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opportunistic infections due to inflammatory bowel disease therapy.the use of biological agents and immunomodulators for inflammatory bowel disease (ibd) has remarkably improved disease management in the current era but at the same time has increased the risk of infectious complications. patients with ibd on corticosteroids, immunomodulators, and biological agents are considered immunocompromised and are at risk for opportunistic infections. these are infections caused by organisms that take advantage of a weakened immune system, and cause disease, when they or ...201424051931
a tool to assess student performance in a clostridium difficile infection simulation scenario.to develop and validate an evaluation tool to assess student pharmacists' performance in a simulation scenario involving a patient with clostridium difficile infection (cdi).201324052652
therapy of clostridium difficile infection: perspectives on a changing paradigm.clostridium difficile disease (cdi) have increased in frequency and severity over the past decade and are a leading cause of hospital acquired infections, contributing to increased hospital length of stay and costs, as well as associated increased mortality, especially amongst the elderly. standard therapy has been associated with 20 - 30% relapse rates. consequently, new cdi therapeutic approaches have emerged.201324053182
human vaccines & immunotherapeutics: news.infant rotavirus vaccination provides for herd immunity nonreplicating sporozoite vaccine protects humans against malaria personalized brain cancer vaccine enters phase 2 trial novel implantable therapeutic cancer vaccine to be tested in humans clostridium difficile vaccine candidate successful in phase 1 cdc reports strong uptake of hpv vaccine in boys whooping cough outbreak in texas.201324056006
[nosocomial diarrhea in intensive care unit: other than clostridium difficile].to investigate the incidence and clinical features of non-clostridium difficile (c. difficile) associated nosocomial diarrhea in intensive care unit (icu) caused by klebsiella oxytoca and clostridium perfringens.201324059125
enterotoxigenic clostridium perfringens infection and pediatric patients with inflammatory bowel disease.clostridium difficile is the major cause of antibiotic-associated diarrhea and is the most well known bacterial pathogen associated with inflammatory bowel disease (ibd). enterotoxigenic clostridium perfringens has also been detected in up to 15% of antibiotic-associated diarrhea cases, and it has not been found in healthy people. the aim of this study was to investigate the prevalence of c. perfringens infection in pediatric patients with ibd.201424060617
temporal bacterial community dynamics vary among ulcerative colitis patients after fecal microbiota transplantation.fecal microbiota transplantation (fmt) from healthy donors, which is an effective alternative for treatment of clostridium difficile-associated disease, is being considered for several disorders such as inflammatory bowel disease, irritable bowel syndrome, and metabolic syndrome. disease remission upon fmt is thought to be facilitated by an efficient colonization of healthy donor microbiota, but knowledge of the composition and temporal stability of patient microbiota after fmt is lacking.201324060759
proton pump inhibitors and risk for recurrent clostridium difficile infection among inpatients.observational studies suggest that proton pump inhibitors (ppis) are a risk factor for incident clostridium difficile infection (cdi). data also suggest an association between ppis and recurrent cdi, although large-scale studies focusing solely on hospitalized patients are lacking. we therefore performed a retrospective cohort analysis of inpatients with incident cdi to assess receipt of ppis as a risk factor for cdi recurrence in this population.201324060760
hype or hypervirulence: a reflection on problematic c. difficile strains.clostridium difficile infections (cdi) have emerged as a major cause of healthcare associated disease, and recent epidemiological evidence also suggests an important role in community-acquired diarrhea. this increase is associated with specific types, especially pcr ribotypes 027 and 078, which are sometimes referred to as "hypervirulent". over the past years major advances have been made in our understanding of c. difficile pathogenicity, with the identification and characterization of the majo ...201324060961
molecular methods in the diagnosis of clostridium difficile infections: an update.nucleic acid amplification techniques (naats) represent a major advance in the diagnosis of clostridium difficile (c. difficile) infection. this review analyzes the different options available for a molecular diagnosis of c. difficile infection, as well as the strengths and weaknesses of naats. the performances of seven commercials naats are compared (bd geneohm cdiff, illumigene c. difficile, xpert c. difficile, bd max cdiff, portrait toxigenic c. difficile, progastro cd, seeplex diarrhea ace). ...201324063396
risk factors for clostridium difficile-associated diarrhea among hospitalized adults with fecal toxigenic c. difficile colonization.patients with toxigenic clostridium difficile colonization (tcdc) are at risk of developing c. difficile-associated diarrhea (cdad). however, the risk factors of hospitalized patients with tcdc developing cdad are not clear.201524064285
clostridium difficile-associated diarrhea: role of the pharmacist in the health system. 201324064434
epidemiology of clostridium difficile infection.there has been dramatic change in the epidemiology of clostridium difficile infection (cdi) since the turn of the 21st century noted by a marked increase in incidence and severity, occurring at a disproportionately higher frequency in older patients. historically considered a nosocomial infection associated with antibiotic exposure, cdi has now also emerged in the community in populations previously considered low risk. emerging risk factors and disease recurrence represent continued challenges ...201324064435
antibiotic-associated diarrhea: a refresher on causes and possible prevention with probiotics--continuing education article.antibiotic-associated diarrhea (aad) describes any unexplained diarrhea associated with the use of an antibiotic. aad also includes infection caused by clostridium difficile, however this organism only accounts for a small percentage of diarrhea caused by antibiotics. aad can be caused by multiple other organisms including c perfringens, s aureus, and candida. some antibiotics are more likely to cause non-c difficile aad, such as erythromycin and the penicillin class. aad develops through the lo ...201324064436
role of fidaxomicin for the treatment of clostridium difficile infection.clostridium difficile is a gram-negative, anaerobic, spore-forming emerging pathogen within health care systems and community-based populations that has a high associated morbidity and mortality as well as cost for the health care system. recent studies reported high rates of recurrence thus a need for new pharmacological agents to treat c difficile infections (cdis). fidaxomicin is a novel macrocyclic antibiotic, originally isolated from fermentation broth of dactylosporangium aurantiacum spp h ...201324064437
dna detection of clostridium difficile infection based on real-time resistance measurement.we used a newly developed electrochemical method, real-time resistance measurement, based on loop-mediated isothermal amplification (lamp), with real-time resistance monitoring and derivative analysis. dna extracted from specimens was amplified through lamp reaction. the 2 products of lamp, dna and pyrophosphate, both are negative ions; they combine with positive dye (crystal violet) and positive ions (mg(2+)), which leads to an increase in the resistivity of the reaction liquid. the changes of ...201324065671
proteomic analysis and label-free quantification of the large clostridium difficile toxins.clostridium difficile is the leading cause of antibiotic-associated diarrhea in hospitals worldwide, due to hypervirulent epidemic strains with the ability to produce increased quantities of the large toxins tcda and tcdb. unfortunately, accurate quantification of tcda and tcdb from different toxinotypes using small samples has not yet been reported. in the present study, we quantify c. difficile toxins in <0.1 ml of culture filtrate by quantitative label-free mass spectrometry (ms) using data-i ...201324066231
diverse sources of c. difficile infection identified on whole-genome sequencing.it has been thought that clostridium difficile infection is transmitted predominantly within health care settings. however, endemic spread has hampered identification of precise sources of infection and the assessment of the efficacy of interventions.201324066741
clostridium difficile--beyond the usual suspects. 201324066748
emerging clinical role of pivmecillinam in the treatment of urinary tract infection in the context of multidrug-resistant bacteria.the continuing spread of resistant gram-negative bacteria is a therapeutic challenge and prudent use of antimicrobials is therefore essential. urinary tract infections (utis), usually due to gram-negative bacteria, are among the most common infections seen in the community. moreover, bacterial strains producing extended-spectrum β-lactamases (esbls) that are resistant not only to cephalosporins and penicillins, but also to fluoroquinolones and trimethoprim, are becoming more prevalent in the com ...201424068280
concurrent infections of giardia duodenalis, enterocytozoon bieneusi, and clostridium difficile in children during a cryptosporidiosis outbreak in a pediatric hospital in china.over 200 cryptosporidiosis outbreaks have been reported, but little is known if other enteric pathogens were also involved in some of these outbreaks. recently, an outbreak of cryptosporidiosis linked to poor hygiene by two cryptosporidium hominis subtypes occurred in a pediatric hospital ward (ward a) in china, lasting for more than 14 months. in this study, the concurrence during the outbreak of three other enteric pathogens with a similar transmission route, giardia duodenalis, enterocytozoon ...201324069491
[fecal transfusion as treatment of clostridium difficile infection].clostridium difficile is the major identified cause of antibiotic-associated diarrhea. metronidazole has been applied as the first-line treatment, while vancomycin has been used in recurring cases of the disease. fecal transfusion has already long been applied as experimental therapy in the treatment of recurring c. difficile infection. the aim of fecal transfusion is normalization of the intestinal microbial flora. an only recently published extensive finnish patient series and a randomized stu ...201324069636
[fulminant clostridium difficile colitis].clostridium difficile is a common cause of nosocomial diarrhea and it's most difficult fulminant form is increasing in prevalence and severity in hospitalized patients. the early diagnostics and intensive conservative therapy are essential in the treatment of this ominous disease. the physicians must be aware of the possibility of this disease, when treating patients, who have received preceding antibiotic therapy. these patients have to be followed up in the surgical units. if the general condi ...201324069637
a review of ischemic colitis: is our clinical recognition and management adequate?ischemic colitis is a common cause of hospital admissions; however it is frequently confused intellectually with mesenteric ischemia and often misdiagnosed as infectious diarrhea or clostridium difficile colitis. ischemic colitis is caused by non-occlusive insult to the small vessels supplying the colon without a clear precipitating factor. it is more common in females and in patients above 60 years of age. the classic presentation includes sudden onset of lower abdominal pain followed by the ur ...201324070152
alteration of the intestinal microbiome: fecal microbiota transplant and probiotics for clostridium difficile and beyond.clostridium difficile infection is increasingly common with a high risk of recurrence despite antibiotic treatment. in cases of recurrent c. difficile infection, fecal microbiota transplant (fmt) is a highly effective treatment option promoting the restoration of normal gut microbiota. furthermore, preliminary uncontrolled evidence demonstrates possible benefit of fmt in the management of some cases of inflammatory bowel disease and chronic constipation. in addition to presenting an overview of ...201324070153
loss of nhe3 alters gut microbiota composition and influences bacteroides thetaiotaomicron growth.changes in the intestinal microbiota have been linked to diabetes, obesity, inflammatory bowel disease, and clostridium difficile (c. difficile)-associated disease. despite this, it remains unclear how the intestinal environment, set by ion transport, affects luminal and mucosa-associated bacterial composition. na(+)/h(+)-exchanger isoform 3 (nhe3), a target of c. difficile toxin b, plays an integral role in intestinal na(+) absorption. thus the nhe3-deficient mouse model was chosen to examine t ...201324072680
[epidemiological characteristics of nosocomial diarrhea caused by clostridium difficile in a tertiary level hospital in serbia].among the most important causes of diarrhea in modern hospitals is clostridium difficile (c. difficile). a wide spectrum of diseases caused by this bacterium is now known as c. difficile associated disease (cdad). the development of cdad is usually preceded by the administration of antimicrobial therapy and fecal-oral infections with c. difficile. over the last years epidemiology of cdad has significantly changed. recently, a hypervirulent bi/nap1/027 strain, the cause of severe epidemics in nor ...201324073554
risk factors for clostridium difficile infection in the community: a case-control study in patients in general practice, denmark, 2009-2011.to identify risk factors for clostridium difficile infection (cdi) in danish patients consulting general practice with gastrointestinal symptoms, a prospective matched case-control study was performed; cases (n = 259) had positive cultures for toxigenic c. difficile and controls (n = 455) negative cultures. data were analysed by conditional logistic regression. in patients aged ⩾2 years (138 cases), hospitalization [odds ratio (or) 8·4, 95% confidence interval (ci) 3·1-23], consumption of beef ( ...201424073613
first case of autochthonous clostridium difficile pcr ribotype 027 detected in spain.clostridium difficile ribotype 027 (cd027) has caused outbreaks in the united states, canada, and europe since 2001. in spain, the importance of cd027 is still unknown. in 2007, we began active surveillance of cd027 to determine its incidence in our hospital.201424074903
murine models to study clostridium difficile infection and transmission.clostridium difficile is the leading cause of antibiotic-associated diarrhea in healthcare facilities worldwide. c. difficile infections are difficult to treat because of the high rate of disease recurrence after antibiotic therapy, leaving few treatment options for patients. c. difficile is also difficult to contain within a healthcare setting due to a highly-transmissible, resistant spore form that challenges standard infection control measures. the recent development of murine infection model ...201324076318
oral vancomycin desensitisation to treat clostridium difficile infection in a vancomycin allergic patient.the prevalence of clostridium difficile infection (cdi) is increasing worldwide. oral vancomycin is an effective and frequently used treatment. however, patients with cdi who are allergic to intravenous vancomycin cannot receive oral vancomycin due to the risk of anaphylaxis if given the oral form.we present a case where oral vancomycin desensitisation was used to successfully treat a vancomycin allergic patient with recurrent cdi.201324079362
the situation and management of clostridium difficile infection in spain: an opinion document. 201324080894
molecular epidemiology of clostridium difficile strains from nosocomial-acquired infections.the purpose of this study is to analyze isolates of clostridium difficile from patients with nosocomial acquired infection in respect to their molecular type and antimicrobial susceptibility. fifty-nine randomly selected clinical isolates were characterized. molecular typing was performed by rep-pcr (diversilab). isolates were tested by disk diffusion towards 11 different antibiotics. all isolates were susceptible to metronidazole and vancomycin. fifty five (93 %) isolates were resistant to eryt ...201424081935
growth-inhibiting and morphostructural effects of constituents identified in asarum heterotropoides root on human intestinal bacteria.the growth-inhibiting and morphostructural effects of seven constituents identified in asarum heterotropoides root on 14 intestinal bacteria were compared with those of the fluoroquinolone antibiotic ciprofloxacin.201324083511
poor functional status as a risk factor for severe clostridium difficile infection in hospitalized older adults.to determine the role of impaired functional status as a risk factor for severe clostridium difficile infection (cdi) in older adults.201324083842
culturing and maintaining clostridium difficile in an anaerobic environment.clostridium difficile is a gram-positive, anaerobic, sporogenic bacterium that is primarily responsible for antibiotic associated diarrhea (aad) and is a significant nosocomial pathogen. c. difficile is notoriously difficult to isolate and cultivate and is extremely sensitive to even low levels of oxygen in the environment. here, methods for isolating c. difficile from fecal samples and subsequently culturing c. difficile for preparation of glycerol stocks for long-term storage are presented. te ...201324084491
the role of flagella in clostridium difficile pathogenesis: comparison between a non-epidemic and an epidemic strain.clostridium difficile is a major cause of healthcare-associated infection and inflicts a considerable financial burden on healthcare systems worldwide. disease symptoms range from self-limiting diarrhoea to fatal pseudomembranous colitis. whilst c. difficile has two major virulence factors, toxin a and b, it is generally accepted that other virulence components of the bacterium contribute to disease. c. difficile colonises the gut of humans and animals and hence the processes of adherence and co ...201324086268
multicenter evaluation of the verigene clostridium difficile nucleic acid assay.the verigene clostridium difficile nucleic acid test (verigene cdf test) (nanosphere, northbrook, il) is a multiplex qualitative pcr assay that utilizes a nanoparticle-based array hybridization method to detect c. difficile tcda and tcdb in fecal specimens. in addition, the assay detects binary toxin gene sequences and the single base pair deletion at nucleotide 117 (δ 117) in tcdc to provide a presumptive identification of the epidemic strain 027/nap1/bi (referred to here as ribotype 027). this ...201324088862
prevalence of clostridium difficile colonization among healthcare workers.clostridium difficile infection (cdi) has increased to epidemic proportions in recent years. the carriage of c. difficile among healthy adults and hospital inpatients has been established. we sought to determine whether c. difficile colonization exists among healthcare workers (hcws) in our setting.201324090343
how do university education and clinical experience influence pre-registration nursing students' infection control practice? a descriptive, cross sectional survey.this study aims to explore nursing students' knowledge of infection control and investigate how university education and clinical experience influence their infection control practice.201424090618
antipathogenic activity of probiotics against salmonella typhimurium and clostridium difficile in anaerobic batch culture systems: is it due to synergies in probiotic mixtures or the specificity of single strains?probiotics are currently being investigated for prevention of infections caused by enteric pathogens. the aim of this in vitro study was to evaluate the influence of three single probiotics: lactobacillus casei ncimb 30185 (pxn 37), lactobacillus acidophilus ncimb 30184 (pxn 35), bifidobacterium breve ncimb 30180 (pxn 25) and a probiotic mixture containing the above strains plus twelve other strains belonging to the lactobacillus, bifidobacterium, lactococcus, streptococcus and bacillus genera o ...201324091275
physician outlook toward fecal microbiota transplantation in the treatment of clostridium difficile infection. 201324091517
depression and clostridium difficile infection. 201324093925
overview of severe clostridium difficile infection.clostridium difficile is an anaerobic, spore-forming, gram-positive bacillus that can produce severe colitis resulting in death. there has been an overall increase in the incidence of clostridium difficile-associated disease and, particularly, an increase in the more virulent forms of the disease. treatment of severe c difficile infection includes management of severe sepsis and shock, pathogen-directed antibiotic therapy, and, in selected cases, surgical intervention. ultimately, prevention is ...201324094379
abdominal catastrophes in the intensive care unit setting.patients in the setting of the intensive care unit can develop intra-abdominal complications that may worsen outcome. clinical suspicion of such complications coupled with early diagnosis and treatment may reduce morbidity and mortality associated with these processes. this article addresses the diagnosis and management of some of the common causes of intra-abdominal catastrophes.201324094389
microbiota-mediated colonization resistance against intestinal pathogens.commensal bacteria inhabit mucosal and epidermal surfaces in mice and humans, and have effects on metabolic and immune pathways in their hosts. recent studies indicate that the commensal microbiota can be manipulated to prevent and even to cure infections that are caused by pathogenic bacteria, particularly pathogens that are broadly resistant to antibiotics, such as vancomycin-resistant enterococcus faecium, gram-negative enterobacteriaceae and clostridium difficile. in this review, we discuss ...201324096337
genome-wide analysis of cell type-specific gene transcription during spore formation in clostridium difficile.clostridium difficile, a gram positive, anaerobic, spore-forming bacterium is an emergent pathogen and the most common cause of nosocomial diarrhea. although transmission of c. difficile is mediated by contamination of the gut by spores, the regulatory cascade controlling spore formation remains poorly characterized. during bacillus subtilis sporulation, a cascade of four sigma factors, σ(f) and σ(g) in the forespore and σ(e) and σ(k) in the mother cell governs compartment-specific gene expressi ...201324098137
the spore differentiation pathway in the enteric pathogen clostridium difficile.endosporulation is an ancient bacterial developmental program that culminates with the differentiation of a highly resistant endospore. in the model organism bacillus subtilis, gene expression in the forespore and in the mother cell, the two cells that participate in endospore development, is governed by cell type-specific rna polymerase sigma subunits. σ(f) in the forespore, and σ(e) in the mother cell control early stages of development and are replaced, at later stages, by σ(g) and σ(k), resp ...201324098139
defining the vulnerable period for re-establishment of clostridium difficile colonization after treatment of c. difficile infection with oral vancomycin or metronidazole.clostridium difficile is an anaerobic, spore-forming bacterium that is the most common cause of healthcare-associated diarrhea in developed countries. a significant proportion of patients receiving oral vancomycin or metronidazole for treatment of clostridium difficile infection (cdi) develop recurrences. however, the period of vulnerability to re-establishment of colonization by c. difficile after therapy is not well defined.201324098459
faecal microbiota transplantation for the treatment of recurrent clostridium difficile infection: current promise and future needs.the use of faecal microbiota transplantation (fmt) as treatment for recurrent clostridium difficile infection (cdi) has increased rapidly over the past few years. in this review, we highlight clinical studies of fmt for treatment of recurrent cdi and discuss the safety, standardization and future of this treatment option. the major risk factor for cdi is prior antibiotic use, which results in an altered state of the gut microbiota characterized by decreased microbial diversity. this altered gut ...201324100717
expanded therapeutic potential in activity space of next-generation 5-nitroimidazole antimicrobials with broad structural diversity.metronidazole and other 5-nitroimidazoles (5-ni) are among the most effective antimicrobials available against many important anaerobic pathogens, but evolving resistance is threatening their long-term clinical utility. the common 5-nis were developed decades ago, yet little 5-ni drug development has since taken place, leaving the true potential of this important drug class unexplored. here we report on a unique approach to the modular synthesis of diversified 5-nis for broad exploration of thei ...201324101497
effect of vancomycin dose on treatment outcomes in severe clostridium difficile infection.current guidelines recommend vancomycin 125 mg four times daily for the treatment of severe clostridium difficile infection (cdi). however, the optimal dose of vancomycin has not been elucidated. this study was conducted to evaluate outcome differences in patients with severe cdi treated with either low-dose (≤500 mg daily) or high-dose (>500 mg daily) oral vancomycin. the medical records of 78 patients with severe cdi were evaluated retrospectively. the primary outcome was time to clinical cure ...201324103633
cadazolid, a novel antibiotic with potent activity against clostridium difficile: safety, tolerability and pharmacokinetics in healthy subjects following single and multiple oral doses.current treatment options for clostridium difficile-associated diarrhoea (cdad) leave a high unmet medical need for new therapies. cadazolid is a new antibiotic in development for the treatment of cdad. the objectives of this study were to evaluate its tolerability and pharmacokinetics following single ascending doses (ac-061-101) and multiple ascending doses (ac-061-102).201424106141
clinical differences in clostridium difficile infection based on age: a multicenter study.advancing age is a well-known risk factor for clostridium difficile infection (cdi). however, age-specific clinical differences in cdi are uncertain. a retrospective comparative analysis was performed based on age in 1367 patients with cdi in korea. most clinical features were similar in the two age groups studied, however malignancy was more common in the older group (age ≥ 65 y) (p < 0.001), while chemotherapy and transplantation were more common in the younger group (age < 65 y) (p < 0.001). ...201424106984
guidance on preparing an investigational new drug application for fecal microbiota transplantation studies.fecal microbiota transplantation (fmt) is an effective treatment for clostridium difficile infections that are refractory to antibiotic therapy. because of the important roles of the microbiota in the function of the gastrointestinal tract and other aspects of human physiology, there is a growing interest in studying fmt for other clinical indications. the us food and drug administration regulates clinical studies to evaluate the safety and efficacy of fmt. studies of fmt for recurrent clostridi ...201424107393
comparison of multilocus variable-number tandem-repeat analysis and whole-genome sequencing for investigation of clostridium difficile transmission.no study to date has compared multilocus variable-number tandem-repeat analysis (mlva) and whole-genome sequencing (wgs) in an investigation of the transmission of clostridium difficile infection. isolates from 61 adults with ongoing and/or recurrent c. difficile infections and 17 asymptomatic carriage episodes in children (201 samples), as well as from 61 suspected outbreaks affecting 2 to 41 patients in 31 hospitals in the united kingdom (300 samples), underwent 7-locus mlva and wgs in paralle ...201324108611
clostridium difficile bacteremia. 201324111758
trends in orthopaedic antimicrobial prophylaxis in the uk between 2005 and 2011.antimicrobial prophylaxis remains the most powerful tool used to reduce infection rates in orthopaedics but the choice of antibiotic is complex. the aim of this study was to examine trends in antimicrobial prophylaxis in orthopaedic surgery involving the insertion of metalwork between 2005 and 2011.201324112496
occurrence of zoonotic clostridia and yersinia in healthy cattle.zoonotic pathogens are a frequent cause of disease worldwide. this study was designed to determine the occurrence of clostridium difficile, clostridium botulinum, and yersinia enterocolitica in cattle in southern bavaria, germany. the study population included 49 farms; 34 were dairy farms (30 also fattening beef cattle) and 15 were solely beef cattle farms. fecal and dust samples were collected from summer 2011 to summer 2012 and analyzed using a combination of enrichment procedures and real-ti ...201324112568
a clostridium difficile infection (cdi) stewardship initiative improves adherence to practice guidelines for management of cdi.a clostridium difficile infection (cdi) stewardship initiative reduced inappropriate prescription of empirical cdi therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of cdi. the initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.201324113611
metabolic engineering of escherichia coli for biosynthesis of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) from glucose.the escherichia coli xl1-blue strain was metabolically engineered to synthesize poly(3-hydroxybutyrate-co-3-hydroxyvalerate) [p(3hb-co-3hv)] through 2-ketobutyrate, which is generated via citramalate pathway, as a precursor for propionyl-coa. two different metabolic pathways were examined for the synthesis of propionyl-coa from 2-ketobutyrate. the first pathway is composed of the dickeya dadantii 3937 2-ketobutyrate oxidase or the e. coli pyruvate oxidase mutant (poxb l253f v380a) for the conver ...201424113828
sensitivity to antibiotics of clostridium difficile toxigenic nosocomial strains.clostridium difficile is the etiological agent of diarrhoea and colitis, especially in elderly patients. the incidence of these diseases has increased during the last 10 years. emergence of so-called hypervirulent strains is considered as one of the main factors responsible for the more severe disease and changed profile of sensitivity to antimicrobial agents. the aim of this work was to determine the sensitivity profile of toxigenic strains of c. difficile in the czech republic in 2011-2012 to ...201424114414
molecular epidemiology of clostridium difficile at a medical center in taiwan: persistence of genetically clustering of a⁻b⁺ isolates and increase of a⁺b⁺ isolates.we investigated the changing trend of various toxigenic clostridium difficile isolates at a 3 500-bed hospital in taiwan. genetic relatedness and antimicrobial susceptibility of toxigenic c. difficile isolates were also examined.201324116048
european society of clinical microbiology and infectious diseases: update of the treatment guidance document for clostridium difficile infection.in 2009 the first european society of clinical microbiology and infection (escmid) treatment guidance document for clostridium difficile infection (cdi) was published. the guideline has been applied widely in clinical practice. in this document an update and review on the comparative effectiveness of the currently available treatment modalities of cdi is given, thereby providing evidence-based recommendations on this issue. a computerized literature search was carried out to investigate randomiz ...201424118601
a new plant-derived antibacterial is an inhibitor of efflux pumps in staphylococcus aureus.an in-depth evaluation was undertaken of a new antibacterial natural product (1) recently isolated and characterised from the plant hypericum olympicum l. cf. uniflorum. minimum inhibitory concentrations (mics) were determined for a panel of bacteria, including: meticillin-resistant and -susceptible strains of staphylococcus aureus, staphylococcus epidermidis and staphylococcus haemolyticus; vancomycin-resistant and -susceptible enterococcus faecalis and enterococcus faecium; penicillin-resistan ...201324119569
microbiological, pathological and histological findings in four danish pig herds affected by a new neonatal diarrhoea syndrome.neonatal diarrhoea is a frequent clinical condition in commercial swine herds, previously regarded to be uncomplicated to treat. however, since 2008 it seems that a new neonatal diarrhoeic syndrome unresponsive to antibiotics and common management practices has emerged. routine laboratory examinations have not detected any pathogen related to this syndrome. the primary purpose of this study was to evaluate if well-known enteric pathogens could be associated with outbreaks of neonatal diarrhoea, ...201324119974
ultrastructure of clostridium difficile colonies.the ultrastructural colony architecture of six clostridium difficile strains belonging to four different ribotypes (001, 027, 078/126 and 036) was studied by scanning electron microscopy (sem). in 2-day-old colonies several microareas differing in cell length and organization could be differentiated. some cells at colony edges were extremely long and exhibited invasiveness into the agar. the ultrastructure of 5-day-old colonies is more homogenous and characterized by presence of sporulating cell ...201324120350
a retrospective study on the etiological diagnoses of diarrhea in neonatal piglets in ontario, canada, between 2001 and 2010.laboratory surveillance data from the animal health laboratory, university of guelph, on the etiological diagnoses of neonatal diarrhea in piglets were analyzed to determine the relative importance and trends of different enteric pathogens in ontario. a total of 237 cases, including live and dead 1- to 7-day-old piglets, were submitted for diagnosis of gastrointestinal illness between 2001 and 2010. the combined frequencies for cases of gastrointestinal illness involving escherichia coli, clostr ...201324124267
common gastrointestinal symptoms: risks of long-term proton pump inhibitor therapy.more than 11 million individuals receive proton pump inhibitor (ppi) prescriptions each year in the united states. although ppis are effective treatment for peptic ulcers and esophagitis and provide symptom relief for many other conditions, their use carries risks. they decrease gastric acid and can lower blood levels of drugs whose absorption is acid dependent, including several antiretroviral and cancer therapy drugs. other drugs, such as digoxin, may be absorbed more extensively when gastric ...201324124705
severe clostridium difficile infection in new zealand associated with an emerging strain, pcr-ribotype 244.to compare disease severity and clinical outcome of clostridium difficile infection (cdi) due to pcr-ribotype (rt) 244 with cdi due to other strains present in auckland.201324126745
in vitro activity of cadazolid against clinically relevant clostridium difficile isolates and in an in vitro gut model of c. difficile infection.we investigated the in vitro activity of cadazolid against 100 clostridium difficile isolates and its efficacy in a simulated human gut model of c. difficile infection (cdi).201424128668
[challenges of clostridium difficile infection].clostridium difficile infections remain a problem especially for patients in the intensive care unit. the fact that c. difficile infections are strongly associated with antibiotic therapy calls for more caution in the use of antibiotics, especially in patients with a high risk of developing c. difficle infections. severe infections and recurrent episodes are usually difficult to manage and therapeutic options are often limited. the method of stool transplantation, though not new, has received mo ...201324129852
a quantitative method for assessment of prescribing patterns using electronic health records.most available quality indicators for hospitals are represented by simple ratios or proportions, and are limited to specific events. a generalized method that can be applied to diverse clinical events has not been developed. the aim of this study was to develop a simple method of evaluating physicians' prescription patterns for diverse events and their level of awareness of clinical practice guidelines.201324130689
added value of multiplex luminex gastrointestinal pathogen panel (xtag® gpp) testing in the diagnosis of infectious gastroenteritis.the luminex gastrointestinal pathogen panel (xtag(®) gpp) detects in one assay the most common gastroenteritis-causing pathogens and toxins, namely adenovirus 40/41, norovirus genogroup (ng) i/ii, rotavirus a, clostridium difficile toxin a/b, campylobacter sp., escherichia coli o157, enterotoxigenic e. coli heat-labile enterotoxin/heat-stable enterotoxin, salmonella sp., shiga-toxin producing e. coli, shiga-like toxin (stx)1/2, shigella sp., vibrio cholerae, yersinia enterocolitica, cryptosporid ...201424131399
horizontal gene transfer converts non-toxigenic clostridium difficile strains into toxin producers.clostridium difficile is a major nosocomial pathogen and the main causative agent of antibiotic-associated diarrhoea. the organism produces two potent toxins, a and b, which are its major virulence factors. these are chromosomally encoded on a region termed the pathogenicity locus (paloc), which also contains regulatory genes, and is absent in non-toxigenic strains. here we show that the paloc can be transferred from the toxin-producing strain, 630δerm, to three non-toxigenic strains of differen ...201324131955
fecal transplantation therapy for clostridium difficile-associated pouchitis. 201424132529
[clostridium difficile infection (cdi) in the course of time - an issue only for the internist?].toxigenic strains of clostridium (c.) difficile are the most prevalent pathogens of antibiotic associated intestinal disease and nosocomial diarrhoea. during the last 10 years, incidences of c. difficile infection (cdi) have increased worldwide.201424132675
colonic decompression and direct intraluminal medical therapy for clostridium difficile-associated megacolon using a tube placed endoscopically in the proximal colon.urgent colectomy for severe clostridium difficile infection can be associated with increased morbidity and mortality. we aimed to use endoscopic methods for treatment.201424134562
fidaxomicin: a review of its use in patients with clostridium difficile infection.oral fidaxomicin (dificid(®); dificlir(®)) is a first-in-class macrocyclic antibacterial that is approved in several countries for the treatment of adult patients with clostridium difficile-associated diarrhoea. fidaxomicin 200 mg twice daily for 10 days was an effective and generally well tolerated treatment in adult patients with a first episode or first recurrence of c. difficile infection. in two multinational phase iii trials, fidaxomicin treatment was noninferior to vancomycin treatment wi ...201324136090
equine hyperimmune serum protects mice against clostridium difficile spore challenge.clostridium (c.) difficile is a common cause of nosocomial diarrhea in horses. vancomycin and metronidazole have been used as standard treatments but are only moderately effective, which highlights the need for a novel alternative therapy. in the current study, we prepared antiserum of equine origin against both c. difficile toxins a and b as well as whole-cell bacteria. the toxin-neutralizing activities of the antibodies were evaluated in vitro and the prophylactic effects of in vivo passive im ...201324136208
linking clostridium difficile infection with depression. 201324137729
a polymorphic, mucocutaneous eruption in a patient with end-stage renal disease.an 81-year-old man is presented who developed cryptococcal infection after treatment for clostridium difficile infection.201324139366
the impact of cefepime as first line therapy for neutropenic fever on clostridium difficile rates among hematology and oncology patients.after changing empiric treatment of febrile neutropenia from meropenem to cefepime, the effect on clostridium difficile infection (cdi) was investigated. the change was assessed using an autoregressive model. a significant increase in cdi rates occurred following the introduction of cefepime. there may be an association between increased cefepime usage and cdi.201324140078
functional analysis of slec from clostridium difficile: an essential lytic transglycosylase involved in spore germination.clostridium difficile is the most common cause of enteric disease and presents a major burden on healthcare systems globally due in part to the observed rapid rise in antibiotic resistance. the ability of c. difficile to form endospores is a key feature in the organism's pathogenesis and transmission, and contributes greatly to its resilient nature. endospores are highly resistant to disinfection, allowing them to persist on hospital surfaces. in order for the organism to cause disease, the spor ...201424140647
simple approach for ultrasensitive electrochemical immunoassay of clostridium difficile toxin b detection.clostridium difficile toxin b (tcd b), as one of the primary contributing factors to the pathogenesis of c. difficile-associated diseases, has raised serious public concerns due to its virulence, spore-forming ability and persistence with major types of infectious diarrhea diseases, and been used as a potential biomarker in clinical diagnoses. thus, a simple method for the determination of tcd b was developed based on a sandwich-type electrochemical immunosensor. greatly enhanced sensitivity was ...201424141113
clostridium difficile glutamate dehydrogenase is a secreted enzyme that confers resistance to h2o2.clostridium difficile produces an nad-specific glutamate dehydrogenase (gdh), which converts l-glutamate into α-ketoglutarate through an irreversible reaction. the enzyme gdh is detected in the stool samples of patients with c. difficile-associated disease and serves as one of the diagnostic tools to detect c. difficile infection (cdi). we demonstrate here that supernatant fluids of c. difficile cultures contain gdh. to understand the role of gdh in the physiology of c. difficile, an isogenic in ...201424145018
investigating clostridium difficile.clostridium difficile is one of the leading health-care-associated infections in the uk and has a significant clinical and economic impact. optimal laboratory testing for this pathogen is controversial and interpretation of results can lead to confusion. in the context of the clinical syndrome of c. difficile infection, this article reviews disease presentation, the diagnostic tests available, and their translation into information that can assist clinical management at the bedside.201324145598
clostridium difficile carriage and serum antitoxin responses in children with inflammatory bowel disease.adults with inflammatory bowel disease (ibd) have a high prevalence of clostridium difficile carriage, but little data exist regarding pediatric patients with ibd. serum antibody responses to c. difficile toxins in correlation with organism carriage are not described in ibd. this study determines the prevalence of c. difficile carriage and compares serum antibody responses to c. difficile toxins in pediatric outpatients with ibd and controls.201324145927
discovery of a cyclic phosphodiesterase that catalyzes the sequential hydrolysis of both ester bonds to phosphorus.the bacterial c-p lyase pathway is responsible for the metabolism of unactivated organophosphonates under conditions of phosphate starvation. the cleavage of the c-p bond within ribose-1-methylphosphonate-5-phosphate to form methane and 5-phospho-ribose-1,2-cyclic phosphate (prcp) is catalyzed by the radical sam enzyme phnj. in escherichia coli the cyclic phosphate product is hydrolyzed to ribose-1,5-bisphosphate by phnp. in this study, we describe the discovery and characterization of an enzyme ...201324147537
what is the value of a food and drug administration investigational new drug application for fecal microbiota transplantation to treat clostridium difficile infection? 201424148361
quality of care delivered to hospitalized inflammatory bowel disease patients.hospitalized patients with inflammatory bowel disease (ibd) are at high risk for morbidity, mortality, and health care utilization costs. while the literature on trends in hospitalization rates for this disease is conflicting, there does appear to be significant variation in the delivery of care to this complex group, which may be a marker of suboptimal quality of care. there is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce admissions. moreover ...201324151354
clostridium difficile surveillance: harnessing new technologies to control transmission.clostridium difficile surveillance allows outbreaks of cases clustered in time and space to be identified and further transmission prevented. traditionally, manual detection of groups of cases diagnosed in the same ward or hospital, often followed by retrospective reference laboratory genotyping, has been used to identify outbreaks. however, integrated healthcare databases offer the prospect of automated real-time outbreak detection based on statistically robust methods, and accounting for conta ...201324151834
surveillance cultures in pediatric allogeneic hematopoietic stem cell transplantation.the value of surveillance cultures in predicting systemic infections and in guiding antimicrobial treatment is controversial. we investigated 57 pediatric allo-scts between 2007 and 2009. all (34), aml (5), and severe aplastic anemia (4) were the largest patient groups. conditioning was tbi-based in 87% and 54% developed gvhd (21% grade iii-iv). of the 2594 weekly colonization samples, 24% were positive (fecal bacteria 86%, fecal fungi 16%, clostridium difficile 16%; throat bacteria 17% and thro ...201424152015
utility of a commercial pcr assay and a clinical prediction rule for detection of toxigenic clostridium difficile in asymptomatic carriers.a commercial pcr assay of perirectal swab specimens detected 17 (68%) of 25 asymptomatic carriers of toxigenic clostridium difficile, including 93% with skin and/or environmental contamination. a clinical prediction rule, followed by pcr screening, could be used to identify carriers at high risk of c. difficile shedding.201424153132
epidemiology of clostridium difficile-associated disease (cdad): a shift from hospital-acquired infection to long-term care facility-based infection.previous epidemiological studies on clostridium-difficile-associated diarrhea (cdad) have focused on hospitalized patients with nosocomial transmission. however, increasing numbers of patients with cdad are being admitted to acute-care hospitals from long-term care facilities (ltcfs) and the local community. the purpose of our study was to study the changing epidemiological trends of cdad patients admitted to an acute-care hospital and examine factors contributing to this shift in epidemiology.201324154638
detection of toxins a/b and isolation of clostridium difficile and clostridium perfringens from dogs in minas gerais, brazil.the objective of this study was to detect c. difficile a/b toxins and to isolate strains of c. perfringens and c. difficile from diarrheic and non-diarrheic dogs in brazil. stool samples were collected from 57 dogs, 35 of which were apparently healthy, and 22 of which were diarrheic. c. difficile a/b toxins were detected by elisa, and c. perfringens and c. difficile were identified by multiplex pcr. c. difficile a/b toxins were detected in 21 samples (36.8%). of these, 16 (76.2%) were from diarr ...201324159295
fulminant colitis.fulminant colitis is an ill-defined entity that is usually viewed as the most severe form of uncomplicated acute colitis. it usually occurs in the course of ulcerative colitis and infectious colitis, but can also be seen in other forms of colitis. every patient with clinical criteria for severe or fulminant colitis should be approached in a systematic way, based on two premises - intense medical treatment and early surgery in non-responders.201324160933
an antibiotic-altered microbiota provides fuel for the enteric foe.antibiotic therapies disrupt the intestinal microbiota and render the host susceptible to enteric infections. a recent report by ng et al. explores the ability of two intestinal pathogens (salmonella enterica serovar typhimurium and clostridium difficile) to use this disruption to their advantage and consume host carbohydrates that would otherwise be unavailable in the presence of a normal gut microbiota.201424165893
is fidaxomicin the drug of choice for treating clostridium difficile-associated diarrhea in patients with cancer? 201324166524
role of leptin-mediated colonic inflammation in defense against clostridium difficile colitis.the role of leptin in the mucosal immune response to clostridium difficile colitis, a leading cause of nosocomial infection, was studied in humans and in a murine model. previously, a mutation in the receptor for leptin (lepr) was shown to be associated with susceptibility to infectious colitis and liver abscess due to entamoeba histolytica as well as to bacterial peritonitis. here we discovered that european americans homozygous for the same lepr q223r mutation (rs1137101), known to result in d ...201424166957
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