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advanced techniques for detection and identification of microbial agents of gastroenteritis.gastroenteritis persists as a worldwide problem, responsible for approximately 2 million deaths annually. traditional diagnostic methods used in the clinical microbiology laboratory include a myriad of tests, such as culture, microscopy, and immunodiagnostics, which can be labor intensive and suffer from long turnaround times and, in some cases, poor sensitivity. [corrected]. this article reviews recent advances in genomic and proteomic technologies that have been applied to the detection and id ...201323931837
lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and clostridium difficile diarrhoea in older inpatients (placide): a randomised, double-blind, placebo-controlled, multicentre trial.antibiotic-associated diarrhoea (aad) occurs most frequently in older (≥65 years) inpatients exposed to broad-spectrum antibiotics. when caused by clostridium difficile, aad can result in life-threatening illness. although underlying disease mechanisms are not well understood, microbial preparations have been assessed in the prevention of aad. however, studies have been mostly small single-centre trials with varying quality, providing insufficient data to reliably assess effectiveness. we aimed ...201323932219
inappropriate use of antibiotics and clostridium difficile infection.we assessed appropriateness of preceding and concurrent antibiotics in 126 consecutive patients with hospital-associated clostridium difficile infection. in 93 (73.8%) episodes, at least 1 preceding course of antibiotics was inappropriate. we provided feedback on concurrent antibiotics on the day of diagnosis during the final 8 months: 17 of 74 (23.0%) patients were on inappropriate antibiotics. our recommendations were well received. reviewing c difficile-infected patients allowed for identific ...201323932828
importance of toxin a, toxin b, and cdt in virulence of an epidemic clostridium difficile strain.clostridium difficile infection is the main cause of healthcare-acquired diarrhea in the developed world. in addition to the main virulence factors toxin a and b, epidemic, pcr ribotype 027 strains, such as r20291, produce a third toxin, cdt. to develop effective medical countermeasures, it is important to understand the importance of each toxin. accordingly, we created all possible combinations of isogenic toxin mutants of r20291 and assessed their virulence. we demonstrated that either toxin a ...201423935202
clostridium difficile 027/bi/nap1 encodes a hypertoxic and antigenically variable form of tcdb.the clostridium difficile exotoxin, tcdb, which is a major virulence factor, varies between strains of this pathogen. herein, we show that tcdb from the epidemic bi/nap1/027 strain of c. difficile is more lethal, causes more extensive brain hemorrhage, and is antigenically variable from tcdb produced by previously studied strains of this pathogen (tcdb003). in mouse intoxication assays, tcdb from a ribotype 027 strain (tcdb027) was at least four fold more lethal than tcdb003. tcdb027 caused a pr ...201323935501
risk factors of fecal toxigenic or non-toxigenic clostridium difficile colonization: impact of toll-like receptor polymorphisms and prior antibiotic exposure.this study is to investigate the significance and risk factors of fecal toxigenic (tcdc) or non-toxigenic clostridium difficile colonization (ntcdc) among hospitalized patients.201323936050
depression and use of antidepressants is associated with increased risk of clostridium difficile infection. 201323939678
nontoxigenic clostridium difficile protects hamsters against challenge with historic and epidemic strains of toxigenic bi/nap1/027 c. difficile.nontoxigenic clostridium difficile (ntcd) has been shown to prevent fatal c. difficile infection in the hamster model when hamsters are challenged with standard toxigenic c. difficile strains. the purpose of this study was to determine if ntcd can prevent c. difficile infection in the hamster model when hamsters are challenged with restriction endonuclease analysis group bi c. difficile strains. groups of 10 hamsters were given oral clindamycin, followed on day 2 by 10(6) cfu of spores of ntcd s ...201323939887
the role of vancomycin and metronidazole for the treatment of clostridium difficile-associated diarrhea.for the treatment of clostridium difficile-associated diarrhea (cdad), metronidazole and vancomycin remain the most commonly used agents. the major advantage of metronidazole is its low cost, while the advantage of oral vancomycin is a more favorable pharmacokinetic profile. the epidemiology and clinical severity of cdad have changed due to the emergence of a hypervirulent strain (bi/nap1/027). in 2010, the infectious diseases society of america/society for health care epidemiology of america ex ...201323940121
antimicrobial selection and its impact on the incidence of clostridium difficile-associated diarrhea.the study objective was to determine which antimicrobials place patients at a higher risk for clostridium difficile-associated diarrhea (cdad) and which interventions can reduce their risk. all patients with diarrhea and a positive toxin assay for clostridium difficile for 3 months were included in the study. patients were broken down into either community-acquired infection or health care-associated infection based on symptom onset, antibiotic usage prior to admission, and where the patient was ...201323940122
recurrent clostridium difficile infection. 201323943969
evaluation of a new immunochromatography test for rapid and simultaneous detection of clostridium difficile antigen and toxins.clostridium difficile infection is considered the most common cause of nosocomial infectious diarrhea among adults in the developed world. it is responsible for virtually all cases of pseudomembranous colitis. the tox a/b enzyme immunoassay (eia) is the most widely used test for the detection of c. difficile toxins a and b. however, it is associated with poor sensitivity and an unacceptable high rate of false-negative results.201323943984
[severe eosinophilia in a patient with clostridium colitis and gastric cancer].a case of a 77-year-old male repeatedly hospitalized with the diagnosis of clostridium difficile colitis associated with eosinophilia is presented. the percentage and number of eosinophils achieved maximal values (54 %, 5.4 times 1.000.000.000/l) during repeated treatment with metronidazole. eosinophilia was accompanied by significant elevation of serum ige and presence of charcot-leyden crystals in stool. helminth infections and hemoblastosis were ruled out as the cause and a working diagnosis ...201323945831
antimicrobial stewardship and clostridium difficile-associated diarrhea.antimicrobial stewardship programs are essential to health care institutions to promote the appropriate use of antibiotics not only to decrease antimicrobial resistance but to prevent the spread and infection of clostridium difficile. clostridium difficile-associated diarrhea is increasing rapidly in the united states and is now considered a major public health problem that poses an immediate threat to the health of patients prescribed antibiotics, more so than antimicrobial resistance. clostrid ...201323946208
probiotics for the treatment of clostridium difficile associated disease.the purpose of this review paper is to update the current and potential future role of probiotics for clostridium difficile-associated disease (cdad). included in this review, is an update on the testing of newer probiotics (e.g., bacillus coagulans gbi-30, 6086) in animal models of cdad. there is a focus on the modulation of signal transduction pathways (i.e., transcription factors like camp response element-binding, activator protein 1, and nuclear factor kappa b), as well as the inhibition of ...201323946887
severe hemorrhagic colitis in a patient with chronic myeloid leukemia in the blastic phase after dasatinib use.dasatinib is a second-line tyrosine kinase inhibitor used in patients with imatinib resistant or intolerant chronic myeloid leukemia (cml) and philadelphia chromosome-positive acute leukemia. gastrointestinal bleeding may occur in up to 7% of patients using dasatinib, although, severe dasatinib-related acute colitis had rarely been reported. here, we present the case of a 36-year-old female who progressed to acute myeloid leukemia after fourteen months of receiving imatinib for cml in the chroni ...201323946889
clostridium difficile exposure as an insidious source of infection in healthcare settings: an epidemiological model.clostridium difficile is the leading cause of infectious diarrhea in hospitalized patients. its epidemiology has shifted in recent years from almost exclusively infecting elderly patients in whom the gut microbiota has been disturbed by antimicrobials, to now also infecting individuals of all age groups with no recent antimicrobial use.201323947736
clostridium difficile--special collection. 201323950217
global analysis of the sporulation pathway of clostridium difficile.the gram-positive, spore-forming pathogen clostridium difficile is the leading definable cause of healthcare-associated diarrhea worldwide. c. difficile infections are difficult to treat because of their frequent recurrence, which can cause life-threatening complications such as pseudomembranous colitis. the spores of c. difficile are responsible for these high rates of recurrence, since they are the major transmissive form of the organism and resistant to antibiotics and many disinfectants. des ...201323950727
is clostridium difficile infection influenced by antimicrobial use density in wards?this study was performed to elucidate the relationship between antimicrobial use density (aud) and clostridium difficile infection (cdi) manifesting as antimicrobial-associated diarrhea (aad) in hospital wards during a 4-year period. case definition of cdi was an adult exhibiting aad with a daily stool frequency of three or more, arising at least 48 hours after ward admission, and fecal samples testing positive for toxin (a and/or b). metronidazole or vancomycin was orally administered as treatm ...201323951727
clostridium difficile infection after lung transplantation: are we really doing everything possible? 201323953917
asymptomatic carriage of toxigenic clostridium difficile by hospitalized patients.asymptomatic carriage of clostridium difficile is common in hospitals, but the risk for transmission by carriers is unclear. in this point prevalence culture survey of asymptomatic hospitalized patients, 18 of 149 (12%) were carriers of toxigenic c. difficile. by comparison with c. difficile infection (cdi) patients, the prevalence of skin and/or environmental contamination was significantly lower in asymptomatic carriers (3/18, 17% versus 5/6, 83%; p = 0.007), but carriers outnumbered cdi patie ...201323954113
acute gastroenteritis.acute gastroenteritis is a common infectious disease syndrome, causing a combination of nausea, vomiting, diarrhea, and abdominal pain. there are more than 350 million cases of acute gastroenteritis in the united states annually and 48 million of these cases are caused by foodborne bacteria. traveler's diarrhea affects more than half of people traveling from developed countries to developing countries. in adult and pediatric patients, the prevalence of clostridium difficile is increasing. contac ...201323958366
fecal microbiota transplantation and emerging treatments for clostridium difficile infection.due to the increased incidence and recurrence of clostridium difficile infection, health care providers are seeking new and alternative treatments to the standard antibiotic therapy. the objective of this article is to present a review on the background, microbiologic efficacy, clinical efficacy, and safety of fecal microbiota transplantation and to provide an overview of emerging treatment options currently under investigation. emerging treatment options discussed include the use of monoclonal ...201323966282
correlation between clostridium difficile bacterial load, commercial real-time pcr cycle thresholds, and results of diagnostic tests based on enzyme immunoassay and cell culture cytotoxicity assay.the impact of clostridium difficile fecal loads on diagnostic test results is poorly understood, but it may have clinical importance. in this study, we investigated the relationship between c. difficile fecal load and the results of four assays: a glutamate dehydrogenase (gdh) enzyme immunoassay (eia), a toxin a/b antigen eia (toxab), a cell culture cytotoxicity assay (cca), and pcr targeting the tcdb gene. we also compared the pcr cycle threshold (ct) with the results of quantitative culture us ...201323966497
one-day point prevalence of emerging bacterial pathogens in a nationwide sample of 62 german hospitals in 2012 and comparison with the results of the one-day point prevalence of 2010.antibiotic resistance of bacterial pathogens is an emerging problem worldwide. to combat multidrug resistant organisms (mrdos) networks of care providers have been established in all states in germany. the hicare-network, a project to combat mrdos, founded by the federal ministry of education and research, has published data from 2010 of a voluntary, german-wide, multicenter point-prevalence survey in 2011 conducted in collaboration with the german society of hospital hygiene. the aim of the pre ...201323967398
fecal transplant for recurrent clostridium difficile infection.clostridium difficile infection (cdi) results in clinical manifestations ranging from mild diarrhea to life-threatening pseudomembranous colitis. infection is most often initiated by antimicrobial therapy which causes an imbalance in normal colonic microflora. the pathogenesis of c. difficile is predominantly controlled by the production of its two cytotoxins, a and b, which damage the intestinal mucosa. in recent years a nationwide increase in the rate of cdi has been noted as well as an increa ...201323967542
[clostridium difficile infection: epidemiology, risk factors, pathogenesis, clinical features, diagnosis and therapy].clostridium difficile is a gram-positive, spore-forming anaerobic bacterium. c.difficile is the leading cause of antibiotic associated diarrhea and colitis. the clinical spectrum of c.difficile infection (cdi) is highly variable, ranging from mild diarrhea to severe forms of intestinal illness including toxic megacolon, ileus, bowel perforation, and pseudomembranous colitis. advanced age, long duration of hospitalization, and exposure to certain antimicrobial agents are the most common risk fact ...201323971935
presence of clostridium difficile in pigs and cattle intestinal contents and carcass contamination at the slaughterhouse in belgium.the objective of this study was to evaluate the presence of clostridium difficile in intestinal and carcass samples collected from pigs and cattle at a single slaughterhouse. c. difficile was isolated in 1% and 9.9% of the pig and cattle intestinal contents and in 7.9% and 7% of cattle and pig carcass samples respectively. a total of 19 different pcr-ribotypes were identified, among them types 078 and 014. seven of 19 ribotypes correlated with the pcr-ribotypes involved in human c. difficile inf ...201323973837
investigating the candidacy of a lipoteichoic acid-based glycoconjugate as a vaccine to combat clostridium difficile infection.a lipoteichoic acid has recently been shown to be conserved in the majority of strains from clostridium difficile and as such is being considered as a possible vaccine antigen. in this study we examine the candidacy of the conserved lipoteichoic acid by demonstrating that it is possible to elicit antibodies against c. difficile strains following immunisation of rabbits and mice with glycoconjugates elaborating the conserved lipoteichoic acid antigen. the present study describes a conjugation str ...201323974722
[drug therapy of infectious diarrhea: part 1: acute diarrhea].diarrhea is one of the most commonly occurring diseases.201323974914
current status of surgical treatment for fulminant clostridium difficile colitis.mortality rates attributable to fulminant clostridium difficile (c. difficile) colitis remain high and are reported to be 38%-80%. historically, the threshold for surgical intervention has been judged empirically because level i evidence to guide decision making is lacking. studies of the surgical management of c. difficile infection have been limited by small sample size and the lack of a standard definition of fulminancy. multiple small and medium-sized series have examined the surgical manage ...201323977418
clostridium difficile infection caused by binary toxin-positive strains. 201323977836
fidaxomicin: a minimally absorbed macrocyclic antibiotic for the treatment of clostridium difficile infections.fidaxomicin was approved for the treatment of clostridium difficile infections in 2011. it has a novel mechanism of action and narrow spectrum of activity that makes it unique among the currently used therapies for this disease. phase iii clinical studies demonstrated a benefit of fidaxomicin over vancomycin for the outcomes of recurrence and global cure or sustained clinical response. this observation was confirmed within specific populations, including those of older age, immunocompromised due ...201323977933
clostridium difficile antibodies: a patent evaluation (wo2013028810).incidence and severity of clostridium difficile infection (cdi) are increasing worldwide. toxins a (tcda) and b (tcdb) and host immune response are the major determinates of cd pathogenesis and represent a new, stimulating therapeutic target to control cdi.201323978053
clinical manifestations of clostridium difficile infection in a medical center in taiwan.to investigate the clinical characteristics of clostridium difficile infection (cdi) at a medical center in taiwan.201423978490
a statewide colectomy experience: the role of full bowel preparation in preventing surgical site infection.to assess the utility of full bowel preparation with oral nonabsorbable antibiotics in preventing infectious complications after elective colectomy.201423979289
moving fecal microbiota transplantation into the mainstream.in recent years, fecal microbiota transplantation (aka fecal transplantation, fecal bacteriotherapy, fmt) has become increasing utilized to treat recurrent and refractory clostridium difficile infection (cdi). almost 600,000 cases of cdi occur each year in the united states. of these, an estimated 15,000 patients have a recurrence. the management of recurrent disease has been challenging for patients and clinicians. increasingly, fmt has been recognized as an effective option for these patients. ...201323979974
[the intestinal microbiota and human disease].advances in sequencing technology and the development of metagenomics have opened up new ways to investigate the microorganisms inhabiting the human gut. the intestinal microbiota confer protection against pathogens, contribute to the maturation of the immune system, and regulate host metabolism. the composition of gut microbiota in early life is influenced by mode of birth, diet, and antibiotics. decreased biodiversity and alterations in the composition of the intestinal microbiota have been ob ...201323981941
recent insights into clostridium difficile pathogenesis.clostridium difficile infection (cdi) is the leading cause of antibiotic-associated diarrhea and pseudomembranous colitis in the healthcare setting. an emerging consensus suggests that cdi is caused by pathogenic toxin production, gut microbial dysbiosis and altered host inflammatory responses. the aim of this review is to summarize and highlight recent advances focused on cdi pathogenic mechanisms.201323982235
clostridium difficile: biological therapies.biological therapies for clostridium difficile infection (cdi) include probiotics and faecal microbiota transplant (fmt). there is significant interest in their use in treating refractory/recurrent cdi. this review summarizes the latest evidence for these approaches.201323982236
new developments in chemotherapeutic options for clostridium difficile colitis.clostridium difficile infections (cdis) are of increasing concern in healthcare due to increasing incidence as well as suboptimal response to standard therapies. this review focuses on current updates in chemotherapeutic treatment options for primary cdi as well as for relapse.201323982237
therapy: probiotics do not reduce antibiotic-associated or clostridium difficile diarrhoea in older hospitalized patients. 201323982682
overlapping roles for toxins in clostridium difficile infection. 201423983214
fulminant clostridium difficile infection: an association with prior appendectomy?to examine if fulminant clostridium difficile infections (cdi) resulting in colectomy was associated with a prior appendectomy and whether any association affected the severity of the disease.201323983904
alerting physicians during electronic order entry effectively reduces unnecessary repeat pcr testing for clostridium difficile.hospital information systems (his) alerts restricting repeat clostridium difficile pcr ordering by physicians in patients with a prior result within 7 days eliminated 91% of repeat tests, from 14.5% (282/1,949) repeats preintervention to 1.3% (135/10,285) postintervention. his alerting is an effective, targeted, patient-specific tool for improving the quality and utilization of c. difficile results.201323985918
[include representations of caregivers coping with nosocomial clostridium difficile in quebec to promote better health]. 201323986384
effects of nitric oxide and reactive oxygen species on hif-1α stabilization following clostridium difficile toxin exposure of the caco-2 epithelial cell line.stabilization of the hypoxia-inducible factor (hif-1α) is proposed to provide a protective host-response to c. difficile intoxication. here, we aimed to elucidate whether nitric oxide and/or reactive oxygen species produced during c. difficile toxin exposure could influence hif-1α stability and initiate protection against epithelial cell damage.201323988581
analysis of metabolic evolution in bacteria using whole-genome metabolic models.recent advances in the automation of metabolic model reconstruction have led to the availability of draft-quality metabolic models (predicted reaction complements) for multiple bacterial species. these reaction complements can be considered as trait representations and can be used for ancestral state reconstruction to infer the most likely metabolic complements of common ancestors of all bacteria with generated metabolic models. we present here an ancestral state reconstruction for 141 extant ba ...201323992299
complicated clostridium difficile colitis in children with cystic fibrosis: association with gastric acid suppression?patients with cystic fibrosis (cf) have several risk factors for clostridium difficile colonization such as frequent hospitalization and exposure to a broad array of antibiotics utilized for the control, eradication, and prophylaxis of respiratory pathogens. however, despite this high rate of colonization, the occurrence of c. difficile infection (cdi) in cf is rare. we report three children with cf who presented with severe community-associated cdi. all three children had complicated courses an ...201423993432
leukemoid reaction: spectrum and prognosis of 173 adult patients.the prognosis of patients with leukemoid reaction (lr) depends mainly on their underlying illness. our aim was to investigate the etiologies and prognosis of a mixed group of patients with lr.201323994818
fecal transplantation: re-discovering the value of stool.for over 1000 years, stool in various forms has been used to treat disease. within the past few decades, fecal infusion either rectally or via a nasogastric tube has become a viable option for the treatment of refractory clostridium difficile infection (cdi), and, more recently, it has shown promise in treating inflammatory bowel disease (ibd) and metabolic disease. the purpose of this article is to review the use of feces as a treatment option in pediatric disease.201323995428
microbiota-liberated host sugars facilitate post-antibiotic expansion of enteric pathogens.the human intestine, colonized by a dense community of resident microbes, is a frequent target of bacterial pathogens. undisturbed, this intestinal microbiota provides protection from bacterial infections. conversely, disruption of the microbiota with oral antibiotics often precedes the emergence of several enteric pathogens. how pathogens capitalize upon the failure of microbiota-afforded protection is largely unknown. here we show that two antibiotic-associated pathogens, salmonella enterica s ...201323995682
in pursuit of protein targets: proteomic characterization of bacterial spore outer layers.bacillus cereus, responsible for food poisoning, and clostridium difficile, the causative agent of clostridium difficile-associated diarrhea (cdad), are both spore-forming pathogens involved in food spoilage, food intoxication, and other infections in humans and animals. the proteinaceous coat and the exosporium layers from spores are important for their resistance and pathogenicity characteristics. the exosporium additionally provides an ability to adhere to surfaces eventually leading to spore ...201323998435
safety of long-term ppi therapy.proton pump inhibitors have become the mainstay of medical treatment of acid-related disorders. long-term use is becoming increasingly common, in some cases without a proper indication. a large number of mainly observational studies on a very wide range of possible associations have been published in the past decade and are critically reviewed in this article and the existing evidence is evaluated and translated into possible clinical consequences. based on the existing evidence the benefits of ...201323998981
health care-associated infections: a meta-analysis of costs and financial impact on the us health care system.health care-associated infections (hais) account for a large proportion of the harms caused by health care and are associated with high costs. better evaluation of the costs of these infections could help providers and payers to justify investing in prevention.201423999949
multifocal clinical performance improvement across 21 hospitals.improving quality and safety across an entire healthcare system in multiple clinical areas within a short time frame is challenging. we describe our experience with improving inpatient quality and safety at kaiser permanente northern california. the foundations of performance improvement are a "four-wheel drive" approach and a comprehensive driver diagram linking improvement goals to focal areas. by the end of 2011, substantial improvements occurred in hospital-acquired infections (central-line- ...201324001267
successful treatment of simulated clostridium difficile infection in a human gut model by fidaxomicin first line and after vancomycin or metronidazole failure.fidaxomicin reduces the risk of recurrent clostridium difficile infection (cdi) compared with vancomycin. we investigated fidaxomicin primary or secondary treatment efficacy using a gut model.201424003182
[colitis precipitated by clostridium difficile -  a serious current problem].clostridium difficile is currently considered a significant cause of nosocomial infection. the probability of a colonisation of hospitalised patients rises with the length of their stay in hospital and depends on the local epidemiologic situation. interdisciplinary collaboration is the foundation of the effort to limit the development of this very serious, often fatal disease. the basic element is a rational antibiotic therapy which builds on the knowledge that the administration of antibiotics, ...201324007234
differences in outcome according to clostridium difficile testing method: a prospective multicentre diagnostic validation study of c difficile infection.diagnosis of clostridium difficile infection is controversial because of many laboratory methods, compounded by two reference methods. cytotoxigenic culture detects toxigenic c difficile and gives a positive result more frequently (eg, because of colonisation, which means that individuals can have the bacterium but no free toxin) than does the cytotoxin assay, which detects preformed toxin in faeces. we aimed to validate the reference methods according to clinical outcomes and to derive an optim ...201324007915
laboratory diagnosis of clostridium difficile. 201324007916
clostridium difficile colitis induced by long-term low-dosage erythromycin. 201324008746
clostridium difficile colitis in the united states: a decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy.clostridium difficile colitis (cdc) is a major health concern in the united states (us), with earlier reports demonstrating a rising incidence. studies analyzing predictors for total colectomy and mortality after colectomy are limited by small numbers.201324011436
cyclodextrin derivatives as anti-infectives.cyclodextrin derivatives can be utilized as anti-infectives with pore-forming proteins as the targets. the highly efficient selection of potent inhibitors was achieved because per-substituted cyclodextrins have the same symmetry as the target pores. inhibitors of several bacterial toxins produced by bacillus anthracis, staphylococcus aureus, clostridium perfringens, clostridium botulinum, and clostridium difficile were identified from a library of ∼200 cd derivatives. it was demonstrated that mu ...201324011515
intestinal inflammatory biomarkers and outcome in pediatric clostridium difficile infections.to identify specific fecal biomarkers for symptomatic clostridium difficile infection and predictors of poor outcomes.201324011765
transmission of clostridium difficile in foods.clostridium difficile is a human intestinal pathogen most frequently involved in diarrheal illnesses following the administration of antibiotics. there is growing concern that some c difficile infections (cdi) may be acquired from ingestion of c difficile spores in contaminated foods. the number of cdi cases is increasing with a heightening in the severity of disease symptoms and an increasing number of community-associated infections not connected to health care-associated risk. this article pr ...201324011836
fecal microbiota transplantation and donor standardization.clostridium difficile diarrhea is a common and severe infectious disease. antibiotics, which are standard initial treatment, are less effective for treating refractory or recurrent infection. fecal microbiota transplantation, where healthy donor stool is transplanted into a patient, is an alternative to antibiotic therapy that requires standardization for donors and patients.201324012274
proton pump inhibitors and the risk for hospital-acquired clostridium difficile infection.to examine the relationship between proton pump inhibitor (ppi) usage and nosocomial clostridium difficile infection (cdi) and determine the duration of therapy at which cdi risk increases.201324012413
treatment approaches including fecal microbiota transplantation for recurrent clostridium difficile infection (rcdi) among infectious disease physicians.clostridium difficile infection (cdi) was the most common nosocomial infection in the u.s. in 2010. most cases of cdi respond to a standard course of antibiotics, but recurrent c. difficile infections (rcdi) are increasingly common. given the lack of randomized clinical trials, it is important to understand how infectious disease physicians are managing rcdi to inform future clinical research.201324012687
detection of clostridium sordellii strains expressing hemorrhagic toxin (tcsh) and implications for diagnostics and regulation of veterinary vaccines.clostridium sordellii is a gram positive anaerobic bacterium that causes multiple disease syndromes in both humans and animals. as with many clostridial pathogens, toxins contribute to the virulence of c. sordellii. two large toxins have been identified: a lethal toxin (tcsl) and a hemorrhagic toxin (tcsh) which are similar in structure and function to clostridium difficile toxin b (tcdb) and toxin a (tcda), respectively. while tcda, tcdb, and tcsl have been extensively studied, relatively littl ...201324016805
therapeutic potential of fecal microbiota transplantation.there has been growing interest in the use of fecal microbiota for the treatment of patients with chronic gastrointestinal infections and inflammatory bowel diseases. lately, there has also been interest in its therapeutic potential for cardiometabolic, autoimmune, and other extraintestinal conditions that were not previously considered to be associated with the intestinal microbiota. although it is not clear if changes in the microbiota cause these conditions, we review the most current and bes ...201324018052
multiplex pcr targeting slpa: a rapid screening method to predict common clostridium difficile ribotypes among fluoroquinolone resistant clinical strains.based on the relationship between clostridium difficile surface layer protein a (slpa) sequence types (sts) and pcr-ribotypes (rts), a multiplex polymerase chain reaction (mpcr) assay was developed to rapidly confirm c. difficile toxigenicity and, simultaneously, to identify any of five slpa sts, gr, hr, fr, gc8 and 078, that usually correspond with globally distributed rts, 001, 014, 017, 027 and 078, respectively.201324018815
impact of change to molecular testing for clostridium difficile infection on healthcare facility-associated incidence rates.change from nonmolecular to molecular testing techniques is thought to contribute to the increasing trend in incidence of clostridium difficile infection (cdi); however the degree of effect attributed to this versus other time-related epidemiologic factors is unclear.201324018922
bed occupancy rates and hospital-acquired clostridium difficile infection: a cohort study.an emergent strain (ribotype 027) of clostridium difficile infection (cdi) has been implicated in epidemics worldwide. organizational factors such as bed occupancy have been associated with an increased incidence of cdi; however, the data are sparse, and the association has not been widely demonstrated. we investigated the association of bed occupancy and cdi within a large hospital organization in the united kingdom.201324018923
a systematic literature review and meta-analysis of factors associated with methicillin-resistant staphylococcus aureus colonization at time of hospital or intensive care unit admission.screening for methicillin-resistant staphylococcus aureus (mrsa) in high-risk patients is a legislative mandate in 9 us states and has been adopted by many hospitals. definitions of high risk differ among hospitals and state laws. a systematic evaluation of factors associated with colonization is lacking. we performed a systematic review of the literature to assess factors associated with mrsa colonization at hospital admission.201324018925
does organic material on hospital surfaces reduce the effectiveness of hypochlorite and uv radiation for disinfection of clostridium difficile?an organic load of 5%-10% fetal calf serum significantly reduced hypochlorite and uv radiation killing of clostridium difficile spores, but organic material collected from hospital surfaces did not affect hypochlorite and only modestly affected uv killing of spores. hypochlorite reduced aerobic microorganisms on unclean surfaces with no wiping.201324018930
risk factors for clostridium difficile-associated diarrhea and the effectiveness of prophylactic probiotic therapy.measures for prevention of clostridium difficile-associated diarrhea, a common nosocomial infection, in hospital settings are urgently needed. this study was conducted to identify the risk factors contributing to c. difficile-associated diarrhea and to evaluate the clinical benefit of probiotics in its prevention. the study included 2716 patients at least 20 years old who received an injected antibiotic at any time between february 2010 and february 2011; a total of 2687 patients (98.9%) were as ...201324020129
fate of ingested clostridium difficile spores in mice.clostridium difficile infection (cdi) is a leading cause of antibiotic-associated diarrhea, a major nosocomial complication. the infective form of c. difficile is the spore, a dormant and resistant structure that forms under stress. although spore germination is the first committed step in cdi onset, the temporal and spatial distribution of ingested c. difficile spores is not clearly understood. we recently reported that camsa, a synthetic bile salt analog, inhibits c. difficile spore germinatio ...201324023628
clostridium difficile genotypes in piglet populations in germany.clostridium difficile was isolated from 147 of 201 (73%) rectal swabs of piglets from 15 farms of lower saxony and north rhine-westphalia. in 14 farms, 14 to 100% (mean, 78%) of the animals tested were culture positive. the rate of isolation was 68% postpartum, increased to 94% in animals 2 to 14 days of age, and declined to 0% for animals 49 days of age and older. there was no link between isolation and antibiotic treatment or diarrhea of piglets. strains were assigned to 10 pcr ribotypes, and ...201324025903
probiotics for the prevention of clostridium difficile. 201324029510
use of data envelopment analysis to quantify opportunities for antibacterial targets for reduction of health care-associated clostridium difficile infection.clostridium difficile infection (cdi) is an important health care-associated infection that leads to increased morbidity and mortality. antibacterial medications used in hospitals serve as targets for antibacterial stewardship programs to reduce c difficile. the objective was to create a benchmark strategy targeting high-risk antibacterials for c difficile. this was a retrospective cross-sectional study using claims data from 58 hospitals. the data envelopment analysis technique was used to iden ...201424031081
clinical importance and representation of toxigenic and non-toxigenic clostridium difficile cultivated from stool samples of hospitalized patients.the aim of this study was to fortify the clinical importance and representation of toxigenic and non-toxigenic clostridium difficile isolated from stool samples of hospitalized patients. this survey included 80 hospitalized patients with diarrhea and positive findings of clostridium difficile in stool samples, and 100 hospitalized patients with formed stool as a control group. bacteriological examination of a stool samples was conducted using standard microbiological methods. stool sample were i ...201224031820
risk factors, preemptive therapy, and antiperistaltic agents for clostridium difficile infection in cancer patients.clostridium difficile infection (cdi) is a serious complication of chemotherapy including high-dose regimens with autologous stem cell transplantation (asct). antiperistaltic agents are contraindicated in cdi and preemptive cdi therapy is not recommended. we assessed the incidence, risk factors, and outcomes of cdi in patients with newly diagnosed multiple myeloma (mm) receiving similar antineoplastic therapy and supportive care including antiperistaltic agents and preemptive cdi antibiotics for ...201324034141
creating the right evidence for system change.most evaluative research is focused on assessing new technologies at the patient level. comparatively little is focused on assessing how system changes could improve the delivery of healthcare. in this article, the authors describe an opportunity to conduct evaluative trials of system changes affordably and efficiently by using a cluster randomized design and mandatory reporting data, using the prevention of clostridium difficile infection as an example. they then describe what must be done to m ...201324034773
increase in reported clostridium difficile cases as unintended consequence of enhanced norovirus testing. 201324035257
short versus long course of antibiotics for catheter-associated urinary tract infections in patients with spinal cord injury: a randomized controlled noninferiority trial.to assess the applicability of a short-course regimen of antibiotics for managing catheter-associated urinary tract infection (ca-uti) in patients with spinal cord injury (sci).201424035770
the second messenger cyclic di-gmp regulates clostridium difficile toxin production by controlling expression of sigd.the gram-positive obligate anaerobe clostridium difficile causes potentially fatal intestinal diseases. how this organism regulates virulence gene expression is poorly understood. in many bacterial species, the second messenger cyclic di-gmp (c-di-gmp) negatively regulates flagellar motility and, in some cases, virulence. c-di-gmp was previously shown to repress motility of c. difficile. recent evidence indicates that flagellar gene expression is tightly linked with expression of the genes encod ...201324039264
appendectomy and clostridium difficile colitis: relationships revealed by clinical observations and immunology.advances in understanding the interaction between the human immune system and the microbiome have led to an improved understanding of the function of the vermiform appendix as a safe-house for beneficial bacteria in the colon. these advances have been made despite long standing clinical observations that the appendectomy is a safe and effective procedure. however, more recent clinical data show that an appendectomy puts patients at increased risk for recurrent clostridium difficile (c. difficile ...201324039352
muricholic acids inhibit clostridium difficile spore germination and growth.infections caused by clostridium difficile have increased steadily over the past several years. while studies on c. difficile virulence and physiology have been hindered, in the past, by lack of genetic approaches and suitable animal models, newly developed technologies and animal models allow these processes to be studied in detail. one such advance is the generation of a mouse-model of c. difficile infection. the development of this system is a major step forward in analyzing the genetic requi ...201324040011
biological evaluation of benzothiazole ethyl urea inhibitors of bacterial type ii topoisomerases.the type ii topoisomerases dna gyrase (gyra/gyrb) and topoisomerase iv (parc/pare) are well-validated targets for antibacterial drug discovery. because of their structural and functional homology, these enzymes are amenable to dual targeting by a single ligand. in this study, two novel benzothiazole ethyl urea-based small molecules, designated compound a and compound b, were evaluated for their biochemical, antibacterial, and pharmacokinetic properties. the two compounds inhibited the atpase act ...201324041906
a lactobacillus casei shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries: a randomised controlled trial.certain probiotics may prevent the development of antibiotic-associated diarrhoea (aad) and clostridium difficile-associated diarrhoea (cdad), but their effectiveness depends on both strain and dose. there are few data on nutritional interventions to control aad/cdad in the spinal cord injury (sci) population. the present study aimed to assess (1) the efficacy of consuming a commercially produced probiotic containing at least 6·5 × 10⁹ live lactobacillus casei shirota (lcs) in reducing the incid ...201424044687
clostridium difficile infection: how safe are the household contacts? 201324045053
editorial commentary: community-associated clostridium difficile infection in children. 201324046300
distinguishing community-associated from hospital-associated clostridium difficile infections in children: implications for public health surveillance.children are increasingly recognized as being at risk for c. difficile infection (cdi), even without prior exposure to antibiotics or the healthcare environment. we aimed to distinguish risk factors, clinical course, and outcomes between healthcare facility-associated (ha) and community-associated (ca) cdi.201324046303
clostridium difficile infection in lung cancer patients.clostridium difficile infection (cdi) is a common nosocomial infection. lung cancer patients have a high risk of developing cdi because of continuous antibiotic treatment or chemotherapy, prolonged hospitalization, and general weakness. this study aimed to analyze predisposing or associated risk factors for cdi in lung cancer patients receiving chemotherapy. this study was a retrospective review of 188 lung cancer patients who were admitted to the wonkwang university hospital between 2008 and 20 ...201324047734
the correlation between clostridium-difficile infection and human gut concentrations of bacteroidetes phylum and clostridial species.we aimed to assess differences in bacterial intensities of bacteroidetes phylum and different clostridial species in the human intestines with respect to c. difficile infection. patients with a stool assay for c. difficile toxin were identified via the microbiology laboratory in our institute. bacterial populations were quantified from stool samples of four groups of patients: group i-patients with c. difficile associated diarrhea (cdad); group ii-asymptomatic c. difficile carriers; group iii-pa ...201424048726
solution nmr structure of cd1104b from pathogenic clostridium difficile reveals a distinct α-helical architecture and provides first structural representative of protein domain family pf14203.a high-quality structure of the 68-residue protein cd1104b from clostridium difficile strain 630 exhibits a distinct all α-helical fold. the structure presented here is the first representative of bacterial protein domain family pf14203 (currently 180 members) of unknown function (duf4319) and reveals that the side-chains of the only two strictly conserved residues (glu 8 and lys 48) form a salt bridge. moreover, these two residues are located in the vicinity of the largest surface cleft which i ...201324048810
fecal microbiota transplantation: an innovative approach to treating clostridium difficile disease.normal gut flora or microbiota, which is key to a healthy digestive tract, can be disrupted by antibiotic therapy, potentially leading to clostridium difficile-associated disease (cdad). fecal microbiota transplant has shown promise in quickly and safely eradicating cdad at low cost.201324049940
reprint of new opportunities for improved ribotyping of c. difficile clinical isolates by exploring their genomes.clostridium difficile causes outbreaks of infectious diarrhoea, most commonly occurring in healthcare institutions. recently, concern has been raised with reports of c. difficile disease in those traditionally thought to be at low risk i.e. community acquired rather than healthcare acquired. this has increased awareness for the need to track outbreaks and pcr-ribotyping has found widespread use to elucidate epidemiologically linked isolates. pcr-ribotyping uses conserved regions of the 16s rrna ...201324050948
structures of a bifunctional cell wall hydrolase cwlt containing a novel bacterial lysozyme and an nlpc/p60 dl-endopeptidase.tn916-like conjugative transposons carrying antibiotic resistance genes are found in a diverse range of bacteria. orf14 within the conjugation module encodes a bifunctional cell wall hydrolase cwlt that consists of an n-terminal bacterial lysozyme domain (n-acetylmuramidase, blysg) and a c-terminal nlpc/p60 domain (γ-d-glutamyl-l-diamino acid endopeptidase) and is expected to play an important role in the spread of the transposons. we determined the crystal structures of cwlt from two pathogens, ...201424051416
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