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a segment of 97 amino acids within the translocation domain of clostridium difficile toxin b is essential for toxicity.clostridium difficile toxin b (tcdb) intoxicates target cells by glucosylating rho gtpases. tcdb (269 kda) consists of at least 4 functional domains including a glucosyltransferase domain (gtd), a cysteine protease domain (cpd), a translocation domain (td), and a receptor binding domain (rbd). the function and molecular mode of action of the td, which is the largest segment of tcdb and comprises nearly 50% of the protein, remain largely unknown. here we show that a 97-amino-acid segment (aa1756 ...201323484044
glutamine and alanyl-glutamine increase rhoa expression and reduce clostridium difficile toxin-a-induced intestinal epithelial cell damage.clostridium difficile is a major cause of antibiotic-associated colitis and is associated with significant morbidity and mortality. glutamine (gln) is a major fuel for the intestinal cell population. alanyl-glutamine (ala-gln) is a dipeptide that is highly soluble and well tolerated. iec-6 cells were used in the in vitro experiments. cell morphology was evaluated by atomic force microscopy (afm) and scanning electron microscopy (sem). cell proliferation was assessed by wst-1 and ki-67 and apopto ...201223484083
portal vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity.portal vein thrombosis has been documented after laparoscopic general surgery and has been uncommonly observed after laparoscopic bariatric surgery. among bariatric operations, the sleeve gastrectomy is being performed with ever-increasing frequency. here we report the case of a man who presented with portal vein thrombosis after laparoscopic sleeve gastrectomy.201223484577
markers of intestinal inflammation, not bacterial burden, correlate with clinical outcomes in clostridium difficile infection.clostridium difficile is a leading hospital-acquired infection. many patients remain symptomatic for several days on appropriate antibiotic therapy. to assess the contribution of ongoing infection vs persistent inflammation, we examined the correlation between fecal cytokine levels, fecal c. difficile burden, and disease outcomes in c. difficile infection (cdi).201323487367
the role of gut inflammation in recurrent clostridium difficile-associated disease. 201323487370
understanding factors that impact on health care professionals' risk perceptions and responses toward clostridium difficile and meticillin-resistant staphylococcus aureus: a structured literature review.clostridium difficile is the most common health care-associated infection. despite considerable efforts to prevent and manage c difficile, poor clinical practice and nonadherence to policy continues to compromise patient safety. risk perception research is essential in gaining understanding about how health care professionals respond.201323489738
current role of surgery for the treatment of fulminant clostridium difficile colitis.this review discusses the current status and progress in studies on fulminant clostridium difficile colitis (fcdc), including the definition, risk factor, diagnostic role of ct, surgical treatment, postoperative mortality, and new therapeutic strategy.201323489808
clostridium difficile in faeces from healthy dogs and dogs with diarrhea.this study was conducted to evaluate the faecal occurrence and characterization of clostridium difficile in clinically healthy dogs (n = 50) and in dogs with diarrhea (n = 20) in the stockholm-uppsala region of sweden.201323497714
clinical and microbiological features of clostridium difficile infections in france: the icd-raisin 2009 national survey.the surveillance of clostridium difficile infections (cdi) in france was reinforced after the emergence of the pcr-ribotype 027 epidemic clone in 2006; notification of case clusters or severe cases by healthcare facilities (hcf) became mandatory. the french public health surveillance institute (invs) and the c. difficile national reference center (nrc) launched a national, prospective, multicentric survey to complete available data, in 2009. the survey had for objectives to assess cdi incidence ...201323498135
effects of nisin and reutericyclin on resistance of endospores of clostridium spp. to heat and high pressure.the effects of high pressure, temperature, and antimicrobial compounds on endospores of clostridium spp. were examined. minimal inhibitory concentrations (mic) of nisin and reutericyclin were determined for vegetative cells and endospores of clostridium sporogenes atcc 7955, clostridium beijerinckii atcc 8260, and clostridium difficile 3195. endospores of c. sporogenes atcc 7955 and c. beijerinckii atcc 8260 were exposed to 90 °c and 90 °c/600 mpa in the presence of 16 mg l(-1) nisin or 6.4 mg l ...201223498177
clostridium difficile contamination of public tap water distribution system during a waterborne outbreak in finland.in november through december 2007, the drinking water distribution system in the town of nokia, finland, was contaminated with treated sewage effluent that resulted in a large gastroenteritis outbreak in the community. the aim of the present study was to investigate if the contaminated water in this outbreak was also a potential source of clostridium difficile infections.201323503193
procalcitonin levels associate with severity of clostridium difficile infection.clostridium difficile infection (cdi) is a major cause of morbidity and biomarkers that predict severity of illness are needed. procalcitonin (pct), a serum biomarker with specificity for bacterial infections, has been little studied in cdi. we hypothesized that pct associated with cdi severity.201323505476
opioid use and clostridium difficile infection. 201323507210
clostridium difficile infection and inflammatory bowel disease.the prevalence of clostridium difficile infection (cdi) in inflammatory bowel disease (ibd) has become a focus of increased attention, as the c. difficile epidemic continues to grow. although first documented more than 20 years ago, only in recent years has the relationship between these 2 entities been better clarified, and recent epidemiologic studies have shown that ibd patients are at increased susceptibility for cdi compared with the general population. despite this increased attention, muc ...201323507767
rifaximin therapy and clostridium difficile infection: a note of caution. 201323507769
effect of host defenses on clostridium difficile toxin-induced intestinal barrier injury.the severity of clostridium difficile-associated infection depends on the virulence factors of the organism and host factors, including intestinal barrier function. the intestinal mucus layer has recently been recognized as the first line of defense against enteric pathogens. its interaction with mucosal humoral immunity provided by secretory immunoglobulin a (siga) is unknown as it relates to c. difficile disease severity. this was studied in vitro.201323511135
fecal microbiota transplantation for clostridium difficile infection: systematic review and meta-analysis.the clinical and economic burden of clostridium difficile infection (cdi) is significant. recurrent cdi management has emerged as a major challenge with suboptimal response to standard therapy. fecal microbiota transplantation (fmt) has been used as a treatment to reconstitute the normal microbial homeostasis and break the cycle of antibiotic agents that may further disrupt the microbiome. given the lack of randomized-controlled trials (rcts) and limitations in previous systematic reviews, we ai ...201323511459
chlorhexidine to maintain cleanliness of laryngoscope handles: an audit and laboratory study.laryngoscope handles are a potential vector for infection transmission and require adequate decontamination.201323511956
decreasing clostridium difficile infections in surgery: impact of a practice bundle incorporating a resident rounding protocol.clostridium difficile (cd) infection is a significant health problem. a new systems approach was introduced to reduce the risk of hospital-acquired cd infection (ha-cd) at our institution. we hypothesized that a practice bundle, including a protocol to limit patient exposures during house staff rounding, would decrease ha-cd infections.201323513633
evaluation of the fully automated bd max cdiff and xpert c. difficile assays for direct detection of clostridium difficile in stool specimens.we evaluated the fully automated molecular bd max cdiff assay (bd diagnostics) and the xpert c. difficile test (cepheid) for rapid detection of clostridium difficile infection. culture was done on chromogenic agar followed by matrix-assisted laser desorption ionization-time of flight (maldi-tof) mass spectrometry identification and toxin detection. repeat testing was required for 1.8% and 6.0% of the bd max and xpert tests, respectively. sensitivities, specificities, positive predictive values ( ...201323515539
cbpa: a novel surface exposed adhesin of clostridium difficile targeting human collagen.clostridium difficile is the leading cause of antibiotic-associated diarrhoea and pseudomembranous colitis. while the role of toxins in pathogenesis has been extensively described, the contribution of surface determinants to intestinal colonization is still poorly understood. we focused our study on a novel member of the mscramm family, named cbpa (collagen binding protein a), for its adhesive properties towards collagen. we demonstrate that cbpa, which carries an lpxtg-like cell wall anchoring ...201323517059
germination efficiency of clinical clostridium difficile spores and correlation with ribotype, disease severity and therapy failure.spore germination is an important part of the pathogenesis of clostridium difficile infection (cdi). spores are resistant to antibiotics, including those therapeutically administered for cdi and strains with a high germination rate are significantly more likely to be implicated in recurrent cdi. the role of germination efficiency in cases of refractory cdi where first-line therapy fails remains unclear. we investigated spore germination efficiencies of clinical c. difficile isolates by measuring ...201323518657
surface-layer (s-layer) of human and animal clostridium difficile strains and their behaviour in adherence to epithelial cells and intestinal colonization.clostridium difficile is a frequent cause of severe, recurrent post-antibiotic diarrhoea and pseudomembranous colitis. the surface layer (s-layer) is the predominant outer surface component of c. difficile which is involved in pathogen-host interactions critical to pathogenesis. in this study, we characterized the s-layer protein a (slpa) of animal and human strains belonging to different pcr-ribotypes (pr) and compared the in vitro adherence and in vivo colonization properties of strains showin ...201323518658
systemic antibody responses induced by a two-component clostridium difficile toxoid vaccine protect against c. difficile-associated disease in hamsters.clostridium difficile infection (cdi) has been identified as the leading cause of nosocomial diarrhoea and pseudomembranous colitis associated with antibiotic therapy. recent epidemiological changes as well as increases in the number of outbreaks of strains associated with increased virulence and higher mortality rates underscore the importance of identifying alternatives to antibiotics to manage this important disease. animal studies have clearly demonstrated the roles that toxins a and b play ...201323518659
comparison of testing approaches for clostridium difficile infection at a large community hospital.multiple diagnostic approaches are available for clostridium difficile infection (cdi); current guidelines support two-step testing (2st) as the preferred approach. we retrospectively evaluated the impact of switching from toxin enzyme immunoassay (eia) to 2st, and then to polymerase chain reaction (pcr), on cdi rates, test utilization and cdi treatment at a 900-bed tertiary care community teaching hospital. all inpatients tested for cdi between december 2008 and february 2011 were included. a p ...201423521523
clostridium difficile infection in italian urban hospitals: data from 2006 through 2011.in developed countries, clostridium difficile infection (cdi) represents an emerging threat in terms of morbidity and mortality rates. in our country limited cdi epidemiological data can be found.201323522431
molecular epidemiology and resistance profiles of clostridium difficile in a tertiary care hospital in spain.epidemiological surveillance of clostridium difficile infection has gained importance in recent years as a result of the rapid spread of epidemic strains, including hypervirulent strains and strains with reduced susceptibility to antimicrobials. the molecular epidemiology and antimicrobial susceptibility of c. difficile in the reference hospital of the balearic islands (spain) is reported in this study. one hundred isolates of toxigenic c. difficile from different patients were selected using ra ...201323523477
similar outcomes of ibd inpatients with clostridium difficile infection detected by elisa or pcr assay.clostridium difficile infection (cdi) is known as a risk factor for exacerbation of inflammatory bowel disease (ibd). cdi has been most commonly tested with enzyme-linked immunosorbent assay for toxins, but with a suboptimal sensitivity. compared with conventional elisa, the polymerase chain reaction-based assay (pcr) is a highly sensitive detection technique for c. difficile. however, its pure detection of only the dna of toxin b may lead to over-treatment.201323525735
clostridium difficile as a cause of acute diarrhea: a prospective study in a tertiary care center.clostridium difficile-associated diarrhea (cdad) is an increasing problem. recent reports suggest presence of community acquired cdad (ca cdad). studies in india have shown varied results.201323526401
confocal laser endomicroscopy for in vivo diagnosis of clostridium difficile associated colitis - a pilot study.clostridium difficile infection (cdi) is one of the most dreaded causes of hospital-acquired diarrhea. main objective was to investigate whether confocal laser endomicroscopy (cle) has the capability for in vivo diagnosis of c. difficile associated histological changes. second objective was to prove the presence of intramucosal bacteria using cle.201323527018
counterpoint: is clostridium difficile a food-borne disease?the increase in community associated clostridium difficile disease paired with recent data on c. difficile in retail foods has led to speculation that c. difficile is a food-borne pathogen. however, there is no current epidemiologic evidence (i.e. restaurant or food-associated outbreaks) to support this hypothesis. rates of c. difficile recovery from food vary widely across laboratories and may be due to a number of confounding factors. this commentary discusses the results of two published inve ...201323528985
derivation and validation of a simple clinical bedside score (atlas) for clostridium difficile infection which predicts response to therapy.clostridium difficile infection (cdi) continues to be a frequent and potentially severe infection. there is currently no validated clinical tool for use at the time of cdi diagnosis to categorize patients in order to predict response to therapy.201323530807
validation of the chronic disease score-infectious disease (cds-id) for the prediction of hospital-associated clostridium difficile infection (cdi) within a retrospective cohort.aggregate comorbidity scores are useful for summarizing risk and confounder control in studies of hospital-associated infections. the chronic disease score - infectious diseases (cds-id) was developed for this purpose, but it has not been validated for use in studies of clostridium difficile infection (cdi). the aim of this study was to assess the discrimination, calibration and potential for confounder control of cds-id compared to age alone or individual comorbid conditions.201323530876
clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children.clostridium difficile infection (cdi) is associated with significant morbidity and mortality among adults. however, outcomes are poorly defined among children.201323532470
editorial commentary: clostridium difficile in children: colonization and consequences. 201323532471
[four new drugs on the market: abiraterone, belatacept, vandetanib and fidaxomycine].among the 35 new molecular entities approved by the fda in 2011, 17 were particularly notable for their significant contributions to the health of patients, including abiraterone acetate, vandetanib, belatacept and fidaxomicin. thus, abiraterone acetate, namely zytiga®, was included as the first in a new class of drugs to treat late-stage prostate cancer. the ability of zytiga® to prolong survival in these patients was considered as significant because they have few other treatments options and ...201323537410
cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of clostridium difficile infection in the united states.fidaxomicin is a novel treatment for clostridium difficile infections (cdis). this new treatment, however, is associated with a higher acquisition cost compared with alternatives. the objective of this study was to evaluate the cost-effectiveness of fidaxomicin or oral vancomycin for the treatment of cdis.201523538181
adjuvant vancomycin for antibiotic prophylaxis and risk of clostridium difficile infection after coronary artery bypass graft surgery.the incidence of hospital-acquired clostridium difficile infection (cdi) has increased rapidly over the past decade; patients undergoing major surgery, including coronary artery bypass grafting (cabg), are at particular risk. intravenous vancomycin exposure has been identified as an independent risk factor for cdi, but this is controversial. it is not known whether vancomycin administered for surgical site infection prophylaxis increases the risk of cdi.201323541855
protective effect of a mixture of kefir-isolated lactic acid bacteria and yeasts in a hamster model of clostridium difficile infection.the objective of this work was to test the protective effect of a mixture (mm) constituted by kefir-isolated microorganisms (lactobacillus plantarum, lactobacillus kefir, lc. lactis, kluyveromyces marxianus and saccharomyces cerevisiae) in a hamster model of infection with clostridium difficile, an anaerobic gram-positive bacterium that causes diarrhoea. placebo or mm was administered ad libitum in drinking water from day 0 to the end of treatment. hamsters received orally 200 μg of clyndamicin ...201323542116
diagnosis and management of clostridium difficile infection.clostridium difficile infection (cdi) is increasing in frequency and severity in and out of the hospital, with a high probability of recurrence after treatment. the recent literature on cdi was reviewed using pubmed to include recent publications dealing with diagnosis and therapy. real-time polymerase chain reaction is a sensitive and useful diagnostic test for cdi but there are growing concerns of false-positive test results if the rate of cdi is low in the patient population providing samples ...201323542332
the clostridium difficile cpr locus is regulated by a noncontiguous two-component system in response to type a and b lantibiotics.the intestinal pathogen clostridium difficile is known to grow only within the intestines of mammals, yet little is known about how the bacterium subsists in this environment. in the intestine, c. difficile must contend with innate defenses within the host, such as cationic antimicrobial peptides (camps) produced by the host and the indigenous microbiota. in this study, we investigated the mechanism of activation and regulation of the cprabc transporter system, which provides resistance to multi ...201323543720
toll-like receptor 5-dependent immunogenicity and protective efficacy of a recombinant fusion protein vaccine containing the nontoxic domains of clostridium difficile toxins a and b and salmonella enterica serovar typhimurium flagellin in a mouse model of clostridium difficile disease.clostridium difficile is a spore-forming bacillus that produces toxin-mediated enteric disease. c. difficile expresses two major virulence factors, toxin a (tcda) and toxin b (tcdb). human and animal studies demonstrate a clear association between humoral immunity to these toxins and protection against c. difficile infection (cdi). the receptor binding-domains (rbds) of tcda and tcdb are known to be immunogenic. here, we tested the immunoadjuvant properties of salmonella enterica serovar typhimu ...201323545305
new opportunities for improved ribotyping of c. difficile clinical isolates by exploring their genomes.clostridium difficile causes outbreaks of infectious diarrhoea, most commonly occurring in healthcare institutions. recently, concern has been raised with reports of c. difficile disease in those traditionally thought to be at low risk i.e. community acquired rather than healthcare acquired. this has increased awareness for the need to track outbreaks and pcr-ribotyping has found widespread use to elucidate epidemiologically linked isolates. pcr-ribotyping uses conserved regions of the 16s rrna ...201323545446
use of rifamycin drugs and development of infection by rifamycin-resistant strains of clostridium difficile.the relationship between rifamycin drug use and the development of resistant strains of clostridium difficile was studied at a large university hospital in houston, tx, between may 2007 and september 2011. in 49 of 283 (17.3%) patients with c. difficile infection (cdi), a rifamycin-resistant strain of c. difficile was identified that compares to a rate of 8% using the same definitions in 2006-2007 (p = 0.59). the 49 patients infected by a resistant organism were matched by date of admission to 9 ...201323545528
clostridium difficile infection in the hospitalized pediatric population: increasing trend in disease incidence.to determine whether the incidence of clostridium difficile infection continues to increase in hospitalized pediatric patients, we evaluated data from a united states national inpatient database. for the period of 2003 to 2009, we found an increasing trend in the incidence of c. difficile infection. these data suggest greater effort be given to prevent and treat this infection in children.201323546535
fecal bacteriotherapy for recurrent clostridium difficile infection: what's old is new again?in recent years, effective management of recurrent clostridium difficile infection (cdi) has emerged as an important issue for those clinicians who treat patients with cdi. in addition to antibiotic-based therapies, including alternating use, chaser, and tapering protocols, interest has increased in the potential utility of a variety of nonantibiotic forms of adjunctive therapy. among these alternative forms of treatment, the concept of transferring extracts of a stool from donors to patients wi ...201323549617
nisin and clostridium difficile: a potentially effective treatment for an increasingly problematic disease. 201323552318
appendectomy is not associated with adverse outcomes in clostridium difficile infection: a population-based study. 201323552320
clostridium difficile ribotype diversity at six health care institutions in the united states.capillary-based pcr ribotyping was used to quantify the presence/absence and relative abundance of 98 clostridium difficile ribotypes from clinical cases of disease at health care institutions in six states of the united states. regionally important ribotypes were identified, and institutions in close proximity did not necessarily share more ribotype diversity than institutions that were farther apart.201323554188
clostridium difficile infections in china.clostridium difficile (c. difficile) infection has become one of the major hospital-associated infections in western countries in the last two decades. however, there is limited information on the status of c. difficile infection in chinese healthcare settings. given the large and increasing elderly population and the well-recognized problem of over-prescribing of broad spectrum antibiotics in china, it is critical to understand the epidemiology and potential risk factors that may contribute to ...201023554657
low cost extraction and isothermal amplification of dna for infectious diarrhea diagnosis.in order to counter the common perception that molecular diagnostics are too complicated to work in low resource settings, we have performed a difficult sample preparation and dna amplification protocol using instrumentation designed to be operated without wall or battery power. in this work we have combined a nearly electricity-free nucleic acid extraction process with an electricity-free isothermal amplification assay to detect the presence of clostridium difficile (c. difficile) dna in the st ...201323555883
clostridium difficile enteritis: a report of two cases and systematic literature review.clostridium difficile (c. difficile) is the most common cause of healthcare associated infectious diarrhea. in the last decade, the incidence of c. difficile infection has increased dramatically. the virulence of c. difficile has also increased recently with toxigenic strains developing. c. difficile is generally a disease of the colon and presents with abdominal pain and diarrhea due to colitis. however, c. difficile enteritis has been reported rarely. the initial reports suggested mortality ra ...201323556059
evaluation of antimicrobial activity of ceftaroline against clostridium difficile and propensity to induce c. difficile infection in an in vitro human gut model.to examine the effects of exposure to ceftaroline or ceftriaxone on the epidemic clostridium difficile strain pcr ribotype 027 and the indigenous gut microflora in an in vitro human gut model. additionally, the mics of ceftriaxone and ceftaroline for 60 c. difficile isolates were determined.201323557928
two cases of fulminant colitis due to binary toxin-positive clostridium difficile that are not pcr ribotype 027 or type 078.two cases of fulminant colitis due to clostridium difficile occurred within ten weeks of each other on the same ward of a hospital in japan. the patients died 2 and 4 days after the onset of colitis. c. difficile isolates obtained from both patients were toxin a-positive, toxin b-positive and binary toxin-positive. these isolates yielded identical results by both pcr ribotyping and slpa sequence typing. however, the banding patterns and slpa sequences of the isolates differed from those of pcr r ...201323558137
cellular uptake of clostridium difficile tcda and truncated tcda lacking the receptor binding domain.the combined repetitive oligopeptides (crops) of clostridium difficile toxins a (tcda) and b (tcdb) induce clathrin-mediated endocytosis of the toxins. inconsistently, crop-truncated tcda(1-1874) is also capable of entering host cells and displaying full cytotoxic properties although with less potency. pre-incubation of cells with isolated crops, however, reconstitutes the reduced uptake of tcda(1-1874) to the level of the full-length toxin. we believe that tcda exhibits an additional binding mo ...201323558138
impact of ribotype 027 on clostridium difficile infection in a geriatric department.the purposes of this study were to describe the epidemiology (2001-2009) of clostridium difficile infections (cdi) in a geriatric department and to compare the clinical data of patients infected with a 027 or non-027 strain. we retrospectively identified all geriatric patients with cdi and analysed the clinical and microbiological data of 133 patients for whom a ribotype was available between march 2003 and december 2009. the incidence of cdi in our geriatric department increased from 0.2 per 10 ...201323558363
intracolonic vancomycin for severe clostridium difficile colitis.clostridium difficile colitis is associated with increased age, antibiotic usage, and hospitalization. severe c. difficile colitis refractory to medical therapy may require surgical intervention including subtotal colectomy. we initiated an adjuvant intracolonic vancomycin (icv) enema protocol for inpatients with severe c. difficile colitis and compared the response to this therapy in patients from the community and nursing homes.201323560732
carbohydrate-based clostridium difficile vaccines.clostridium difficile is responsible for thousands of deaths each year and a vaccine would be welcomed, especially one that would disrupt bacterial maintenance, colonization and persistence in carriers and convalescent patients. structural explorations at the university of guelph (on, canada) discovered that c. difficile may express three phosphorylated polysaccharides, named psi, psii and psiii; this review captures our recent efforts to create vaccines based on these glycans, especially psii, ...201323560922
emergence of a highly resistant clostridium difficile strain (nap/bi/027) in a tertiary care center in saudi arabia. 201323563012
do statins protect against the development of clostridium difficile-associated diarrhoea?to assess whether prior statin use protects against the development of clostridium difficile-associated diarrhoea (cdad) in hospitalized patients.201323563740
does a rapid diagnosis of clostridium difficile infection impact on quality of patient management?a rapid and accurate diagnosis of clostridium difficile infection (cdi) is essential for patient management and implementation of infection control measures. during a prospective time-series study, we compared the impact of three different diagnostic strategies on patient care. each strategy was tested during a 3-month period: p1 (diagnosis based on the stool cytotoxicity assay and the toxigenic culture), p2 (diagnosis based on pcr) and p3 (two-step algorithm based on glutamate dehydrogenase det ...201423565919
calcineurin inhibitors and clostridium difficile infection in adult lung transplant recipients: the effect of cyclosporine versus tacrolimus.tacrolimus (fk506) has a superior immunosuppressive effect compared with cyclosporine (csa) without a significant increase in generalized infectious complications. differences in specific infections such as clostridium difficile (cdi) have not been reported. we investigated the relationship between calcineurin inhibitors and cdi, hypothesizing that choice of calcineurin inhibitor (csa or fk506) after lung transplantation would have no effect on the incidence of cdi.201323566442
antimicrobial susceptibility profiles of human and piglet clostridium difficile pcr-ribotype 078.in the last decade, outbreaks of nosocomial clostridium difficile infections (cdi) occurred worldwide. a new emerging type, pcr-ribotype 027, was the associated pathogen. antimicrobial susceptibility profiles of this type were extensively investigated and used to partly explain its spread. in europe, the incidence of c. difficile pcr-ribotype 078 recently increased in humans and piglets. using recommendations of the european committee on antimicrobial susceptibility testing (eucast) and the clin ...201323566553
detection of clostridium difficile in small and medium-sized wild mammals in southern ontario, canada.we sampled 325 small and medium-sized wild mammals in ontario, canada in 2007 and 2010 to determine the prevalence and characteristics of clostridium difficile in wild mammals living in proximity to captive wildlife and livestock. clostridium difficile was isolated from five of 109 animals (4.6%) on four of 25 farms (16%), but was not isolated from any of the 216 samples from raccoons (procyon lotor) living on the grounds of the toronto zoo. the positive animals included two raccoons from one be ...201323568920
management and prevention of recurrent clostridium difficile infection in patients after total joint arthroplasty: a review.clostridium difficile infection (cdi) is the most common infectious cause of nosocomial diarrhea in elderly patients, accounting for 15% to 25% of all cases of antibiotic-induced diarrhea in those patients. virulent forms of this organism have developed, increasing the associated morbidity, mortality, and complication rates. the average patient undergoing total joint arthroplasty is at particular risk of cdi because of advanced age, the use of prophylactic antibiotic coverage in the perioperativ ...201223569710
nanolitre real-time pcr detection of bacterial, parasitic, and viral agents from patients with diarrhoea in nunavut, canada.little is known about the microbiology of diarrhoeal disease in canada's arctic regions. there are a number of limitations of conventional microbiology testing techniques for diarrhoeal pathogens, and these may be further compromised in the arctic, given the often long distances for specimen transport.201323570023
an environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of clostridium difficile isolation rooms.objective. effective disinfection of hospital rooms after discharge of patients with clostridium difficile infection (cdi) is necessary to prevent transmission. we evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in cdi rooms after cleaning. design. prospective intervention. setting. a veterans affairs hospital. interventions. during a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide ...201323571361
decontamination of targeted pathogens from patient rooms using an automated ultraviolet-c-emitting device.objective. to determine the effectiveness of an automated ultraviolet-c (uv-c) emitter against vancomycin-resistant enterococci (vre), clostridium difficile, and acinetobacter spp. in patient rooms. design. prospective cohort study. setting. two tertiary care hospitals. participants. convenience sample of 39 patient rooms from which a patient infected or colonized with 1 of the 3 targeted pathogens had been discharged. intervention. environmental sites were cultured before and after use of an au ...201323571362
beyond the hawthorne effect: reduction of clostridium difficile environmental contamination through active intervention to improve cleaning practices.education and passive observation resulted in a significant improvement in housekeeper disinfection of nontoxigenic clostridium difficile spores artificially inoculated onto surfaces in c. difficile infection rooms. a further significant reduction occurred with direct supervision and real-time feedback, suggesting that optimal disinfection is achieved by working closely with housekeepers.201323571372
rapid hospital room decontamination using ultraviolet (uv) light with a nanostructured uv-reflective wall coating.we tested the ability of an ultraviolet c (uv-c)-reflective wall coating to reduce the time necessary to decontaminate a room using a uv-c-emitting device (tru-d smartuvc). the reflective wall coating provided the following time reductions for decontamination: for methicillin-resistant staphylococcus aureus, from 25 minutes 13 seconds to 5 minutes 3 seconds ([formula: see text]), and for clostridium difficile spores, from 43 minutes 42 seconds to 9 minutes 24 seconds ([formula: see text]).201323571373
analysis of anti-clostridium difficile activity of thuricin cd, vancomycin, metronidazole, ramoplanin, and actagardine, both singly and in paired combinations.due to the ongoing problem of recurrence of clostridium difficile-associated diarrhea following antibiotic treatment, there is an urgent need for alternative treatment options. we assessed the mics of five antimicrobials singly and in combinations against a range of c. difficile clinical isolates. ramoplanin-actagardine combinations were particularly effective, with partial synergistic/additive effects observed against 61.5% of c. difficile strains tested.201323571539
a culture-independent sequence-based metagenomics approach to the investigation of an outbreak of shiga-toxigenic escherichia coli o104:h4.identification of the bacterium responsible for an outbreak can aid in disease management. however, traditional culture-based diagnosis can be difficult, particularly if no specific diagnostic test is available for an outbreak strain.201323571589
total colectomy for ulcerative colitis in children: when are we operating?ulcerative colitis (uc) in children is frequently severe and treatment-refractory. while medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric uc patients.201323571824
impact of preoperative organ failures on survival in intensive care unit patients with colectomy.the present study aimed to evaluate the prognostic value of preoperative changes in sequential organ failure assessment (sofa) score, daily norepinephrine (ne) dose, lactate, c-reactive protein, and white blood cell count among patients with colectomy in the intensive care unit (icu).201323571867
diagnosing clostridial enteric disease in poultry.the world's poultry industry has grown into a multibillion-dollar business, the success of which hinges on healthy intestinal tracts, which result in effective feed conversion. enteric disease in poultry can have devastating economic effects on producers, due to high mortality rates and poor feed efficiency. clostridia are considered to be among the most important agents of enteric disease in poultry. diagnosis of enteric diseases produced by clostridia is usually challenging, mainly because man ...201323572451
longitudinal study of clostridium difficile and methicillin-resistant staphylococcus aureus associated with pigs from weaning through to the end of processing.there has been a recent increase in community-associated infections linked to methicillin-resistant staphylococcus aureus (mrsa) and clostridium difficile. it is established that both pathogens can be recovered from retail pork, although it is unclear to what degree contamination is acquired at the farm in comparison to that acquired during processing. to address this gap, the following study reports on the carriage of mrsa and c. difficile on pigs from birth through to the end of processing. c. ...201323575124
if microbial ecosystem therapy can change your life, what's the problem?the increased incidence of morbidity and mortality due to clostridium difficile infection, had led to the emergence of fecal microbial transplantation (fmt) as a highly successful treatment. from this, a 32 strain stool substitute has been derived, and successfully tested in a pilot human study. these approaches could revolutionize not only medical care of infectious diseases, but potentially many other conditions linked to the human microbiome. but a second revolution may be needed in order for ...201323575749
isolation of clostridium difficile from faecal specimens--a comparison of chromid c. difficile agar and cycloserine-cefoxitin-fructose agar.the culture of toxigenic clostridium difficile from stool specimens is still seen as the gold standard for the laboratory diagnosis of c. difficile infection (cdi). biomérieux have released chromid cdiff chromogenic agar (cdif) for the isolation and identification of c. difficile in 24 h. in this study, we compared cdif to pre-reduced cycloserine-cefoxitin-fructose agar with sodium taurocholate (tccfa) in the examination of glutamate dehydrogenase-positive faecal specimens that were either geneo ...201323579394
clostridium septicum gas gangrene in a previously healthy 8-year-old female with survival.we present the only reported case of an immunocompetent pediatric patient in the literature to have fulminate gas gangrene of the lower extremity and concomitant gastrointestinal tract infection due to clostridium septicum coinfected with clostridium difficile colitis respectively. the patient survived with aggressive medical and surgical treatment.201323583163
evaluation of multiplex pcr with enhanced spore germination for detection of clostridium difficile from stool samples of the hospitalized patients.clostridium difficile poses as the most common etiologic agent of nosocomial diarrhea. although there are many diagnostic methods to detect c. difficile directly from stool samples, the nucleic acid-based approach has been largely performed in several laboratories due to its high sensitivity and specificity as well as rapid turnaround time. in this study, a multiplex pcr was newly designed with recent accumulated nucleotide sequences. the pcr testing with various c. difficile ribotypes, other cl ...201323586062
what is hot in the anaerobe literature? clostridium difficile infections. 201323587754
specialty care delivery: bringing infectious disease expertise to the residents of a veterans affairs long-term care facility.to initiate a long-term care facility (ltcf) infectious disease (lid) service that provides on-site consultations to ltcf residents to improve the care of residents with possible infections.201323590125
effect of occurrence of infection-related never events on length of stay and hospital charges in patients undergoing radical neck dissection for head and neck cancer.to estimate the impact of infection-related never events (postoperative pneumonia, clostridium difficile infection, infection with microorganisms resistant to penicillin, postoperative infections, and decubitus ulcers) following radical neck dissections for head and neck cancers.201323591100
comparison of detection methods for clostridium difficile. 201323592854
reply to "comparison of detection methods for clostridium difficile". 201323592855
prebiotics, faecal transplants and microbial network units to stimulate biodiversity of the human gut microbiome.accumulating evidence demonstrates the intimate association between human hosts and the gut microbiome. starting at birth, the sterile gut of the newborn acquires a diverse spectrum of microbes, needed for immunological priming. however, current practices (caesarean sections, use of formula milk) deprive newborns from being exposed to this broad spectrum of microbes. unnecessary use of antibiotics and excessive hygienic precautions (e.g. natural versus chlorinated drinking water) together with t ...201323594389
clostridium difficile vertebral osteomyelitis.clostridium difficile is the most common cause of antibiotic-associated diarrhea, and it occasionally causes extraintestinal infections. we present a case of c. difficile-associated diarrhea that led to vertebral osteomyelitis associated with hardware. the osteomyelitis became symptomatic 2 years after the initial diarrheal event. c. difficile recovered from internal hardware sites cannot simply be regarded as a contaminant but should be treated.201323594589
clostridium difficile psi polysaccharide: synthesis of pentasaccharide repeating block, conjugation to exotoxin b subunit, and detection of natural anti-psi igg antibodies in horse serum.clostridium difficile is the most common cause of antimicrobial-associated diarrhea in humans and may cause death. previously, we discovered that c. difficile expresses three polysaccharides, named psi, psii, and psiii. it has now been established that psii is a conserved antigen abundantly present on the cell-surface and biofilm of c. difficile. in contrast, the expression of psi and psiii appears to be stochastic processes. in this work, the total chemical synthesis of the psi pentasaccharide ...201323597587
advances in molecular surveillance of clostridium difficile in bulgaria.the increasing incidence of clostridium difficile infection (cdi) in bulgaria has indicated the need to implement better surveillance approaches. the aim of the present work was to improve the current surveillance of cdi in bulgaria by introducing innovative methods for identification and typing. one hundred and twenty stool samples obtained from 108 patients were studied over 4 years from which 32 c. difficile isolates were obtained. an innovative duplex evagreen real-time pcr assay based on si ...201323598377
intestinal alkaline phosphatase prevents antibiotic-induced susceptibility to enteric pathogens.to determine the efficacy of oral supplementation of the gut enzyme intestinal alkaline phosphatase (iap) in preventing antibiotic-associated infections from salmonella enterica serovar typhimurium (s. typhimurium) and clostridium difficile.201423598380
concomitant typhlitis and clostridium difficile colitis developed after first r-chop chemotherapy in a non-hodgkin lymphoma patient.typhlitis or neutropenic enterocolitis (nec) is a life-threatening condition that occurs in neutropenic patients. early recognition is crucial owing to high death rate. we present a case of a 54-year-old man, diagnosed with non-hodgkin lymphoma who received a first cycle of rituximab, cyclophosphamide, hydroxydaunorubicin (doxorubicin), oncovin (vincristine), prednisolone (r-chop) chemotherapy 10 days prior presenting. he developed fever, mucositis, watery diarrhoea and right lower quadrant pain ...201323598937
structural and functional investigation into acetyl-coenzyme a synthase and methyltransferase from human pathogen clostridium difficile.methyltransferase (metrcd) and acetyl-coenzyme a synthase (acscd) are two key enzymes in the acetyl-coenzyme a synthesis pathway of the human pathogen clostridium difficile. the pathway is absent in humans and is essential for the survival of the pathogen. metrcd and acscd were cloned, expressed in e. coli, and characterized for the first time. structural and functional investigations of the two enzymes were performed using homology structure modeling, fluorescence spectroscopy, and steady state ...201323599026
architecture and assembly of the gram-positive cell wall.the bacterial cell wall is a mesh polymer of peptidoglycan--linear glycan strands cross-linked by flexible peptides--that determines cell shape and provides physical protection. while the glycan strands in thin 'gram-negative' peptidoglycan are known to run circumferentially around the cell, the architecture of the thicker 'gram-positive' form remains unclear. using electron cryotomography, here we show that bacillus subtilis peptidoglycan is a uniformly dense layer with a textured surface. we f ...201323600697
attenuation of clostridium difficile toxin-induced damage to epithelial barrier by ecto-5'-nucleotidase (cd73) and adenosine receptor signaling.clostridium difficile (cdf) releases toxins (tcda and tcdb) that damage the intestinal epithelial barrier. ecto-5'-nucleotidase (cd73) is expressed on intestinal epithelial cells, and it is hypothesized to protect against toxin-induced epithelial damage through the cleavage of 5'-amp to adenosine (ado) and subsequent activation of adenosine receptors (adors). herein, we sought to assess the potential protective effects of cd73 and ador signaling on the injurious effects of cdf toxins.201323600886
evaluation of the bd max cdiff assay for the detection of the toxin b gene of clostridium difficile out of faecal specimens.in this evaluation study, 180 faecal specimens were tested in parallel with the new bd max™ cdiff assay, the premier™ toxins a&b, and toxigenic culture as reference method. bd max™ cdiff presented a high sensitivity (96.0%) and specificity (99.4%) with a negative predictive value of 99.4%.201323602785
pouchitis: what every gastroenterologist needs to know.pouchitis is the most common complication among patients with ulcerative colitis who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis. pouchitis is actually a spectrum of diseases that vary in etiology, pathogenesis, phenotype, and clinical course. although initial acute episodes typically respond to antibiotic therapy, patients can become dependent on antibiotics or develop refractory disease. many factors contribute to the course of refractory pouchitis, such as the ...201323602818
systematic application of multiplex pcr enhances the detection of bacteria, parasites, and viruses in stool samples.to determine whether systematic testing of faecal samples with a broad range multiplex pcr increases the diagnostic yield in patients with diarrhoea compared with conventional methods and a clinician initiated testing strategy.201323603249
diagnostic accuracy of a multiplex real-time pcr to predict clostridium difficile ribotype 027. 201323603384
site-directed mutations in the lanthipeptide mutacin 1140.the oral bacterium streptococcus mutans, strain jh1140, produces the antibiotic mutacin 1140. mutacin 1140 belongs to a group of antibiotics called lanthipeptides. more specifically, mutacin 1140 is related to the epidermin type a(i) lanthipeptides. mutagenesis experiments of this group of lanthipeptides have been primarily restricted to the posttranslationally modified meso-lanthionine and 3-methyllanthionine residues. site-directed mutagenesis of the core peptide of mutacin 1140 was performed ...201323603688
the antimicrobial effects of helium and helium-air plasma on staphylococcus aureus and clostridium difficile.healthcare-associated infections (hcai) affect 5-10% of acute hospital admissions. environmental decontamination is an important component of all strategies to prevent hcai as many bacterial causes survive and persist in the environment, which serve as ongoing reservoirs of infection. current approaches such as cleaning with detergents and the use of chemical disinfectant are suboptimal. we assessed the efficacy of helium and helium-air plasma in killing staphylococcus aureus and clostridium dif ...201323607860
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