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[clostridium difficile epidemic, chile 2012: report of the chilean society for infectious diseases. a scientific historical analysis].a summary report from the chilean society for infectious diseases regarding the presence of a clostridium difficile epidemic with several fatalities in chile's premier emergency public hospital in santiago is used to make a scientific historical analysis of the situation. this summary report identifies several hygienic and sanitary shortcomings that may have played a role in triggering this major epidemic. these include deficiencies in hand washing policies, overcrowding of beds in wards, relaxa ...201223096554
vitamin d deficiency: a potential risk factor for clostridium difficile infection. 201223097616
[clostridium difficile--unfairly set in the corner?]. 201223097893
clostridium difficile testing: have we got it right? 201323100357
clostridium difficile infection and partial membrane cofactor protein (cd46) deficiency. 201223101426
the role of probiotics in the prevention and treatment of antibiotic-associated diarrhea and clostridium difficile colitis.clostridium difficile colitis is the most common gastrointestinal infection, exceeding all other gastrointestinal infections combined. there has been a dramatic increase in clostridium difficile infection (cdi) worldwide during the past decade. antibiotic therapy is a trigger precipitating antibiotic-associated diarrhea (aad), which may lead to cdi. the antibiotic alters the protective, diverse bacteria allowing pathogenic bacteria to cause disease. probiotics have been effective in reducing aad ...201223101686
fecal microbiota transplantation: techniques, applications, and issues.fecal microbiota transplantation (fmt) has gained widespread recognition in light of the recent clostridium difficile infection (cdi) epidemic, responsible for almost 110,000 deaths per year. the procedure's success rate has caused experts to reflect on what other conditions may benefit. this article provides an overview of (1) description and history of fmt, (2) fmt publications in cdi, (3) the concept of the gut microbiota as a virtual organ, (4) rationale for fmt use, (5) fmt use in inflammat ...201223101687
electronic ward round: finding time for the inpatient with clostridium difficile infection. 201323103665
clostridium difficile: a european perspective.clostridium difficile infection is the leading cause of diarrhoea in the industrialised world. first identified in 1935, our knowledge about the clonal population structure, toxins and pcr ribotypes is still increasing. new pcr ribotypes and sequence types are frequently added. in the last decade hypervirulent strains have emerged and been associated with increased severity of disease, high recurrence and significant mortality. although previously a primarily hospital- or health-care acquired in ...201323103666
diagnosis of clostridium difficile infection using real-time pcr.clostridium difficile is known to cause antibiotic-associated diarrhea and pseudomembranous colitis. toxinogenic strains of the bacterium produce toxins a (tcda) and b (tcdb), which are associated with the pathogenicity. the standard methods for diagnosis of c. difficile infection include the cell cytotoxicity assay and the culture of a toxinogenic strain. due to the long turnaround time of these methods, more rapid methods are preferred. enzyme immunoassays are fast, but lack sensitivity. there ...201323104294
analysis of metronidazole susceptibility in different clostridium difficile pcr ribotypes.susceptibility to metronidazole was investigated in 81 clostridium difficile strains, belonging to nine different pcr ribotypes, by three different laboratory methods.201323104495
comparison of a frozen human foreskin fibroblast cell assay to an enzyme immunoassay and toxigenic culture for the detection of toxigenic clostridium difficile.this study set out to validate the hs27 readycell assay (rccna) as an alternative ccna method compared against a commonly used commercial enzyme immunoassay (eia) method and toxigenic culture (tc) reference standard. a total of 860 samples were identified from those submitted to the health protection agency microbiology laboratories over a 30-week period. rccna performed much better than eia when using tc as a gold standard, with sensitivities of 90.8% versus 78.6% and positive predictive value ...201323107315
response failure to the treatment of clostridium difficile infection and its impact on 30-day mortality.few data are available on response failure and hospital mortality. this study aimed to evaluate the association between response failure to the treatment of cdi and 30-day mortality.201323108084
new molecular methods for the diagnosis of clostridium difficile infections.clostridium difficile is recognized as the major agent responsible for nosocomial diarrhea in hospitalized patients. accurate diagnosis of c. difficile infection (cdi) is essential for optimal treatment and prevention but continues to be challenging. there are currently two reference assays for the diagnosis of cdi with different targets: the cytotoxicity assay that detects free toxins and the toxigenic culture which detects the organism with the potential to produce toxin. in 2009, nucleic acid ...201223110263
from natural product to marketed drug: the tiacumicin odyssey.the first members of the tiacumicin family of antibiotics, encompassing more than 40 compounds, were isolated in 1975. structurally, the core aglycon is an 18-membered macrolactone having two conjugated diene units, one isolated double bond, 5 stereogenic centers and most often, at least one glycosidic linkage. tiacumicin b, a rna synthesis inhibitor, is a narrow-spectrum antibiotic against clostridia. for the treatment of clostridium difficile infection (cdi), it has the same cure rate as vanco ...201323111588
pneumatosis intestinalis in a patient with recurrent clostridium difficile infection.a 65-year-old man with long-standing diarrhoea, recurrent clostridium difficile infection (cdi) in the previous 5 months presented to the gastroenterology clinic with recurrent diarrhoea and abdominal cramping. physical examination was negative for signs of acute abdomen. stool c difficile pcr was positive. abdominal imaging demonstrated an extensive pneumatosis intestinalis involving the small bowel and a dilated small bowel loop. he was treated conservatively with oral vancomycin for recurrent ...201223112256
clostridium difficile 027-associated pseudomembranous colitis after short-term treatment with cefuroxime and cephalexin in an elderly orthopedic patient: a case report.clostridium difficile ribotype 027 has become increasingly prevalent in european countries. the clinical picture varies from self-limiting diarrhea to pseudomembranous colitis with toxic megacolon and ultimately death. use of antibiotics is the principal risk factor; others include comorbidity, advanced age and hospitalization. however even with extensive knowledge of risk factors, it remains difficult to define "minimum risk," as illustrated by the following case.201223113897
[current data and trends on the development of antibiotic resistance of clostridium difficile].clostridium difficile is the most common pathogen causing antibiotic-associated diarrhea. antibiotic therapy also favors the development and the epidemic spreading of multiresistant strains. in this present retrospective study clinical isolates from the university of saarland medical center and of other german isolate referring hospitals were characterized by genotyping and antibiotic resistance testing. the most prevalent strains were ribotypes 001 (18%), 014 (16%) and 027 (15%). sensitivity to ...201223114440
increased susceptibility of melanin-concentrating hormone-deficient mice to infection with salmonella enterica serovar typhimurium.melanin-concentrating hormone (mch) was initially identified in mammals as a hypothalamic neuropeptide regulating appetite and energy balance. however, the wide distribution of mch receptors in peripheral tissues suggests additional functions for mch which remain largely unknown. we have previously reported that mice lacking mch develop attenuated intestinal inflammation when exposed to clostridium difficile toxin a. to further characterize the role of mch in host defense mechanisms against inte ...201323115043
community-acquired clostridium difficile nap1/027-associated diarrhea in an eighteen month old child.clostridium difficile infection (cdi), characterized by symptoms varying from diarrhea to life-threatening colitis, is a major complication of antibiotic therapy. studies suggested that cdi is emerging as an important cause of childhood diarrhea in community and hospital settings. this work is the first report of a documented case of community-acquired cdi by a nap1 hypervirulent strain in an eighteen month old child from latin america.201223116882
faecal microbiota transplantation for severe clostridium difficile infection in the intensive care unit.we describe a case of faecal microbiota transplantation (fmt) used for severe binary toxin-positive clostridium difficile infection in an intensive care setting. the patient was admitted to the icu of a tertiary hospital and failed traditional maximal pharmacological management. adjunctive therapy with fmt given through gastroscopy resulted in resolution of the c. difficile-related symptoms. although there is a growing experience with fmt for recurrent c. difficile infection, published evidence ...201323117471
c. difficile 630δerm spo0a regulates sporulation, but does not contribute to toxin production, by direct high-affinity binding to target dna.clostridium difficile is a gram positive, anaerobic bacterium that can form highly resistant endospores. the bacterium is the causative agent of c. difficile infection (cdi), for which the symptoms can range from a mild diarrhea to potentially fatal pseudomembranous colitis and toxic megacolon. endospore formation in firmicutes, including c. difficile, is governed by the key regulator for sporulation, spo0a. in bacillus subtilis, this transcription factor is also directly or indirectly involved ...201223119071
time to act against clostridium difficile infection. 201223121547
breaking the cycle of recurrent clostridium difficile infections. 201223121548
consequences of clostridium difficile infection: understanding the healthcare burden.clostridium difficile is the leading cause of infectious nosocomial diarrhoea in developed countries, with a measured incidence of approximately five episodes per 10,000 days of hospital stay in europe. accurate diagnosis of c. difficile infection (cdi) is a prerequisite for obtaining reliable epidemiological data, but in many european countries diagnosis is probably suboptimal. a significant percentage of cdi cases are missed because clinicians often fail to request tests for c. difficile toxin ...201223121549
overcoming barriers to effective recognition and diagnosis of clostridium difficile infection.with the frequency of cases of clostridium difficile infection (cdi) increasing in many developed countries, accurate and reliable laboratory diagnosis of cdi is more important than ever. however, the diagnosis of cdi has been handicapped by the existence of two reference standards, one of which detects c. difficile toxin (cytotoxin assay) and the other only toxigenic strains (cytotoxigenic culture). being relatively slow and laborious to perform, these reference methods were largely abandoned a ...201223121550
can we identify patients at high risk of recurrent clostridium difficile infection?although most patients with clostridium difficile infection (cdi) can be managed effectively with discontinuation of prescribed antibiotics and additional treatment with oral metronidazole or vancomycin, up to 25% experience disease recurrence, usually within 30 days of treatment. failure to mount a systemic anti-toxin antibody response differentiates patients with cdi and recurrent cdi from symptomless carriers of toxinogenic c. difficile. the immunological senescence that accompanies ageing ma ...201223121551
current and emerging management options for clostridium difficile infection: what is the role of fidaxomicin?until recently, treatment of clostridium difficile infection (cdi) was mainly limited to oral metronidazole and vancomycin, neither of which is optimal. up to 25% of patients with cdi experience recurrence of infection within 30 days following treatment with these agents, while c. 45-65% of these patients experience further (and sometimes multiple) recurrences. recurrent cdi represents a major treatment challenge for which new therapeutic options are sorely needed. fidaxomicin is a first-in-clas ...201223121552
fecal microbiota transplantation for fulminant clostridium difficile infection in an allogeneic stem cell transplant patient.we present a case of severe clostridium difficile infection (cdi) in a non-neutropenic allogeneic hematopoietic stem cell transplant recipient who was treated successfully with fecal microbiota therapy after standard pharmacologic therapy had failed. following naso-jejunal instillation of donor stool, the patient's symptoms resolved within 48 h. bowel resection was averted. this is the first case in the literature, to our knowledge, to describe fecal microbiota therapy in a profoundly immunocomp ...201223121625
antibody against tcdb, but not tcda, prevents development of gastrointestinal and systemic clostridium difficile disease.a dramatic increase in morbidity and mortality from clostridium difficile infection (cdi) due to the recent emergence of virulent, antibiotic-resistant strains has led to a search for alternatives to antibiotics, including vaccines and immune-based therapy that target the 2 key toxins-tcda and tcdb.201323125448
outcome of icu patients with clostridium difficile infection.as data from clostridium difficile infection (cdi) in intensive care unit (icu) are still scarce, our objectives were to assess the morbidity and mortality of icu-acquired cdi.201223127327
clostridium difficile: the emerging epidemic. 201223127729
clostridium difficile infection in patients with chronic kidney disease.to examine the rate of clostridium difficile infection (cdi) and hospital-associated outcomes in a national cohort of hospitalized patients with chronic kidney disease (ckd) and assess the impact of long-term dialysis on outcome in these patients.201223127731
clostridium difficile infection: new insights into management.clostridium difficile was first described as a cause of diarrhea in 1978 and is now among the leading 3 hospital-acquired infections in the united states, along with methicillin-resistant staphylococcus aureus and vancomycin-resistant enterococci. in the past 2 decades, there has been an increase in the incidence, severity, and recurrence rates of c difficile infection, all of which are associated with poor outcomes. in addition, several novel risk factors and newer treatment methods are emergin ...201223127735
evaluation of commercial kits for extraction of dna and rna from clostridium difficile.commercial nucleic acid extraction kits are a cost effective, efficient and convenient way to isolate dna and rna from bacteria. despite the increasing importance of the gastrointestinal pathogen, clostridium difficile, and the increased use of nucleic acids in its identification, characterization, and investigation of virulence factors, no standardized or recommended methods for nucleic acid isolation exist. here, we sought to evaluate 4 commercial dna extraction kits and 3 commercial rna extra ...201223128271
targeted restoration of the intestinal microbiota with a simple, defined bacteriotherapy resolves relapsing clostridium difficile disease in mice.relapsing c. difficile disease in humans is linked to a pathological imbalance within the intestinal microbiota, termed dysbiosis, which remains poorly understood. we show that mice infected with epidemic c. difficile (genotype 027/bi) develop highly contagious, chronic intestinal disease and persistent dysbiosis characterized by a distinct, simplified microbiota containing opportunistic pathogens and altered metabolite production. chronic c. difficile 027/bi infection was refractory to vancomyc ...201223133377
the surgical management of active ulcerative colitis complicated by clostridium difficile infection.clostridium difficile stool toxin is detected in 5-20 % of patients with acute exacerbations of ulcerative colitis (uc). there is little data regarding the safety of surgery for uc with concurrent c. difficile.201323135837
quantitative fecal lactoferrin in toxin-positive and toxin-negative clostridium difficile specimens.quantitative fecal lactoferrin was measured in 112 patients tested for toxigenic clostridium difficile using glutamate dehydrogenase (gdh) and toxin immunoassays combined with tcdb pcr. lactoferrin levels were higher in the gdh-positive/toxin-positive group (79 μg/ml) than in the gdh-positive/toxin-negative/pcr-positive (21 μg/ml) and the gdh-negative groups (13 μg/ml). differences in fecal lactoferrin levels suggest variable presence or severity of c. difficile infection among toxin-positive an ...201323135940
a prospective study to examine the epidemiology of methicillin-resistant staphylococcus aureus and clostridium difficile contamination in the general environment of three community hospitals in southern ontario, canada.the hospital environment has been suggested as playing an important role in the transmission of hospital-associated (ha) pathogens. however, studies investigating the contamination of the hospital environment with methicillin-resistant staphylococcus aureus (mrsa) or clostridium difficile have generally focused on point prevalence studies of only a single pathogen. research evaluating the roles of these two pathogens, concurrently, in the general hospital environment has not been conducted. the ...201223136936
colectomy in intensive care patients: operative findings and outcomes.with a critical illness, intestinal complications are associated with high morbidity and mortality.201323142989
effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a lid on antibiotic use.we introduced a long-term care facility (ltcf) infectious disease (id) consultation service (lid service) that provides on-site consultations to residents of a veterans affairs (va) ltcf. we determined the impact of the lid service on antimicrobial use and clostridium difficile infections at the ltcf.201223143354
efficacy of different cleaning and disinfection methods against clostridium difficile spores: importance of physical removal versus sporicidal inactivation.we tested the effectiveness of disinfectants and wipe methods against clostridium difficile spores. wiping with nonsporicidal agents (physical removal) was effective in removing more than 2.9 log(10) c. difficile spores. wiping with sporicidal agents eliminated more than 3.90 log(10) c. difficile spores (physical removal and/or inactivation). spraying with a sporicide eliminated more than 3.44 log(10) c. difficile spores but would not remove debris.201223143366
protective antibody responses against clostridium difficile elicited by a dna vaccine expressing the enzymatic domain of toxin b.a dna vaccination approach was used in the current study to screen for the immunogenicity of different fragments of toxin a and toxin b from clostridium difficile. with this approach, protein antigens do not need to be produced in vitro and the immunogenicity of candidate c. difficile antigens can be identified directly in animals. codon optimized toxin gene fragments were individually cloned into the dna vaccine vector and tested in mice and rabbits for their ability to elicit c. difficile toxi ...201323143772
structural insight into the clostridium difficile ethanolamine utilisation microcompartment.bacterial microcompartments form a protective proteinaceous barrier around metabolic enzymes that process unstable or toxic chemical intermediates. the genome of the virulent, multidrug-resistant clostridium difficile 630 strain contains an operon, eut, encoding a bacterial microcompartment with genes for the breakdown of ethanolamine and its utilisation as a source of reduced nitrogen and carbon. the c. difficile eut operon displays regulatory genetic elements and protein encoding regions in co ...201223144756
both fidaxomicin and vancomycin inhibit outgrowth of clostridium difficile spores.fidaxomicin (fdx) is approved to treat clostridium difficile-associated diarrhea and is superior to vancomycin in providing a sustained clinical response (cure without recurrence in the subsequent 25 days). the mechanism(s) behind the low recurrence rate of fdx-treated patients could be multifactorial. here, we tested effects of fdx, its metabolite op-1118, and vancomycin on spore germination and determined that none affected the initiation of spore germination but all inhibited outgrowth of veg ...201323147724
vancomycin treatment's association with delayed intestinal tissue injury, clostridial overgrowth, and recurrence of clostridium difficile infection in mice.antibiotic treatment, including vancomycin, for clostridium difficile infection (cdi) has been associated with recurrence of disease in up to 25% of infected persons. this study investigated the effects of vancomycin on the clinical outcomes, intestinal histopathology, and anaerobic community during and after treatment in a murine model of cdi. c57bl/6 mice were challenged with c. difficile strain vpi 10463 after pretreatment with an antibiotic cocktail. twenty-four hours after infection, mice w ...201323147742
biocidal activity of metalloacid-coated surfaces against multidrug-resistant microorganisms. 201223148568
antimicrobial susceptibility and resistance mechanisms of clinical clostridium difficile from a chinese tertiary hospital.clostridium difficile is a predominant cause of antibiotic-associated diarrhoea. it is increasingly difficult to treat c. difficile infection efficiently owing to its multidrug resistance. in the present study, 60 clinical c. difficile isolates were collected and analysed for their genotype, antimicrobial susceptibility and resistance mechanisms. tandem repeat sequence typing (trst) generated 21 types, including the epidemic clone tr017. antimicrobial susceptibility testing of eight antibiotics ...201323148985
comparative analysis of fecal microflora of healthy full-term indian infants born with different methods of delivery (vaginal vs cesarean): acinetobacter sp. prevalence in vaginally born infants.in this study fecal microflora of human infants born through vaginal delivery (vb) and through cesarean section (cb) were investigated using culture-independent 16s rdna cloning and sequencing approach. the results obtained clearly revealed that fecal microbiota of vb infants distinctly differ from those in their counterpart cb infants. the intestinal microbiota of infants delivered by cesarean section appears to be more diverse, in terms of bacteria species, than the microbiota of vaginally del ...201223151789
safety and efficacy of fidaxomicin in the treatment of clostridium difficile-associated diarrhea.clostridium difficile-associated diarrhea (cdad) is the most common cause of healthcare-associated diarrhea. the current recommended treatment regimens of metronidazole and vancomycin have not changed in nearly 25 years. fidaxomicin, an exceedingly narrow spectrum macrolide antibiotic, was recently approved for the treatment of cdad. in phase iii clinical trials, fidaxomicin was noninferior to vancomycin in achieving clinical cure of cdad. furthermore, fidaxomicin was associated with fewer recur ...201223152733
fecal microbiota transplantation in relapsing clostridium difficile infection.clostridium difficile infection rates are climbing in frequency and severity, and the spectrum of susceptible patients is expanding beyond the traditional scope of hospitalized patients receiving antibiotics. fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. cure rates of > 90% are being consistently reported from multiple centers. transplantation ca ...201223152734
[clostridium difficile: is it time to start worrying?]. 201223153414
fidaxomicin for the treatment of clostridium difficile infections.clostridium difficile infection (cdi), also known as c. difficile-associated disease or diarrhoea (cdad), is an important cause of hospital-acquired diarrhoea with disease severity ranging from mild diarrhoea to fulminant colitis. in addition, over 40% of new cases of cdi occur outside hospital. ▾ fidaxomicin (dificlir - astellas), the first antibiotic in a new class called macrocyclics, has recently been licensed for the treatment of c. difficile infection in adults. here we provide a brief ove ...201223154594
ribotyping in the detection of clostridium difficile outbreaks in a single university hospital.clostridium difficile infection (cdi) is the most important bacterial cause of hospital-acquired diarrhoea. although reports of deaths associated with cdi have been decreasing since a peak in 2007 in england and northern ireland, it remains a major cause of morbidity and mortality. the health protection agency's clostridium difficile ribotyping network (cdrn) aims to provide information to help optimize the management of cases of cdi. this study assesses the value of ribotyping to detect outbrea ...201323158685
[infection frequency in patients with chronic idiopathic ulcerative colitis].ulcerative colitis (uc) is a chronic inflammatory bowel disease characterized by diffuse inflammation of the mucosa of the colon. up to now, diverse observational studies have implicated a wide variety of pathogenic microorganisms as causal and exacerbating factors in uc. clostridium difficile (c. difficile) infection has been associated with recurrence and treatment failure and its incidence in patients with uc has been on the rise in the last few years.201223159238
isolation of clostridium difficile from peritoneal fluid. 201223163311
relationship of symptom duration and fecal bacteriotherapy in clostridium difficile infection-pooled data analysis and a systematic review.clostridium difficle-associated infection (cdi) is usually treated with antibiotics; nevertheless, the infection has a high relapse rate. case series and case reports using fecal microbiota transplant (fmt) for cdi show promising results. however, there are no large studies to provide evidence for the efficacy of this therapy. the aim of this pooled patient data meta-analysis was to determine the efficacy of fmt in cdi.201323163886
significance of proton pump inhibitor types for clostridium difficile infection. 201323164689
an unusual method of diagnosing a common disease.a 34-year-old woman presented with non-bloody diarrhoea of 14 days duration and vomiting. physical examination was unremarkable. she had hypokalaemia and metabolic acidosis. stool studies were negative for clostridium difficile toxin, faecal leucocytes and parasites. colon appeared normal on colonoscopy. pronounced scalloping of ileal folds was noted on ileoscopy. ileal biopsies revealed villous blunting, crypt hyperplasia, marked intraepithelial lymphocytosis and lymphocytic infiltration of the ...201223166167
the nose knows not: poor predictive value of stool sample odor for detection of clostridium difficile. 201323166192
probiotics prevent clostridium difficile in people taking antibiotics. 201223169808
clostridium difficile isolated from the fecal contents of swine in japan.a total of 250 fecal content samples were collected from 25 farrow-to-finish pig farms and examined for the prevalence of clostridium difficile by using ethanol treatment followed by plating onto selective media--cycloserine-cefoxitin-mannitol agar--for the isolation of clostridium difficile. two specimens (0.8%, 95% confidential interval: 0-2.9%) were positive for c. difficile. one isolate was only positive for toxin b, and the other isolate was negative for both toxins a and b. thus, prevalenc ...201323171688
epidemiology, risk factors, and outcomes of clostridium difficile infection in kidney transplant recipients.we sought to describe the epidemiology and risk factors for clostridium difficile infection (cdi) among kidney transplant recipients (ktr) between 1 january 2008 and 31 december 2010.201323173772
development and evaluation of a novel, semiautomated clostridium difficile typing platform.we describe a novel, semiautomated clostridium difficile typing platform that is based on pcr-ribotyping in conjunction with a semiautomated molecular typing system. the platform is reproducible with minimal intra- or interassay variability. this method exhibited a discriminatory index of 0.954 and is therefore comparable to more arduous typing systems, such as pulsed-field gel electrophoresis.201323175261
a laboratory-developed taqman array card for simultaneous detection of 19 enteropathogens.the taqman array card (tac) system is a 384-well singleplex real-time pcr format that has been used to detect multiple infection targets. here we developed an enteric taqman array card to detect 19 enteropathogens, including viruses (adenovirus, astrovirus, norovirus gii, rotavirus, and sapovirus), bacteria (campylobacter jejuni/c. coli, clostridium difficile, salmonella, vibrio cholerae, diarrheagenic escherichia coli strains including enteroaggregative e. coli [eaec], enterotoxigenic e. coli [ ...201323175269
multiple factors modulate biofilm formation by the anaerobic pathogen clostridium difficile.bacteria within biofilms are protected from multiple stresses, including immune responses and antimicrobial agents. the biofilm-forming ability of bacterial pathogens has been associated with increased antibiotic resistance and chronic recurrent infections. although biofilms have been well studied for several gut pathogens, little is known about biofilm formation by anaerobic gut species. the obligate anaerobe clostridium difficile causes c. difficile infection (cdi), a major health care-associa ...201323175653
clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines--is there a problem?acute severe colitis (asc) is a serious condition with possible outcomes of emergency colectomy and mortality. validated guidelines exist to help avoid these.201323176535
lymphopenia as a novel marker of clostridium difficile infection recurrence.treatment of clostridium difficile infection (cdi) is often limited by recurrence in 25% of cases. the objective of this study was to determine risk factors of cdi recurrence during a provincial endemic.201323178420
real-time polymerase chain reaction method for detection of toxigenic clostridium difficile from stools and presumptive identification of nap1 clone.this study describes the development of a cost-effective, multiplex real-time polymerase chain reaction (rtpcr) method for detection of toxigenic clostridium difficile from stools and presumptive identification of the nap-1 strain. the diagnostic value of the new method is for the detection of toxigenic c. difficile which has the following performance characteristics: 99.8% specificity, 95.1% sensitivity, 97.5% positive predictive value, and 99.5% negative predictive value. examination of 24 spe ...201323182075
preventing clostridium difficile infection in the intensive care unit.clostridium difficile is a formidable problem in the twenty-first century. because of injudicious use of antibiotics, the emergence of the hypervirulent epidemic strain of this organism has been difficult to contain. the nap1/bi/027 strain causes more-severe disease than other widely prevalent strains and affects patients who were not traditionally thought to be at risk for clostridium difficile infection. critically ill patients remain at high risk for this pathogen, and preventive measures, su ...201323182524
fecal microbiome transplantation for recurrent clostridium difficile infection: report on a case series.clostridium difficile infection (cdi) continues to increase in incidence and severity, and was the most common nosocomial infection in the usa in 2010. most cases of cdi respond to a standard course of antibiotics, but recurrent c. difficile infection (rcdi) has become increasingly frequent, and alternative treatments are needed. we examined the efficacy of fecal microbiota transplantation (fmt) instilled into the upper gastrointestinal tract for rcdi.201323182843
effect of biotherapeutics on antitoxin igg in experimentally induced clostridium difficile infection.recurrent diarrhoea after successful treatment of primary clostridium difficile associated disease (cdad) occurs due to bowel flora alterations and failure to mount an effective antibody response. apart from antibiotics, risk factors include immunosuppressive and acid-suppressive drug administration. biotherapeutics such as probiotic and epidermal growth factor (egf) may offer potential effective therapy for cdad.201223183468
retrospective analysis of fluoroquinolone prophylaxis in patients undergoing allogeneic hematopoietic stem cell transplantation.patients undergoing allogeneic hematopoietic stem cell transplant are at a high risk for infection-related mortality in the immediate post-transplantation phase. prophylaxis with a fluoroquinolone is now recommended to reduce this risk with the stipulation that surveillance for increased fluoroquinolone resistance clostridium difficile associated diarrhea be conducted.201323184539
virulence and clinical outcomes in clostridium difficile infection: a complex business. 201323196956
neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy.neutropenic enterocolitis (nec) is a life-threatening disease with substantial morbidity and mortality, seen primarily in patients with hematologic malignancies. the frequency of nec has increased with the widespread use of chemotherapeutic agents such as the taxanes, which cause severe gastrointestinal mucositis. neutropenic patients with fever and abdominal symptoms (cramping, pain, distention, diarrhea, gi bleeding), should undergo evaluation of the abdomen for bowel wall thickening of >4 mm, ...201323196957
renal impairment after high-dose flucloxacillin and single-dose gentamicin prophylaxis in patients undergoing elective hip and knee replacement.following advice from the scottish antimicrobial prescribing group, we switched our antibiotic prophylaxis for elective hip and knee replacement surgery from cefuroxime to flucloxacillin with single-dose gentamicin in order to reduce the incidence of clostridium difficile associated diarrhoea (cdad). a clinical impression that more patients subsequently developed acute kidney injury (aki) led us to examine this possibility in more detail.201323197677
understanding factors that impact on public and patient's risk perceptions and responses toward clostridium difficile and other health care-associated infections: a structured literature review.clostridium difficile is the most common health care-associated infection and a major cause of death and increased morbidity. it is vital that patients and the public are provided with the right information and communication to assist them to understand their role in preventative measures. successful implementation of communication and management strategies hinges on individuals' risk perceptions.201323199700
laboratory tests for diagnosis of clostridium difficile infection: past, present, and future. 201323200729
comparison of two selective media for the recovery of clostridium difficile from environmental surfaces.two culture media were compared for their ability to isolate clostridium difficile from environmental sites within a uk hospital. the media were cefoxitin-cycloserine-egg yolk agar plus lysozyme (ccey/l) and chromid c. difficile. a wide range of environmental surfaces was sampled using sterile sponges (polywipes) and these were inoculated on to both media. c. difficile was recovered from 105 of 496 sites (21%) using a combination of both media. the sensitivity of chromid c. difficile was 87.6% c ...201323201396
reduction in clostridium difficile infections in finland, 2008-2010.in january 2008, laboratory-based surveillance of clostridium difficile was initiated as a part of the finnish national infectious disease register (nidr) and enhanced surveillance of hospitalized patients with c. difficile-associated infections (cdi) by the finnish hospital infection programme (siro).201323201398
recombinational switching of the clostridium difficile s-layer and a novel glycosylation gene cluster revealed by large-scale whole-genome sequencing.clostridium difficile is a major cause of nosocomial diarrhea, with 30-day mortality reaching 30%. the cell surface comprises a paracrystalline proteinaceous s-layer encoded by the slpa gene within the cell wall protein (cwp) gene cluster. our purpose was to understand the diversity and evolution of slpa and nearby genes also encoding immunodominant cell surface antigens.201323204167
development of novel sugar isomerases by optimization of active sites in phosphosugar isomerases for monosaccharides.phosphosugar isomerases can catalyze the isomerization of not only phosphosugar but also of monosaccharides, suggesting that the phosphosugar isomerases can be used as sugar isomerases that do not exist in nature. determination of active-site residues of phosphosugar isomerases, including ribose-5-phosphate isomerase from clostridium difficile (cdrpi), mannose-6-phosphate isomerase from bacillus subtilis (bsmpi), and glucose-6-phosphate isomerase from pyrococcus furiosus (pfgpi), was accomplishe ...201323204422
immunisation of mares with binding domains of toxins a and b of clostridium difficile elicits serum and colostral antibodies that block toxin binding.enterocolitis caused by clostridium difficile (c. difficile) is a serious, sometimes fatal, disease of neonatal foals and older horses. toxins a and b (tcda and b) produced by c. difficile are important virulence factors. immunisation of mares with receptor binding domains of toxins may prevent or reduce the severity of c. difficile colitis in foals.201323206274
[preliminary investigation of intestinal microflora in patients with hepatic cirrhosis].to examine the differential levels of fecal bifidobacterium, bacteroides, eubacterium rectale-clostridium, escherichia coli, enterococcus, and clostridium difficile between patients with hepatic cirrhosis and healthy controls. fecal samples were collected from 29 patients with hepatic cirrhosis treated in the department of digestive diseases at zunyi hospital between march and december of 2010.201223206299
important clinical advances in the understanding of clostridium difficile infection.clostridium difficile remains an important cause of infectious colitis, particularly in healthcare facilities. this review summarizes recent advances in the epidemiology, diagnosis, and treatment of this endemic pathogen.201323207596
fidaxomicin inhibits toxin production in clostridium difficile.fidaxomicin, which was recently approved for the treatment of clostridium difficile-associated diarrhoea, demonstrates narrow-spectrum bactericidal activity via inhibition of rna polymerase. in this study we evaluated its inhibitory activity versus c. difficile toxin gene expression and toxin production by quantifying toxin mrna and protein.201323208832
[recommendations for diagnosis and therapy of colitis caused by clostridium difficile].clostridium difficile infection (cdi) is a disease of varying severity. its manifestations range from mild diarrhea to life-threatening paralytic ileus, painful distension of the large bowel and sepsis. another possible manifestation of the disease is recurrent colitis that can exhaust the patient. for establishing the diagnosis, the patient's stool should be examined with two or three different microbiological methods. immunochemical testing for the presence of clostridial toxins a and b shows ...201223208871
simultaneous detection of viral and bacterial enteric pathogens using the seeplex® diarrhea ace detection system.a panel of 223 faecal samples was analysed to determine the clinical utility of the seeplex® diarrhea ace detection multiplex pcr system (seeplex system; seegene, korea), a qualitative multiplexing pcr technology that enables simultaneous multi-pathogen detection of four viruses and/or ten bacteria associated with acute gastroenteritis. conventional diagnostic methods and a norovirus-specific multiplex real-time rt–pcr detected 98 pathogens in 96 samples. the seeplex system detected 81 pathogens ...201323211606
colonoscopic fecal microbiota transplant for recurrent clostridium difficile infection in a child. 201223211865
urinary tract infection in male veterans: treatment patterns and outcomes.lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. the optimal treatment duration and current treatment patterns for urinary tract infection (uti) in men are unknown. we used veterans affairs administrative data to study male uti treatment and outcomes.201323212273
development of clostridium difficile colitis in peritoneal dialysis patients treated for peritonitis. 201523212865
internal delorme's procedure for rectal outlet obstruction.the outcome of the internal delorme's procedure (idp) for obstructed defaecation was assessed.201323216880
adenosine a2a receptor activation reduces recurrence and mortality from clostridium difficile infection in mice following vancomycin treatment.activation of the a2a adenosine receptor (a2aar) decreases production of inflammatory cytokines, prevents c. difficile toxin a-induced enteritis and, in combination with antibiotics, increases survival from sepsis in mice. we investigated whether a2aar activation improves and a2aar deletion worsens outcomes in a murine model of c. difficile (strain vpi10463) infection (cdi).201223217055
kefir-isolated lactococcus lactis subsp. lactis inhibits the cytotoxic effect of clostridium difficile in vitro.kefir is a dairy product obtained by fermentation of milk with a complex microbial population and several health-promoting properties have been attributed to its consumption. in this work, we tested the ability of different kefir-isolated bacterial and yeast strains (lactobacillus kefir, lb. plantarum, lactococcus lactis subps. lactis, saccharomyces cerevisiae and kluyveromyces marxianus) or a mixture of them (mm) to antagonise the cytopathic effect of toxins from clostridium difficile (tcda and ...201323217732
characteristics of patients with clostridium difficile infection in taiwan.the medical records of 84 patients with stool cultures positive for clostridium difficile during the period august 2007 to june 2009 were retrospectively reviewed. a case of confirmed (toxigenic)c. difficile infection (cdi) was defined by the presence of symptoms (fever, diarrhoea, abdominal discomfort or distension, ileus) and the presence of toxigenic c. difficile. patients with compatible clinical symptoms and stool cultures positive for non-toxigenic c. difficile isolates were defined as pro ...201323218131
patient-days used for isolation in a community hospital.isolation of patients with known or suspected infection strains the resources of hospitals, but little information exists on the actual utilization of isolation beds.201323219671
implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic clostridium difficile infection rates.implementation of a hospital-wide program of terminal cleaning of patient rooms revolving around hydrogen peroxide vapor (hpv) technology and evaluation of its impact on endemic nosocomial clostridium difficile-associated diarrhea (cdad) have not been previously reported.201323219675
changing epidemiology of clostridium difficile-associated disease during stem cell transplantation.the incidence and severity of clostridium difficile-associated disease (cdad) within the general population has risen dramatically over the past decade, yet little data are available from hematopoietic stem cell transplantation (hsct) centers. in the present study, we performed a chart review of 822 consecutive autologous and allogeneic hcst recipients treated at northwestern memorial hospital between 2004 and 2008 to determine the incidence of cdad at our institution. variables including age, s ...201323219779
[acute clostridium difficile gastroenteritis at the department of infectious diseases].clostridium difficile infection is known as the primary cause of nosocomial gastroenteritis, which accounts for approximately 20-25% of all diarrhea. infection can lead to a potentially fatal disease and the incidence of that is increasing worldwide.201223220365
proton pump inhibitor use may be associated with an increased risk of clostridium difficile infection. 201323220471
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