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[clostridium difficile--an increasing problem]. 201323828075
[case report. leukocytosis in the course of clostridium difficile infection].clostridium difficile infections (cdi) are increasing in incidence and severity, amongst other reasons because of the increasing spread of hypervirulent strains. leukocytosis is a sign of severe cdi and is predictive for a complicated course. in this case report, we describe 2 patients with cdi who developed leukocytosis within a leukemoid range. in both cases high white blood cell counts returned totally to normal range under cdi therapy according to guidelines. leukemia-related therapy pattern ...201323828079
clinical relevance of a positive molecular test in the diagnosis of clostridium difficile infection.in 2011, the department of health advised that a two-stage test approach should be used to improve accuracy of clostridium difficile infection (cdi) diagnosis. no specific test protocol was established at that time.201323831282
a genomic update on clostridial phylogeny: gram-negative spore formers and other misplaced clostridia.the class clostridia in the phylum firmicutes (formerly low-g+c gram-positive bacteria) includes diverse bacteria of medical, environmental and biotechnological importance. the selenomonas-megasphaera-sporomusa branch, which unifies members of the firmicutes with gram-negative-type cell envelopes, was recently moved from clostridia to a separate class negativicutes. however, draft genome sequences of the spore-forming members of the negativicutes revealed typically clostridial sets of sporulatio ...201323834245
assessment of treatment patterns and patient outcomes before vs after implementation of a severity-based clostridium difficile infection treatment policy.national guidelines recommend oral vancomycin for severe clostridium difficile infection (cdi) based on results from recent clinical trials demonstrating improved clinical outcomes. however, real-world data to support these clinical trials are scant.201323834988
glycan arrays containing synthetic clostridium difficile lipoteichoic acid oligomers as tools toward a carbohydrate vaccine.clostridium difficile is a leading cause of severe nosocomial infections. cell-surface carbohydrate antigens are promising vaccine candidates. here we report the first total synthesis of oligomers of the lipoteichoic acid antigen repeating unit. synthetic glycan microarrays revealed anti-glycan antibodies in the blood of patients that help to define epitopes for vaccine development.201323836132
fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid organ and hematopoietic stem cell transplantation with clostridium difficile-associated diarrhea.the feasibility of fidaxomicin versus vancomycin and metronidazole (conventional therapy) was assessed in 59 transplant recipients with 61 episodes of clostridium difficile-associated diarrhea (cdad). overall clinical cure was achieved in 86% of episodes, and in 7% of episodes, infection recurred. fidaxomicin was well tolerated. clinical cures were not significantly different compared with conventional therapy (67% versus 89%, respectively; p = 0.06). univariate analysis of predictors for lack o ...201323836168
antimicrobial regime for cardiac surgery: the safety and effectiveness of short-course flucloxacillin (or teicoplanin) and gentamicin-based prophylaxis.to determine if changing from multidose cefuroxime-based to flucloxacillin (or teicoplanin) and gentamicin-based antibiotic prophylaxis for cardiac surgery was as effective at preventing infections without increasing postoperative renal impairment.201323837413
[reply to «infections caused by clostridium difficile. addendum»]. 201323838212
discontinuation of reflex testing of stool samples for vancomycin-resistant enterococci resulted in increased prevalence.discontinuation of reflex testing of stool submitted for clostridium difficile testing for vancomycin-resistant enterococci (vre) led to an increase in the number of patients with healthcare-associated vre bacteremia and bacteriuria (0.21 vs 0.36 cases per 1,000 patient-days; p<.01). cost-benefit analysis showed reflex screening and isolation of vre reduced hospital costs.201323838226
utility of an adenosine triphosphate bioluminescence assay to evaluate disinfection of clostridium difficile isolation rooms. 201323838235
clostridium difficile infection in pediatric acute myeloid leukemia: from the canadian infections in acute myeloid leukemia research group.the prevalence and severity of clostridium difficile infection (cdi) has increased over time in adult patients, but little is known about cdi in pediatric cancer. the primary objectives were to describe the incidence and characteristics of cdi in children with de novo acute myeloid leukemia (aml). the secondary objective was to describe factors associated with cdi.201323838731
viral co-infections are common and are associated with higher bacterial burden in children with clostridium difficile infection.clostridium difficile infections in children are increasing. in this cohort study, we enrolled 62 children with diarrhea and c difficile. we performed polymerase chain reaction assays to detect viral agents of gastroenteritis and quantify c difficile burden. fifteen (24%) children diagnosed as having c difficile infection had a concomitant viral co-infection. these patients tended to be younger and had a higher c difficile bacterial burden than children with no viral co-infections (median differ ...201323838821
treatment of recurrent clostridium difficile infection: a systematic review.clostridium difficile infection (cdi) recurs in nearly one-third of patients who develop an initial infection. recurrent cdi (rcdi) is associated with considerable morbidity, mortality, and cost. treatment for rcdi has not been not well examined.201423839210
excess risk of clostridium difficile infection in ovarian cancer is related to exposure to broad-spectrum antibiotics.the purpose of the study was to determine if a diagnosis of ovarian cancer is independently associated with an increased risk of clostridium difficile infection (cdi).201323839499
fecal microbiota transplantation for treating recurrent clostridium difficile infection. 201323841136
clostridium difficile in a hiv-infected cohort: incidence, risk factors, and clinical outcomes.clostridium difficile is the most commonly reported infectious diarrhoea in hiv-infected patients in the united states. we set out to determine the incidence, risk factors and clinical presentation of c. difficile infections (cdis) in a cohort of hiv-infected individuals.201323842125
emerging therapies for clostridium difficile infection - focus on fidaxomicin.the epidemiology of clostridium difficile infections (cdi) has evolved during the last decades, with an increase in the reported incidence, severity of cases, and rate of mortality and relapses. these increases have primarily affected some special populations including the elderly, patients requiring concomitant antibiotic therapy, patients with renal failure, and patients with cancer. until recently, the treatment of cdi was limited to either metronidazole or vancomycin. new therapeutic options ...201323843696
novel strategies for enhanced removal of persistent bacillus anthracis surrogates and clostridium difficile spores from skin.removing spores of clostridium difficile and bacillus anthracis from skin is challenging because they are resistant to commonly used antimicrobials and soap and water washing provides only modest efficacy. we hypothesized that hygiene interventions incorporating a sporicidal electrochemically generated hypochlorous acid solution (vashe(®)) would reduce the burden of spores on skin.201323844234
[harnessing nature for treating infectious and autoimmune diseases: good and bad bacteria].clostridium difficile is the etiologic agent of nosocomial and community-acquired diarrhea associated with exposure to antibiotics that disrupt the normal colonic flora. as antibacterials currently used for primary c. difficile infections favor recurrences, new methods able to neutralize the bacterium without affecting the gut microbiota are badly needed. complementary treatment with probiotic agents to reconstitute the physiological intestinal flora does not yield any consistent benefit. in rec ...201323844515
the adoptive transfer of behavioral phenotype via the intestinal microbiota: experimental evidence and clinical implications.there is growing interest in the ability of the intestinal microbiome to influence host function within and beyond the gastrointestinal tract. here we review evidence of microbiome-brain interactions in mice and focus on the ability to transfer behavioral traits between mouse strains using fecal microbiota transplantation (fmt). transplantation alters brain chemistry and behavior in recipient ex-germ free mice, raising the possibility of using fmt for disorders of the central nervous system, and ...201323845749
comparison of chromid c. difficile agar and cycloserine-cefoxitin-fructose agar for the recovery of clostridium difficile.the rapidly changing epidemiology of clostridium difficile infection highlights the need for improved and continuing surveillance involving stool culturing to enable molecular tracking. culture of c. difficile can be difficult and time consuming. in this report chromid c. difficile agar (cdif) was compared to cycloserine-cefoxitin-fructose-egg-yolk agar which contained 0.1% sodium taurocholate (tccfa) as a germinant.201323846295
clostridium difficile associated disease in a neurointensive care unit.critically ill patients are at high risk for acquiring clostridium difficile infection. the aim of this study was to investigate the prevalence, severity, and outcome of neurointensive care unit (nicu) acquired clostridium difficile associated disease (cdad).201323847584
genetic risk factors for clostridium difficile infection in ulcerative colitis.patients with inflammatory bowel disease (ibd) are at higher risk for clostridium difficile infection (cdi). disruption of gut microbiome and interaction with the intestinal immune system are essential mechanisms for pathogenesis of both cdi and ibd. whether genetic polymorphisms associated with susceptibility to ibd are also associated with risk of cdi is unknown.201323848254
derivation and validation of a simple, accurate and robust prediction rule for risk of mortality in patients with clostridium difficile infection.clostridium difficile infection poses a significant healthcare burden. however, the derivation of a simple, evidence based prediction rule to assist patient management has not yet been described.201323849267
epidemiology of adverse events and clostridium difficile-associated diarrhea during long-term antibiotic therapy for osteoarticular infections.osteoarticular infections require several weeks of antibiotic therapy, but little is known about the epidemiology of adverse events (ae) including symptomatic clostridium difficile-associated diarrhea during treatment in these patients.201323850617
efficacy and safety of paromomycin for treating amebiasis in japan.the clinical management of amebiasis is a growing concern, particularly among human immunodeficiency virus (hiv)-infected individuals who are predisposed to severe illness. treatment with a luminal amebicide is strongly recommended following acute-stage treatment with a nitroimidazole. in 2004, the japanese research group on chemotherapy of tropical diseases introduced paromomycin, which was not nationally licensed, and offered it to a number of patients. from 2004 to 2011, 143 case records of a ...201323850836
evaluation of luminex xtag gastrointestinal pathogen analyte-specific reagents for high-throughput, simultaneous detection of bacteria, viruses, and parasites of clinical and public health importance.acute diarrheal disease (add) can be caused by a range of pathogens, including bacteria, viruses, and parasites. conventional diagnostic methods, such as culture, microscopy, biochemical assays, and enzyme-linked immunosorbent assays (elisa), are laborious and time-consuming and lack sensitivity. combined, the array of tests performed on a single specimen can increase the turnaround time (tat) significantly. we validated a 19plex laboratory-developed gastrointestinal pathogen panel (gpp) using l ...201323850948
prevalence of gastrointestinal clostridium difficile carriage in australian sheep and lambs.recently, clostridium difficile has been isolated from a wide variety of animals, particularly production animals, mainly cattle and pigs. concurrently, the incidence of c. difficile infection (cdi) in humans has increased in the community, with some suggestions that food-borne transmission of c. difficile is occurring. interestingly, sheep and lambs appear not to have been investigated for carriage/colonization with c. difficile. the aim of this project was to determine the prevalence of carria ...201323851101
potent monoclonal antibodies against clostridium difficile toxin a elicited by dna immunization.recent studies have demonstrated that dna immunization is effective in eliciting antigen-specific antibody responses against a wide range of infectious disease targets. the polyclonal antibodies elicited by dna vaccination exhibit high sensitivity to conformational epitopes and high avidity. however, there have been limited reports in literature on the production of monoclonal antibodies (mab) by dna immunization. here, by using clostridium difficile (c. diff) toxin a as a model antigen, we demo ...201323851482
fecal microbiota transplantation: indications, methods, evidence, and future directions.fecal microbiota transplantation (fmt) has attracted great interest in recent years, largely due to the global clostridium difficile infection (cdi) epidemic and major advances in metagenomic sequencing of the gastrointestinal (gi) microbiota, with growing understanding of its structure and function. fmt is now recommended as the most effective therapy for relapsing cdi and, with further refinement, may even be used in "first-time" cdi. there is interest also in other conditions related to gi dy ...201323852569
major infection events over 5 years: how is media coverage influencing online information needs of health care professionals and the public?the last decade witnessed turbulent events in public health. emerging infections, increase of antimicrobial resistance, deliberately released threats and ongoing battles with common illnesses were amplified by the spread of disease through increased international travel. the internet has dramatically changed the availability of information about outbreaks; however, little research has been done in comparing the online behavior of public and professionals around the same events and the effect of ...201323856364
antimicrobial stewardship in pediatrics: how every pediatrician can be a steward.antimicrobial stewardship (as) programs are effective in improving clinical outcomes associated with antimicrobial therapies while improving patient safety by reducing adverse events and development of bacterial resistance. understanding the basic principles of as is essential to the successful development and implementation of as strategies. identifying and developing strategies to address barriers and challenges to as can facilitate the establishment of financial, administrative, and organizat ...201323857121
antimicrobial susceptibility of animal and human isolates of clostridium difficile by broth microdilution.a total of 188 human (n = 92) and animal (n = 96) isolates of clostridium difficile of different pcr ribotypes were screened for susceptibility to 30 antimicrobials using broth microdilution. when comparing the prevalence of antimicrobial resistance, the isolates of animal origin were significantly more often resistant to oxacillin, gentamicin and trimethoprim/sulfamethoxazole (p<0.01). the most significant difference between the animal and human populations (p = 0.0006) was found in the level o ...201323861298
horizontal gene transfer in human pathogens.horizontal gene transfer has a tremendous impact on the genome plasticity, adaptation and evolution of bacteria. horizontally transferred mobile genetic elements are involved in the dissemination of antibiotic resistance and virulence genes, thus contributing to the emergence of novel "superbugs". this review provides update on various mechanisms of horizontal gene transfer and examines how horizontal gene transfer contributes to the evolution of pathogenic bacteria. special focus is paid to the ...201523862575
clostridium difficile infection: a multicenter study of epidemiology and outcomes in mechanically ventilated patients.clostridium difficile is a leading cause of hospital-associated infection in the united states. the purpose of this study is to assess the prevalence of c. difficile infection among mechanically ventilated patients within the icus of three academic hospitals and secondarily describe the influence of c. difficile infection on the outcomes of these patients.201323863229
the protective effect of recombinant lactococcus lactis oral vaccine on a clostridium difficile-infected animal model.oral immunization with vaccines may be an effective strategy for prevention of clostridium difficile infection (cdi). however, application of previously developed vaccines for preventing cdi has been limited due to various reasons. here, we developed a recombinant lactococcus lactis oral vaccine and evaluated its effect on a c. difficile-infected animal model established in golden hamsters in attempt to provide an alternative strategy for cdi prevention.201323865596
indeterminate tcdb using a clostridium difficile pcr assay: a retrospective cohort study.c. difficile (cd) real-time polymerase chain reaction (pcr) for toxin b gene (tcdb) is more sensitive, and reduces turnaround time when compared to toxin immunoassay. we noted typical amplification curves with high tcdb cycle thresholds (ct) and low endpoints (ept) that are labeled negative by the xpert(®) c. difficile assay (cepheid) and undertook this study to determine their significance.201323865713
bacteriotherapy for the treatment of intestinal dysbiosis caused by clostridium difficile infection.faecal microbiota transplantation (fmt) has been used for more than five decades to treat a variety of intestinal diseases associated with pathological imbalances within the resident microbiota, termed dysbiosis. fmt has been particularly effective for treating patients with recurrent clostridium difficile infection who are left with few clinical options other than continued antibiotic therapy. our increasing knowledge of the structure and function of the human intestinal microbiota and c. diffi ...201323866975
is clostridium difficile associated with relapse of inflammatory bowel disease? results from a retrospective and prospective cohort study in the netherlands.although clostridium difficile may be associated with exacerbations in inflammatory bowel diseases (ibd), prospective studies identifying the role of c. difficile in disease activity are currently lacking. we examined the prevalence of c. difficile in feces of (1) symptomatic ibd patients retrospectively and (2) consecutive outpatients in relation to disease activity prospectively.201323867869
fecal transplantation for recurrent clostridium difficile infection in older adults: a review.recurrent clostridium difficile infection (cdi) is a common nosocomial infection that has a large effect on morbidity and quality of life in older adults in hospitals and long-term care facilities. because antibiotics are often unsuccessful in curing this disease, fecal transplantation has emerged as a second-line therapy for treatment of recurrent cdi. a comprehensive literature search of pubmed, embase, and web of science regarding fecal transplantation for cdi was performed to further evaluat ...201323869970
disruption of intrinsic motions as a mechanism for enzyme inhibition.clostridium difficile (c. diff) is one of the most common and most severe hospital-acquired infections; its consequences range from lengthened hospital stay to outright lethality. c. diff causes cellular damage through the action of two large toxins tcda and tcdb. recently, there has been increased effort toward developing antitoxin therapies, rather than antibacterial treatments, in hopes of mitigating the acquisition of drug resistance. to date, no analysis of the recognition mechanism of tcda ...201323870270
reducing health care-associated infections: patients want to be engaged and learn about infection prevention.multidrug-resistant organisms (mdros) are common in health care-associated infection (hai). the aim of this study was to examine patient's willingness to learn about mdros and hais and their preferred ways of education about mdro hais.201323870794
fulminant clostridium difficile colitis: a complication of perioperative antibiotic prophylaxis.antibiotic prophylaxis for maxillofacial surgical wounds remains common practice. surgeons must weigh the risks (e.g., clostridium difficile colitis) against the benefits before administering antibiotics for any reason and the relative risk and morbidity of c difficile colitis against those of a potential postoperative wound infection. in addition, the possibility of c difficile infection as a complication of perioperative antibiotic prophylaxis should be discussed with patients before surgery, ...201323871314
identification and characterization of clostridium sordellii toxin gene regulator.toxigenic clostridium sordellii causes uncommon but highly lethal infections in humans and animals. recently, an increased incidence of c. sordellii infections has been reported in women undergoing obstetric interventions. pathogenic strains of c. sordellii produce numerous virulence factors, including sordellilysin, phospholipase, neuraminidase, and two large clostridial glucosylating toxins, tcsl and tcsh. recent studies have demonstrated that tcsl toxin is an essential virulence factor for th ...201323873908
the complex dynamics of antimicrobial activity in the human gastrointestinal tract.the human gastrointestinal tract is a complex environment of mutualistic associations. as bacteria form a major component of fecal content, the natural balance of the colon can be significantly altered by exposure to antimicrobial agents. however, the effects of antimicrobial therapy on fecal content are difficult to predict and can at times be quite surprising. the emergence and spread of vancomycin-resistant enterococci are cases in point. resistance to the glycopeptide vancomycin emerged in e ...201323874016
infections and inflammatory bowel disease: challenges in asia.the diagnosis and management of inflammatory bowel disease (ibd) in asia can be challenging as certain infections can mimic ibd and lead to a misdiagnosis. colitis can be caused by bacterial infections, ileitis can result from yersinia and salmonella infections and ileocolonic ulcers can be seen in intestinal tuberculosis and amebiasis. in addition, cytomegalovirus and clostridium difficile infection may mimic a flare of ibd and their presence is associated with an increased risk of colectomy an ...201323875824
high prevalence of the epidemic clostridium difficile pcr ribotype 078 in iberian free-range pigs.previous studies in intensively raised piglets have detected a high prevalence of the epidemic clostridium difficile pcr ribotype 078. in this article we present a longitudinal survey of c. difficile colonisation in a population of iberian pigs reared under a free-range system. a total of 160 faecal samples from 20 piglets belonging to different litters were obtained by weekly sampling. c. difficile was recovered from samples collected at different times throughout the survey from a 90% of pigle ...201323876331
[clostridium difficile infection: epidemiology, disease burden and therapy].c. difficile causes 25 percent of the antibiotic associated infectious nosocomial diarrhoeas. c. difficile infection is a high-priority problem of public health in each country. the available literature of c. difficile infection's epidemiology and disease burden is limited.201323876616
comparison of treatment outcomes with vancomycin alone versus combination therapy in severe clostridium difficile infection.the recommended treatment for severe clostridium difficile infection (cdi) is oral vancomycin alone. combination therapy with metronidazole is only recommended in cases complicated by shock, ileus, or toxic megacolon. however, patients with severe infection are often treated with combination therapy despite a lack of data supporting this practice.201323876778
[infections caused by clostridium difficile. addendum]. 201323876975
comparative in vitro activities of smt19969, a new antimicrobial agent, against clostridium difficile and 350 gram-positive and gram-negative aerobic and anaerobic intestinal flora isolates.the comparative in vitro activity of smt19969, a novel, narrow-spectrum, nonabsorbable agent, was studied against 50 ribotype-defined clostridium difficile strains, 174 gram-positive and 136 gram-negative intestinal anaerobes, and 40 gram-positive aerobes. smt19969 was one dilution more active against c. difficile isolates (mic range, 0.125 to 0.5 μg/ml; mic90, 0.25 μg/ml), including ribotype 027 strains, than fidaxomicin (range, 0.06 to 1 μg/ml; mic90, 0.5 μg/ml) and two to six dilutions lower ...201323877700
clinical approach to fever in the neurosurgical intensive care unit: focus on drug fever.as fever is one of the cardinal signs of infection, the presence of fever in a patient in the neurosurgical intensive care unit (nsicu) raises the question of whether it is infectious in etiology. infectious and noninfectious causes of fever in the nsicu may be determined based upon assessment of clinical signs and symptoms, the degree of temperature elevation, the relationship of the pulse to the fever (e.g., an infectious process resulting in hyperpyrexia and bradycardia), and when the fever o ...201323878765
a surview of recent patents on anti-infective therapy for clostridium difficile.clostridium difficile has become the most common infectious cause of healthcare-associated diarrhea, with serious morbidity, prolonged hospitalization and even death. treatment of the disease utilizing today's therapies does not guarantee a successful outcome. in the past decade, many new ideas and inventions have surfaced exploring different treatment strategies of clostridium difficile associated diarrhea (cdad). these treatments include antitoxins, novel antimicrobials, immunoglobulins and la ...201323879822
use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in clostridium difficile transmission.previous studies have suggested that asymptomatic carriers of toxigenic clostridium difficile are a source of hospital-associated (ha) infections. multilocus variable number of tandem repeats analysis (mlva) is a highly discriminatory molecular subtyping tool that helps to determine possible transmission sources.201323881150
editorial commentary: looking to the future: vertical vs horizontal prevention of clostridium difficile infections. 201323881152
hemolytic uremic syndrome and clostridium difficile colitis.hemolytic uremic syndrome (hus) can be associated with different infectious etiologies, but the relationship between pseudomembranous colitis and hus was first described in the 1970s in some childhood patients. there is very limited published literature on clostridium difficile-associated hus. we report a case of c. difficile-related hus in an adult patient and provide a review of the literature.201223882375
the identification and epidemiology of meticillin-resistant staphylococcus aureus and clostridium difficile in patient rooms and the ward environment.research has indicated that the environment may play an important role in the transmission of meticillin-resistant staphylococcus aureus (mrsa) and clostridium difficile in healthcare facilities. despite the significance of this finding, few data exist from longitudinal studies investigating mrsa and c. difficile contamination, concurrently, in both patient rooms and the general ward environment. the objectives of this study were to determine the prevalence of mrsa and c. difficile contamination ...201323883171
diarrhoea in the icu: respective contribution of feeding and antibiotics.diarrhoea is frequently reported in the icu. little is known about diarrhoea incidence and the role of the different risk factors alone or in combination. this prospective observational study aims at determining diarrhoea incidence and risk factors in the first 2 weeks of icu stay, focusing on the respective contribution of feeding, antibiotics, and antifungal drugs.201323883438
in vitro selection, via serial passage, of clostridium difficile mutants with reduced susceptibility to fidaxomicin or vancomycin.current treatments for clostridium difficile infection include vancomycin, metronidazole and fidaxomicin. lff571 is an experimental agent undergoing evaluation in humans for the treatment of moderate c. difficile infection. reduced susceptibility of c. difficile to fidaxomicin or lff571 in vitro can be mediated by single point mutations in genes encoding the targets, whereas the mechanism(s) mediating reduced susceptibility to vancomycin in vitro remains elusive. to further characterize mechanis ...201423887866
presumably hospital-transmitted clostridium difficile infections based on epidemiological linkage.given the traditionally low cdad (clostridium difficile associated diarrhoea) prevalence in switzerland, cdad patients are not routinely contact-isolated in our institution. in light of the globally changing c. difficile epidemiology, we sought to determine our institutional cdad rate and to detect possible hospital transmission by means of epidemiological linkage.201323888435
molecular test to determine toxigenic capabilities in gdh-positive, toxin-negative samples: evaluation of the portrait toxigenic c. difficile assay.new recommendations for testing and reporting of clostridium difficile were introduced in the nhs in 2012. these guidelines have improved identification of potential c. difficile infection (cdi) cases, but questions remain around the management of glutamate dehydrogenase (gdh)-positive, toxin-negative patients. this study aims to assess the introduction of the portrait c. difficile assay as the third step to identify the presence of the toxigenic c. difficile b (tcdb) gene and thus determine tox ...201323888607
reducing clostridium difficile incidence, colectomies, and mortality in the hospital setting: a successful multidisciplinary approach.health care associated clostridium difficile infections are a major cause of morbidity and mortality in hospitals. in the united states, from 2000 through 2009, discharge diagnoses from hospitals in the united states that included c. difficile increased from 139,000 to 336,600, and the yearly national excess hospital cost associated with hospital-onset c. difficile is estimated to be upwards of $1.3 billion.201323888639
[outcomes of clostridium difficile enterocolitis after administration of antibiotics along with probiotic supplement].clostridium difficile enterocolitis is a potentially fatal disease showing increasing incidence in hospital environment. therapeutic approach in the management of clostridium difficile enterocolitis is highly complex, particularly because of its tendency to relapse and reinfection. the study was aimed at investigating the factors influencing the development of clostridium difficile enterocolitis and outcomes of enterocolitis after administration of standard antimicrobial therapy combined with pr ...201323888728
the anticancer drug tirapazamine has antimicrobial activity against escherichia coli, staphylococcus aureus and clostridium difficile.rapidly increasing bacterial resistance to existing therapies creates an urgent need for the development of new antibacterials. tirapazamine (tpz, 3-amino-1,2,4-benzotriazine 1,4 dioxide) is a prodrug undergoing clinical trials for various types of cancers. in this study, we showed that tpz has antibacterial activity, particularly at low oxygen levels. with escherichia coli, tpz was bactericidal under both aerobic and anaerobic conditions. escherichia coli mutants deficient in homologous recombi ...201323888874
the effects of statins on the clinical outcomes of clostridium difficile infection in hospitalised patients.an association between exposure to statin drugs and favourable treatment outcomes for various types of infections has been established.201323888883
risk factors associated with clostridium difficile infection after kidney and pancreas transplantation.clostridium difficile infection (cdi) is a common cause of nosocomial antibiotic-associated diarrhea with an increased incidence reported in solid organ transplant recipients. we sought to determine if kidney and/or pancreas transplant recipients possess unique risk factors for cdi.201323890202
clostridium difficile infection increases mortality risk in lung transplant recipients.clostridium difficile infection (cdi) and associated mortality in solid organ transplant recipients is rising, but data are scarce in lung transplant recipients. we aimed to characterize cdi and its effect on mortality in a large cohort of lung transplant recipients.201323891145
biofilm formation by clostridium difficile.clostridium difficile infection (cdi) is a major healthcare-associated disease worldwide. recurring infections and increasing antibiotic resistance have complicated treatment of cdi. while c. difficile spores are important for transmission and persistence of cdi, other factors such as gut colonization and formation of bacterial communities in the gut may also contribute to pathogenesis and persistence, but have not been well investigated. recently, we reported that important clinical c. difficil ...201523892245
outpatient healthcare settings and transmission of clostridium difficile.recent reports suggest that community-associated clostridium difficile infection (cdi) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. we hypothesized that outpatient clinics could be an important source for acquisition of community-associated cdi.201323894609
clostridium difficile colitis: is severity increased with previous appendectomy? 201323896227
adaptive strategies and pathogenesis of clostridium difficile from in vivo transcriptomics.clostridium difficile is currently the major cause of nosocomial intestinal diseases associated with antibiotic therapy in adults. in order to improve our knowledge of c. difficile-host interactions, we analyzed the genome-wide temporal expression of c. difficile 630 genes during the first 38 h of mouse colonization to identify genes whose expression is modulated in vivo, suggesting that they may play a role in facilitating the colonization process. in the ceca of the c. difficile-monoassociated ...201323897605
in vivo physiological and transcriptional profiling reveals host responses to clostridium difficile toxin a and toxin b.toxin a (tcda) and toxin b (tcdb) of clostridium difficile cause gross pathological changes (e.g., inflammation, secretion, and diarrhea) in the infected host, yet the molecular and cellular pathways leading to observed host responses are poorly understood. to address this gap, we evaluated the effects of single doses of tcda and/or tcdb injected into the ceca of mice, and several endpoints were analyzed, including tissue pathology, neutrophil infiltration, epithelial-layer gene expression, chem ...201323897615
alteration of intestinal dysbiosis by fecal microbiota transplantation does not induce remission in patients with chronic active ulcerative colitis.in patients with ulcerative colitis (uc), alterations of the intestinal microbiota, termed dysbiosis, have been postulated to contribute to intestinal inflammation. fecal microbiota transplantation (fmt) has been used as effective therapy for recurrent clostridium difficile colitis also caused by dysbiosis. the aims of the present study were to investigate if patients with uc benefit from fmt and if dysbiosis can be reversed.201323899544
effect of nucleic acid amplification testing on population-based incidence rates of clostridium difficile infection.nucleic acid amplification testing (naat) is increasingly being adopted for diagnosis of clostridium difficile infection (cdi). data from 3 states conducting population-based cdi surveillance showed increases ranging from 43% to 67% in cdi incidence attributable to changing from toxin enzyme immunoassays to naat. cdi surveillance requires adjustment for testing methods.201323899677
establishment of the intestinal microbiota and its role for atopic dermatitis in early childhood.perturbations in the intestinal microbiota may disrupt mechanisms involved in the development of immunologic tolerance. the present study aimed to examine the establishment of the infant microbiota and its association to the development of atopic dermatitis (ad).201323900058
a severe case of rat lungworm disease in hawa'i.a 23-year-old man living on the island of hawa'i developed a life threatening case of eosinophilic meningitis caused by infection with angiostrongylus cantonensis (rat lungworm disease: rlwd). he was comatose for 3 months, incurring brain and nerve damage sufficiently extensive that he was not expected to recover. the case was complicated by secondary infections of methicillin-resistant staphylococcus aureus, clostridium difficile, and pneumonia, which resulted in an empyema requiring a thoracos ...201323900708
[largest eu prevalence studies of clostridium difficile infection reveals that perhaps more than one-fifth of the patient are wrongly diagnosed]. 201323901614
molecular epidemiology of clostridium difficile infection in a major chinese hospital: an underrecognized problem in asia?clostridium difficile infection is almost unrecognized in mainland china. we have undertaken a study in a large chinese teaching hospital in changsha, hunan, china, to identify cases of c. difficile, record patient characteristics, and define the molecular epidemiology with respect to ribotype distribution and cross-infection. between april 2009 and february 2010, we examined fecal samples from 70 hospitalized patients with diarrhea who were receiving or had received antibiotics within the previ ...201323903542
[laboratory diagnosis of clostridium difficile infection].for the diagnosis of clostridium difficile infection (cdi), it is necessary to obtain microbiological evidence of toxigenic c. difficile with a compatible clinical picture (diarrhoea or ileus). two gold standards exist: cell culture cytotoxicity neutralization assay (specific, but less sensitive than previously acknowledged) and toxigenic culture (very sensitive but less specific because it also detects asymptomatic colonization). these gold standards are not used routinely because at least 2 or ...201323906566
temporal phenome analysis of a large electronic health record cohort enables identification of hospital-acquired complications.to develop methods for visual analysis of temporal phenotype data available through electronic health records (ehr).201323907284
clostridium difficile infection outbreak in a male rehabilitation ward, hong kong special administrative region (china), 2011. 201223908942
influence of cohorting patients with clostridium difficile infection on risk of symptomatic recurrence.cohorting of patients with clostridium difficile infection (cdi) is recommended when single side-rooms are unavailable. although patients may remain infectious after cessation of diarrhoea, continued cohorting may place them at increased risk of reinfection.201323910403
fecal microbiota transplant for recurrent clostridium difficile infection: mayo clinic in arizona experience.to report the initial experience of treating recurrent clostridium difficile infection (cdi) with fecal microbiota transplant (fmt) at mayo clinic in arizona.201323910407
is the prevalence of clostridium difficile in animals underestimated?reported prevalence rates of clostridium difficile infection in animals differ considerably depending on the nature of the study and the population surveyed. the methods used to recover this organism from faecal samples may account for some of the prevalence variation. the objective of this study was to assess the performance of two different methods of detecting c. difficile in animal faeces in comparison with a conventional isolation procedure ('ethanol shock' of faecal samples followed by cul ...201323911042
norovirus gastroenteritis after fecal microbiota transplantation for treatment of clostridium difficile infection despite asymptomatic donors and lack of sick contacts. 201323912408
genetically diverse clostridium difficile strains harbouring abundant prophages in an estuarine environment.clostridium difficile is the leading cause of antibiotic-associated diarrhoeal disease in healthcare settings across the world. despite its pathogenic capacity, it can be carried asymptomatically and has been found in terrestrial and marine ecosystems outside hospital environments. less is known about these environmental strains and few studies have been conducted on estuarine systems. although prophage abundance and diversity is known within in clinical strains, prophage carriage within environ ...201323913427
clostridium difficile infection after adult autologous stem cell transplantation: a multicenter study of epidemiology and risk factors.we sought to describe the epidemiology of clostridium difficile infection (cdi) among adult recipients of autologous hematopoietic stem cell transplantation (auto-hsct) within the first year after hsct in centers with variable epidemiology of hypertoxigenic strains. a multicenter, retrospective nested case-control study was conducted among 873 auto-hsct recipients at johns hopkins hospital (jhh) and hôpital maisonneuve-rosemont (hmr) between january 2003 and december 2008. despite center differe ...201323916741
evaluation of a commercial real-time polymerase chain reaction assay for detection of environmental contamination with clostridium difficile.contaminated environmental surfaces are an important source for transmission of clostridium difficile. however, there are no efficient and easy methods to assess contamination. the performance of a commercial real-time polymerase chain reaction (pcr) assay was evaluated for detection of environmental toxigenic c. difficile in comparison with anaerobic culture followed by toxin testing of isolates. for 66 sites sampled, pcr had a sensitivity of 17.39%, specificity 100%, positive predictive value ...201323916890
detection of mixed populations of clostridium difficile from symptomatic patients using capillary-based polymerase chain reaction ribotyping.to investigate the simultaneous occurrence of more than 1 clostridium difficile ribotype in patients' stool samples at the time of diagnostic testing.201323917911
antidepressant drugs and infectious disease.clostridium difficile (c.difficile) infection (cdi) is a common and clinically significant cause of diarrhea associated with the use of antibiotic drugs. two observational studies have suggested that antidepressant drug use is associated with an increased risk of developing cdi. because of the potential public health significance of this finding, this article critically evaluates the methodology of these studies and provides evidence to question the plausibility and validity of this finding. the ...201323919230
stool therapy may become a preferred treatment of recurrent clostridium difficile?fecal enemas were first reported to successfully treat life threatening enterocolitis in 1958, but fecal therapy to treat clostridium difficile (c. difficile) infection has remained esoteric and not well investigated until recently. in the past few years, systematic reviews of case series and case reports of fecal microbiota transplant for recurrent c. difficile infection have become available and validate use of fecal transplant for c. difficile enterocolitis. methods of fecal transplant report ...201323922461
clostridium difficile modulates host innate immunity via toxin-independent and dependent mechanism(s).clostridium difficile infection (cdi) is the leading cause of hospital and community-acquired antibiotic-associated diarrhoea and currently represents a significant health burden. although the role and contribution of c. difficile toxins to disease pathogenesis is being increasingly understood, at present other facets of c. difficile-host interactions, in particular, bacterial-driven effects on host immunity remain less studied. using an ex-vivo model of infection, we report that the human gastr ...201323922820
fecal transplantation for the treatment of recurrent clostridium difficile infection.clostridium difficile infection (cdi) is currently a leading cause of antibiotic and health care-related diarrhea. the incidence and the severity of cdi-related diarrhea have increased dramatically in the usa and europe in the past few decades. the emergence of multidrug-resistant hypervirulent strains of c. difficile has led to an increase in mortality. fecal microbiota transplantation (fmt) (also known as fecal bacteriotherapy) has been utilized sporadically since the 1950s; and currently, the ...201323923106
comparison of perirectal versus rectal swabs for detection of asymptomatic carriers of toxigenic clostridium difficile.for long-term care and spinal cord injury patients, the sensitivity, specificity, and positive and negative predictive values of perirectal versus rectal cultures for detection of asymptomatic carriers of clostridium difficile were 95%, 100%, 100%, and 97%, respectively. perirectal cultures provide an accurate method to detect asymptomatic carriers of c. difficile.201323926162
clostridium difficile pcr ribotype 046 is common among neonatal pigs and humans in sweden.clostridium difficile pcr ribotype 046 was found in 67% of neonatal piglets (45/67) sampled from three separate pig-breeding farms in sweden. sows from the same farms were tested and 50% were colonized in faeces and 30% were colonized on skin. an environmental source was suggested because identical pcr ribotypes were isolated from faeces as well as externally. human c. difficile infection outbreaks in southern sweden by the identical pcr ribotype 046 indicate its zoonotic potential.201423927574
perils and pitfalls of long-term effects of proton pump inhibitors.this review summarizes the literature regarding long-term adverse effects of proton pump inhibitors (ppis). a pubmed search (1966 to february 2013) for english language studies was conducted using key terms ppi: omeprazole, esomeprazole, pantoprazole, lansoprazole, dexlansoprazole, rabeprazole, pneumonia, clostridium difficile, osteoporosis, risk of fractures, thrombocytopenia, rhabdomyolysis, anemia, iron deficiency, hypomagnesemia, vitamin b₁₂ and nephritis. the risk of pneumonia was increased ...201323927671
healthcare-associated infections studies project: an american journal of infection control and national healthcare safety network data quality collaboration-labid clostridium difficile event 2013.this is the first in a series of case studies that will be published in american journal of infection control following the centers for disease control and prevention/national healthcare safety network (nhsn) surveillance definition update of 2013. these cases reflect some of the complex patient scenarios infection professionals encounter during daily surveillance of health care-associated infections using nhsn definitions. answers to the questions posed and immediate feedback in the form of ans ...201323928030
treatment of an initial infection with clostridium difficile in patients with inflammatory bowel disease.: although the incidence of clostridium difficile-associated diarrhea in the general population has increased dramatically over the past decade, an even greater rate of infection exists in patients with inflammatory bowel disease. susceptibility in this population is likely inherent to the pathophysiology and treatment of these diseases. c. difficile infection can cause serious complications and death. consequently, early diagnosis and initiation of effective antibacterial therapy is imperative. ...201323929262
impact of adding prophylactic probiotics to a bundle of standard preventative measures for clostridium difficile infections: enhanced and sustained decrease in the incidence and severity of infection at a community hospital.in 2003, hospitals in quebec, canada experienced an increase of nap1/027 clostridium difficile infections following antibiotic administration (cdiaa). at pierre-le gardeur hospital (plgh), the incidence increased from 10 to over 25 cases per 1000 patient admissions.201323931498
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