environment.201222952726
prolongation of length of stay and clostridium difficile infection: a review of the methods used to examine length of stay due to healthcare associated infections. 201222958238
antimicrobial stewardship in scotland: impact of a national programme.the scottish antimicrobial prescribing group (sapg) was established by the scottish government in 2008 to lead the first national initiative to actively address antimicrobial stewardship. healthcare associated infection (hai) is a priority in scotland and the work of sapg contributes to the national hai delivery plan. sapg's early work has focused on restricting the use of antibiotics associated with a high risk of clostridium difficile infection (cdi) and development of national prescribing ind ...201222958296
mortality and clostridium difficile infection: a review. 201222958425
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