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tea and recurrent clostridium difficile infection.background and aims. studies have shown effects of diet on gut microbiota. we aimed to identify foods associated with recurrent clostridium difficile infection (cdi). methods. in this cross-sectional survey, consecutive patients diagnosed with cdi were identified by electronic medical records. colitis symptoms and positive clostridium difficile assay were confirmed. health-care onset-health-care facility associated cdi was excluded. food surveys were mailed to 411 patients. survey responses serv ...201627651790
clostridium difficile infection diagnostics - evaluation of the c. diff quik chek complete assay, a rapid enzyme immunoassay for detection of toxigenic c. difficile in clinical stool samples.diagnostic testing for clostridium difficile infection (cdi) has, in recent years, seen the introduction of rapid dual-eia (enzyme immunoassay) tests combining species-specific glutamate dehydrogenase (gdh) with toxin a/b. in a prospective study, we compared the c. diff quik chek complete test to a combination of selective culture (sc) and loop-mediated isothermal amplification (lamp) of the toxin a gene. of 419 specimens, 68 were positive in sc including 62 positive in lamp (14.7%). the combine ...201627651167
a comparison of histamine receptor antagonists versus proton pump inhibitor gastrointestinal ulcer prophylaxis in kidney transplant recipients.there are several different agents that can be used for gastrointestinal (gi) ulcer prophylaxis in posttransplant recipients, such as histamine-2 receptor antagonists (h2ra) or proton pump inhibitors (ppis).201627650918
community- and healthcare-associated clostridium difficile infections, finland, 2008-2013(1).we evaluated incidence, case-fatality rate, and trends of community-associated (ca) and healthcare-associated (ha) clostridium difficile infections (cdis) in finland during 2008-2013. cdis were identified in the national infectious disease register, deaths in the national population information system, hospitalizations to classify infections as ca or ha in the national hospital discharge register, and genotypes in a reference laboratory. a total of 32,991 cdis were identified: 10,643 (32.3%) wer ...201627648884
fecal microbiota transplant in patients with clostridium difficile infection: a systematic review.fecal microbiota transplantation (fmt) restores a diverse bacterial profile to the gastrointestinal tract and may effectively treat patients with clostridium difficile infection (cdi). the objective of this systematic review was to evaluate the effectiveness of fmt in the treatment of cdi.201627648772
the phosphotransfer protein cd1492 represses sporulation initiation in clostridium difficile.the formation of spores is critical for the survival of clostridium difficile outside the host gastrointestinal tract. persistence of c. difficile spores greatly contributes to the spread of c. difficile infection (cdi), and the resistance of spores to antimicrobials facilitates the relapse of infection. despite the importance of sporulation to c. difficile pathogenesis, the molecular mechanisms controlling spore formation are not well understood. the initiation of sporulation is known to be reg ...201627647869
risk factors for short- and long-term mortality in very old patients with clostridium difficile infection: a retrospective study.most cases of clostridium difficile infections (cdi) occur in patients aged 65 years and older. older age is associated with increased mortality. risk factors for mortality in patients aged 80 years and older are not well recognized.201627647625
taking advantage of public reporting: an infection composite score to assist evaluating hospital performance for infection prevention efforts.the standardized infection ratio (sir) evaluates individual publicly reported health care-associated infections, but it may not assess overall performance.201627645403
proton pump inhibitors and risk of clostridium difficile infection: a multi-country study using sequence symmetry analysis.to determine the association between incident proton pump inhibitor (ppi) use and clostridium difficile infections across multiple countries method: national data covering the total population in australia and korea, the canadian population over 65 years and a 3 million person random sample data set from taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in japan. sequence symmetry analysis was used to assess the association with ...201627645304
non-invasive fecal microbiota transplantation for recurrent clostridium difficile infection in a patient presenting with hypertensive disorder post interventionem.fecal microbiota transplantation has gathered much attention due to its high efficacy in resolving recurrent clostridium difficile infection. until today, it is recognized as a safe procedure without any severe side effects. patients with impaired conscious states suffering from recurrent episodes of aspiration are at increased risk by endoscopic interventions needed during standard approaches for fecal microbiota transplantation application.here, we illustrate the case of a tetraplegic patient ...201627644000
[fecal microbiota transplantation, a novel therapy for recurrent clostridium difficile infection].clostridium difficile infection is caused by a disturbance of the gut microbiota, often resulting from the use of antibiotics. among a sub group of patients with this disorder, treatment with antibiotics is not effective. they develop a chronic, recurrent infection. such patients can be treated with a fecal microbiota transplantation (fmt), or fecal transplantation. the crucial steps for safe application of fecal transplantation are central donor selection and screening. to optimise safety and t ...201627643493
molecular types and antimicrobial susceptibility patterns of clostridium difficile isolates in different epidemiological settings in a tertiary care center in israel.the aims of this prospective study were to examine the correlation between the molecular types and the antimicrobial susceptibility patterns of clostridium difficile isolates with the source of acquisition and the occurrence of c. difficile infections (cdi) in a tertiary center in israel. all available isolates from community-acquired (ca) cdi episodes (n=43) and matching numbers of isolates from community-onset, hospital acquired (co-ha, n=67) and ha-cdi (n=56) and 32 cases of recurrent cdi wer ...201627638350
pantoprazole or placebo for stress ulcer prophylaxis (pop-up): randomized double-blind exploratory study.pantoprazole is frequently administered to critically ill patients for prophylaxis against gastrointestinal bleeding. however, comparison to placebo has been inadequately evaluated, and pantoprazole has the potential to cause harm. our objective was to evaluate benefit or harm associated with pantoprazole administration.201627635481
endoscopic delivery of fecal biotherapy in inflammatory bowel disease.the intestinal microbiome plays an important role in the pathogenesis of inflammatory bowel disease (ibd). we are able to use the microbiome as a therapeutic target with use of fecal microbiota transplantation (fmt) for cure of recurrent clostridium difficile infection. given our ability to target the dysbiotic state with fmt, its use as therapy in ibd has tremendous potential. this overview discusses the practical considerations of fmt therapy with respect to our current understanding of safety ...201627633598
reprofiled anthelmintics abate hypervirulent stationary-phase clostridium difficile.prolonged use of broad-spectrum antibiotics disrupts the indigenous gut microbiota, which consequently enables toxigenic clostridium difficile species to proliferate and cause infection. the burden of c. difficile infections was exacerbated with the outbreak of hypervirulent strains that produce copious amounts of enterotoxins and spores. in recent past, membrane-active agents have generated a surge of interest due to their bactericidal property with a low propensity for resistance. in this stud ...201627633064
a recombination directionality factor controls the cell type-specific activation of σk and the fidelity of spore development in clostridium difficile.the strict anaerobe clostridium difficile is the most common cause of nosocomial diarrhea, and the oxygen-resistant spores that it forms have a central role in the infectious cycle. the late stages of sporulation require the mother cell regulatory protein σk. in bacillus subtilis, the onset of σk activity requires both excision of a prophage-like element (skinbs) inserted in the sigk gene and proteolytical removal of an inhibitory pro-sequence. importantly, the rearrangement is restricted to the ...201627631621
'get in early'; biofilm and wax moth (galleria mellonella) models reveal new insights into the therapeutic potential of clostridium difficile bacteriophages.clostridium difficile infection (cdi) is a global health threat associated with high rates of morbidity and mortality. conventional antibiotic cdi therapy can result in treatment failure and recurrent infection. c. difficile produces biofilms which contribute to its virulence and impair antimicrobial activity. some bacteriophages (phages) can penetrate biofilms and thus could be developed to either replace or supplement antibiotics. here, we determined the impact of a previously optimized 4-phag ...201627630633
hypersensitivity reaction following administration of low-dose oral vancomycin for the treatment of clostridium difficile in a patient with normal renal function.systemic absorption of oral vancomycin for the treatment of clostridium difficile is thought to be trivial in patients without risk factors for increased systemic absorption and is often overlooked in clinical practice. a 51-year-old male elicits a suspected immunoglobulin e-mediated hypersensitivity following administration of low-dose oral vancomycin for the treatment of severe c difficile the patient had normal renal function and was administered low doses of the medication, however, had a me ...201627630210
laparobotic duodenal diverticulectomy and choledochoduodenostomy: a case study and review of the literature.the duodenum is the second most common site for diverticulae, after the colon. they are common after the fifth decade and usually asymptomatic. ten percent of patients present with symptoms, which include abdominal pain, hemorrhage, duodenal obstruction, diverticulitis, perforation, pancreatitis, and obstructive jaundice. after a thorough search of medline we present, for the first time, a case of obstructive jaundice secondary to duodenal diverticulum compressing the common bile duct. it was ma ...201027628639
use of a collagen membrane to enhance the survival of primary intestinal epithelial cells.intestinal epithelial cell culture is important for biological, functional and immunological studies. since enterocytes have a short in vivo life span due to anoikis, we aimed to establish a novel and reproducible method to prolong the survival of mouse and human cells. cells were isolated following a standard procedure, and cultured on ordered-cow's collagen membranes. a prolonged cell life span was achieved; cells covered the complete surface of bio-membranes and showed a classical enterocyte ...201627626762
modulation of the surface-layer protein of clostridium difficile through cwp84 inhibition.cysteine protease cwp84 is responsible for surface-layer processing in clostridium difficile and was also shown to cleave several human extracellular matrix components in vitro. to enable the facile identification and characterization of cwp84 inhibitors, we developed a fluorogenic 10-mer peptide based on the enzyme's natural substrate slpa that is amenable for use in fret-based high-throughput screening. the design of substrate-mimetic inhibitors led to epoxysuccinate 8c, which displayed an ina ...201627626098
evaluation of the performance of c. diff quik chek complete and its usefulness in a hospital setting with a high prevalence of clostridium difficile infection.rapid and accurate diagnosis of clostridium difficile infection (cdi) is crucial for patient care, infection control, and efficient surveillance. we evaluated c. diff quik chek complete (qcc; techlab), which detects glutamate dehydrogenase (gdh) antigen (qcc-ag) and toxin a/b (qcc-tox) simultaneously, and compared it to the laboratory diagnostics for cdi currently in use in a tertiary hospital setting with a high prevalence of cdi. qcc, ridascreen c. difficile toxin a/b assay (toxin eia; r-bioph ...201727625418
disparate prevalence of toxigenic and nontoxigenic clostridium difficile among distinct adult patient populations in a single institution.clostridium difficile (cd) disease remains a costly and important hospital-associated infection. although nontoxigenic cd is detected by some cd testing methods, can interfere with some detection algorithms and has been suggested as a treatment for cd disease, little is known about the relative occurrence of toxigenic and nontoxigenic cd in a single institution.we used both chromogenic and selective agar media to recover cd isolates and a molecular method to detect the toxin b gene from over 240 ...201627624898
crystal structures of two nitroreductases from hypervirulent clostridium difficile and functionally related interactions with the antibiotic metronidazole.nitroreductases (nrs) are flavin mononucleotide (fmn)-dependent enzymes that catalyze the biotransformation of organic nitro compounds (rno2; r = alkyl, aryl) to the nitroso rn=o, hydroxylamino rnhoh, or amine rnh2 derivatives. metronidazole (mtz) is a nitro-containing antibiotic that is commonly prescribed for lower-gut infections caused by the anaerobic bacterium clostridium difficile. c. difficile infections rank number one among hospital acquired infections, and can result in diarrhea, sever ...201627623089
compared lethality rates of clostridium difficile infections at the local, regional and national levels in france. 201627621820
modulation of microbiota as treatment for intestinal inflammatory disorders: an uptodate.alterations of intestinal microflora may significantly contribute to the pathogenesis of different inflammatory and autoimmune disorders. there is emerging interest on the role of selective modulation of microflora in inducing benefits in inflammatory intestinal disorders, by as probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (fmt). to summarize recent evidences on microflora modulation in main intestinal inflammatory disorders, pubmed was searched using ter ...201627621567
risk factors for recurrent clostridium difficile infections and strategies to decrease readmissions in a community hospital.currently there are no universally accepted approaches for the prevention of recurrent clostridium difficile infections (cdi) following the initial infection. several studies have identified common risk factors for the emergence of recurrent cdi. identifying patients at high risk for recurrent cdi through the assessment of risk factors at initial diagnosis could enable health care providers to optimize available treatment options. a vancomycin hydrochloride-tapered regimen may be an effective tr ...201527621508
antibiotic treatment of hospitalized patients with pneumonia complicated by clostridium difficile infection.clostridium difficile infection (cdi) is one of the most common gastrointestinal complication after antimicrobial treatment. it is estimated that cdi after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. the aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia cdi. we addressed the issue by examining retrospectively the records of 217 patients who met the diagno ...201627620311
efficacy of secondary prophylaxis with vancomycin for preventing recurrent clostridium difficile infections.patients with clostridium difficile infection (cdi) who are re-exposed to antibiotics have a high likelihood of recurrence. we aimed to determine whether oral vancomycin as secondary prophylaxis reduces the risk of recurrence in patients recently diagnosed with cdi who undergo subsequent antibiotic exposure (cdi-ae).201627619835
therapeutic manipulation of the microbiota: past, present, and considerations for the future.the growing appreciation of the potential role of indigenous microbiota in disease has resulted in a concomitant interest in manipulating the microbiome for therapeutic effect. the most successful example of microbiota manipulation for treatment of a disease is in recurrent infection with the bacterial pathogen clostridium difficile.201627619640
assessment of the overall and multidrug-resistant organism bioburden on environmental surfaces in healthcare facilities.objective to determine the typical microbial bioburden (overall bacterial and multidrug-resistant organisms [mdros]) on high-touch healthcare environmental surfaces after routine or terminal cleaning. design prospective 2.5-year microbiological survey of large surface areas (>1,000 cm2). setting mdro contact-precaution rooms from 9 acute-care hospitals and 2 long-term care facilities in 4 states. participants samples from 166 rooms (113 routine cleaned and 53 terminal cleaned rooms). methods usi ...201627619507
why rifampin (rifampicin) is a key component in the antibiotic treatment of hidradenitis suppurativa: a review of rifampin's effects on bacteria, bacterial biofilms, and the human immune system.combinations of rifampin and clindamycin or rifampin, metronidazole, and moxifloxcin have been reported as effective treatments for hidradenitis suppurativa (hs) hurley stage 1 and hurley stage 2.  clinical trials suggest that for stage 1 and mild stage 2 hs, clindamycin 300 mg twice daily and rifampin 300 mg twice daily for 10 weeks can substantially abate hs in ~80% of cases and remit hs in ~50% of cases.  another study notes use of rifampin-moxifloxacin-metronidazole given for 6 weeks, dosed ...201627617596
antibiotic resistance.antimicrobial resistance in bacterial pathogens is a challenge that is associated with high morbidity and mortality. multidrug resistance patterns in gram-positive and -negative bacteria are difficult to treat and may even be untreatable with conventional antibiotics. there is currently a shortage of effective therapies, lack of successful prevention measures, and only a few new antibiotics, which require development of novel treatment options and alternative antimicrobial therapies. biofilms ar ...201627616769
clostridium difficile presence in spanish and belgian hospitals.clostridium difficile is recognised worldwide as the main cause of infectious bacterial antibiotic-associated diarrhoea in hospitals and other healthcare settings. the aim of this study was to first survey c. difficile prevalence during the summer of 2014 at the central university hospital of asturias (spain). by typing the isolates obtained, it was then possible to compare the ribotype distribution at the spanish hospital with results from the st luc university hospital in belgium over the same ...201627616443
asymptomatic clostridium difficile colonization in two australian tertiary hospitals, 2012-2014: prospective, repeated cross-sectional study.to investigate the prevalence and risk factors for asymptomatic toxigenic (tcd) and nontoxigenic clostridium difficile (ntcd) colonization in a broad cross section of the general hospital population over a 3-year period.201727615716
thrombocytopenia in hospitalized patients with severe clostridium difficile infection.clostridium difficile infection (cdi) is a common cause of nosocomial diarrhea and colitis. the incidence and prognostic significance of thrombocytopenia as related to mode of acquisition (hospital vs. community), nap1/027 strain, and disease severity has not been examined. we performed a single-institution retrospective analysis of all adult inpatients from 2013 to 2014 diagnosed with cdi during their hospitalization to document the incidence/prevalence of thrombocytopenia and associated outcom ...201727614757
healthcare personnel attire and devices as fomites: a systematic review.background transmission of pathogens within the hospital environment remains a hazard for hospitalized patients. healthcare personnel clothing and devices carried by them may harbor pathogens and contribute to the risk of pathogen transmission. objective to examine bacterial contamination of healthcare personnel attire and commonly used devices. methods systematic review. results of 1,175 studies screened, 72 individual studies assessed contamination of a variety of items, including white coats, ...201627609491
oral, frozen fecal microbiota transplant (fmt) capsules for recurrent clostridium difficile infection.fecal microbiota transplantation (fmt) has been shown to be safe and effective in treating refractory or relapsing c. difficile infection (cdi), but its use has been limited by practical barriers. we recently reported a small preliminary feasibility study using orally administered frozen fecal capsules. following these early results, we now report our clinical experience in a large cohort with structured follow-up.201627609178
the epidemiology of clostridium difficile infection in patients with cancer.clostridium difficile infection (cdi) is a significant cause of healthcare-associated diarrhoea, and the emergence of endemic strains resulting in poorer outcomes is recognised worldwide. patients with cancer are a specific high-risk group for development of infection. areas covered: in this review, modifiable and non-modifiable risk factors for cdi in adult patients with haematological malignancy or solid tumours are evaluated. in particular, the contribution of antimicrobial exposure, hospital ...201627606976
clostridium difficile infection in production animals and avian species: a review.clostridium difficile is the leading cause of antibiotic-associated diarrhea and colitis in hospitalized humans. recently, c. difficile infection (cdi) has been increasingly recognized as a cause of neonatal enteritis in food animals such as pigs, resulting in stunted growth, delays in weaning, and mortality, as well as colitis in large birds such as ostriches. c. difficile is a strictly anaerobic spore-forming bacterium, which produces two toxins a (tcda) and b (tcdb) as its main virulence fact ...201627602596
bed utilisation and increased risk of clostridium difficile infections in acute hospitals in england in 2013/2014.the study aimed to identify thresholds for hospital bed utilisation which are independently associated with significantly higher risks for clostridium difficile infections (cdi) in acute hospitals in england.201627601687
[a scoring system for prescribing fidaxomicin in clostridium diffícile infection].recurrences of clostridium difficile infections lead to hospital readmissions and high costs, in addition to the suffering and frustration for the patients. fidaxomicin has recently been introduced as a new antibiotic that has been shown to significantly reduce the recurrence of this infection. despite this superiority, its high cost has led to very restrictive policies in its use, as such that many institutions only use it in patients with multiple recurrences. while waiting for new predictive ...201627601193
rapid detection of clostridium difficile toxins and laboratory diagnosis of clostridium difficile infections.clostridium difficile is an anaerobic, spore-forming and gram-positive bacillus. it is the major cause of antibiotic-associated diarrhea prevailing in hospital settings. the morbidity and mortality of c. difficile infection (cdi) has increased significantly due to the emergence of hypervirulent strains. because of the poor clinical different between cdi and other causes of hospital-acquired diarrhea, laboratory test for c. difficile is an important intervention for diagnosis of cdi.201627601055
use of intravenous tigecycline in patients with severe clostridium difficile infection: a retrospective observational cohort study.there are only a limited number of antimicrobials for treating severe clostridium difficile infection (scdi). tigecycline shows significant in vitro effect against c. difficile and is approved for management of complicated intra-abdominal infections. our aim was to analyse the efficacy of tigecycline compared with standard therapy (oral vancomycin plus intravenous metronidazole) in adults treated for scdi. a retrospective cohort study of such patients hospitalized at our department from january ...201627599690
growth patterns of clostridium difficile - correlations with strains, binary toxin and disease severity: a prospective cohort study.a broad spectrum of symptoms has been associated with c. difficile infection (cdi). several studies indicate that toxin-production correlates with growth rates of c. difficile. this study aimed to correlate growth rates of c. difficile with disease severity and strain characteristics. from 01/2003 to 10/2011, strains from a prospective cohort of all inpatients with cdi at the university hospital basel, switzerland were analyzed regarding binary toxin, presence of the tcdc deletion and ribotype. ...201627598309
comparison of agar dilution and broth microdilution methods for clostridium difficile antimicrobial susceptibility testing.in this study, the performance of the broth microdilution (bmd) method for testing the antimicrobial susceptibility of clostridium difficile in comparison with the agar dilution (ad) method used by the clinical and laboratory standards institute (clsi) was evaluated. in total, 70 non-duplicate c. difficile clinical isolates were used in this study. the minimum inhibitory concentrations (mics) of clindamycin, moxifloxacin, metronidazole and vancomycin were examined using ad and bmd. the results s ...201627598055
effect of an antimicrobial stewardship intervention on outcomes for patients with clostridium difficile infection.although antimicrobial stewardship programs (asps) are uniquely positioned to improve treatment of clostridium difficile infection (cdi) through targeted interventions, studies to date have not rigorously evaluated the influence of asp involvement on clinical outcomes attributed to cdi.201627592160
epidemiology of multidrug resistant bacterial organisms and clostridium difficile in german hospitals in 2014: results from a nationwide one-day point prevalence of 329 german hospitals.one important aspect in combatting resistance to antibiotics is to increase the awareness and knowledge by epidemiological studies. we therefore conducted a german-wide point-prevalence survey for multidrug resistant bacterial organisms (mdros) and clostridium difficile (cd) to assess the epidemiology and structure quality of infection control in german hospitals.201627590879
generic aspects of the airborne spread of human pathogens indoors and emerging air decontamination technologies.indoor air can be an important vehicle for a variety of human pathogens. this review provides examples of airborne transmission of infectious agents from experimental and field studies and discusses how airborne pathogens can contaminate other parts of the environment to give rise to secondary vehicles leading air-surface-air nexus with possible transmission to susceptible hosts. the following groups of human pathogens are covered because of their known or potential airborne spread: vegetative b ...201627590695
variability in testing policies and impact on reported clostridium difficile infection rates: results from the pilot longitudinal european clostridium difficile infection diagnosis surveillance study (lucid).lack of standardised clostridium difficile testing is a potential confounder when comparing infection rates. we used an observational, systematic, prospective large-scale sampling approach to investigate variability in c. difficile sampling to understand c. difficile infection (cdi) incidence rates. in-patient and institutional data were gathered from 60 european hospitals (across three countries). testing methodology, testing/cdi rates and case profiles were compared between countries and insti ...201627590621
draft genome sequence of clostridium difficile belonging to ribotype 018 and sequence type 17.clostridium difficile, belonging to ribotype 018 (rt018), is one of the most prevalent genotypes circulating in hospital settings in italy. here, we report the draft genome of c. difficile cd8-15 belonging to rt018, isolated from a patient with fatal c. difficile-associated infection.201627587821
vaccines against major icu pathogens: where do we stand?multidrug resistance of bacterial pathogens has confronted physicians around the world with the threat of inefficacy of the antibiotic regime, which is particularly important for patients with sepsis. antibiotic resistance has revived search for alternative nonantibiotic strategies. among them, prophylaxis by vaccination is an appealing concept.201627583587
clostridium difficile infection and takotsubo cardiomyopathy: is there a relation?takotsubo cardiomyopathy (tcm) mimics acute coronary syndrome and is accompanied by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis. it is a transient condition that typically precedes physical or emotional triggers.201627583241
a quantitative analysis of fda adverse event reports with oral bisphosphonates and clostridium difficile.studies have shown associations between clostridium difficile infection (cdi) and non-antimicrobial medications including proton pump inhibitors, osteoporosis medications, and antidepressants.201627582058
fecal microbiota transplantation is safe and efficacious for recurrent or refractory clostridium difficile infection in patients with inflammatory bowel disease.new treatments are needed as clostridium difficile infection (cdi) is becoming increasingly formidable. fecal microbiota transplantation (fmt) has a 90% success rate in the treatment of recurrent cdi. however, evidence regarding its safety, efficacy, and effect on disease activity in patients with inflammatory bowel disease (ibd) is lacking.201627580384
cost-effectiveness analysis of the use of probiotics for the prevention of clostridium difficile-associated diarrhea in a provincial healthcare system - erratum. 201627580173
high mobility group box1 protein is involved in endoplasmic reticulum stress induced by clostridium difficile toxin a.high mobility group box1 (hmgb1), a damage-associated inflammatory factor, plays an important role in the pathogenesis of numerous chronic inflammatory and autoimmune diseases. in this study, the role of the hmgb1 in tcda-induced er stress was identified. clostridium difficile toxin a is one of the major virulence factors of c. difficile infection (cdi) and has been proved to induce apoptotic cell death through er stress. our results showed that hmgb1 might play an important role in the tcda-ind ...201627579314
epidemiology of diarrheal illness in pediatric oncology patients.diarrhea is common in children with cancer, but this has not been systematically studied to date.201627578209
infective thoracic aortic aneurysm caused by clostridium difficile after endovascular aortic repair.clostridium difficile generally causes enterocolitis by producing pathogenic toxins, while extraintestinal infections with c. difficile are extremely rare. here we report the first documented case of an infective thoracic aortic aneurysm caused by nontoxic c. difficile that occurred after vascular interventions including endovascular aortic repair. the present case illustrates that endovascular interventions may expose patients to the rare infection by yielding the ischemic intestinal tract as a ...201727578027
crispr diversity and microevolution in clostridium difficile.virulent strains of clostridium difficile have become a global health problem associated with morbidity and mortality. traditional typing methods do not provide ideal resolution to track outbreak strains, ascertain genetic diversity between isolates, or monitor the phylogeny of this species on a global basis. here, we investigate the occurrence and diversity of clustered regularly interspaced short palindromic repeats (crispr) and crispr-associated genes (cas) in c. difficile to assess the poten ...201627576538
proton pump inhibitors do not increase risk for clostridium difficile infection in the intensive care unit.patients in the intensive care unit (icu) frequently receive proton pump inhibitors (ppis) and have high rates of clostridium difficile infection (cdi). ppis have been associated with cdi in hospitalized patients, but icu patients differ fundamentally from non-icu patients and few studies have focused on ppi use exclusively in the critical care setting. we performed a retrospective cohort study to determine the associations between ppis and health-care facility-onset cdi in the icu.201627575714
endoscopic peroral jejunal fecal microbiota transplantation.fecal microbiota transplantation (fmt) is a valuable treatment modality for recurrent clostridium difficile (c. difficile) colitis. multiple questions including the best delivery route and volume remain unanswered. here, we report a case series of high-volume fmt using endoscopic jejunal application route.201627575658
clostridium difficile colitis: pathogenesis and host defence.clostridium difficile is a major cause of intestinal infection and diarrhoea in individuals following antibiotic treatment. recent studies have begun to elucidate the mechanisms that induce spore formation and germination and have determined the roles of c. difficile toxins in disease pathogenesis. exciting progress has also been made in defining the role of the microbiome, specific commensal bacterial species and host immunity in defence against infection with c. difficile. this review will sum ...201627573580
evaluation of gastrointestinal leakage using serum (1→3)-β-d-glucan in a clostridium difficile murine model.gastrointestinal (gi) leakage in clostridium difficile-associated diarrhea (cdad) is well known but is not routinely assessed in clinical practice. serum (1→3)-β-d-glucan (bg), a fungal cell wall component used as a biomarker for invasive fungal disease, was tested in a cdad mouse model with and without probiotics. higher serum fluorescein isothiocyanate-dextran (fitc-dextran) and spontaneous gram-negative bacteremia, gi leakage indicators, were frequently found in cdad mice, which died compared ...201627573235
the binary toxin cdt enhances clostridium difficile virulence by suppressing protective colonic eosinophilia.clostridium difficile is the most common hospital acquired pathogen in the usa, and infection is, in many cases, fatal. toxins a and b are its major virulence factors, but expression of a third toxin, known as c. difficile transferase (cdt), is increasingly common. an adenosine diphosphate (adp)-ribosyltransferase that causes actin cytoskeletal disruption, cdt is typically produced by the major, hypervirulent strains and has been associated with more severe disease. here, we show that cdt enhanc ...201627573114
mortality and costs in clostridium difficile infection among the elderly in the united states.objective to examine attributable mortality and costs of clostridium difficile infection (cdi) in the medicare population. design a population-based cohort study among us adults aged at least 65 years in the 2008-2010 medicare 5% sample, with follow-up of 12 months. patients incident cdi episode was defined by the international classification of diseases, ninth revision, clinical modification code of 008.45 and no other occurrences within the preceding 12 months. to quantify the adjusted mortali ...201627572289
role of coinfecting strains in recurrent clostridium difficile infection.the contribution of mixed infection in recurrent clostridium difficile infection (cdi) episodes is not known. among paired isolates from 52 patients, mixed infection due to >1 toxigenic strain of c. difficile was identified in 8% of first episodes. among recurrences, relapse from 1 or both co-infecting strains was uncommon; it was detected in a single case each. infect control hosp epidemiol 2016;1481-1484.201627572118
crystal structure of clostridium difficile toxin a.clostridium difficile infection is the leading cause of hospital-acquired diarrhoea and pseudomembranous colitis. disease is mediated by the actions of two toxins, tcda and tcdb, which cause the diarrhoea, as well as inflammation and necrosis within the colon. the toxins are large (308 and 270 kda, respectively), homologous (47% amino acid identity) glucosyltransferases that target small gtpases within the host. the multidomain toxins enter cells by receptor-mediated endocytosis and, upon exposu ...201627571750
molecular characteristics of clostridium difficile isolates from human and animals in the north eastern region of india.a total of 1034 samples were collected from different sources and c. difficile was isolated from 18 (9.04%) of 199 human, 9 (4.89%) of 184 cattle, 29 (12.44%) of 233 pig, and from 23 (13.94%) of 165 poultry samples. variations were observed on the rate of isolation according to age and clinical conditions (diarrhoea). none of the samples from cow, sheep, goat, local chicken, and wild animals yielded any c. difficile. out of those isolates, 8, 2, 19 and 6 isolates from human, cattle, pig and poul ...201627569848
clostridium difficile infection health disparities by race among hospitalized adults in the united states, 2001 to 2010.recognition of health disparities in clostridium difficile infection (cdi) is an initial step toward improved resource utilization and patient health. the purpose of this study was to identify health disparities by black vs. white race among hospitalized adults with cdi in the united states (u.s.) over 10 years.201627568176
efficacy of oral vancomycin in preventing recurrent clostridium difficile infection in patients treated with systemic antimicrobial agents. 201627567123
coordination between t helper cells, inkt cells, and their follicular helper subsets in the humoral immune response against clostridium difficile toxin b.activation of inkt cells with the cd1d-binding glycolipid adjuvant α-galactosylceramide (α-gc) enhances humoral immunity specific for coadministered t-dependent ag. however, the relationship between the inkt cell and the classic t helper (th) or t follicular helper (tfh) function following this immunization modality remains unclear. we show that immunization with the c-terminal domain (ctd) of clostridium difficile toxin b (tcdb), accompanied by activation of inkt cells with α-gc, led to enhance ...201727566831
hospital acquired clostridium difficile infection in pediatric wards: a retrospective case-control study.clostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections. the aim of this study was to determine the incidence and potential risk factors for c. difficile infection (cdi) in hospitalized children who developed diarrhea. a retrospective study was performed at a university hospital in istanbul over a three-year period (2012-2014).201627563524
identification of signet ring cell change in colonic subserosa in the setting of clostridium difficile colitis.signet ring cell change of intestinal epithelial cells is a rare but well-known mimicker of signet ring cell carcinoma and is often associated with ischemic and/or pseudomembranous colitis. instead, signet ring cell change involving nonepithelial cells in the subserosa of the intestine is an extremely rare finding with only a single case report in the literature to date. we report a new case of benign signet ring cell change localized in the subserosa of the large bowel incidentally identified i ...201727562801
cost of hospital management of clostridium difficile infection in united states-a meta-analysis and modelling study.clostridium difficile infection (cdi) is the leading cause of infectious nosocomial diarrhoea but the economic costs of cdi on healthcare systems in the us remain uncertain.201627562241
coinfection and emergence of rifamycin resistance during a recurrent clostridium difficile infection.clostridium difficile (peptoclostridium difficile) is a common health care-associated infection with a disproportionately high incidence in elderly patients. disease symptoms range from mild diarrhea to life-threatening pseudomembranous colitis. around 20% of patients may suffer recurrent disease, which often requires rehospitalization of patients. c. difficile was isolated from stool samples from a patient with two recurrent c. difficile infections. pcr ribotyping, whole-genome sequencing, and ...201627558181
performance of the artus c. difficile qs-rgq kit for the detection of toxigenic clostridium difficile.nucleic acid amplification tests are commonly used for the direct detection of toxigenic clostridium difficile. we evaluated the diagnostic performance of newly launched, artus c. difficile qs-rgq kit (artus c. difficile, qiagen, hilden, germany), in comparison with toxigenic culture (tc) and xpert c. difficile (cepheid, sunnyvale, ca, usa).201727556286
eosinophils, probiotics, and the microbiome.there is currently substantial interest in the therapeutic properties of probiotic microorganisms as recent research suggests that oral administration of specific bacterial strains may reduce inflammation and alter the nature of endogenous microflora in the gastrointestinal tract. eosinophils are multifunctional tissue leukocytes, prominent among the resident cells of the gastrointestinal mucosa that promote local immunity. recent studies with genetically altered mice indicate that eosinophils n ...201627549754
any future for fecal microbiota transplantation as treatment strategy for inflammatory bowel diseases?fecal microbiota transplantation (fmt) is a novel therapeutic procedure aiming at restoring a normal intestinal microbiota by application of fecal microorganisms from a healthy subject into the gastrointestinal tract of a patient. fmt is the most effective treatment for recurrent clostridium difficile infections (cdi). these infections also occur in patients with inflammatory bowel diseases (ibds), where case series demonstrated a successful treatment of cdi by fmt in 83-92% of patients. the eff ...201727548724
effect of fecal microbiota transplantation on recurrence in multiply recurrent clostridium difficile infection: a randomized trial.to date, evidence for the efficacy of fecal microbiota transplantation (fmt) in recurrent clostridium difficile infection (cdi) has been limited to case series and open-label clinical trials.201627547925
tracking inhibitory alterations during interstrain clostridium difficile interactions by monitoring cell envelope capacitance.global threats arising from the increasing use of antibiotics coupled with the high recurrence rates of clostridium difficile (c. difficile) infections (cdi) after standard antibiotic treatments highlight the role of commensal probiotic microorganisms, including nontoxigenic c. difficile (ntcd) strains in preventing cdi due to highly toxigenic c. difficile (htcd) strains. however, optimization of the inhibitory permutations due to commensal interactions in the microbiota requires probes capable ...201627547818
typhlocolitis associated with clostridium difficile ribotypes 078 and 110 in neonatal piglets from a commercial irish pig herd.clostridium difficile is a recognised cause of typhlocolitis and diarrhoea in neonatal pigs but has never been confirmed in association with pathology and disease in irish pigs.201527547375
nursing home residence is associated with spread of clostridium difficile ribotype 027 in central italy. 201627546454
acyldepsipeptide antibiotics as a potential therapeutic agent against clostridium difficile recurrent infections.alternative antimicrobial therapies based on acyldepsipeptides may hold promising results, based on the fact that they have shown to efficiently eradicate persister cells, stationary cells and cell in biofilm structures of several pathogenic bacteria from the infected host. clostridium difficile infection is considered the result of extensive hospital use of expanded-spectrum antibiotics, which cause dysbiosis of the intestinal microbiota, enhancing susceptibility to infection and persistence. c ...201627546386
impact of a pharmacist-driven protocol to decrease proton pump inhibitor use in non-intensive care hospitalized adults.results of a pharmacist-driven protocol to decrease proton pump inhibitor (ppi) use in non-intensive care unit (icu) hospitalized adults are presented.201627543598
false negative results in clostridium difficile testing.accurate diagnosis of clostridium difficile infection (cdi) is paramount for patient management. the wrong diagnosis places patients at risk, delays treatment, and/ or contributes to transmission of infection in the healthcare setting. although amplification of the toxin b gene by polymerase chain reaction (pcr) is a sensitive method for detecting toxigenic c. difficile, false negative results still occur and could impact the diagnosis and treatment of this infection.201627543102
antimicrobial susceptibility of brazilian clostridium difficile strains determined by agar dilution and disk diffusion.clostridium difficile is a leading cause of diarrhea in hospitalized patients worldwide. while metronidazole and vancomycin are the most prescribed antibiotics for the treatment of this infection, teicoplanin, tigecycline and nitazoxanide are alternatives drugs. knowledge on the antibiotic susceptibility profiles is a basic step to differentiate recurrence from treatment failure due to antimicrobial resistance. because c. difficile antimicrobial susceptibility is largely unknown in brazil, we ai ...201727542867
a sialic acid aldolase from peptoclostridium difficile nap08 with 4-hydroxy-2-oxo-pentanoate aldolase activity.sialic acid aldolases (e.c.4.1.3.3) catalyze the reversible aldol cleavage of n-acetyl-d-neuraminic acid (neu5ac) to from n-acetyl-d-mannosamine (mannac) and pyruvate. in this study, a sialic acid aldolase (pdnal) from peptoclostridium difficile nap08 was expressed in escherichia coli bl21 (de3). this homotetrameric enzyme was purified with a specific activity of 18.34u/mg for the cleavage of neu5ac. the optimal ph and temperature for aldol addition reaction were 7.4 and 65°c, respectively. pdna ...201627542750
antimicrobial stewardship in paediatrics.antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. unfortunately, a great number of these prescriptions are unnecessary or inappropriate. antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. in this paper, the principle of and stra ...201627538503
[new aspects on clostridium difficile infection]. 201627538120
identification of an essential region for translocation of clostridium difficile toxin b.clostridium difficile toxin a (tcda) and toxin b (tcdb) are the major virulence factors involved in c. difficile-associated diarrhea and pseudomembranous colitis. tcda and tcdb both contain at least four distinct domains: the glucosyltransferase domain, cysteine protease domain, receptor binding domain, and translocation domain. few studies have investigated the translocation domain and its mechanism of action. recently, it was demonstrated that a segment of 97 amino acids (aa 1756-1852, designa ...201627537911
surveillance of antibiotic resistance among hospital- and community-acquired toxigenic clostridium difficile isolates over 5-year period in kuwait.clostridium difficile infection (cdi) is a leading and an important cause of diarrhea in a healthcare setting especially in industrialized countries. community-associated cdi appears to add to the burden on healthcare setting problems. the aim of the study was to investigate the antimicrobial resistance of healthcare-associated and community-acquired c. difficile infection over 5 years (2008-2012) in kuwait. a total of 111 hospital-acquired (ha-cd) and 35 community-acquired clostridium difficile ...201627536994
a phenotypically silent vanb2 operon carried on a tn1549-like element in clostridium difficile.in the last decade, clostridium difficile infection (cdi) has reached an epidemic state with increasing incidence and severity in both health care and community settings. vancomycin is an important first-line therapy for cdi, and the emergence of resistance would have significant clinical consequences. in this study, we describe for the first time a vanb2 vancomycin resistance operon in c. difficile, isolated from an australian veal calf at slaughter. the operon was carried on an ~42-kb element ...201727536735
a multi-center study of fidaxomicin use for clostridium difficile infection.fidaxomicin use in real-world clinical practice, especially for severe clostridium difficile infection (cdi), is mainly based on single-center observational studies. the purpose of this pharmacoepidemiology study was to assess outcomes of patients given fidaxomicin based on episode number and use of concomitant antibiotics.201627536508
an update on antibody-based immunotherapies for clostridium difficile infection.clostridium difficile continues to be one of the most prevalent hospital-acquired bacterial infections in the developed world, despite the recent introduction of a novel and effective antibiotic agent (fidaxomicin). alternative approaches under investigation to combat the anaerobic gram-positive bacteria include fecal transplantation therapy, vaccines, and antibody-based immunotherapies. in this review, we catalog the recent advances in antibody-based approaches under development and in the clin ...201627536153
bolaamphiphile-based nanocomplex delivery of phosphorothioate gapmer antisense oligonucleotides as a treatment for clostridium difficile.despite being a conceptually appealing alternative to conventional antibiotics, a major challenge toward the successful implementation of antisense treatments for bacterial infections is the development of efficient oligonucleotide delivery systems. cationic vesicles (bolasomes) composed of dequalinium chloride ("dqasomes") have been used to deliver plasmid dna across the cardiolipin-rich inner membrane of mitochondria. as cardiolipin is also a component of many bacterial membranes, we investiga ...201627536102
distribution of pcr ribotypes among recent clostridium difficile isolates collected in two districts of hungary using capillary gel electrophoresis and review of changes in the circulating ribotypes over time.following the first description of a clostridium difficile case caused by ribotype 027 in hungary in 2007, the rapid spread of c. difficile infection in different hospitals within the country was observed. the aim of this pilot study was to investigate the distribution of different pcr ribotypes among inpatient and outpatient isolates obtained in two geographically different parts of hungary. one hundred and ninety-two toxigenic c. difficile isolates collected between 1 october and 1 december 20 ...201627534855
physical pre-treatment improves efficient dna extraction and qpcr sensitivity from clostridium difficile spores in faecal swine specimens.a considerable fraction of the faecal microbiota is spore-forming. molecular quantification of bacteria may be underestimated if preceded with nucleic acid extraction without special treatment to extract recalcitrant bacterial spores. the objective of this study was to improve the dna extraction regarding the presence of clostridium difficile spores in faecal swine specimens. sow faeces were inoculated with spores of c. difficile (10(6) cfu), frozen at - 30 °c overnight and subjected to dna extr ...201627534405
infection-related hospitalizations in the first year after inflammatory bowel disease diagnosis.with the rapid increase in the incidence of inflammatory bowel disease (ibd) in asia, the natural course of the early phase of disease in these patients remains poorly defined. this study aimed to determined the incidence and characteristics of infection-related hospitalization in the first year in patients newly diagnosed with ibd in hong kong sar, china.201627533786
community-acquired clostridium difficile infection, queensland, australia. 201627533328
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