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clostridium difficile toxin a inhibits erythropoietin receptor-mediated colonocyte focal adhesion through inactivation of janus kinase-2.previously, we demonstrated that the erythropoietin receptor (epor) is present on fibroblasts, where it regulates focal contact. here, we assessed whether this action of epor is involved in the reduced cell adhesion observed in colonocytes exposed to clostridium difficile toxin a. epor was present and functionally active in cells of the human colonic epithelial cell line ht29 and epithelial cells of human colon tissues. toxin a significantly decreased activating phosphorylations of epor and its ...201223221524
proline-dependent regulation of clostridium difficile stickland metabolism.clostridium difficile, a proteolytic gram-positive anaerobe, has emerged as a significant nosocomial pathogen. stickland fermentation reactions are thought to be important for growth of c. difficile and appear to influence toxin production. in stickland reactions, pairs of amino acids donate and accept electrons, generating atp and reducing power in the process. reduction of the electron acceptors proline and glycine requires the d-proline reductase (pr) and the glycine reductase (gr) enzyme com ...201323222730
emergence and global spread of epidemic healthcare-associated clostridium difficile.epidemic c. difficile (027/bi/nap1) has rapidly emerged in the past decade as the leading cause of antibiotic-associated diarrhea worldwide. however, the key events in evolutionary history leading to its emergence and the subsequent patterns of global spread remain unknown. here, we define the global population structure of c. difficile 027/bi/nap1 using whole-genome sequencing and phylogenetic analysis. we show that two distinct epidemic lineages, fqr1 and fqr2, not one as previously thought, e ...201323222960
physician attitudes toward the use of fecal transplantation for recurrent clostridium difficile infection in a metropolitan area. 201323223589
[why should antibiotic therapy be avoided in case of acute infectious diarrhea?].antibiotic prescription for acute diarrhea is not devoid of risks. there are individual risks for the patient, such as allergy, gastrointestinal side effects, clostridium difficile infection. there is also a risk of selection of antibiotic resistance in the digestive microbiota, leading to the emergence of multiresistant isolates such as extended-spectrum β-lactamase or carbapenemase producing enterobacteriaceae, which are able to disseminate worldwide. antibiotic prescriptions may thus be limit ...201323228474
nosocomial infections in leukemic and solid-tumor cancer patients: distribution, outcome and microbial spectrum of anaerobes.nosocomial infections cause significant morbidity and mortality in cancer patients. as a result of their debilitated immune system, cancer patients are likely candidates for colonization with anaerobes. we sought to compare the distribution of nosocomial infections in neutropenic and non-neutropenic cancer patients and to calculate the associated mortality rates.201223231490
fidaxomicin in the treatment of clostridium difficile-associated diarrhoea. 201323233241
concomitant clostridium difficile colitis and cytomegalovirus colitis in an immunocompetent elderly female.a 78-year-old japanese woman with diarrhoea and abdominal pain was admitted for pcr test (pcr)-proven clostridium difficile colitis. the patient's symptoms persisted despite multiple courses of antibiotics including intravenous metronidazole, oral  vancomycin and oral fidaxomicin. she underwent a stool transplant without improvement. biopsies from a colonoscopy revealed concomitant cytomegalovirus (cmv) infection. the patient was immediately started on intravenous ganciclovir. unfortunately, she ...201223234822
clostridium difficile toxin b causes epithelial cell necrosis through an autoprocessing-independent mechanism.clostridium difficile is the most common cause of antibiotic-associated nosocomial infection in the united states. c. difficile secretes two homologous toxins, tcda and tcdb, which are responsible for the symptoms of c. difficile associated disease. the mechanism of toxin action includes an autoprocessing event where a cysteine protease domain (cpd) releases a glucosyltransferase domain (gtd) into the cytosol. the gtd acts to modify and inactivate rho-family gtpases. the presumed importance of a ...201223236283
characterisation of clostridium difficile biofilm formation, a role for spo0a.clostridium difficile is a gram-positive anaerobic, spore-forming bacillus that is the leading cause of nosocomial diarrhoea worldwide. we demonstrate that c. difficile aggregates and forms biofilms in vitro on abiotic surfaces. these polymicrobial aggregates are attached to each other and to an abiotic surface by an extracellular polymeric substance (eps). the eps matrix provides the scaffold bonding together vegetative cells and spores, as well as forming a protective barrier for vegetative ce ...201223236376
association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.emerging epidemiological evidence suggests that proton pump inhibitor (ppi) acid-suppression therapy is associated with an increased risk of clostridium difficile infection (cdi).201223236397
cd44 promotes intoxication by the clostridial iota-family toxins.various pathogenic clostridia produce binary protein toxins associated with enteric diseases of humans and animals. separate binding/translocation (b) components bind to a protein receptor on the cell surface, assemble with enzymatic (a) component(s), and mediate endocytosis of the toxin complex. ultimately there is translocation of a component(s) from acidified endosomes into the cytosol, leading to destruction of the actin cytoskeleton. our results revealed that cd44, a multifunctional surface ...201223236484
using a dog's superior olfactory sensitivity to identify clostridium difficile in stools and patients: proof of principle study.to investigate whether a dog's superior olfactory sensitivity can be used to detect clostridium difficile in stool samples and hospital patients.201223241268
recent trends in the epidemiology and treatment of c. difficile infection in children.clostridium difficile is the most common cause of healthcare-associated diarrhea among adults in western countries, and is increasingly recognized as an important pathogen in children. this review provides an update on the changing epidemiology of c. difficile infection (cdi) for pediatric providers and summarizes current knowledge regarding available therapies.201323241874
pang, a new ketopantoate reductase involved in pantothenate synthesis.pantothenate, commonly referred to as vitamin b(5), is an essential molecule in the metabolism of living organisms and forms the core of coenzyme a. unlike humans, some bacteria and plants are capable of de novo biosynthesis of pantothenate, making this pathway a potential target for drug development. francisella tularensis subsp. tularensis schu s4 is a zoonotic bacterial pathogen that is able to synthesize pantothenate but is lacking the known ketopantoate reductase (kpr) genes, pane and ilvc, ...201323243306
a systematic evaluation of methods to optimize culture-based recovery of clostridium difficile from stool specimens.with the increasing prevalence of clostridium difficile infection among hospitalized patients, a clear understanding of c. difficile epidemiology is needed to evaluate current prevention policies, and to create new and effective policies. to determine the epidemiology of c. difficile, the most sensitive methods for detection of c. difficile are required. the purpose of this study was to systematically assess multiple methods to determine the most sensitive method to recover c. difficile from sto ...201323247066
infection: understanding how clostridium difficile infection in health-care settings spread around the world. 201323247509
a cohort study for derivation and validation of a clinical prediction scale for hospital-onset clostridium difficile infection.to develop and validate a clinical prediction scale for hospital-onset clostridium difficile infection (cdi).201223248788
letter: clostridium difficile colitis in patients with ulcerative colitis. 201323252787
surveillance for clostridium difficile infection in nursing homes.to define the time of onset of clostridium difficile infection (cdi) in the community nursing home setting.201323253029
[acute infectious diarrhea in adults: epidemiology and management].acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days. more than three millions cases of acute diarrhea, presumably due to intestinal infections, are seen in general practice every year in france. most of the cases are benign and resolve under symptomatic treatment within 3 days, without need for biological tests or antibiotics. in special contexts (septicemic syndrome, visible blood in stools, severe dehydratio ...201323253255
epidemiology, diagnosis and treatment of clostridium difficile infection.clostridium difficile infection (cdi) is considered to be the main cause of bacterial infectious diarrhea in nosocomial settings. since the beginning of the new century a continuous rise in the incidence of severe cdi has been observed worldwide. even though some cdi cases are not associated with previous antibiotic exposure, this remains as the principal risk factor for the development of cdi. the rate of recurrences represents perhaps one the most challenging aspect on the management of cdi. t ...201223253319
which are the antibodies to watch in 2013?the start of the new year signals that it is time for mabs' annual review of the therapeutic monoclonal antibodies (mabs) in active phase 2/3 or phase 3 clinical studies. the entire clinical pipeline currently includes ~350 mabs, but most of these are in early development. as of the beginning of 2013, our "antibodies to watch" list includes 28 single mabs and one mab mixture that are undergoing evaluation in phase 3 studies for inflammatory or immunological disorders, cancers, high cholesterol, ...201623254906
microbial ecosystems therapeutics: a new paradigm in medicine?increasing evidence indicates that the complex microbial ecosystem of the human intestine plays a critical role in protecting the host against disease. this review discusses gut dysbiosis (here defined as a state of imbalance in the gut microbial ecosystem, including overgrowth of some organisms and loss of others) as the foundation for several diseases, and the applicability of refined microbial ecosystem replacement therapies as a future treatment modality. consistent with the concept of a 'co ...201323257018
influence of environmental conditions on the expression and the maturation process of the clostridium difficile surface associated protease cwp84.expression of the clostridium difficile protease gene, cwp84, was moderately up-regulated by decreasing ph due to glucose metabolism. purification under different ph conditions influenced the proteolytic process of cwp84. given this, acidic ph could favor the appearance of different forms of cwp84 that may have different roles during the infection.201323257307
microevolutionary analysis of clostridium difficile genomes to investigate transmission.the control of clostridium difficile infection is a major international healthcare priority, hindered by a limited understanding of transmission epidemiology for these bacteria. however, transmission studies of bacterial pathogens are rapidly being transformed by the advent of next generation sequencing.201223259504
clostridium difficile 027 infection in central italy.clostridium difficile (cd) has increasingly become recognised as a significant international health burden, often associated with the healthcare environment. the upsurge in incidence of cd coincided with the emergence of a hypervirulent strain of cd characterized as 027. in 2010, 8 cases of cd 027 infections were identified in italy. since then, no further reports have been published. we describe 10 new cases of cd 027 infection occurring in italy.201223259814
[when should request a stool culture?].a stool culture needs a medical prescription and is justified only in a case of clearly defined acute diarrhea. the clinical context must be suggestive of a bacterial etiology. the detection of the bacterial agents has to follow a well-defined strategy to optimize a rigorous prescription. standardized stool culture is for patients treated in medical community practice and for patients hospitalized for less than 3 days. clostridium difficile toxin testing is systematically performed in case of no ...201323260762
clostridium difficile flagellin stimulates toll-like receptor 5, and toxin b promotes flagellin-induced chemokine production via tlr5.clostridium difficile is an important pathogen in nosocomial infections. although c. difficile toxins are considered to be major virulence factors, pathogenesis of c. difficile associated diseases remains to be determined. in this study, we investigated whether c. difficile flagellin is involved in the pathogenesis of c. difficile-associated diseases.201323261530
[successful treatment of life-threatening, treatment resistant clostridium difficile infection associated pseudomembranous colitis with faecal transplantation].due to world-wide spread of hypervirulent and antibiotic resistant clostridium difficile strains, the incidence of these infections are dramatically increasing in hungary with appalling mortality and recurrence rates. authors present a case of a 59-year-old patient who developed a severe, relapsing pseudomembranous colitis after antibiotic treatment. life-threatening symptoms of fulminant colitis were successfully treated with prolonged administration of metronidazole and vancomycin, careful sup ...201223261996
risk factors for recurrence of clostridium difficile-associated diarrhoea.clostridium difficile associated disease (cdad) is one of the most common causes of hospital-acquired diarrhea. despite increasing incidence of clostridium difficile-associated diarrhea, there are few data on risk factors associated with its relapse.201323262313
mapk-activated protein kinase 2 contributes to clostridium difficile-associated inflammation.clostridium difficile infection (cdi) results in toxin-induced epithelial injury and marked intestinal inflammation. fecal markers of intestinal inflammation correlate with cdi disease severity, but regulation of the inflammatory response is poorly understood. previous studies demonstrated that c. difficile toxin tcda activates p38 kinase in tissue culture cells and mouse ilium, resulting in interleukin-8 (il-8) release. here, we investigated the role of phosphorylated mitogen-activated protein ...201223264053
the membrane as a target for controlling hypervirulent clostridium difficile infections.the stationary phase of clostridium difficile, which is primarily responsible for diarrhoeal symptoms, is refractory to antibiotic killing. we investigated whether disrupting the functions of the clostridial membrane is an approach to control c. difficile infections by promptly removing growing and non-growing cells.201323264511
local injection of dsrna targeting calcitonin receptor-like receptor (clr) ameliorates clostridium difficile toxin a-induced ileitis.enteritis caused by clostridium difficile toxin (tx) is a nosocomial disease of increasing clinical concern, but the local mediators of c. difficile txa inflammation are unknown. the potent vasodilator calcitonin gene-related peptide mediates neurogenic inflammation via the calcitonin receptor-like receptor (clr). here we examined the ileum-specific effects of reducing clr on txa ileitis by local preinjection of double-stranded rnas. treatment with clr dsrna for 7 d decreased clr immunoreactivit ...201323267070
clostridium difficile healthcare-associated epidemics. 201323268129
performance of clostridium difficile toxin enzyme immunoassay and nucleic acid amplification tests stratified by patient disease severity.many clinical laboratories in the united states are transitioning from toxin enzyme immunoassays (eia) to nucleic acid amplification tests (naats) as the primary diagnostic test for clostridium difficile infection (cdi). while it is known that the analytical sensitivity of the toxin eia is poor, there are limited clinical data on the performance of these assays for patients with mild or severe cdi. two hundred ninety-six hospital inpatients with diarrhea and clinical suspicion for cdi were teste ...201323269736
evaluation of the chromogenic agar chromid c. difficile.three selective media (chromid c. difficile agar, taurocholate cycloserine cefoxitin agar [tcca; homemade], and clo medium) were compared from 406 stool samples of patients suspected of having clostridium difficile infection. the sensitivities of chromid c. difficile agar at 24 h and 48 h, clo medium, and tcca were 74.1%, 87%, 85.2%, and 70.4%, respectively.201323269743
a genomic analysis of clostridium difficile infections in blunt trauma patients.evidence demonstrates that susceptibility to clostridium difficile infection is related to host risk factors as much as bacterial potency. using blood leukocyte genome-wide expression patterns of severe blunt trauma patients obtained by the national institute of general medical sciences-sponsored glue grant inflammation and the host response to injury, we examined leukocyte genomic profiles of patients with c. difficile infection to determine preinfection and postinfection gene expression change ...201323271108
[detailed methodological recommendations for the treatment of clostridium difficile-associated diarrhea with faecal transplantation].the incidence of clostridium difficile associated enteral disease shows dramatic increase worldwide, with appallingly high treatment costs, mortality figures, recurrence rates and treatment refractoriness. it is not surprising, that there is significant interest in the development and introduction of alternative therapeutic strategies. among these only stool transplantation (or faecal bacteriotherapy) is gaining international acceptance due to its excellent cure rate (≈92%), low recurrence rate ...201323274229
approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant staphylococcus aureus.a restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. monthly consumption of nine antibiotics was monitored in defined daily doses (ddds) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. hospital-acquired clostridium difficile, meticillin-resistant staphylococcus aureus (mrsa) and extended-spectrum β-lactamase (esbl)-p ...201223276500
clostridium difficile infection in infants and children.infections caused by clostridium difficile in hospitalized children are increasing. the recent publication of clinical practice guidelines for c difficile infection in adults did not address issues that are specific to children. the purpose of this policy statement is to provide the pediatrician with updated information and recommendations about c difficile infections affecting pediatric patients.201323277317
clostridium difficile infection in travelers--a neglected pathogen?until recently, clostridium difficile infection (cdi) has been mostly diagnosed in hospitalized elderly patients treated with antibacterial agents. the epidemiology of c difficile is changing as the ribotype 027 strain is spreading worldwide, and more infections are diagnosed in patients residing in the community. although only few data about the epidemiology of cdi in developing countries are available, a number of reports seem to indicate that the incidence of cdi may be high in some such coun ...201323279229
infections following facial composite tissue allotransplantation--single center experience and review of the literature.we reviewed medical records of all patients (n = 4) who underwent facial composite tissue allotransplantation (fcta) at our center between april 2009 and may 2011; data were censored in june 2012. we searched for fcta publications and reviewed them for infectious complications and prophylaxis strategies. three patients received full and one partial fcta at our institution. two recipients were cytomegalovirus (cmv) donor (d)+/recipient (r)- and two cmv d+/r+. perioperative prophylaxis included va ...201323279299
an economic evaluation of clostridium difficile infection management in an italian hospital environment.clostridium difficile infection (cdi) accounts for the majority of nosocomial cases of diarrhea, and with recent upsurge of multidrug-resistant strains, morbidity and mortality have increased. data on clinical impact of cdi come mostly from anglo-saxon countries, while in italy only two studies address the issue and no economic data exist on costs of cdi in the in hospital setting. a retrospective cross-sectional study with pharmacoeconomic analysis was performed on the cdi series of the policli ...201223280031
[report: clostridium difficile outbreak at the dr. alejandro del río emergency hospital in santiago, chile]. 201223282496
cell death and clostridium difficile toxins: the murder weapon uncovered. 199723282760
[assessment of the usefulness of chromogenic medium for the isolation of clostridium difficile from the gastrointestinal tract of children with diarrhoea].clostridium difficile is well known as an important cause of nosocomial infection. laboratory diagnostics have included bacterial culture or more commonly, direct detection of preformed toxin in stool samples using different assays. the aim of this study was to evaluate and compare two selecitve media to isolation of c. difficile from paediatric diarrhoeal stool samples.201223285773
the c-di-gmp recognition mechanism of the pilz domain of bacterial cellulose synthase subunit a.in some proteobacteria and firmicutes such as pseudomonas aeruginosa, vibrio cholerae, xanthomonas campestris, and clostridium difficile, cyclic dimeric guanosine monophosphate (c-di-gmp) is known to regulate cellular processes, including motility, biofilm formation, and virulence, as a second messenger. cellulose production in acetobacter xylinum, a model organism of cellulose biosynthesis, also depends on by cellular c-di-gmp level. in cellulose-synthesizing bacteria, a terminal complex locali ...201323291177
clostridium difficile progress lags other infection-control goals. 201323292259
spoiva and sipl are clostridium difficile spore morphogenetic proteins.clostridium difficile is a major nosocomial pathogen whose infections are difficult to treat because of their frequent recurrence. the spores of c. difficile are responsible for these clinical features, as they resist common disinfectants and antibiotic treatment. although spores are the major transmissive form of c. difficile, little is known about their composition or morphogenesis. spore morphogenesis has been well characterized for bacillus sp., but bacillus sp. spore coat proteins are poorl ...201323292781
prevention of hospital-onset clostridium difficile infection in the new york metropolitan region using a collaborative intervention model.the incidence, severity, and associated costs of clostridium difficile (c. difficile) infection (cdi) have dramatically increased in hospitals over the past decade, indicating an urgent need for strategies to prevent transmission of c. difficile. this article describes a multifaceted collaborative approach to reduce hospital-onset cdi rates in 35 acute care hospitals in the new york metropolitan region. hospitals participated in a comprehensive cdi reduction intervention and formed interdiscipli ...201423294050
mortality and clostridium difficile infection in an australian setting.to quantify the risk of death associated with clostridium difficile infection, in an australian tertiary hospital.201323294464
unnecessary antimicrobial use in patients with current or recent clostridium difficile infection.to determine the fraction of unnecessary antimicrobial use among patients with current and/or recent clostridium difficile infection (cdi).201323295554
clostridium difficile infection and limitations of markers for severity in patients with hematologic malignancy.to describe characteristics of clostridium difficile infection (cdi) and markers of severe cdi among patients with hematologic malignancies.201323295558
the changing faces of clostridium difficile: a personal reflection of the past 34 years.late in 1978 my boss gave me a folder with "clostridium difficile (diffikilé)" written on it. inside were a few recent and now classic papers by bartlett, larson and co. it was suggested that this might be an interesting research topic. so began a continuing adventure which has resulted in at least 50 publications from my group. over the years we have made several important contributions to the field. beginning in 1982 we showed that c. difficile was a common cause of community-acquired infectio ...201323296302
proteomic comparison of historic and recently emerged hypervirulent clostridium difficile strains.clostridium difficile in recent years has undergone rapid evolution and has emerged as a serious human pathogen. proteomic approaches can improve the understanding of the diversity of this important pathogen, especially in comparing the adaptive ability of different c. difficile strains. in this study, tmt labeling and nanolc-ms/ms driven proteomics were used to investigate the responses of four c. difficile strains to nutrient shift and osmotic shock. we detected 126 and 67 differentially expre ...201323298230
all-cause and disease-specific mortality in hospitalized patients with clostridium difficile infection: a multicenter cohort study.mortality among patients with clostridium difficile infection (cdi) is high. because of high age and multiple underlying diseases, cdi-related mortality is difficult to estimate. we estimated cdi-related mortality in an endemic situation, not influenced by outbreaks and consequently certain patients and c. difficile strains.201323300235
five years experience of clostridium difficile infection in children at a uk tertiary hospital: proposed criteria for diagnosis and management.clostridium difficile infection (cdi) is associated with significant morbidity and mortality in adults. there is increasing evidence of the pathogenic role of c. difficile in the paediatric population. we sought to ascertain the clinical presentation and severity of cdi in children at our institution and develop criteria to aid management.201223300561
clostridium difficile tcdc protein binds four-stranded g-quadruplex structures.clostridium difficile infections are increasing worldwide due to emergence of virulent strains. infections can result in diarrhea and potentially fatal pseudomembranous colitis. the main virulence factors of c. difficile are clostridial toxins tcda and tcdb. transcription of the toxins is positively regulated by the sigma factor tcdr. negative regulation is believed to occur through tcdc, a proposed anti-sigma factor. here, we describe the biochemical properties of tcdc to understand the mechani ...201323303781
phenome based analysis as a means for discovering context dependent clinical reference ranges.robust electronic medical records (emr's) have made large-scale phenome-based analysis feasible. the context-dependent phenome of a large icu-based emr database (mimic ii) was explored, as a function of a clinical feature: white blood cell count (wbc). phenome visualization led to the discovery that peak wbc in the range 15-45 k/μl was highly associated with the diagnoses of clostridium difficile and bacterial sepsis; thus, it is conceivable that clinicians might delay ordering targeted antimicr ...201223304424
in recurrent c. difficile, the crp response to the primary c. difficile infection predicts whether the same strain or a different strain will cause a second infection.clostridium difficile is the leading cause of antibiotic-associated diarrhoea and is associated with an increase in morbidity and mortality. there is a wide variance in disease severity with some patients suffering a single, self-limiting episode of diarrhoea while others suffer more intractable problems with recurrent attacks or toxic dilatation. numerous different c. difficile ribotypes exist, some of which are considered hypervirulent. the magnitude of toxin production alone is not sufficient ...201323306854
using rapid diagnostic tests to optimize antimicrobial selection in antimicrobial stewardship programs.new advances in rapid diagnostic tests provide several collaborative opportunities for stewardship teams, particularly in processes where delay in the initiation of appropriate therapy has significant consequences for patient outcomes. rapid molecular tests enhance one of the key functions of microbiology laboratories, which is to produce accurate organism identification and timely antimicrobial susceptibility testing data. these data are used to guide the choice of antimicrobial agents for trea ...201223307517
characterization of continued antibacterial therapy after diagnosis of hospital-onset clostridium difficile infection: implications for antimicrobial stewardship.to determine the proportion of hospitalized adults with hospital-onset clostridium difficile infection (cdi) who continued to receive concomitant non-cdi antibacterial agents, to characterize the antibacterial therapy that these patients received before and after the diagnosis of cdi, and to compare hospital outcomes between those patients who did and those who did not have their previous antibacterial therapy discontinued after cdi diagnosis.201223307522
understanding gut-immune interactions in management of acute infectious diarrhoea.this article discusses the role that immunity plays in the risk of diarrhoea and the potential role for probiotics in the management of acute infectious diarrhoea in older people, including antibiotic-associated diarrhoea and clostridium difficile-associated diarrhoea.201223311278
incidence and risk factors for hospital-acquired clostridium difficile infection among inpatients in an orthopaedic tertiary care hospital.the aim of this retrospective study was to identify risk factors for hospital-acquired clostridium difficile infection (ha-cdi) in orthopaedic patients. thirty-two ha-cdi cases were each matched with two controls. incidence rate was 0.33 cases per 1000 patient-days. univariate analyses showed that surgery >24 h after admission, antibiotics for treatment, and proton pump inhibitors were associated with ha-cdi. multivariate analyses revealed that surgery >24 h after admission was associated with h ...201323313026
lack of clostridium difficile infection in patients treated with rifaximin for hepatic encephalopathy: a retrospective analysis.the purpose of this study was to assess the incidence of clostridium difficile infection in patients who received rifaximin for the treatment of hepatic encephalopathy (he).201323314671
unusual localization of clostridium difficile infection in an isolated segment of the descending colon in a critical care patient.unrecognized severe pseudomembranous colitis may become life threatening. a typical clostridium difficile infection is associated with involvement of the colon; however, small bowel disease has also been described. here, we present a case of a 48-year-old man with clostridium difficile colitis of an isolated segment in the descending colon treated by a novel catheter intraluminal antibiotic irrigation. the intraluminal antibiotic irrigation was performed through a foley catheter inserted into th ...201223316409
the rise of clostridium difficile infection in lung transplant recipients in the modern era.clostridium difficile infection (cdi) rates have been rising in recent years. we aimed to characterize cdi in lung transplant recipients in the modern era and hypothesized that cdi would increase the mortality risk.201323316931
american journal of gastroenterology lecture: intestinal microbiota and the role of fecal microbiota transplant (fmt) in treatment of c. difficile infection.the vital roles that intestinal flora, now called microbiota, have in maintaining our health are being increasingly appreciated. starting with birth, exposure to the outside world begins the life-long intimate association our microbiota will have with our diet and environment, and initiates determination of the post-natal structural and functional maturation of the gut. moreover, vital interactions of the microbiota with our metabolic activities, as well as with the immunological apparatus that ...201323318479
proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis.critically ill patients may develop bleeding caused by stress ulceration. acid suppression is commonly prescribed for patients at risk of stress ulcer bleeding. whether proton pump inhibitors are more effective than histamine 2 receptor antagonists is unclear.201323318494
the intestinal microbiota dysbiosis and clostridium difficile infection: is there a relationship with inflammatory bowel disease?gut microbiota is a compilation of microorganisms dwelling in the entire mammalian gastrointestinal tract. they display a symbiotic relationship with the host contributing to its intestinal health and disease. even a slight fluctuation in this equipoise may be deleterious to the host, leading to many pathological conditions like clostridium difficile infection or inflammatory bowel disease (ibd). in this review, we focus on the role of microbial dysbiosis in initiation of c. difficile infection ...201323320050
hemolytic uremic syndrome associated with clostridium difficile infection.we report 3 cases of clostridium difficile-associated hemolytic uremic syndrome (hus) with biopsy proven renal thrombotic microangiopathy. two patients with acute renal failure were kidney transplants recipients whereas the third patient developed renal failure in the native kidneys. the presentation was preceded by acute diarrhea and stool. clostridium difficile toxin was detected in all the 3 patients. stool studies were negative for escherichia coli, shigella dysenteriae and other enteric pat ...201423320969
duodenal infusion of donor feces for recurrent clostridium difficile.recurrent clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. we studied the effect of duodenal infusion of donor feces in patients with recurrent c. difficile infection.201323323867
a mixture of functionally oligoclonal humanized monoclonal antibodies that neutralize clostridium difficile tcda and tcdb with high levels of in vitro potency shows in vivo protection in a hamster infection model.clostridium difficile infections are a major cause of antibiotic-associated diarrhea in hospital and care facility patients. in spite of the availability of effective antibiotic treatments, c. difficile infection (cdi) is still a major cause of patient suffering, death, and substantial health care costs. clostridium difficile exerts its major pathological effects through the actions of two protein exotoxins, tcda and tcdb, which bind to and disrupt gut tissue. antibiotics target the infecting ba ...201323324518
clostridium difficile in foods and animals: history and measures to reduce exposure.many articles have summarized the changing epidemiology of clostridium difficile infections (cdi) in humans, but the emerging presence of c. difficile in foods and animals and possible measures to reduce human exposure to this important pathogen have been infrequently addressed. cdis have traditionally been assumed to be restricted to health-care settings. however, recent molecular studies indicate that this is no longer the case; animals and foods might be involved in the changing epidemiology ...201323324529
postoperative antibacterial prophylaxis for the prevention of infectious complications associated with tube thoracostomy in patients undergoing elective general thoracic surgery: a double-blind, placebo-controlled, randomized trial.to determine whether extended postoperative antibacterial prophylaxis for patients undergoing elective thoracic surgery with tube thoracostomy reduces the risk of infectious complications compared with preoperative prophylaxis only.201323325435
clinical and microbiological profile of hiv/aids cases with diarrhea in north india.intestinal infections are a significant cause of morbidity and mortality in people living with hiv/aids (plwha) especially in developing countries. the present study was conducted to assess the clinical and microbiological spectrum in hiv/aids cases with diarrhea and to correlate the occurrence of such pathogens with stool characters, hiv seropositivity status, and cd4 counts. stools from 154 hiv seropositive subjects and 50 hiv negative controls were examined by direct microscopy, fecal culture ...201223326669
risk factors and outcome of pcr-detected clostridium difficile infection in ileal pouch patients.the clinical implication of clostridium difficile infection (cdi) in patients with ileal pouch-anal anastomosis (ipaa) for underlying inflammatory bowel disease (ibd) has not been well studied. this study was designed to investigate the cumulative incidence, risk factors, and outcome of cdi in patients with ileal pouches.201323328770
rifaximin: recent advances in gastroenterology and hepatology.rifaximin was initially developed for the treatment of bacteria-related diarrhea, but appreciation of its potentially broader use has increased as understanding of the importance of enteric bacteria in many organic and functional gastrointestinal diseases has advanced. this article reviews data that have been presented at medical meetings or published in medical journals since the publication of a 2006 rifaximin review in this journal. the data presented expand previous research, suggesting that ...200723329908
[the effect of clostridium difficile infection on length of hospital stay. a cohort study].clostridium difficile is responsible for a spectrum of diseases known as "clostridium difficile infection" (cdi). it is currently the leading cause of nosocomial diarrhea in developed countries. this infection has been associated with both increased hospital stay and mortality, and to a greater likelihood of readmission. in our country these undesirable effects have not yet been characterized. our objective was to quantify the increase in hospital stay attributable to infection by c.difficile.201323332449
ecological impact of doxycycline at low dose on normal oropharyngeal and intestinal microflora.this study included 34 healthy volunteers (16 male and 18 female) aged 19-37 years, of whom 17 received doxycycline 40 mg capsules orally once daily (o.d.) and 17 received placebo 40 mg capsules orally o.d. for 16 weeks. plasma, saliva and faecal samples were collected before drug administration and at 4, 8, 16 and 20 weeks. plasma samples were assayed for doxycycline concentrations, and saliva and faecal samples were investigated for doxycycline concentrations and microbiological analyses. plas ...201323332619
high-throughput dna sequence analysis reveals stable engraftment of gut microbiota following transplantation of previously frozen fecal bacteria.fecal microbiota transplantation (fmt) is becoming a more widely used technology for treatment of recurrent clostridum difficile infection (cdi). while previous treatments used fresh fecal slurries as a source of microbiota for fmt, we recently reported the successful use of standardized, partially purified and frozen fecal microbiota to treat cdi. here we report that high-throughput 16s rrna gene sequencing showed stable engraftment of gut microbiota following fmt using frozen fecal bacteria fr ...201623333862
functional characterization of clostridium difficile spore coat proteins.spores of clostridium difficile play a key role in the dissemination of this important human pathogen, and until recently little has been known of their functional characteristics. genes encoding six spore coat proteins (cota, cotb, cotcb, cotd, cote, and soda) were disrupted by clostron insertional mutagenesis. mutation of one gene, cota, presented a major structural defect in spore assembly, with a clear misassembly of the outermost layers of the spore coat. the cota protein is most probably s ...201323335421
impact of clostridium difficile colitis following closure of a diverting loop ileostomy: results of a matched cohort study.previous reports describing clostridium difficile colitis (cdc) developing after the closure of a loop ileostomy suggest it is severe. in this study the incidence of cdc following ileostomy closure and its effect on the postoperative outcome have been studied.201323336347
length of stay and mortality due to clostridium difficile infection acquired in the intensive care unit.the purpose of this study was to determine the attributable intensive care unit (icu) and hospital length of stay and mortality of icu-acquired clostridium difficile infection (cdi).201323337482
antimicrobial susceptibilities of clostridium difficile isolated in japan.clostridium difficile is a common causative organism of antimicrobial-associated diarrhea and is often responsible for nosocomial infection. c. difficile infection has traditionally been treated with metronidazole (mnz) or vancomycin (vcm); however, mnz-resistant strains have reported in some countries. in this study the broth microdilution method was used to determine the minimum inhibitory concentrations (mics) of 15 drugs against 157 clinical isolates of c. difficile in japan. all c. difficil ...201323338015
rifaximin in the treatment of irritable bowel syndrome: is there a high risk for development of antimicrobial resistance?irritable bowel syndrome (ibs), a chronic, nonfatal illness is commonly encountered in clinical practice; however, treatment options are limited and often ineffectual. despite this, there is increasing evidence that bacterial overgrowth in the bowel (dysbiosis) may be an etiological factor in ibs. this has lead to studies in which the antibiotic agent rifaximin has been used to reduce the microbial burden in the bowel, to some extent alleviating the symptoms of ibs. rifaximin is a member of the ...201323340064
inpatient diarrhoea and clostridium difficile infection. 201223342416
identification of novel host-targeted compounds that protect from anthrax lethal toxin-induced cell death.studying how pathogens subvert the host to cause disease has contributed to the understanding of fundamental cell biology. bacillus anthracis, the causative agent of anthrax, produces the virulence factor lethal toxin to disarm host immunity and cause pathology. we conducted a phenotypic small molecule screen to identify inhibitors of lethal toxin-induced macrophage cell death and used an ordered series of secondary assays to characterize the hits and determine their effects on cellular function ...201323343607
donor faeces for recurrent clostridium difficile diarrhoea? 201323344312
difference in f-actin depolymerization induced by toxin b from the clostridium difficile strain vpi 10463 and toxin b from the variant clostridium difficile serotype f strain 1470.clostridium difficile toxin a (tcda) and toxin b (tcdb) are the causative agent of the c. difficile-associated diarrhea (cdad) and its severe form, the pseudomembranous colitis (pmc). tcdb from the c. difficile strain vpi10463 mono-glucosylates (thereby inactivates) the small gtpases rho, rac, and cdc42, while toxin b from the variant c. difficile strain serotype f 1470 (tcdbf) specifically mono-glucosylates rac but not rho(a/b/c). tcdbf is related to lethal toxin from c. sordellii (tcsl) that g ...201323344455
an unexpected ct finding in a patient with abdominal pain.a fit and well 16-year-old girl presented to the emergency department with signs and symptoms suggestive of appendicitis. a transabdominal ultrasound scan revealed a normal appendix but there was significant free fluid in the pelvis. consequently, a ct scan of her abdomen was performed which showed mucosal oedema and inflammation involving virtually the entire length of her large bowel (the 'accordion sign'). clostridium difficile colitis was thus suspected; however, the toxin was not detected i ...201323345475
pseudomembranous colitis due to clostridium difficile as a cause of perineal necrotising fasciitis.although rare, pseudomembranous colitis may be a cause of perineal necrotising fasciitis in a context of immunosuppression, as in the case we report. this origin must be quickly identified because the therapeutic management, especially surgery, is unlikely to be the same as usual. similarly, antibiotic treatment is also a matter of discussion due to the potential deleterious role of antibiotics in pseudomembranous colitis.201323345501
atypical presentation of pseudomembranous colitis localized in adenomatous polyps.the most frequent cause of pseudomembranous colitis is clostridium difficile (c. difficile) infection. this type of colitis is characterized by an endoscopic pattern of numerous small, yellowish or whitish plaques diffusely distributed, which typically compromises the rectum extending to proximal colon. occasionally, the pseudomembranes compromise only the transverse or right colon, but their exclusive localization over polyps has not been reported. in this case report we have described a patien ...201323345958
characterization of a stable, metronidazole-resistant clostridium difficile clinical isolate.clostridium difficile are gram-positive, spore forming anaerobic bacteria that are the leading cause of healthcare-associated diarrhea, usually associated with antibiotic usage. metronidazole is currently the first-line treatment for mild to moderate c. difficile diarrhea however recurrence occurs at rates of 15-35%. there are few reports of c. difficile metronidazole resistance in the literature, and when observed, the phenotype has been transient and lost after storage or exposure of the bacte ...201323349739
activate to eradicate: inhibition of clostridium difficile spore outgrowth by the synergistic effects of osmotic activation and nisin.germination is the irreversible loss of spore-specific properties prior to outgrowth. because germinating spores become more susceptible to killing by stressors, induction of germination has been proposed as a spore control strategy. however, this strategy is limited by superdormant spores that remain unaffected by germinants. harsh chemicals and heat activation are effective for stimulating germination of superdormant spores but are impractical for use in a hospital setting, where clostridium d ...201323349961
is colectomy for fulminant clostridium difficile colitis life saving? a systematic review.it is unclear whether colectomy for fulminant clostridium difficile colitis (fcdc) leads to a improvement in survival compared with continued medical therapy for this moribund population.201323350898
mixed infection by clostridium difficile in an in vitro model of the human gut.clostridium difficile infection (cdi) is still a major clinical challenge. previous studies have demonstrated multiple distinct c. difficile strains in the faeces of patients with cdi; yet whether true mixed cdi occurs in vivo is unclear. in this study we evaluated whether two distinct c. difficile strains could co-germinate and co-proliferate in an in vitro human gut model.201323354280
length of stay and hospital costs among high-risk patients with hospital-origin clostridium difficile-associated diarrhea.hospital-onset clostridium difficile-associated diarrhea (ho-cdad) has been associated with longer length of stay (los) and higher hospital costs among patients in general. the burden of ho-cdad is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [ibd]), and those with concomitant antibiotic (cabx) use during treatment for cdad.201323356421
clostridium difficile infection: real or fake--faecal matter does the trick for recurrent cdi. 201323358398
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