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duodenal infusion of feces for recurrent clostridium difficile. 201323718169
duodenal infusion of feces for recurrent clostridium difficile. 201323718170
duodenal infusion of feces for recurrent clostridium difficile. 201323718171
duodenal infusion of feces for recurrent clostridium difficile. 201323718172
evaluating the impact of a pharmacist's absence from an antimicrobial stewardship team.results of a study to determine the impact of a clinical pharmacist's temporary absence from a hospital's antimicrobial stewardship team are presented.201323719885
mortality in patients with clostridium difficile infection correlates with host pro-inflammatory and humoral immune responses.host anti-toxin immune responses play important roles in clostridium difficile disease and outcome. the relationship between host immune and inflammatory responses during severe c. difficile infection (cdi) and the risk of mortality has yet to be defined. we aimed to investigate the host systemic igg anti-toxin immune responses, the in vitro cytotoxicity of the infecting c. difficile ribotyped strain, and the host inflammatory markers and their relationship to cdi disease severity and risk of mo ...201323722431
diversity of cwp loci in clinical isolates of clostridium difficile.an increased incidence of clostridium difficile infection (cdi) is associated with the emergence of epidemic strains characterized by high genetic diversity. among the factors that may have a role in cdi is a family of 29 paralogues, the cell-wall proteins (cwps), which compose the outer layer of the bacterial cell and are likely to be involved in colonization. previous studies have shown that 12 of the 29 cwp genes are clustered in the same region, named after slpa (cwp1), the slpa locus, where ...201323722432
candidemia subsequent to severe infection due to clostridium difficile: is there a link? 201323723197
molecular typing and epidemiology of clostridium difficile in respiratory care wards of central taiwan.in industrialized countries, clostridium difficile is the major cause of nosocomial diarrhea. this study involved a broad overview of baseline epidemiology for c. difficile in taiwan.201523726464
[a case of diarrhoea by clostridium difficile].we present a patient who developed a pseudomembranous colitis due to clostridium difficile with a prolonged course. the diarrhoea symptoms worsened after two hospitalisations, but there was an improvement with outpatient treatment. the first diagnosis was made in primary care. we summarise the preventive measures, and present the severity criteria of this condition, as well as the failure antibiotic treatment with metronidazole and the possible aggravation by the use of other antibiotics in thes ...201223726735
a clinical and epidemiological review of non-toxigenic clostridium difficile.clostridium difficile is a significant nosocomial threat to human health and is the most commonly identified cause of antibiotic-associated diarrhea. the development of c. difficile colitis requires production of toxins a and/or b, but some strains do not express these proteins. these non-toxigenic c. difficile (ntcd) have garnered attention for their capacity to colonize humans and potentially reduce the risk for symptomatic colitis caused by toxigenic strains. isolates of ntcd have been obtain ...201323727391
[antimicrobial therapy of clostridium difficile infection. systematic review and meta-analysis of the scientific evidence].clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of clostridium difficile infection. the available scientific evidence is limited and hardly comparable.201323728312
probiotics for the prevention of clostridium difficile-associated diarrhea in adults and children.antibiotics are widely prescribed; however they can cause disturbances in gastrointestinal flora which may lead to reduced resistance to pathogens such as clostridium difficile (c. difficile). probiotics are live organisms thought to balance the gastrointestinal flora.201323728658
improved bacterial mutagenesis by high-frequency allele exchange, demonstrated in clostridium difficile and streptococcus suis.here we show that the frequency of mutant isolation by two-step allele exchange can be improved by increasing the length of homologous dna and the opportunity for recombination, obviating the need for counterselection markers. these principles are demonstrated in clostridium difficile and streptococcus suis but are likely to be generally applicable.201323728809
control of clostridium difficile-associated diarrhea by antibiotic stewardship in a small community hospital. 201223730314
impact of toxigenic clostridium difficile polymerase chain reaction testing on the clinical microbiology laboratory and inpatient epidemiology.conversion from clostridium difficile toxin a/b eia to tcdb polymerase chain reaction for diagnosis of c. difficile infection (cdi) resulted in significant decreases in laboratory testing volume and largely unchanged c. difficile toxin detection rates. decreases in healthcare-associated cdi rates (p ≤ 0.05) reflected a clinical practice benefit of this conversion.201323731555
expression and cytoprotective activity of the small gtpase rhob induced by the escherichia coli cytotoxic necrotizing factor 1.rhob is the only member of the rho subfamily of small gtpases, which is classified as an immediate early gene product. rhob is up-regulated in response to growth factors as well as cytotoxic and genotoxic agents. clostridial glucosylating toxins have been reported to evoke pronounced rhob expression, based on the inactivation of rho/ras proteins. in this study, we report on a long lasting expression of rhob in cultured cells upon activation of rho proteins by the cytotoxic necrotizing factor 1 ( ...201323732113
clostridium difficile: a cause of diarrhea in children. 201323733223
hospital-acquired clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards.clostridum difficile (c. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. we aimed to determine the rate and characteristics of hospital-acquired c. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards.201323734349
challenges and opportunities for faecal microbiota transplantation therapy.the incidence, morbidity, and mortality associated with clostridium difficile gastrointestinal infections has increased greatly over recent years, reaching epidemic proportions; a trend due, in part, to the emergence of hypervirulent and antibiotic-resistant strains. the need to identify alternative, non-antibiotic, treatment strategies is therefore urgent. the ability of bacteria in faecal matter transplanted from healthy individuals to displace pathogen populations is well recognized. further, ...201323735045
[septic shock due to a community acquired clostridium difficile infection. a case study and a review of the literature].the epidemiology of clostridium difficile infection has changed in the past decade. the incidence rate of community acquired cases has increased in patients with no typical risk factors. we present a patient who was diagnosed with community-acquired clostridium difficile infection who presented with acute abdominal pain, and subsequently developed acute renal failure and septic shock. we describe the diagnosis, treatment and outcome and brief review of the literature.201423735318
clostridium difficile infection associated with pig farms. 201323735347
antimicrobial de-escalation strategies in hospitalized patients with pneumonia, intra-abdominal infections, and bacteremia.increasing numbers of serious hospital/healthcare- or community-acquired infections are caused by resistant (often multi-drug resistant) bacterial pathogens. because delayed or ineffective initial therapy can have severe negative consequences, patients at risk for these types of infections typically receive initial empiric antibiotic therapy with a broad-spectrum regimen covering the most likely pathogens, based on local surveillance data and risk factors for infection with a resistant microorga ...201223737333
duration and cessation of antimicrobial treatment.shortening the duration of antimicrobial therapy is an important strategy for optimizing patient care and reducing the spread of antimicrobial resistance. it is best used in the context of an overall approach to infection management that includes a focus on selecting the right initial drug and dosing regimen for empiric therapy, and de-escalation to a more narrowly focused drug regimen (or termination) based on subsequent culture results and clinical data. in addition to reducing resistance, oth ...201223737335
essential oil composition and antimicrobial activity of aerial parts and ripe fruits of echinophora spinosa (apiaceae) from italy.the chemical composition and antimicrobial activity of the essential oils obtained from the flowering aerial parts and ripe fruits of echinophora spinosa l. (apiaceae) from central italy were analyzed by gc/ms. the major constituents of the oil from the aerial parts were beta-phellandrene (34.7%), myristicin (16.5%), delta3-carene (12.6%), alpha-pinene (6.7%) and alpha-phellandrene (6.2%), and of the oil from the ripe fruits p-cymene (50.2%), myristicin (15.3%), alpha-pinene (15.1%) and alpha-ph ...201323738471
prevalence of colonization and infection with methicillin-resistant staphylococcus aureus and vancomycin-resistant enterococcus and of clostridium difficile infection in canadian hospitals.to determine the prevalence of methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), and clostridium difficile infection (cdi) in canadian hospitals.201323739072
impact of electronic surveillance on isolation practices.to assess the impact of an electronic surveillance system on isolation practices and rates of methicillin-resistant staphylococcus aureus (mrsa).201323739073
burden of hospital-onset clostridium difficile infection in patients discharged from rhode island hospitals, 2010-2011: application of present on admission indicators.the year 2010 is the first time that the rhode island hospital discharge database included present on admission (poa) indicators, which give us the opportunity to distinguish cases of hospital-onset clostridium difficile infection (cdi) from cases of community-onset cdi and to assess the burden of hospital-onset cdi in patients discharged from rhode island hospitals during 2010 and 2011.201323739074
clostridium difficile erm(b)-containing elements and the burden on the in vitro fitness.in clostridium difficile, resistance to the macrolide-lincosamide-streptogramin b group of antibiotics generally relies on erm(b) genes. in this study, we investigated elements with a genetic organization different from tn5398, the mobilizable non-conjugative element identified in c. difficile strain 630. our results suggested that the elements most frequently found in strains isolated during the european surveillance study in 2005 were related to tn6194, the conjugative transposon recently dete ...201323741023
single-port laparoscopic right hemicolectomy: intermediate results.single-port laparoscopic colectomy was first described in 2008 as a new technique for colorectal surgery. no available reports have stated the intermediate- or long-term outcome. we report our intermediate results for the first 20 single-port laparoscopic right hemicolectomies performed by a single laparoscopically trained surgeon at our institution.201723743366
the role of the surface environment in healthcare-associated infections.this article reviews the evidence demonstrating the importance of contamination of hospital surfaces in the transmission of healthcare-associated pathogens and interventions scientifically demonstrated to reduce the levels of microbial contamination and decrease healthcare-associated infections.201323743816
assessment of 30-day all-cause mortality in metronidazole-treated patients with clostridium difficile infection.the society for healthcare epidemiology (shea) and the infectious diseases society of america (idsa) clinical practice guidelines for clostridium difficile infection (cdi) help to define and make recommendations for the treatment of mild to moderate disease with metronidazole and severe disease with vancomycin. we retrospectively evaluated 285 patients who were initially treated with metronidazole and stratified them by severity of illness using the guideline criteria. we compared the outcomes i ...201323746336
[cost of clostridium difficile associated diarrhea in spain].there are not available adequate studies of the costs of clostridium difficile-associated diarrhea (cdad) in spain. the aim of the study is to estimate the cost of cdad for the national health service (nhs).201623748655
diagnostic testing for clostridium difficile infection in patients with inflammatory bowel disease. 201323751851
fecal transplant for clostridium difficile-reply. 201223752359
new drugs and strategies for management of clostridium difficile colitis.approaches for management of clostridium difficile infection continually evolve as research reveals shifts in epidemiology, microbial pathogenesis, disease severity states, and response to therapy. these new discoveries significantly impact diagnostic and therapeutic strategies, given the high morbidity associated with this common nosocomial infectious diarrhea. critically ill patients are at an increased risk of developing diarrheal illness like c. difficile and succumbing to potentially fatal ...201523753229
modern trends in infection control practices in intensive care units.hospital-acquired infections (hais) are common in intensive care unit (icu) patients and are associated with increased morbidity and mortality. there has been an increasing effort to prevent hais, and infection control practices are paramount in avoiding these complications. in the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. this article reviews the modern trends in infection control practices to prevent hais in ...201423753240
evaluation of the rapid loop-mediated isothermal amplification assay illumigene for diagnosis of clostridium difficile in an outbreak situation.an outbreak of clostridium difficile infection (cdi) at höglandet hospital eksjö in southern sweden in 2011 was mainly due to a multidrug-resistant pcr ribotype 046 (30% of all samples). diagnostics used routinely was the vidas cdab assay, but to control the outbreak the rapid loop-mediated isothermal amplification (lamp) assay illumigene was introduced and both techniques were compared to toxigenic culture (tc) prospectively. the lamp assay had a superior sensitivity, that is, 98% compared to 7 ...201423758095
acid suppression and the risk of clostridium difficile infection. 201323759424
evaluation of the effect of oritavancin on clostridium difficile spore germination, outgrowth and recovery.previous work suggests oritavancin may be inhibitory to clostridium difficile spores. we have evaluated the effects of oritavancin exposure on c. difficile spore germination, outgrowth and recovery.201323759507
effect of ribotype on all-cause mortality following clostridium difficile infection.clostridium difficile infection (cdi) is significantly associated with subsequent all-cause mortality. although a number of studies have investigated mortality associated with cdi, few have compared all-cause mortality between ribotypes.201323759667
clostridium difficile infection: the importance of accurate diagnosis. 201323763047
characterization of swine isolates of clostridium difficile in spain: a potential source of epidemic multidrug resistant strains?clostridium difficile is an emerging pathogen for humans and animals and there is concern about the possibility that livestock might serve as a reservoir of epidemic strains. in spain, ribotype 078 is one of the most prevalent in human episodes of c. difficile infection, but the distribution of this and other ribotypes in animals is yet unknown. we present the first report on the ribotype distribution and antimicrobial susceptibility of c. difficile in swine in spain. a total of 144 isolates wer ...201323764416
clostridium difficile infection. 201323764494
declining cephalosporin and fluoroquinolone non-susceptibility among bloodstream enterobacteriaceae from the uk: links to prescribing change?the uk saw major increases in cephalosporin and quinolone resistance amongst enterobacteriaceae from 2001 to 2006, with cephalosporin resistance largely reflecting dissemination of ctx-m extended-spectrum β-lactamases (esbls). we review subsequent trends.201323766490
clostridium difficile infection--is it coming at us? 201223767195
incidence of clostridium difficile associated diarrhoea in a tertiary care hospital.rampant and injudicious use of broad spectrum antibiotics in hospitalized patients has increased the incidence of clostridium difficile associated diarrhoea (cdad). though antibiotic use is the best known risk factor for cdad, the occurrence of community acquired c. difficile suggests the presence of other risk factors too. however cdad is still under-recognized in india and asia. therefore we undertook a prospective study to determine the incidence of clostridium difficile associated diarrhoea ...201223767199
diarrhea-associated pathogens, lactobacilli and cellulolytic bacteria in equine feces: responses to antibiotic challenge.antibiotics are important to equine medicine, but antibiotic-associated diarrhea (aad) can lead to poor performance and even mortality. aad is attributed to disruption of the hindgut microbiota, which permits proliferation of pathogenic microbes. the goal of this study was to evaluate the effects of common antibiotics on cellulolytic bacteria, lactobacilli, and aad-associated pathogens in the feces of healthy horses. fifteen horses were assigned to three treatment groups (blocked by age and sex) ...201323769300
clostridium difficile in the icu: study of the incidence, recurrence, clinical characteristics and complications in a university hospital.although several studies have established the association between antibiotics and clostridium difficile infection (cdi), there is a lack of epidemiological studies on the incidence of cdi in european intensive care units outside the context of infection outbreaks. the present study describes the incidence, patient characteristics, complications, and recurrence rates of cdi in a spanish icu.201423769945
in vitro selective inhibitory effect of 8-hydroxyquinoline against bifidobacteria and clostridia.8-hydroxyquinoline (8hq) inhibited clostridium tertium, clostridium clostridioforme, clostridium difficile and clostridium perfringens in vitro with mics of 8, 16, 32 and 32 μg/ml, respectively. in contrast, mics of most bifidobacteria (84%) were 512 μg/ml or higher. thus, 8hq could be used as anti-clostridial agent or in selective media for bifidobacteria isolation.201323770542
clostridium difficile infection in hospitalized cancer patients in beijing, china is facilitated by receipt of cancer chemotherapy.the purpose of this study was to determine the presence of clostridium difficile infection (cdi) and risk factors for infection in hospitalized patients with diarrhea in a cancer hospital in beijing, china. a total of 277 patients with hospital-associated diarrhea (had) were studied of which 41 (15%) were positive for fecal c. difficile toxin a/b. for each cdi case identified, a control with had but negative c. difficile specimen was enrolled to look for cdi risk factors. receipt of cancer chemo ...201323770543
elevated lactoferrin is associated with moderate to severe clostridium difficile disease, stool toxin, and 027 infection.we evaluated blood and fecal biomarkers as indicators of severity in symptomatic patients with confirmed clostridium difficile infection (cdi). recruitment included patients with cdi based on clinical symptoms and supporting laboratory findings. disease severity was defined by physician's assessment and blood and fecal biomarkers were measured. toxigenic culture done using spore enrichment and toxin b detected by tissue culture were done as confirmatory tests. polymerase chain reaction (pcr) rib ...201323771554
extraintestinal clostridium difficile infections.clostridium difficile causes diarrhea that ranges from a benign, self-limiting antibiotic use-associated disease to a life-threatening pseudomembranous colitis. clostridium difficile has rarely been isolated in extraintestinal infections. our objective was to characterize clinical features and risk factors of these infections. methods extraintestinal c. difficile infections (cdis) were searched for in an electronic database of all c. difficile-positive isolates found during a 10-year period. the ...201323771984
the agr locus regulates virulence and colonization genes in clostridium difficile 027.the transcriptional regulator agra, a member of the lyttr family of proteins, plays a key role in controlling gene expression in some gram-positive pathogens, including staphylococcus aureus and enterococcus faecalis. agra is encoded by the agracdb global regulatory locus, and orthologues are found within the genome of most clostridium difficile isolates, including the epidemic lineage 027/bi/nap1. comparative rna sequencing of the wild type and otherwise isogenic agra null mutant derivatives of ...201323772065
effect of an oxygen-tolerant bifurcating butyryl coenzyme a dehydrogenase/electron-transferring flavoprotein complex from clostridium difficile on butyrate production in escherichia coli.the butyrogenic genes from clostridium difficile dsm 1296(t) have been cloned and expressed in escherichia coli. the enzymes acetyl-coenzyme a (coa) c-acetyltransferase, 3-hydroxybutyryl-coa dehydrogenase, crotonase, phosphate butyryltransferase, and butyrate kinase and the butyryl-coa dehydrogenase complex composed of the dehydrogenase and two electron-transferring flavoprotein subunits were individually produced in e. coli and kinetically characterized in vitro. while most of these enzymes wer ...201323772070
infectious agents associated with diarrhoea in neonatal foals in central kentucky: a comprehensive molecular study.diarrhoea caused by infectious agents is common in foals but there is no comprehensive molecular work-up of the relative prevalence of common agents and appearance of coinfections.201423773143
clostridium difficile: restoring the balance--microbes for the management of clostridium difficile infection? 201323774772
clostridium difficile infection in the elderly.the incidence of c. difficile infections (cdi) in the elderly continues to rise and infection is associated with increased morbidity and mortality when compared to those affected in younger age-groups. immunosenescence may be a contributory factor yet the exact immune responses that may protect against cdi are incompletely understood. increased exposure to antibiotics, frequent and/or prolonged hospital admissions and residing in long-term care facilities provide multiple opportunities for host ...201323774972
role of interleukin 23 signaling in clostridium difficile colitis.clostridium difficile is currently the leading cause of hospital-acquired infections in the united states. here, we observed increased interleukin 23 (il-23) protein levels in human colon biopsy specimens positive for c. difficile toxins, compared with levels in negative controls (p = .008) we also investigated the role of il-23 during c. difficile infection, using 2 distinct murine models. mice lacking il-23 signaling had a significant increase in survival (100% [12 mice]), compared with contro ...201323776194
recent advances in antibacterial drugs.the incidence of antimicrobial resistance is on continued rise with a threat to return to the "pre-antibiotic" era. this has led to emergence of such bacterial infections which are essentially untreatable by the current armamentarium of available treatment options. various efforts have been made to develop the newer antimicrobials with novel modes of action which can act against these multi-drug resistant strains. this review aims to focus on these newly available and investigational antibacteri ...201323776832
clinical utility of retrograde terminal ileum intubation in the evaluation of chronic non-bloody diarrhea.the aims of this study were to investigate the frequency and factors involved in the terminal ileum intubation of patients with chronic, non-bloody diarrhea and to compare diagnostic yields of colonoscopy and ileocolonoscopy.201323777610
clostridium difficile leaves the hospital--what's next? 201323778358
epidemiology of community-associated clostridium difficile infection, 2009 through 2011.clostridium difficile infection (cdi) has been increasingly reported among healthy individuals in the community. recent data suggest that community-associated cdi represents one-third of all c difficile cases. the epidemiology and potential sources of c difficile in the community are not fully understood.201323780507
clostridium difficile colitis acquired in the intensive care unit: outcome and prognostic factors.we assessed factors associated with mortality and complicated course in the case of clostridium difficile infection (cdi) acquired in the intensive care unit (icu).201423780568
the functional vangcd cluster of clostridium difficile does not confer vancomycin resistance.vangcd, a cryptic gene cluster highly homologous to the vang gene cluster of enterococcus faecalis is largely spread in clostridium difficile. since emergence of vancomycin resistance would have dramatic clinical consequences, we have evaluated the capacity of the vangcd cluster to confer resistance. we showed that expression of vangcd is inducible by vancomycin and that vangcd , vanxycd and vantcd are functional, exhibiting d-ala : d-ser ligase, d,d-dipeptidase and d-ser racemase activities res ...201323782343
clostridium difficile infection in newly diagnosed pediatric inflammatory bowel disease in the mid-southern united states.clostridium difficile is an emerging opportunistic pathogen that infects patients with underlying chronic disorders such as inflammatory bowel diseases (ibd) at high rates. an extremely high prevalence of clostridium difficile infection (cdi) was noted recently in new-onset pediatric ibd from eastern europe (poland). we examined the rate of cdi in our new pediatric ibd patients (123 tested) from 2010 to 2012. the overall prevalence of cdi at disease onset was 8.1%, significantly (p < 0.0001) low ...201323783013
challenges for standardization of clostridium difficile typing methods.typing of clostridium difficile facilitates understanding of the epidemiology of the infection. some evaluations have shown that certain strain types (for example, ribotype 027) are more virulent than others and are associated with worse clinical outcomes. although restriction endonuclease analysis (rea) and pulsed-field gel electrophoresis have been widely used in the past, pcr ribotyping is the current method of choice for typing of c. difficile. however, global standardization of ribotyping r ...201323784128
impact of cleaning and other interventions on the reduction of hospital-acquired clostridium difficile infections in two hospitals in england assessed using a breakpoint model.clostridium difficile infection remains a major challenge for hospitals. although targeted infection control initiatives have been shown to be effective in reducing the incidence of hospital-acquired c. difficile infection, there is little evidence available to assess the effectiveness of specific interventions.201323787167
laboratory diagnosis of clostridium difficile infections: there is light at the end of the colon.single molecular or multistep assays (glutamate dehydrogenase, toxin a/b, ± molecular) are recommended for the diagnosis of cdi in patients with clinically significant diarrhea. rapid and accurate tests can improve resource allocations and improve patient care. enzyme immunoassay (eia) for toxins a/b is too insensitive for use as a stand-alone assay. this guideline will examine the use of molecular tests and multitest algorithms for the diagnosis of clostridium difficile infection (cdi). these n ...201323788237
clostridium difficile infections in south east scotland: mortality and recurrence in a region without pcr ribotype 027.three hundred and thirty-five patients with laboratory-confirmed clostridium difficile infections (cdis) were studied for epidemiological features, clinical presentation and laboratory markers. they were followed up for 1 year to determine recurrence and mortality. four hundred and thirty-two episodes were recorded. one year mortality was 41.8 % of which cdi was listed on 20 % of the death certificates. one year recurrence rate was 22.9 %. pcr ribotype 001 was the commonest epidemiological type ...201323788595
rapid detection of clostridium difficile toxins from stool samples using real-time multiplex pcr.in this study, a total of 650 stool samples were tested to show that our method is capable of detecting four clostridium difficile genes; tcda, tcdb, encoding toxin a (tcda) and toxin b (tcdb), and the binary toxin c. difficile transferase genes (cdta and/or cdtb) encoding cdt toxin. besides detecting the targeted c. difficile genes, our method can be used to detect the presence of any inhibitory components in the pcr. this assay, combined with a selective culture medium, such as the chromid™ c. ...201323788597
national variability in surveillance, testing, and infection prevention for clostridium difficile infection in pediatric populations.to assess national variability in methods of identifying and preventing clostridium difficile infection (cdi) in pediatric populations, an anonymous survey was sent to hospital epidemiologists at us children's hospitals. data from 30 hospitals indicate substantial variability in surveillance, testing, and infection control strategies, which may limit reliable interfacility comparison of cdi rates. in addition, only 60% of respondents perform surveillance for community-associated cdi.201323790613
the clostridium difficile exosporium cysteine (cdec)-rich protein is required for exosporium morphogenesis and coat assembly.clostridium difficile is an important nosocomial pathogen that has become a major cause of antibiotic-associated diarrhea. there is a general consensus that c. difficile spores play an important role in c. difficile pathogenesis, contributing to infection, persistence, and transmission. evidence has demonstrated that c. difficile spores have an outermost layer, termed the exosporium, that plays some role in adherence to intestinal epithelial cells. recently, the protein encoded by cd1067 was sho ...201323794627
immunological evaluation of a synthetic clostridium difficile oligosaccharide conjugate vaccine candidate and identification of a minimal epitope.clostridium difficile is the cause of emerging nosocomial infections that result in abundant morbidity and mortality worldwide. thus, the development of a vaccine to kill the bacteria to prevent this disease is highly desirable. several recently identified bacterial surface glycans, such as ps-i and ps-ii, are promising vaccine candidates to preclude c. difficile infection. to circumvent difficulties with the generation of natural ps-i due to its low expression levels in bacterial cultures, impr ...201323795894
renal impairment and clinical outcomes of clostridium difficile infection in two randomized trials.patients with chronic kidney disease (ckd) have increased risk for clostridium difficile infection (cdi) and for subsequent mortality. we determined the effect of ckd on response to treatment for cdi.201323796582
vancomycin use for pediatric clostridium difficile infection is increasing and associated with specific patient characteristics.in adults with clostridium difficile infection (cdi), enteral vancomycin is considered the preferred initial regimen for severe disease; however, patterns of antimicrobial use for children with cdi are unknown. we sought to describe trends in and predictors of vancomycin use for the treatment of children with cdi admitted to tertiary-care children's hospitals in the united states. we used a database of freestanding children's hospitals to identify patients 1 to 18 years old with cdi between janu ...201323796942
increased hospital length of stay attributable to clostridium difficile infection in patients with four co-morbidities: an analysis of hospital episode statistics in four european countries.hospital-onset clostridium difficile infection (cdi) places a significant burden on health care systems throughout europe, estimated at around €3 billion per annum. this burden is shared between national payers and hospitals that support additional bed days for patients diagnosed with cdi while in hospital or patients re-admitted from a previous hospitalisation. this study was performed to quantify additional hospital stay attributable to cdi in four countries, england, germany, spain, and the n ...201323797490
imipenem versus piperacillin/tazobactam for empiric treatment of neutropenic fever in adults.australian guidelines for neutropenic fever recommend piperacillin/tazobactam (pip-taz) or cefepime for first-line empiric treatment of neutropenic fever. we compared outcomes among haematology patients before and after changing our first-line neutropenic fever treatment from imipenem to pip-taz. forty-five patients received imipenem and 60 pip-taz. despite a higher rate of antibiotic modification in the pip-taz cohort, treatment success and time to defervescence were similar, with a trend towar ...201323800137
quinolone prophylaxis for the prevention of bk virus infection in kidney transplantation: study protocol for a randomized controlled trial.bk virus infection has emerged as a major complication in kidney transplantation leading to a significant reduction in graft survival. there are currently no proven strategies to prevent or treat bk virus infection. quinolone antibiotics, such as levofloxacin, have demonstrated activity against bk virus. we hypothesize that administration of a quinolone antibiotic, when given early post-transplantation, will prevent the establishment of bk viral replication in the urine and thus prevent systemic ...201323800312
correlation between virulence gene expression and proton pump inhibitors and ambient ph in clostridium difficile: results of an in vitro study.proton pump inhibitors (ppis) are associated with the development of clostridium difficile infection in humans. though it is assumed that ppis mediate this effect through gastric acid suppression, there has been little investigation into whether ppis, or ambient ph, might directly affect the expression of c. difficile toxin genes. in the present study, c. difficile ribotypes 001, 027 and 078 obtained from human subjects were grown under anaerobic conditions prepared at phs of 5, 7.3 and 9. match ...201323800596
ceftaroline fosamil: a review of its use in the treatment of complicated skin and soft tissue infections and community-acquired pneumonia.ceftaroline, the active metabolite of the prodrug ceftaroline fosamil (zinforo, teflaro), is an advanced-generation, parenteral cephalosporin with broad-spectrum antibacterial activity in vitro against gram-positive bacteria, including methicillin-resistant staphylococcus aureus (mrsa) and multidrug resistant streptococcus pneumoniae and gram-negative bacteria, including haemophilus influenzae and moraxella catarrhalis, but not pseudomonas aeruginosa. ceftaroline has demonstrated a low potential ...201323801418
intestinal dysbiosis and depletion of butyrogenic bacteria in clostridium difficile infection and nosocomial diarrhea.clostridium difficile infection (cdi) causes nearly half a million cases of diarrhea and colitis in the united states each year. although the importance of the gut microbiota in c. difficile pathogenesis is well recognized, components of the human gut flora critical for colonization resistance are not known. culture-independent high-density roche 454 pyrosequencing was used to survey the distal gut microbiota for 39 individuals with cdi, 36 subjects with c. difficile-negative nosocomial diarrhea ...201323804381
evaluation of a new automated homogeneous pcr assay, genomera c. difficile, for rapid detection of toxigenic clostridium difficile in fecal specimens.we evaluated a new automated homogeneous pcr assay to detect toxigenic clostridium difficile, the genomera c. difficile assay (abacus diagnostica, finland), with 310 diarrheal stool specimens and with a collection of 33 known clostridial and nonclostridial isolates. results were compared with toxigenic culture results, with discrepancies being resolved by the genexpert c. difficile pcr assay (cepheid). among the 80 toxigenic culture-positive or genexpert c. difficile assay-positive fecal specime ...201323804386
evaluation of cycloserine-cefoxitin fructose agar (ccfa), ccfa with horse blood and taurocholate, and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme for recovery of clostridium difficile isolates from fecal samples.cycloserine-cefoxitin fructose agar (ccfa), ccfa with horse blood and taurocholate (ccfa-ht), and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme (ccmb-tal) were compared for recovery of clostridium difficile from 120 stool specimens. compared to ccfa, ccfa-ht enhanced c. difficile growth and improved recovery by 4%. in a separate study, 9% (8/91) of stool samples previously c. difficile negative on plate medium were c. difficile positive when cultured in ccmb-tal.201323804392
a retrospective review of metronidazole and vancomycin in the management of clostridium difficile infection in patients with hematologic malignancies.the incidence and severity of clostridium difficile infection has significantly increased over the past decade. although the epidemiology and treatment of c. difficile infection is well elucidated in the non-oncology population, it is poorly understood among cancer patients. this illustrates great concern as the majority of these patients are immunosuppressed, which puts them at higher risk for developing severe disease. furthermore, suboptimal treatment of c. difficile infection can compromise ...201423804627
clostridium difficile infection among hematopoietic stem cell transplant recipients: beyond colitis.to review the most recent data regarding the epidemiology, risks factors, and outcomes among hematopoietic stem cell transplant recipients with clostridium difficile infection (cdi).201323806895
clostridium difficile infection.clostridium difficile is emerging as a common cause of infectious diarrhea. incidence has increased dramatically since 2000, associated with a new strain that features both increased toxin production and increased resistance to antibiotics. for patients with mild to moderate disease, oral metronidazole is usually the first choice of treatment, and those with severe disease should be treated with vancomycin, with additional intravenous metronidazole in some cases. fecal microbiota transplantation ...201323809712
unusual case of prosthetic shoulder joint infection due to clostridium difficile.extraintestinal manifestatation such as prosthetic joint infection due to clostridium difficile is a rare diagnosis. a 47-year-old female patient presented with chronic pain in left shoulder prosthetic joint. plain roentgenogram of left shoulder prosthetic joint revealed anterior dislocation and loosening of prosthesis. the synovial fluid cultures and intraoperative deep joint cultures repeatedly grew clostridium difficile. patient was treated with antimicrobial therapy and surgical debridement ...201323811577
clostridium difficile infection associated with antituberculous agents in a patient with tuberculous pericarditis.clostridium difficile can cause pseudomembranous colitis (pmc). antimicrobial agent exposure is a risk factor for clostridium difficile-associated disease, whereas the use of antituberculous (anti-tb) agents is not. we herein report a case of pmc-associated with antituberculous therapy. a 63-year-old woman with tuberculous pericarditis treated with anti-tb agents was admitted for abdominal pain and diarrhea. on colonoscopy, mucoid exudate and yellowish plaque lesions were observed. the anti-tb a ...201323812197
pre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients.patients requiring mechanical ventilation (mv) for >48 h after major heart surgery (mhs) are at a high risk of acquiring ventilator-associated pneumonia (vap) and tracheobronchitis (vat). most non-pharmacological interventions to prevent vap in such patients are usually already implemented. the objective of this study was to evaluate the efficacy in preventing lower respiratory infections of antibiotics active against multidrug-resistant pathogens in this very high-risk population.201323812339
nutritional and microbial analysis of bully sticks and survey of opinions about pet treats.the objectives of this study were to measure the caloric density of bully sticks, to analyze the bully sticks for bacterial contamination, and to assess owner opinions about these and other pet treat products. mean caloric density was 15 kcal/inch (38 kcal/cm) [range: 9 to 22 kcal/inch (23 to 56 kcal/cm), 2.96 to 3.07 kcal/g]. of 26 bully sticks that were tested for bacterial contamination 1 (4%) was contaminated with clostridium difficile, 1 was contaminated with methicillin-resistant staphyloc ...201323814301
an investigation into the association between cpb2-encoding clostridium perfringens type a and diarrhea in neonatal piglets.to investigate the possible role of cpb2-positive type a clostridium perfringens in neonatal diarrheal illness in pigs, the jejunum and colon of matched normal and diarrheic piglets from 10 farms with a history of neonatal diarrhea were examined grossly and by histopathology, and tested for c. perfringens, for c. perfringens beta2 (cpb2) toxin, as well as for clostridium difficile toxins, salmonella, enterotoxigenic escherichia coli, rotavirus, transmissible gastroenteritis (tge) virus, and cocc ...201323814355
community-acquired clostridium difficile infection: awareness and clinical implications.the epidemiology of clostridium difficile infection (cdi) is changing. cdi, usually depicted as a nosocomial infection in the elderly, is now occurring in community-dwelling persons who are younger and otherwise dissimilar. a more virulent isolate (north american pulsed field type 1 (nap1) associated with increased morbidity and mortality, has been identified. in 2005, similar strains were associated with severe disease in community-dwelling patients at a rate of 7.6/100,000. screening patients ...201323814528
a unique strain of community-acquired clostridium difficile in severe complicated infection and death of a young adult.clostridium difficile is the major cause of nosocomial antibiotic-associated diarrhoea with the potential risk of progressing to severe clinical outcomes including death. it is not unusual for clostridium difficile infection to progress to complications of toxic megacolon, bowel perforation and even gram-negative sepsis following pathological changes in the intestinal mucosa. these complications are however less commonly seen in community-acquired clostridium difficile infection than in hospital ...201323815405
epidemiology of clostridium difficile infection in asia.while clostridium difficile infection (cdi) has come to prominence as major epidemics have occurred in north america and europe over the recent decade, awareness and surveillance of cdi in asia have remained poor. limited studies performed throughout asia indicate that cdi is also a significant nosocomial pathogen in this region, but the true prevalence of cdi remains unknown. a lack of regulated antibiotic use in many asian countries suggests that the prevalence of cdi may be comparatively high ...201323816346
clinical features and treatment responses in pediatric lymphocytic and collagenous colitis.microscopic colitis (mc) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric mc is limited.201323820404
diagnosis of clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories.clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. since the early 2000s, the incidence of c. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. for many years, the mainstay of c. difficile disease diagnosis was enzyme immunoassays for detection of the c. difficile to ...201323824374
[multiresistant organisms].infections caused by multidrug resistant (mdr) organisms are becoming more frequently in daily practice and are associated with an increase in duration of treatment and mortality. during the past decades, particular attention in the field of mdr pathogens was paid to methicillin-resistant staphylococcus aureus (mrsa). for the last years, mdr gram-negative organisms, with e.g., "extended-spectrum beta-lactamases" (esbl), have been gaining a growing significance. currently, treatment of infections ...201523824619
caspase activation as a versatile assay platform for detection of cytotoxic bacterial toxins.pathogenic bacteria produce several virulence factors that help them establish infection in permissive hosts. bacterial toxins are a major class of virulence factors and hence are attractive therapeutic targets for vaccine development. here, we describe the development of a rapid, sensitive, and high-throughput assay that can be used as a versatile platform to measure the activities of bacterial toxins. we have exploited the ability of these toxins to cause cell death via apoptosis of sensitive ...201323824772
community-associated clostridium difficile infection among older people in tayside, scotland, is associated with antibiotic exposure and care home residence: cohort study with nested case-control.to estimate the risks of community-associated clostridium difficile infection (ca-cdi) among the population aged ≥ 65 years associated with antibiotic exposure and care home residence.201323825381
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