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identification of risk factors associated with clostridium difficile infection in liver transplantation recipients: a single-center analysis.clostridium difficile remains the leading cause of health care-associated infectious diarrhea, and its incidence and severity are increasing in liver transplant recipients. several known risk factors for c difficile infection (cdi) are inherently associated with liver transplantation, such as severe underlying illness, immunosuppression, abdominal surgery, and broad-spectrum antibiotic use. we conducted a single-center retrospective case control study to characterize risk factors for cdi among p ...201627788814
[clostridium difficile infections in geriatric patients].clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in europe and north america. infections with c. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. other risk factors are proton pump inhibitors, which are taken by many elderly patients. the main virulence factors are toxins a and b. the clinical spectrum ranges from asymptomatic colonization to severe disease with abdominal complications and sepsis. the cur ...201627785569
proton pump inhibitors and clostridium difficile infection: are we propagating an already rapidly growing healthcare problem?proton pump inhibitors (ppis) have been associated with clostridium difficile infection (cdi) in several recent studies. the exact mechanism through which ppis may cause clostridium difficile infection is not well understood. one potential mechanism to explain this association may be that elevated gastric ph levels facilitate the growth of potentially pathogenic upper and lower gastrointestinal tract flora. although clostridium difficile spores are acid resistant, vegetative forms are susceptibl ...201327785249
corticosteroids in the treatment of pseudomembranous colitis: a report of 3 cases.clostridium difficile associated diarrhoea has been an increasing problem in the last decade in the uk and is a cause of significant morbidity. at the most severe end of the spectrum it causes pseudomembranous colitis which has a significant associated mortality rate and can be refractory to standard treatments. here we present three cases of proven pseudomembranous colitis in which systemic corticosteroids were used as an adjunct to treatment, raising the possibility of a new treatment option f ...201227785209
insight into the 3d structure and substrate specificity of previously uncharacterized gnat superfamily acetyltransferases from pathogenic bacteria.members of the gcn5-related n-acetyltransferase (gnat) superfamily catalyze the acetylation of a wide range of small molecule and protein substrates. due to their abundance in all kingdoms of life and diversity of their functions, they are implicated in many aspects of eukaryotic and prokaryotic physiology. although numerous gnats have been identified thus far, many remain structurally and functionally uncharacterized. the elucidation of their structures and functions is critical for broadening ...201727783928
mechanisms for floor surfaces or environmental ground contamination to cause human infection: a systematic review.shoe soles have been shown to transfer infectious microorganisms to floor and ground surfaces. however, the possible modes of transmission of infectious agents from floors or ground surfaces to human contact for infection have not been systematically reviewed. a systematic review was performed on articles indexed in medical databases (medline, embase, pubmed) using a pre-defined search strategy and mesh terms (date of last search: 15 march 2016). only primary research studies in english that inv ...201727780492
a population-based longitudinal study of clostridium difficile infection-related hospitalization in mid-age and older australians.clostridium difficile is the principal cause of infectious diarrhoea in hospitalized patients. we investigated the incidence and risk factors for hospitalization due to c. difficile infection (cdi) in older australians. we linked data from a population-based prospective cohort study (the 45 and up study) of 266 922 adults aged ⩾45 years recruited in new south wales, australia to hospitalization and death records for 2006-2012. we estimated the incidence of cdi hospitalization and calculated days ...201727780483
a descriptive case study of the changing nature of nurses' work: the impact of managing infectious diseases requiring isolation.methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, and clostridium difficile have increased in health care facilities worldwide. the complexity of caring for patients with infectious comorbidities has impacted nurses' daily work. a mixed-methods study at 1 community hospital in ontario, canada, demonstrated the cumulative effect of additional time spent on infection prevention and control measures resulted in trade-offs, cutting corners, and raised concerns about the ...201727776824
ensuring the safe and effective fda regulation of fecal microbiota transplantation.scientists, policymakers, and medical professionals alike have become increasingly worried about the rise of antibiotic resistance, and the growing number of infections due to bacteria like clostridium difficile, which cause a significant number of deaths and are imposing increasing costs on our health care system. however, in the last few years, fecal microbiota transplantation (fmt), the transplantation of stool from a healthy donor into the bowel of a patient, has emerged as a startlingly eff ...201527774199
determining the cause of recurrent clostridium difficile infection using whole genome sequencing.understanding the contribution of relapse and reinfection to recurrent clostridium difficile infection (cdi) has implications for therapy and infection prevention, respectively. we used whole genome sequencing to determine the relation of c. difficile strains isolated from patients with recurrent cdi at an academic medical center in the united states. thirty-five toxigenic c. difficile isolates from 16 patients with 19 recurrent cdi episodes with median time of 53.5days (range, 13-362) between e ...201727771207
enteropathogen infections in canine puppies: (co-)occurrence, clinical relevance and risk factors.laboratory confirmation of the causative agent(s) of diarrhoea in puppies may allow for appropriate treatment. the presence of potential pathogens however, does not prove a causal relationship with diarrhoea. the aim of this study was to identify specific enteropathogens in ≤12 month old puppies with and without acute diarrhoea and to assess their associations with clinical signs, putative risk factors and pathogen co-occurrence. faecal samples from puppies with (n=113) and without (n=56) acute ...201627771056
a dna vaccine targeting tcda and tcdb induces protective immunity against clostridium difficile.clostridium difficile-associated disease (cdad) constitutes a great majority of hospital diarrhea cases in industrialized countries and is induced by two types of large toxin molecules: toxin a (tcda) and toxin b (tcdb). development of immunotherapeutic approaches, either active or passive, has seen a resurgence in recent years. studies have described vaccine plasmids that express either tcda and/or tcdb receptor binding domain (rbd). however, the effectiveness of one vector encoding both toxin ...201627770789
rapid identification of the etiological factors causing diarrheal diseases.the main objective of this investigation was to develop and pilot a real-time polymerase chain reaction (rt-pcr) diagnostic system for rapid and simultaneous identification of pathogens with a particular emphasis on diarrheal disease diagnostics. the diarrheal diseases were selected as a target for the pilot because they constitute a primary public health priority in georgia and worldwide. the product developed by our research team "neo_pcr_diagnostics" represents an original system for the iden ...201627770538
epidemiology and recurrence rates of clostridium difficile infections in germany: a secondary data analysis.clostridium difficile infection (cdi) is the most common cause of health-care-associated infectious diarrhea. recurrence rates are as high as 20-30% after standard treatment with metronidazole or vancomycin, and appear to be reduced for patients treated with fidaxomicin. according to the literature, the risk of cdi recurrence increases after the second relapse to 30-65%. accurate data for germany are not yet available.201627770261
correction: importance of glutamate dehydrogenase (gdh) in clostridium difficile colonization in vivo.[this corrects the article doi: 10.1371/journal.pone.0160107.].201627768767
household transmission of clostridium difficile to family members and domestic pets.objective to determine the risk of clostridium difficile transmission from index cases with c. difficile infection (cdi) to their household contacts and domestic pets. design a prospective study from april 2011 to june 2013. setting patients with cdi from canadian tertiary care centers. participants patients with cdi, their household human contacts, and pets. methods epidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. ...201627767004
fear of failure: engaging patients in antimicrobial stewardship after fecal transplantation for recurrent clostridium difficile infection. 201727766987
laboratory experience with the liaison analyzer in the diagnosis of clostridium difficile-associated diarrhea.chemiluminescent or enzyme-linked fluorescent immunoassays are commonly used to diagnose clostridium difficile-associated diarrhea.201627766170
utilization of health services among adults with recurrent clostridium difficile infection: a 12-year population-based study.background considerable efforts have been dedicated to developing strategies to prevent and treat recurrent clostridium difficile infection (rcdi); however, evidence of the impact of rcdi on patient healthcare utilization and outcomes is limited. objective to compare healthcare utilization and 1-year mortality among adults who had rcdi, nonrecurrent cdi, or no cdi. methods we performed a nested case-control study among adult kaiser foundation health plan members from september 1, 2001, through d ...201727760583
wall teichoic acids are involved in the medium-induced loss of function of the autolysin cd11 against clostridium difficile.bacterial lysins are potent antibacterial enzymes with potential applications in the treatment of bacterial infections. some lysins lose activity in the growth media of target bacteria, and the underlying mechanism remains unclear. here we use cd11, an autolysin of clostridium difficile, as a model lysin to demonstrate that the inability of this enzyme to kill c. difficile in growth medium is not associated with inhibition of the enzyme activity by medium, or the modification of the cell wall pe ...201627759081
the type b flagellin of hypervirulent clostridium difficile is modified with novel sulfonated peptidylamido-glycans.glycosylation of flagellins is a well recognized property of many bacterial species. in this study, we describe the structural characterization of novel flagellar glycans from a number of hypervirulent strains of c. difficile we used mass spectrometry (nano-lc-ms and ms/ms analysis) to identify a number of putative glycopeptides that carried a variety of glycoform substitutions, each of which was linked through an initial n-acetylhexosamine residue to ser or thr. detailed analysis of a lldgsstei ...201627758867
the monoclonal antitoxin antibodies (actoxumab-bezlotoxumab) treatment facilitates normalization of the gut microbiota of mice with clostridium difficile infection.antibiotics have significant and long-lasting impacts on the intestinal microbiota and consequently reduce colonization resistance against clostridium difficile infection (cdi). standard therapy using antibiotics is associated with a high rate of disease recurrence, highlighting the need for novel treatment strategies that target toxins, the major virulence factors, rather than the organism itself. human monoclonal antibodies mk-3415a (actoxumab-bezlotoxumab) to c. difficile toxin a and toxin b, ...201627757389
burden of six healthcare-associated infections on european population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study.estimating the burden of healthcare-associated infections (hais) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. based on the methodology of the burden of communicable diseases in europe (bcode) project and 2011-2012 data from the european centre for disease prevention and control (ecdc) point prevalence survey (pps) of hais and antimicrobial use in european acute care hospit ...201627755545
the use and efficacy of fecal microbiota transplantation for refractory clostridium difficile in patients with inflammatory bowel disease.clostridium difficile (cd) is an anaerobic, spore-forming bacillus that is responsible for a spectrum of gastrointestinal illness ranging from asymptomatic carriage to toxic megacolon and death. the prevalence of cd infection is increasing in both hospitalized and community-based inflammatory bowel disease populations. standard antibiotic therapy fails to cure or prevent recurrence in more than 50% of patients, thus increasing the need for alternative therapies. recently, fecal microbiota transp ...201627755271
increased rates of clostridium difficile infection and poor outcomes in patients with ibd with cytomegalovirus.clostridium difficile infection (cdi) and cytomegalovirus (cmv) reactivation are associated with disease exacerbations and poor outcomes in inflammatory bowel disease (ibd). therefore, we assessed the association between these organisms in patients with ibd and the impact on colectomy.201627755270
new and emerging therapies for clostridium difficile infection.clostridium difficile infection has attained high prominence given its prevalence and impacts on patients and healthcare institutions. multiple new approaches to the prevention and treatment of c. difficile infection (cdi) are undergoing clinical trials.201627753689
emergence and spread of moxifloxacin-resistant clostridium difficile ribotype 231 in sweden between 2006 and 2015.an aggregation of moxifloxacin-resistant clostridium difficile ribotype 231 (rt231) isolates was first identified in the county of stockholm in 2008, and by the end of 2015 isolates of rt231 had spread to 13 of 21 swedish counties. we investigated the epidemiology of c. difficile rt231 in sweden between 2006 and 2015 using whole genome sequencing (wgs) and evaluated whether its emergence could be associated with extended moxifloxacin use. we performed wgs and phylogenetic analysis of 51 c. diffi ...201627752322
distribution of clostridium difficile pcr ribotypes and high proportion of 027 and 176 in some hospitals in four south eastern european countries.while clostridium difficile epidemiology is well documented in many european countries, data are largely missing for south eastern european region. here we report the pcr ribotype distribution of 249 c. difficile isolates received for typing from six hospital settings from croatia, bosnia and herzegovina, republic of macedonia and serbia in time period from 2008 to 2015. twenty-four pcr ribotypes were detected. the majority of strains from bosnia and herzegovina and serbia belonged to pcr riboty ...201627751937
thermal contrast amplification reader yielding 8-fold analytical improvement for disease detection with lateral flow assays.there is an increasing need for highly sensitive and quantitative diagnostics at the point-of-care. the lateral flow immunoassay (lfa) is one of the most widely used point-of-care diagnostic tests; however, lfas generally suffer from low sensitivity and lack of quantification. to overcome these limitations, thermal contrast amplification (tca) is a new method that is based on the laser excitation of gold nanoparticles (gnps), the most commonly used visual signature, to evoke a thermal signature. ...201627750420
the cost-efficiency and care effectiveness of probiotic administration with antibiotics to prevent hospital-acquired clostridium difficile infection.health care facility-acquired clostridium difficile infections (hcfa-cdi) have increased over the last several decades despite facilities developing protocols for prescribing probiotics with antibiotics to prevent hcfa-cdi. the literature does not consistently support this. a retrospective medical record review evaluated the care effectiveness of this practice. care effectiveness was not found; patients receiving probiotics with antibiotics were twice as likely to develop hcfa-cdi (p = .004). ex ...201627749722
an antimicrobial stewardship program based on systematic infectious disease consultation in a rehabilitation facility.objective to assess the impact of an antimicrobial stewardship program (asp) on antibiotic consumption, clostridium difficile infections (cdi), and antimicrobial resistance patterns in a rehabilitation hospital. design quasi-experimental study of the periods before (from january 2011 to june 2012) and after (from july 2012 to december 2014) asp implementation. setting 150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries. intervention beginning in july 2012, an asp was ...201727745559
failure of risk-adjustment by test method for c. difficile laboratory-identified event reporting.using an algorithm including both enzyme immunoassay (eia) and nucleic acid amplification (naat) for clostridium difficile infection (cdi) diagnosis, we found that the use of naat versus eia almost doubled our hospital-onset cdi laboratory-identified (labid) event standardized infection ratio (sir). we recommend that the current risk adjustment approach be modified. infect control hosp epidemiol 2016:1-3.201727745553
clostridium difficile environmental contamination within a clinical laundry facility in the usa.clostridium difficile is both a hospital and community acquired pathogen. the current study determined if c. difficile could be cultured from clinical laundry facility surfaces. a total of 240 surface samples were collected from dirty areas (n = 120), which handle soiled clinical linens, and from clean areas (n = 120), which process and fold the clean linens, within the university of washington consolidated laundry facility in 2015. sampling was done four times over the course of one year. the d ...201627744367
the tipping point: patients predisposed to clostridium difficile infection and a hospital antimicrobial stewardship programme.the incidence and severity of clostridium difficile infection (cdi) have increased in recent years. predictive models may help to identify at-risk patients before the onset of infection. early identification of high-risk patients could help antimicrobial stewardship (ams) programmes and other initiatives to better prevent c. difficile in these patients.201627742079
scandal-hit hospital empowers ward sisters to slash infection rates.a hospital where clostridium difficile was found to have contributed to the deaths of 90 patients has slashed infection rates by empowering ward sisters.201027741749
clostridium difficile infection.clostridium difficile can be cultured from the stool of 3 per cent of healthy adults but most people remain asymptomatic. clinical disease develops when normal gut flora is disrupted, usually by antibiotic exposure, thereby creating conditions that favour c. difficile proliferation in the colon. gastrointestinal diseases associated with c. difficile infection range from mild diarrhoea to fulminant colitis. some 'silent' infections present with abdominal pain and distension but little or no diarr ...201027741668
a clostridium difficile cell wall glycopolymer locus influences bacterial shape, polysaccharide production and virulence.clostridium difficile is a diarrheagenic pathogen associated with significant mortality and morbidity. while its glucosylating toxins are primary virulence determinants, there is increasing appreciation of important roles for non-toxin factors in c. difficile pathogenesis. cell wall glycopolymers (cwgs) influence the virulence of various pathogens. five c. difficile cwgs, including psii, have been structurally characterized, but their biosynthesis and significance in c. difficile infection is un ...201627741317
probiotics and liver disease: where are we now and where are we going?probiotics are live, nonpathogenic bacteria capable of colonizing the colonic mucosa. the most common probiotics include strains of lactobacillus or bifidobacteria, which are part of the normal gastrointestinal microbiota. initial studies of selected probiotic species have suggested potential efficacy in several gastrointestinal diseases including inflammatory bowel diseases (particularly pouchitis), antibiotic-related diarrhea, clostridium difficile toxin-induced colitis, infectious diarrhea, i ...201627741172
probiotics history.gut microbiota promotes healthy effects on the host and prevents diseases. probiotic (probios, for life) are defined as "live microorganisms which when administered in adequate amounts confer a health benefit on the host." at the beginning of 1900s louis pasteur identified the microorganisms responsible for the process of fermentation, whereas e. metchnikoff associated the enhanced longevity of bulgarian rural people to the regular consumption of fermented dairy products such as yogurt. he sugge ...201627741152
clostridium difficile infection in dialysis patients.clostridium difficile infection (cdi) is the most common cause of nosocomial diarrhea. patients with end-stage renal disease (esrd) may be at increased risk for cdi. patients with esrd with cdi have increased mortality, longer length of stay, and higher costs. the present studies extend these observations and address associated comorbidities, incidence of recurrence, and risk factors for mortality. we queried the united states renal data system (usrds) for patients with esrd diagnosed with cdi, ...201727737913
'superbug supremo' to oversee random hospital inspections.a 'superbug supremo' is to be appointed to spearhead scotland's new inspectorate to scrutinise hospitals' performance in dealing with infections such as mrsa and clostridium difficile.200927732445
beating the bug.nhs trusts across england are under orders from the chief nursing officer christine beasley to step up their efforts to control clostridium difficile infection rates.200727732112
quantitative structure activity relationship (qsar) studies on nitazoxanide-based analogues against clostridium difficile in vitro.quantitative structure activity relationship (qsar) has been established between the various physiochemical parameters of a series of nitazoxanide-based analogues and its antibacterial activity against clostridium difficile. genetic function approximation (gfa) and comparative molecular field analysis (comfa) techniques were used to identify the descriptors that have influence on biological activity. the most influencing molecular descriptors identified in 2d-qsar include spatial, topological, a ...201627731829
clinical use comparison of a semiautomated pcr with fluorescent ribotyping for typing of clostridium difficile.molecular typing of clostridium difficile is performed to assess strain relatedness or place strains within an epidemiological context. different c. difficile ribotyping systems are available. however, a common strain library does not exist. we aimed to compare ribotyping results of 29 clinical c. difficile isolates by two methods: semiautomated pcr-ribotyping and fluorescent pcr-ribotyping. for certain ribotypes (n = 16/29; 55.2 %), the inter-laboratory reproducibility was consistent among mult ...201727730251
semicarbazone ega inhibits uptake of diphtheria toxin into human cells and protects cells from intoxication.diphtheria toxin is a single-chain protein toxin that invades human cells by receptor-mediated endocytosis. in acidic endosomes, its translocation domain inserts into endosomal membranes and facilitates the transport of the catalytic domain (dta) from endosomal lumen into the host cell cytosol. here, dta adp-ribosylates elongation factor 2 inhibits protein synthesis and leads to cell death. the compound 4-bromobenzaldehyde n-(2,6-dimethylphenyl)semicarbazone (ega) has been previously shown to pr ...201627729638
the projected effectiveness of clostridium difficile vaccination as part of an integrated infection control strategy.early clinical trials of a clostridium difficile toxoid vaccine show efficacy in preventing c. difficile infection (cdi). the optimal patient group to target for vaccination programmes remains unexplored. this study performed a model-based evaluation of the effectiveness of different cdi vaccination strategies, within the context of existing infection prevention and control strategies such as antimicrobial stewardship.201627727031
surviving between hosts: sporulation and transmission.to survive adverse conditions, some bacterial species are capable of developing into a cell type, the "spore," which exhibits minimal metabolic activity and remains viable in the presence of multiple environmental challenges. for some pathogenic bacteria, this developmental state serves as a means of survival during transmission from one host to another. spores are the highly infectious form of these bacteria. upon entrance into a host, specific signals facilitate germination into metabolically ...201627726794
selected topics in anaerobic bacteriology.alteration in the host microbiome at skin and mucosal surfaces plays a role in the function of the immune system, and may predispose immunocompromised patients to infection. because obligate anaerobes are the predominant type of bacteria present in humans at skin and mucosal surfaces, immunocompromised patients are at increased risk for serious invasive infection due to anaerobes. laboratory approaches to the diagnosis of anaerobe infections that occur due to pyogenic, polymicrobial, or toxin-pr ...201627726792
characterization of clostridium difficile pcr-ribotype 018: a problematic emerging type.recent surveys indicate that the majority of toxigenic clostridium difficile strains isolated in european hospitals belonged to pcr-ribotypes (rts) different from rt 027 or rt 078. among these types, rt 018 has been reported in italy and, more recently, in korea and japan. in italy, strains rt 018 have become predominant in the early 2000s, whereas the majority of strains isolated before were rt 126, a type belonging to the same lineage as the rt 078. in this study, we have found that italian st ...201627725230
long-term effects on luminal and mucosal microbiota and commonly acquired taxa in faecal microbiota transplantation for recurrent clostridium difficile infection.faecal microbiota transplantation (fmt) is an effective treatment for recurrent clostridium difficile infection (rcdi). it restores the disrupted intestinal microbiota and subsequently suppresses c. difficile. the long-term stability of the intestinal microbiota and the recovery of mucosal microbiota, both of which have not been previously studied, are assessed herein. further, the specific bacteria behind the treatment efficacy are also investigated.201627724956
hearing the alarm.many directors of nursing will, like me, have read with interest the healthcare commission ( 2007 ) report into the outbreaks of clostridium difficile at maidstone and tunbridge wells nhs trust, kent, and, being responsible to their trust boards for infection control, will have reassessed their trusts' policies in light of its recommendations.200827724551
receipt of antibiotics in hospitalized patients and risk for clostridium difficile infection in subsequent patients who occupy the same bed.to assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for cdi in subsequent patients who occupy the same bed.201627723860
more than 50% of clostridium difficile isolates from pet dogs in flagstaff, usa, carry toxigenic genotypes.nosocomial acquisition of clostridium difficile is well documented, yet recent studies have highlighted the importance of community acquired infections and identified community associated reservoirs for this pathogen. multiple studies have implicated companion pets and farm animals as possible sources of community acquired c. difficile infections in humans. to explore the potential role of pet dogs in human c. difficile infections we systematically collected canine fecal samples (n = 197) in fla ...201627723795
fecal microbiota-based therapeutics for recurrent clostridium difficile infection, ulcerative colitis and obesity.the human gut microbiome is a complex ecosystem of fundamental importance to human health. our increased understanding of gut microbial composition and functional interactions in health and disease states has spurred research efforts examining the gut microbiome as a valuable target for therapeutic intervention. this review provides updated insight into the state of the gut microbiome in recurrent clostridium difficile infection (cdi), ulcerative colitis (uc), and obesity while addressing the ra ...201627720396
successful colonoscopic fecal microbiota transplantation for active ulcerative colitis: first report from india.forty-four-year-old male with ulcerative colitis (uc) for 11 years reported frequent relapse despite daily sulfasalazine 4 g, azathioprine 125 mg, and rectal 5-aminosalicylic acid. repeated use of corticosteroids led to cataract. at enrollment, he was passing eight stools a day with blood with a mayo score of 9 (3+1+3+2). stool was negative for ova/cysts/acid fast bacilli and clostridium difficile toxin assay. rectal biopsy showed cryptitis, crypt abscess, and crypt distortion with no inclusion ...201627718119
the efficacy of fidaxomicin in the treatment of clostridium difficile infection in a real-world clinical setting: a spanish multi-centre retrospective cohort.the objective of this study was to evaluate the efficacy and safety of fidaxomicin in the real-life clinical setting. this was a retrospective cohort of patients with clostridium difficile infection (cdi) treated with fidaxomicin in 20 spanish hospitals between july 2013 and july 2014. clinical cure, 30-day recurrence, 30-day mortality, sustained cure, and factors associated with the failure to achieve sustained cure were analyzed. of the 72 patients in the cohort 41 (56.9 %) had a fatal underly ...201727718071
rapid change of fecal microbiome and disappearance of clostridium difficile in a colonized infant after transition from breast milk to cow milk.clostridium difficile is the most common known cause of antibiotic-associated diarrhea. upon the disturbance of gut microbiota by antibiotics, c. difficile establishes growth and releases toxins a and b, which cause tissue damage in the host. the symptoms of c. difficile infection disease range from mild diarrhea to pseudomembranous colitis and toxic megacolon. interestingly, 10-50 % of infants are asymptomatic carriers of c. difficile. this longitudinal study of the c. difficile colonization in ...201627717398
longitudinal survey of clostridium difficile presence and gut microbiota composition in a belgian nursing home.increasing age, several co-morbidities, environmental contamination, antibiotic exposure and other intestinal perturbations appear to be the greatest risk factors for c. difficile infection (cdi). therefore, elderly care home residents are considered particularly vulnerable to the infection. the main objective of this study was to evaluate and follow the prevalence of c. difficile in 23 elderly care home residents weekly during a 4-month period. a c. difficile microbiological detection scheme wa ...201627716140
crystal structure and dna binding activity of a padr family transcription regulator from hypervirulent clostridium difficile r20291.clostridium difficile is a spore-forming obligate anaerobe that can remain viable for extended periods, even in the presence of antibiotics, which contributes to the persistence of this bacterium as a human pathogen during host-to-host transmission and in hospital environments. we examined the structure and function of a gene product with the locus tag cdr20291_0991 (cdpadr1) as part of our broader goal aimed at elucidating transcription regulatory mechanisms involved in virulence and antibiotic ...201627716049
characterization of the adherence of clostridium difficile spores: the integrity of the outermost layer affects adherence properties of spores of the epidemic strain r20291 to components of the intestinal mucosa.clostridium difficile is the causative agent of the most frequently reported nosocomial diarrhea worldwide. the high incidence of recurrent infection is the main clinical challenge of c. difficile infections (cdi). formation of c. difficile spores of the epidemic strain r20291 has been shown to be essential for recurrent infection and transmission of the disease in a mouse model. however, the underlying mechanisms of how these spores persist in the colonic environment remains unclear. in this wo ...201627713865
gut eradication of vim-1 producing st9 klebsiella oxytoca after fecal microbiota transplantation for diarrhea caused by a clostridium difficile hypervirulent r027 strain.we report the fecal carriage eradication of a vim-1-producing st9 klebsiella oxytoca strain in a pluripathological 84-year-old woman after fecal microbiota transplantation to control relapsing r027 hypervirulent clostridium difficile infections. the donor was her son, in which the absence of fecal carbapenemase-producing bacteria was corroborated.201627712927
in vitro antibacterial activity of rhodanine derivatives against pathogenic clinical isolates.bacterial infections present a serious challenge to healthcare practitioners due to the emergence of resistance to numerous conventional antibacterial drugs. therefore, new bacterial targets and new antimicrobials are unmet medical needs. rhodanine derivatives have been shown to possess potent antimicrobial activity via a novel mechanism. however, their potential use as antibacterials has not been fully examined. in this study, we determined the spectrum of activity of seven rhodanine derivative ...201627711156
short- and long-term effects of oral vancomycin on the human intestinal microbiota.oral vancomycin remains the mainstay of therapy for severe infections produced by clostridium difficile, the most prevalent cause of healthcare-associated infectious diarrhoea in developed countries. however, its short- and long-term effects on the human intestinal microbiota remain largely unknown.201727707993
impact of ultraviolet germicidal irradiation for no-touch terminal room disinfection on clostridium difficile infection incidence among hematology-oncology patients.objective to evaluate the impact of no-touch terminal room no-touch disinfection using ultraviolet wavelength c germicidal irradiation (uvgi) on c. difficile infection (cdi) rates on inpatient units with persistently high rates of cdi despite infection control measures. design interrupted time-series analysis with a comparison arm. setting 3 adult hematology-oncology units in a large, tertiary-care hospital. methods we conducted a 12-month prospective valuation of uvgi. rooms of patients with cd ...201727707423
clearance of vancomycin-resistant enterococcus concomitant with administration of a microbiota-based drug targeted at recurrent clostridium difficile infection.background.  vancomycin-resistant enterococcus (vre) is a major healthcare-associated pathogen and a well known complication among transplant and immunocompromised patients. we report on stool vre clearance in a post hoc analysis of the phase 2 punch cd study assessing a microbiota-based drug for recurrent clostridium difficile infection (cdi). methods.  a total of 34 patients enrolled in the punch cd study received 1 or 2 doses of rbx2660 (microbiota suspension). patients were requested to volu ...201627703995
role of glycosyltransferases modifying type b flagellin of emerging hypervirulent clostridium difficile lineages and their impact on motility and biofilm formation.clostridium difficile is the principal cause of nosocomial infectious diarrhea worldwide. the pathogen modifies its flagellin with either a type a or type b o-linked glycosylation system, which has a contributory role in pathogenesis. we study the functional role of glycosyltransferases modifying type b flagellin in the 023 and 027 hypervirulent c. difficile lineages by mutagenesis of five putative glycosyltransferases and biosynthetic genes. we reveal their roles in the biosynthesis of the flag ...201627703012
nodular colitis: endoscopic image an unusual finding.an 82-year-old male with a history of high blood pressure, copd, chronic myeloid leukemia, and stage-4 chronic renal failure. admitted to hospital for lower-limb cellulitis and severe copd exacerbation, he received antibiotic therapy and bronchodilators. during his hospital stay he developed severe anemia and had an hematochezia event with no diarrhea. a complete colonoscopy found small (4-7 mm) nacreous elevated lesions, circumferential in shape, in the cecum and ascending colon with some bleed ...201627701886
norovirus infection in solid organ transplant recipients: a single-center retrospective study.norovirus (nov) is gaining recognition as an important cause of diarrhea among solid organ transplant (sot) recipients, but existing studies have been limited by a small sample size.201627699965
assessing methanobrevibacter smithii and clostridium difficile as not conventional faecal indicators in effluents of a wastewater treatment plant integrated with sludge anaerobic digestion.wastewater treatment plants (wwtp) are an important source of surface water contamination by enteric pathogens, affecting the role of environmental water as a microbial reservoir. we describe the release to the environment of certain anaerobes of human and environmental concern. the work was focused on emerging microbial targets. they are tracing, by rt-qpcr, on wwtp effluents, both liquid and solid, when an anaerobic digestion step is included. the focus is placed on clostridium spp. with the s ...201627697372
toxin a-negative toxin b-positive ribotype 017 clostridium difficile is the dominant strain type in patients with diarrhoea attending tuberculosis hospitals in cape town, south africa.the molecular epidemiology of c. difficile strains causing disease in south africa is currently unknown. previously, multidrug resistant ribotype (rt)017 strains were those most commonly isolated from patients with diarrhoea attending groote schuur hospital in cape town, south africa. this larger study aimed to investigate the molecular epidemiology and antibiotic susceptibility profiles of c. difficile strains in the greater cape town and regional areas. c. difficile strains were isolated from ...201727696234
clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.clostridium difficile infection (cdi) is increasingly found in children worldwide, but limited data are available from children living in southern europe. a 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in italy. data of children with community- and hospital-acquired cdi (ca-cdi and ha-cdi, respectively) seen at seven pediatric referral centers in italy were recorded retrospectively. annual infection rates/10,000 ho ...201727696233
effect of detecting and isolating asymptomatic clostridium difficile carriers-reply. 201627695841
effect of detecting and isolating asymptomatic clostridium difficile carriers. 201627695834
influence of saccharomyces boulardii cncm i-745on the gut-associated immune system.the probiotic saccharomyces boulardii cncm i-745 (also known as saccharomyces cerevisiae hansen cbs 5926; in the following s. boulardii) has proven its effectiveness in preventive and therapeutic treatment of many gastrointestinal diseases, especially diseases associated with acute diarrhea. in particular, antibiotic-associated diarrhea, clostridium difficile-associated diarrhea, traveller's diarrhea, as well as acute diarrhea due to common viral and bacterial infections in children and adults.201627695355
host response to clostridium difficile infection: diagnostics and detection.clostridium difficile infection (cdi) is a significant healthcare concern worldwide, and c. difficile is recognised as the most frequent aetiological agent of infectious healthcare-associated diarrhoea in hospitalised adult patients. the clinical manifestation of cdi varies from self-limited diarrhoea to life-threatening colitis. such a broad disease spectrum can be explained by the impact of host factors. currently, a complex cdi aetiology is widely accepted, acknowledging the interaction betwe ...201627693863
clostridium difficile: a rare cause of pyogenic liver abscess.extra-intestinal infections due to clostridium difficile have been reported rarely. herein we report a case of pyogenic liver abscess from toxigenic c. difficile in an 80-year-old non-hospitalized woman with diabetes mellitus, cerebrovascular and cardiovascular diseases. the patient was admitted to the emergency department with fever and abdominal pain. there was no history of diarrhea or use of antibiotics. laboratory parameters revealed signs of inflammation and elevated ast and alt levels. ab ...201627693543
high prevalence of nontoxigenic clostridium difficile isolated from hospitalized and non-hospitalized individuals in rural ghana.since data about clostridium difficile infection in sub-saharan africa are scarce, we determined its epidemiology and risk factors in a cross-sectional study in eikwe, a rural community in ghana. we tested stool samples from 176 hospitalized patients with diarrhoea and from 131 asymptomatic non-hospitalized individuals for c. difficile and some other enteric pathogens. the overall prevalence rate of c. difficile was 4.9% with ribotype 084 being predominant. with 75% of the isolates, a high rate ...201627693000
reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens.the purpose of this study was to determine the effectiveness of copper-impregnated composite hard surfaces and linens in an acute care hospital to reduce health care-associated infections (hais).201627692785
an evaluation of food as a potential source for clostridium difficile acquisition in hospitalized patients.objective to determine whether clostridium difficile is present in the food of hospitalized patients and to estimate the risk of subsequent colonization associated with c. difficile in food. methods this was a prospective cohort study of inpatients at a university-affiliated tertiary care center, may 9, 2011-july 12, 2012. enrolled patients submitted a portion of food from each meal. patient stool specimens and/or rectal swabs were collected at enrollment, every 3 days thereafter, and at dischar ...201627691986
mathematical modeling of the transmission dynamics of clostridium difficile infection and colonization in healthcare settings: a systematic review.we conducted a systematic review of mathematical models of transmission dynamic of clostridium difficile infection (cdi) in healthcare settings, to provide an overview of existing models and their assessment of different cdi control strategies.201727690247
henoch schonlein purpura and clostridium difficile infection: a hematologist's point of view. 201627689213
serendipity in refractory celiac disease: full recovery of duodenal villi and clinical symptoms after fecal microbiota transfer.treatment of refractory celiac disease type ii (rcd ii) and preventing the development of an enteropathy associated t-cell lymphoma in these patients is still difficult. in this case report, we describe a patient with rcd ii who received fecal microbiota transfer as treatment for a recurrent clostridium difficile infection, and remarkably showed a full recovery of duodenal villi and disappearance of celiac symptoms. this case suggests that altering the gut microbiota may hold promise in improvin ...201627689204
chemokine cxcl13 expression was up-regulated in clostridium difficile infection.clostridium difficile infection (cdi) is the leading cause of antibiotic- and healthcare-associated diarrhea. cxcl13 is a well-known cxc chemokine involved in inflammation, but its role in cdi remains unknown. in this study, serum and fecal samplings were collected from 51 cdi patients, 50 diarrhea patients without cdi and 50 healthy control subjects to determine the cxcl13 levels by enzyme-linked immunosorbent assay (elisa). besides, a mouse model of c. difficile infection was established, and ...201627685937
measuring appropriate antimicrobial use: attempts at opening the black box.indiscriminate antimicrobial use has plagued medicine since antibiotics were first introduced into clinical practice >70 years ago. infectious diseases physicians and public health officials have advocated for preservation of these life-saving drugs for many years. with rising burden of antimicrobial-resistant organisms and clostridium difficile infections, halting unnecessary antimicrobial use has become one of the largest public health concerns of our time. inappropriate antimicrobial use has ...201627682070
frizzled proteins are colonic epithelial receptors for c. difficile toxin b.clostridium difficile toxin b (tcdb) is a critical virulence factor that causes diseases associated with c. difficile infection. here we carried out crispr-cas9-mediated genome-wide screens and identified the members of the wnt receptor frizzled family (fzds) as tcdb receptors. tcdb binds to the conserved wnt-binding site known as the cysteine-rich domain (crd), with the highest affinity towards fzd1, 2 and 7. tcdb competes with wnt for binding to fzds, and its binding blocks wnt signalling. fzd ...201627680706
eccmid 2016: addressing the burden of recurrent clostridium difficile infections.26th european congress of clinical microbiology and infectious diseases (eccmid), 9-12th april 2016, amsterdam, the netherlands the european congress of clinical microbiology and infectious diseases (eccmid) is the annual scientific meeting of the european society of clinical microbiology. eccmid 2016, held in amsterdam, the netherlands, was attended by over 11,600 clinical microbiologists and infectious disease physicians from more than 120 countries. the congress offered an essential opportuni ...201627679929
assessing the risk of hospital-acquired clostridium difficile infection with proton pump inhibitor use: a meta-analysis.background clostridium difficile is the principal infectious cause of antibiotic-associated diarrhea and accounts for 12% of hospital-acquired infections. recent literature has shown an increased risk of c. difficile infection (cdi) with proton pump inhibitor (ppi) use. objective to conduct a systematic assessment of the risk of hospital-acquired cdi following exposure to ppi. methods we searched multiple databases for studies examining the relationship between ppi and hospital-acquired cdi. poo ...201627677811
the housefly musca domestica as a mechanical vector of clostridium difficile.clostridium difficile is a bacterial healthcare-associated infection that may be transferred by houseflies (musca domestica) due to their close ecological association with humans and cosmopolitan nature.201627671221
patients with risk factors for complications do not require longer antimicrobial therapy for complicated intra-abdominal infection.a prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. we hypothesized that patients with specific risk factors for complications also had similar outcomes. short-course patients with obesity, diabetes, or acute physiology and chronic health evaluation ii ≥15 from the stop-it trial were compared with longer duration patients. outcomes ...201627670577
dietary zinc alters the microbiota and decreases resistance to clostridium difficile infection.clostridium difficile is the most commonly reported nosocomial pathogen in the united states and is an urgent public health concern worldwide. over the past decade, incidence, severity and costs associated with c. difficile infection (cdi) have increased dramatically. cdi is most commonly initiated by antibiotic-mediated disruption of the gut microbiota; however, non-antibiotic-associated cdi cases are well documented and on the rise. this suggests that unexplored environmental, nutrient and hos ...201627668938
inappropriate clostridium difficile testing and consequent overtreatment and inaccurate publicly reported metrics.background the nationally reported metric for clostridium difficile infection (cdi) relies solely on laboratory testing, which can result in overreporting due to asymptomatic c. difficile colonization. objective to review the clinical scenarios of cases of healthcare facility-onset cdi (ho-cdi) and to determine the appropriateness of c. difficile testing on the basis of presence of symptomatic diarrhea in order to identify areas for improvement. design retrospective cohort study. setting northwe ...201627666285
faecal microbiota transplantation for recurring clostridium difficile infection in a patient with crohn's disease and ileorectal anastomosis.faecal microbiota transplantation (fmt) is increasingly being used to treat refractory and recurring clostridium difficile infection (cdi). although fmt appears to be safe and highly effective in patients with a preserved colon and immunocompetence, its use in patients with inflammatory bowel disease (ibd) who are on immunomodulating therapies is controversial. in particular, patients who have undergone colectomy may have different treatment responses to fmt. in this case report, we describe the ...201627664230
vaccinology gets help from chemistry.a recent report on the immunological activity of protein conjugates of synthetic lipoteicoic fragments from clostridium difficile underpins the use of these molecules for the development of a vaccine. in a recent issue of cell chemical biology, broecker et al. (2016) illustrate the utility of glycoarray-based selection of bacterial carbohydrates with the potential to become vaccine candidates.201627662251
prevention of infection due to clostridium difficile.clostridium difficile is one of the foremost nosocomial pathogens. preventing infection is particularly challenging. effective prevention efforts typically require a multifaceted bundled approach. a variety of infection control procedures may be advantageous, including strict hand decontamination with soap and water, contact precautions, and using chlorine-containing decontamination agents. additionally, risk factor reduction can help reduce the burden of disease. the risk factor modification is ...201627660089
role of cephalosporins in the era of clostridium difficile infection.the incidence of clostridium difficile infection (cdi) in europe has increased markedly since 2000. previous meta-analyses have suggested a strong association between cephalosporin use and cdi, and many national programmes on cdi control have focused on reducing cephalosporin usage. despite reductions in cephalosporin use, however, rates of cdi have continued to rise. this review examines the potential association of cdi with cephalosporins, and considers other factors that influence cdi risk. e ...201727659735
fecal microbiota transplant in patients with recurrent clostridium difficile infection.the clinical effectiveness of fecal microbiota transplant (fmt) for the treatment of recurrent clostridium difficile infections (rcdi) has been demonstrated in randomized controlled trials. to assess the current status of fmt in germany with respect to active centers, local standards, clinical effectiveness and safety, the microtrans registry (nct02681068) was established.201627658471
overwhelming recurrent clostridium difficile infection after reversal of diverting loop ileostomy created for prior fulminant c. difficile colitis. 201627657564
advances in the microbiome: applications to clostridium difficile infection.clostridium difficile is a major cause of morbidity and mortality worldwide, causing over 400,000 infections and approximately 29,000 deaths in the united states alone each year. c. difficile is the most common cause of nosocomial diarrhoea in the developed world, and, in recent years, the emergence of hyper-virulent (mainly ribotypes 027 and 078, sometimes characterised by increased toxin production), epidemic strains and an increase in the number of community-acquired infections has caused fur ...201627657145
2016 update on medical overuse: a systematic review.overuse of medical care is an increasingly recognized problem in clinical medicine.201627654002
what's a snp between friends: the influence of single nucleotide polymorphisms on virulence and phenotypes of clostridium difficile strain 630 and derivatives.clostridium difficile is a major cause of antibiotic induced diarrhea worldwide, responsible for significant annual mortalities and represents a considerable economic burden on healthcare systems. the two main c. difficile virulence factors are toxins a and b. isogenic toxin b mutants of 2 independently isolated erythromycin-sensitive derivatives (630e and 630δerm) of strain 630 were previously shown to exhibit substantively different phenotypes. compared to 630, strain 630e and its progeny grow ...201627652799
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