Publications

protection of hamsters against clostridium difficile ileocaecitis by prior colonisation with non-pathogenic strains.	prior colonisation of clindamycin-treated hamsters with non-toxigenic strains of c. difficile protected them from subsequent colonisation with a toxigenic pathogenic strain. in total, 13 of 18 'protected' hamsters survived for up to 27 days whereas all 27 animals challenged with the toxigenic strain alone died within 48 h. protection was not evident if a heat-killed suspension was used or if the colonising non-toxigenic strain was first removed with vancomycin. no antitoxic activity could be det ...	1985	4009689
clostridium difficile-associated diarrhoea.		1985	4008969
evaluation of gas-liquid chromatography for the rapid diagnosis of clostridium difficile associated disease.	direct gas-liquid chromatography of faecal specimens with isocaproic acid as a marker was used for the rapid diagnosis of clostridium difficile associated diarrhoeal diseases. ninety stools were examined and results were compared with conventional culture on selective medium and cytotoxin assay in tissue culture. using a combined analysis of isocaproic acid and butyric acid peak heights we defined three categories: positive, negative, and indeterminate. when the indeterminate group was excluded, ...	1985	4008667
enrichment media for isolation of clostridium difficile from faeces.		1985	4006930
enzyme immunoassay for detection of clostridium difficile toxins a and b in patients with antibiotic-associated diarrhoea and colitis.	a sandwich enzyme immunoassay (elisa) was developed to detect clostridium difficile toxins a and b in stools from patients with antibiotic associated diarrhoea and colitis. immune serum to crude clostridium difficile toxin and non-immune serum were coated onto polystyrene microtiter plates to act as capture antibodies; toxins a and b in human stools were detected by antibodies from rabbits immunized with purified toxins a and b. the elisa for toxin b showed cross-reactions with clostridium bifer ...	1985	4006928
pseudomembranous colitis in spinal cord injury.	pseudomembranous colitis is a well-known disease associated with antibiotic administration and caused by the clostridium difficile toxin. clinical presentation is usually marked by watery diarrhea, crampy abdominal pain, and fever. since early appropriate therapy can reduce morbidity and mortality, it is important for health care professionals to be aware of this disease. patients with spinal cord injury have a relatively high incidence of respiratory and urinary tract infections that are treate ...	1985	4004539
effect of l-cysteine on the activity of penicillin antibiotics against clostridium difficile.	we observed elevated mics of penicillin antibiotics while performing agar dilution susceptibility testing of strains of clostridium difficile on supplemented brain heart infusion agar, an effect which was completely eliminated by the exclusion of l-cysteine from the medium. l-cysteine antagonizes the activity of penicillins against c. difficile, most likely by direct inactivation of the antibiotic.	1985	3994352
antibiotic-associated pseudomembranous colitis.	all antibiotics, except parenteral aminoglycosides, sulfonamides and vancomycin, can induce pseudomembranous colitis. the worst offenders are clindamycin, ampicillin, amoxicillin and the cephalosporins. the cytotoxin produced by clostridium difficile has been identified as the cause of pseudomembranous colitis. treatment includes an antimicrobial to eradicate the organism and cholestyramine or colestipol to bind the toxin.	1985	3993509
ceftriaxone: pharmacokinetics and effect on the intestinal microflora in patients with acute bacterial infections.	12 patients with acute bacterial infections were treated with ceftriaxone, 1.5 g intravenously twice daily for 7-13 days. pharmacokinetic variables were studied in 11 patients. in older subjects, serum half-lives were longer and serum clearances lower than in younger individuals. after the last dose, a larger increase in auc compared to the first dose was observed in older patients and a biphasic elimination curve appeared in all patients but 2, with a terminal half-life of 15.6 h and 11.4 in ol ...	1985	3992209
effect of adding sodium taurocholate to selective media on the recovery of clostridium difficile from environmental surfaces.	the recovery of clostridium difficile on a medium containing cefoxitin, cycloserine, fructose, and egg yolk was compared with that on media containing one of three preparations of sodium taurocholate. in aerobic environments contaminated with c. difficile, media containing either crude taurocholate from mann research laboratories, new york, n.y., or pure taurocholate from sigma chemical co., st. louis, mo., recovered organisms significantly more often than did cefoxitin-cycloserine-fructose-egg ...	1985	3988904
detection of clostridium difficile enterotoxin in neonates by latex agglutination.	clostridium difficile enterotoxin (d-1) was detected in 13 symptomatic and nine asymptomatic neonates in the neonatal intensive care unit by latex agglutination test but was not found in 18 healthy neonates in two other newborn nurseries. environmental contamination in the intensive care unit may have been the cause. an association between the presence of enterotoxin and clinical symptoms is discussed.	1985	3985657
serogrouping of clostridium difficile strains by slide agglutination.	six different agglutinating antisera were obtained by immunizing rabbits with formol-treated strains of clostridium difficile. after appropriate absorption, these antisera were used to define six serogroups designated by the letters a, b, c, d, f, and g. altogether, 315 strains of c. difficile from various origins were tested for slide agglutination by these antisera; 312 (99%) of them were agglutinated by one of these antisera. a and c were the most common serogroups. an excellent correlation, ...	1985	3980688
modulation of cytotoxin production by clostridium difficile in the intestinal tracts of gnotobiotic mice inoculated with various human intestinal bacteria.	gnotobiotic mice died 2 days after inoculation of a cytotoxigenic clostridium difficile strain. protection occurred when mice were previously inoculated with a strain of escherichia coli or bifidobacterium bifidum. intestinal cytotoxin production was highly reduced in the surviving mice, whereas the c. difficile population level did not decrease to a great extent.	1985	3977313
indium-111 leukocyte imaging in colitis induced by clostridium difficile.		1985	3973743
antimicrobial agents and clostridium difficile in acute enteric disease: epidemiological data from sweden, 1980-1982.	the carrier rate of clostridium difficile in an adult swedish population was found to be 11 (1.9%) of 594. all isolates were toxigenic in vitro, but no healthy individual harbored free cytotoxin in stool. of 398 patients with acute diarrhea not associated with antibiotic use, cytotoxin was found in stool filtrates of four (1%). in 4,793 patients with antibiotic-associated diarrhea from all parts of sweden during 1980-1982, c. difficile cytotoxin was demonstrated in 873 (18%). the tissue culture ...	1985	3973405
two bacteriophages of clostridium difficile.	two temperate bacteriophages of differing morphology and host range were isolated by screening 94 isolates of clostridium difficile. phage 41 had a 300-nm flexible tail, whereas phage 56 had a shorter tail with a contractile sheath. electron microscopy of phage 56 lysates exposed to elevated magnesium concentrations showed small virus-like particles which were 21 nm in diameter. the addition of mgcl2 to semisolid agar overlays enhanced both the titer and plaque size of phage 56. phage 56 was mor ...	1985	3972994
interaction between penicillin, clindamycin or metronidazole and gentamicin against species of clostridia and anaerobic and facultatively anaerobic gram-positive cocci.	seven anaerobic and facultative gram-positive cocci and 12 clostridial species were tested for in-vitro and in-vivo susceptibilities to penicillin, clindamycin, and metronidazole, used singly or in combination with gentamicin. the in-vitro tests consisted of determination of minimal inhibitory concentration (mic), done without or with constant amounts of gentamicin. when used alone or in combination with penicillin or metronidazole, gentamicin had negligible effects on the bacteria. when used wi ...	1985	3972757
population dynamics of ingested clostridium difficile in the gastrointestinal tract of the syrian hamster.	the population dynamics of clostridium difficile in the hamster gastrointestinal tract were studied after intragastric inoculation with organisms and a 51cr tracer. seventy-eight percent of spores germinated within the small intestine within 1 hr. germinated spores and vegetative cells both showed two phases of elimination from the hamster cecum--an initial phase of rapid death that was not affected by antibiotic treatment followed by a phase of complete inhibition of multiplication. the latter ...	1985	3968453
effect of antibiotic concentration in a selective medium on the isolation of clostridium difficile from faecal specimens.		1985	3968221
gas chromatographic identification of clostridium difficile and detection of cytotoxin from a modified selective medium.	a modification of an existing selective medium for clostridium difficile is described. inclusion in the medium of dl nor-leucine and p-hydroxyphenylacetic acid enables identification of c difficile to be made directly from primary isolation plates by gas chromatographic detection of caproic acid and p-cresol. plugs of agar withdrawn from the selective medium also allow the detection of cytotoxin production in vitro.	1985	3968212
improved gas-liquid chromatography method for the identification of clostridium difficile.		1985	3968205
monoclonal and specific polyclonal antibodies for immunoassay of clostridium difficile toxin a.	monoclonal antibody, affinity-purified antibody, and monospecific antiserum against toxin a were produced. the monoclonal antibody was an immunoglobulin g2a kappa chain isotype that immunoprecipitated toxin a, as shown by crossed immunoelectrophoresis. these antibodies were compared by counterimmunoelectrophoresis, latex agglutination, and indirect enzyme-linked immunosorbent assay for their sensitivity in detecting toxin a. our findings indicate that these antibodies may be useful as immunodiag ...	1985	3968199
pseudomembranous colitis following prophylactic antibiotic use in primary cesarean section.	a report of a hospital outbreak of pseudomembranous colitis in three patients given prophylactic antibiotic therapy before and after primary cesarean section is presented. all patients shared the same ward and labor and delivery room, and the colitis occurred within an 8-day period. the diagnosis of pseudomembranous colitis was suspected clinically and confirmed by limited colonoscopy and biopsy followed by stool culture and toxin assay for clostridium difficile. the high carrier rate of clostri ...	1985	3966512
clinical and endoscopic findings in patients early in the course of clostridium difficile-associated pseudomembranous colitis.	endoscopic and clinical features are reported for 39 patients detected early in the course of pseudomembranous colitis. disease was detected early by virtue of careful surveillance in patients in whom diarrhea developed. early proctosigmoidoscopic findings in pseudomembranous colitis are illustrated. clinical presentation includes development of fever, leukocytosis, abdominal pain, and even an ileus picture on radiography in addition to diarrhea.	1985	3966488
etiology of acute infectious diarrhea in a highly industrialized area of switzerland.	during an 18-mo period between 1981 and 1982, a prospective study was conducted in 119 adult patients with acute diarrhea. a diarrhea-inducing microorganism or toxin could be identified in 38.7% of the patients. salmonella sp and campylobacter jejuni were the leading agents that caused diarrheal illness in 25% of the investigated population. clostridium difficile was found in 6%, mainly after previous antibiotic therapy. rotavirus was rarely isolated and enterotoxigenic escherichia coli were not ...	1985	3964774
recurrent clostridium difficile-associated colitis responding to cholestyramine.	we describe a patient with relapses of clostridium difficile cytotoxin-positive pseudomembranous colitis (pmc) after treatment with vancomycin, a course of metronidazole and a trial of bacitracin. she remains free of disease after a prolonged course of cholestyramine. we suggest there may be a role for anion-exchange resins in patients with pmc relapsing after vancomycin therapy.	1986	3956890
significance of clostridium difficile and its cytotoxin in children.	stools of 147 children belonging to different age groups were examined for the presence of clostridium difficile, its cytotoxin and other enteric pathogens. none of the 31 full-term neonates, 5 (16%) of the 32 premature neonates, 27 (46%) of the 59 infants and 1 (4%) of the 25 older children excreted c. difficile in their stools. faecal cytotoxin was only detected in four infants (7%). there was no correlation with diarrhoea, previous antibiotic therapy, type of diet, or the concomitant presence ...	1986	3956538
pseudomembranous colitis in children and adults.	pseudomembranous colitis remains a potentially lethal complication of antibiotic usage. identification of clostridium difficile as the major pathogen has led to a rational successful approach to therapy and has widened the spectrum of associated disease. the frequent asymptomatic colonization of healthy neonates by c. difficile remains an enigma.	1986	3955286
chronic diarrhoea in dogs associated with clostridium difficile infection.		1986	3952954
detection of clostridium difficile toxins by enzyme immunoassay.	an enzyme-linked immunosorbent assay (elisa) for the rapid diagnosis of antibiotic-associated colitis (aac) is presented. commercially available antisera to clostridium difficile toxins contain antibodies to other antigens found in non-toxigenic c. difficile and other bacteria. removal of these unwanted antibodies by absorption increased the specificity of elisa for detection of c. difficile toxins. specimens tested included 40 faecal extracts positive for cytotoxicity from cases of aac, 30 diar ...	1986	3950397
clostridium difficile in general practice and community health.	the isolation rate for clostridium difficile in diarrhoeal stools was investigated in patients from general practice and community health centres over a 14-month period. c. difficile or its cytotoxin was detected in specimens from 89 (4.7%) of 1882 patients studied and accounted for 30.3% of all enteropathogenic micro-organisms isolated. overall c. difficile was second only to giardia lamblia in frequency. recovery rates in the different groups of patients surveyed varied from 3.6 to 27.5%. the ...	1986	3950393
latex particle agglutination for detecting and identifying clostridium difficile.	a total of 329 selective enrichment broth cultures were tested for detection of clostridium difficile by latex particle agglutination (lpa), gas-liquid chromatography, and bacterial culture. of 53 broths positive by lpa, 36 were positive by gas-liquid chromatography, and 42 were positive by bacterial culture. the sensitivity and specificity of lpa relative to bacterial culture was 95.6% and 96.3%, respectively, while the sensitivity and specificity of gas-liquid chromatography relative to bacter ...	1986	3950045
effect of toxin a and b of clostridium difficile on rabbit ileum and colon.	the effect of purified toxin a and partially purified toxin b on rabbit ileum and colon was investigated. toxin a caused tissue damage which was followed by permeability changes and fluid accumulation in both tissues. toxin a did not increase the permeability of the colon to the extent observed for ileum; secreted fluid contained less protein of plasma origin. toxin b had no effect on either tissue. secretory and tissue damaging properties of crude c difficile toxins were found to be due to toxi ...	1986	3949240
purification and properties of clostridium difficile cytotoxin b.	toxin b, a potent cytotoxin produced by clostridium difficile, was purified to homogeneity from 6-day broth cultures of a toxigenic isolate. cytotoxin was purified approximately 4000-fold by sequential ammonium sulfate precipitation, deae-sepharose chromatography, and high performance liquid chromatography on a mono q anion-exchange column. the molecular weight of reduced purified toxin was 50,000 on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, compared to 150,000 for unreduced tox ...	1986	3944088
clostridium difficile colitis/diarrhea.		1986	3942643
clostridium difficile-associated diarrhea and colitis in adults. a prospective case-controlled epidemiologic study.	in a one-year period, 149 adult cases of clostridium difficile-associated diarrhea and colitis were compared with 148 diarrhea-free controls. eighty-seven percent were nosocomial and 75% were on surgical services. endoscopy revealed pseudomembranes in 51% of the 109 cases in which stool cytotoxin was present, compared with 11% of the 40 cases that were culture-positive but cytotoxin-negative. cases diagnosed only by stool culture showed essentially no differences from controls, 21% of whom had a ...	1986	3942469
testing for clostridium difficile.		1986	3941630
the epidemiology of clostridium difficile with use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients.		1986	3941281
[enterocolitis caused by clostridium difficile. analysis of 15 cases in adults].	each of 48 patients with suspected clostridium difficile enterocolitis after treatment with antibiotics underwent a faecal test in which a clostridium difficile culture was set up and a cytotoxin test carried out. the detection of clostridium difficile was positive in 15 cases. diarrhoea with varying severity was present in all patients, most frequently after medication with the newer cephalosporins. nine patients also underwent rectoscopy: a typical pseudo-membranous colitis was seen only in 5 ...	1986	3940837
[demonstration of clostridium difficile and toxin b in patients at a university clinic].	107 stool specimens from not hospitalized individuals and 69 stool specimens from 61 hospitalized patients (internal medicine) were examined for c. difficile and toxin b. included were 42 specimens of 33 female patients of the department of maxillo-facial surgery, receiving prophylactic clindamycin and 7 samples from the ward staff. from the samples of the first group, c. difficile was isolated in one case (0.93%), whereas 8 out of 61 internal patients (13%) were positive for c. difficile by cul ...	1985	3939049
p-cresol formation by cell-free extracts of clostridium difficile.	cell-free extracts of clostridium difficile were shown to form p-cresol by decarboxylation of p-hydroxyphenylacetic acid. this activity required both high and low molecular weight fractions. the active component of the low molecular weight fraction had properties of an amino acid and could be replaced by serine, threonine or the corresponding alpha keto acids. pyruvate was shown to function catalytically. since the high molecular weight fraction was o2-sensitive and since dithionite was as effec ...	1985	3938267
antimicrobial activity of aridicins, novel glycopeptide antibiotics with high and prolonged levels in blood.	three new glycopeptide antibiotics, aridicins a, b, and c, produced by kibdelosporangium aridum have a spectrum of antimicrobial activity in vitro which is similar to that of vancomycin. the antimicrobial activities of these glycopeptides against clinical bacterial isolates were compared with those of vancomycin and other related glycopeptide antibiotics in vitro by agar dilution and microtiter broth dilution tests and in vivo in mouse protection studies. in vitro they were somewhat less effecti ...	1985	3937489
[the effect of prostaglandins on cytotoxin and enterotoxin production of clostridium difficile].		1985	3936886
[significance of ureaplasma urealyticum and clostridium difficile in nongonococcal urethritis].		1985	3932554
clostridium difficile colitis mimicking acute peritonitis.	five patients receiving penicillin v potassium or a cephalosporin antibiotic for 18 hours to 22 days developed fever, marked leukocytosis, and signs and symptoms that suggested right-lower-quadrant peritoneal irritation. all underwent emergency laparotomy, at which dilatation and inflammation of the ascending colon were found. only one of the patients had profuse diarrhea, and two patients had no diarrhea prior to laparotomy. postoperatively, clostridium difficile colitis was diagnosed by stool ...	1985	3931611
in-vitro activity of sch 34343 against nosocomial pathogens: methicillin-resistant staphylococci, gentamicin-susceptible and -resistant streptococcus faecalis, clostridium difficile and bacteroides fragilis.	the in-vitro activity of sch 34343, a new beta-lactam antimicrobial, was studied in vitro by quantitative broth dilution methods. it was found to have good antibacterial activity against four emerging problem pathogens: methicillin-resistant staphylococcus aureus, streptococcus faecalis isolates showing high level resistance to gentamicin (and other aminoglycosides), clostridium difficile (the cause of pseudomembranous colitis), and bacteroides fragilis. on the basis of these promising results, ...	1985	3928577
[a case of clostridium difficile colitis induced by rifampicin].		1985	3925038
[isolation of clostridium difficile from specimens other than stool].		1985	3923135
effects of clostridium difficile toxins given intragastrically to animals.	we examined the activities of clostridium difficile toxin preparations given intragastrically to hamsters, mice, and rats. the culture filtrate from a highly toxigenic strain of c. difficile caused hemorrhage and accumulation of fluid in the small intestine and cecum, diarrhea, and death in hamsters and mice. in rats, the culture filtrate caused only a small amount of fluid accumulation and slight hemorrhage along the small intestine. when toxin a was removed from the culture filtrate, the filtr ...	1985	3917975
cefuroxime versus ceftriaxone prophylaxis in cardiovascular surgery.	in a randomized, prospective study a 2-day course of cefuroxime prophylaxis (zinacef, 1.5g every 12 h) was compared with 2-day ceftriaxone prophylaxis (rocephin, 2g i.v. plus 1g i.v. after 24 h). to date 512 patients undergoing cardiac (n = 418) and major vascular surgery (n = 94) entered the study: 258 in the cefuroxime and 254 in the ceftriaxone group. the one-month lethality rate was 1.0%. the total infection rate was 4.7% (12 patients in the cefuroxime and 12 in the cefuroxime group. septica ...	1985	3915287
clinical experience with aztreonam in the treatment of gram-negative bacteremia.	aztreonam was used for the treatment of gram-negative bacteremia in 101 patients. in 34 instances a second antibiotic was prescribed for the treatment of suspected or documented gram-positive or anaerobic infection. the sources of bacteremia were the urinary tract (50 patients), an intraabdominal site (17), the respiratory tract (8), an intravascular site (9), and an unknown site (17). the clinical response rate was 92% (91 of 99 patients). the bacteriologic response rate was 97% (98 of 101 pati ...	1985	3909338
discovery and development of the monobactams.	a novel procedure designed to detect naturally occurring beta-lactam-containing molecules led to isolation of the monobactams - structurally unique, bacterially produced, monocyclic beta-lactam antibiotics. although none of these monobactams exhibited impressive antimicrobial activity, side-chain variation - as with the penicillins and cephalosporins - resulted in potently active compounds. aztreonam was chosen from hundreds of compounds for extended laboratory studies. in addition to a unique c ...	1985	3909315
pathogenesis and diagnosis of clostridium difficile enterocolitis.	antibiotic associated clostridium difficile enterocolitis is an infectious disease with symptoms ranging from self-limiting diarrhoea to severe colitis with bloody stools and formation of pseudomembranes. the carrier rate of c. difficile in a general swedish population was found to be low (2%; 11/594). in patients with acute diarrhoea unrelated to antibiotics the bacterium or its toxin was found in 3% (12/398). in patients with diarrhoea associated with antibiotics c. difficile or its toxin was ...	1985	3906856
an immunochemical method for fingerprinting clostridium difficile.	the use of sodium dodecyl sulphate-polyacrylamide gel electrophoresis in association with electrophoretic transfer of proteins to nitrocellulose and subsequent probing with antisera appears useful as a method for fingerprinting clostridium difficile. thorough testing of the stability of the antigenic nature of isolates of the organism during subculture and antigen preparation has shown it to be remarkably stable both in vitro and in vivo. minor differences in the method of antigen extraction do ...	1985	3902977
the significance of quantitative results of c. difficile cultures and toxin assays in patients with diarrhea.	the clinical courses of 114 patients with positive clostridium difficile cultures or toxin assays performed between 1981 and 1984 were reviewed to determine the relationship between outcome of treatment and quantitative bacteriologic test results. c. difficile culture was positive in 60 of 91 patients while toxin assay was positive in 99 of 114. one third of the patients received supportive therapy only, and 30 percent of these failed to resolve their symptoms. ninety-one percent of the patients ...	1985	3902411
treatment of clostridium difficile colitis.		1985	3899842
management of antibiotic-associated pseudomembranous colitis.	the diagnosis, etiology, epidemiology, and drug therapy of antibiotic-associated pseudomembranous colitis (aapmc) are reviewed. aapmc is an uncommon but potentially serious adverse reaction to therapy with almost any oral or injectable antibiotic and certain antineoplastic agents that alter intestinal flora. proliferation of clostridium difficile and subsequent release of clostridial cytotoxins cause pseudomembranous lesions and symptoms such as watery diarrhea, cramping abdominal pain, and low- ...	1985	3891202
review of the in vitro spectrum of activity of imipenem.	imipenem (n-formimidoyl thienamycin, mk0787), a new carbapenem was found to have the widest antimicrobial activity of currently available beta-lactam drugs. enterobacteriaceae had minimal inhibitory concentrations of imipenem of 8.0 micrograms/ml or less for 99.8 percent of clinical isolates. only rare strains of enterobacter species and proteus mirabilis have higher imipenem minimal inhibitory concentration results. hemophilus and neisseria species were inhibited, but minimal inhibitory concent ...	1985	3890537
short-chain fatty acids in intestinal content of germfree mice monocontaminated with escherichia coli or clostridium difficile.	the short-chain fatty acids (scfas) have been analysed in coecal and small-intestinal content of conventional (conv) and germfree (gf) mice, in germfree mice monocontaminated with escherichia coli (mec) or clostridium difficile (mcd), and in germfree mice conventionalized by the visitor technique (exg). the total concentrations of scfas in coecal content, measured by gas chromatography, were (mean (sd), mmol/kg): conv, 125.2 (32.9); gf, 1.02 (0.39); mec, 6.88 (0.76); mcd, 4.50 (0.12); and exg, 1 ...	1985	3890142
increased risk of illness among nursery staff caring for neonates with necrotizing enterocolitis.	in 1983 an outbreak of necrotizing enterocolitis (nec) and hemorrhagic gastroenteritis occurred in our newborn nurseries. eleven children were ill and three required bowel resections. during the outbreak many of the medical and nursing staff in the nurseries also were ill, prompting a microbiologic and epidemiologic investigation. bacterial and viral cultures, clostridium difficile toxin assays, enzyme-linked immunosorbent assays for viral antigens and immunoelectron microscopy of stools identif ...	1985	3889874
studies of metabolites in diarrheal stool specimens containing shigella species by frequency-pulsed electron capture gas-liquid chromatography.	eleven diarrheal stool specimens and 10 control stool specimens from cairo, egypt, were studied by frequency-pulsed electron capture gas-liquid chromatography (fpec-glc). four cases involving shigella sonnei, three cases involving shigella boydii, and four cases involving shigella flexneri were studied. the aqueous stools were centrifuged, extracted with organic solvents, and derivatized to form specific electron-capturing derivatives of carboxylic acids, alcohols, hydroxy acids, and amines. ana ...	1985	3886695
pathogenesis of pseudomembranous colitis.	this work is concerned with new morphologic data pointing to an immune component in the pathogenesis of pseudomembranous colitis. the focal distribution of the pseudomembranes suggests selective damage induced by clostridium difficile toxins. the sites of attachment to the mucosa correspond anatomically to the intestinal structures specialized for immune information and response. furthermore, viable iga production supports the view that toxins are carried to lymphoid aggregates where plasma cell ...	1985	3885623
stool desorbing activity: a possible cause of false-positive reactions in competitive enzyme immunoassays.	we have developed a competitive enzyme immunoassay for the measurement of purified toxin a of clostridium difficile. however, when we applied this assay to the detection of c. difficile toxin in stool specimens, we noted a high rate of nonspecific activity in fecal specimens which did not contain toxin. we found that the low specificity (26%) of the assay was due to the presence in stool specimens of interfering factors which desorbed the antigen coated on the solid-phase surface. these factors ...	1985	3882746
the pharmacokinetics and safety of ceftazidime in the neonate.	the pharmacokinetics and safety of ceftazidime (25 mg/kg twice daily intravenously or intramuscularly) were determined in 41 young, premature neonates who were clinically infected and would otherwise have received gentamicin plus penicillin. ceftazidime was assayed in 46 series of blood samples by hplc. blood was collected before, during and after treatment for analysis of biochemical and haematological factors. faecal specimens were examined for the presence of clostridium difficile and its tox ...	1985	3882658
studies with temocillin in a hamster model of antibiotic-associated colitis.	hamsters given the new penicillin temocillin, either orally or by injection, did not develop antibiotic-associated colitis, whereas animals given the control antibiotics cefoxitin or clindamycin developed the disease, which is characterized by marked hemorrhagic cecitis and high cecal levels of clostridium difficile cytotoxin.	1985	3875312
relationship between fecal alpha 1-antitrypsin and colonization with clostridium difficile in asymptomatic infants.		1985	3874946
[a clinical study of antibiotic-associated acute hemorrhagic colitis, with special reference of clostridium difficile].		1985	3872955
effect of imipenem/cilastatin on the colonic microflora.	the effect of imipenem/cilastatin on the colonic microflora was investigated in 10 patients receiving the drug for six to 11 days. fecal specimens were cultured quantitatively for aerobic and anaerobic microorganisms before, during, and after therapy. imipenem/cilastatin treatment was associated with minor changes in the colonic flora. a small decrease in the numbers of enterobacteria, enterococci, anaerobic cocci, and organisms of the bacteroides fragilis group was observed. after treatment was ...	1985	3863218
the comparative in-vitro activity of cefotetan against anaerobic bacteria.	the in-vitro activity of cefotetan, a new cephamycin, was assessed against a total of 336 strains of anaerobic bacteria by means of an agar dilution procedure and compared with that of cefoxitin, mezlocillin, piperacillin, clindamycin and metronidazole. overall clindamycin and metronidazole were the most active of the test compounds. cefotetan showed good activity against anaerobic cocci and clostridia, except for clostridium difficile (mic90 = 16 mg/l), although it was comparatively less active ...	1985	3861604
safety and efficacy of high-dose treatment with imipenem-cilastatin in seriously ill patients.	imipenem-cilastatin was given in doses of 1 g intravenously every 6 h to 31 patients. twenty-five patients, with 27 infections, were clinically evaluable and received 20 to 210 g of imipenem for a duration of 5 to 56 days (average 16.3 days). infections included seven cases of osteomyelitis, seven of bacteremia, five of cellulitis, two of pneumonia, three of pelvic cellulitis, two of intraabdominal abscess, and one each of empyema, mediastinitis, and endometritis. fifty-five percent of the infec ...	1985	3860187
role for newer beta-lactam antibiotics in treatment of osteomyelitis.	monotherapy of osteomyelitis with the newer broad-spectrum beta-lactam antibiotics has become attractive because of the efficacy, safety, and cost of these antibiotics when compared with conventional combination therapy. imipenem/cilastatin is a recent and promising addition to this antibiotic family. experience with imipenem/cilastatin and that reported for cefotaxime, ceftazidime, and ceftizoxime in the treatment of biopsy-proved osteomyelitis was compared, using data from published reports fr ...	1985	3859212
clostridium difficile in haematological malignancy.	twenty patients with haematological malignancies who developed clostridium difficile bowel infection or colonisation are described. all isolates of c difficile were toxigenic in vitro and faecal cytotoxin (toxin b) was detected in 20/26 episodes. ten of 20 episodes with detectable faecal cytotoxin were associated with typical antibiotic associated diarrhoea. in the other 10 episodes (nine patients), there was a severe unusual illness which was associated with detection of c difficile. the unusua ...	1985	3857233
clostridium difficile isolation in leukemic children on maintenance cancer chemotherapy. a preliminary study.	between december 1982 and november 1983, stool specimens from 15 children with acute lymphoblastic leukemia, who were on maintenance cancer chemotherapy, were examined weekly for the presence of clostridium difficile and its toxin. four out of 15 patients were positive for c. difficile: three patients had stool specimens that did not contain toxin, but cultures yielded growth of toxigenic c. difficile on only one occasion. the fourth patient, who had a recent history of hospitalization, particul ...	1985	3857141
effect of aspoxicillin on anaerobic bacteria.	aspoxicillin (aspc), a semisynthetic penicillin has a broad spectrum of antibacterial activities against gram-positive and gram-negative anaerobic bacteria. its in vitro antibacterial activity was less than those of cefoxitin against peptostreptococcus and veillonella, but was significantly high against bacteroides fragilis, one of the most clinically important anaerobe. the therapeutic and/or protective effect of aspc in experimental subcutaneous abscess or experimental intraabdominal mixed inf ...	1985	3850132
in vitro activity of cefbuperazone against anaerobic bacteria.	the in vitro activity of cefbuperazone was compared with that of cefoxitin, moxalactam, and piperacillin against 305 strains of anaerobic bacteria. piperacillin was the most active overall, inhibiting 97% of all anaerobes tested at 128 micrograms/ml. cefbuperazone had poor activity against the bacteroides fragilis group and clostridium difficile (43 and 0% susceptible, respectively) but good activity (90.5%) against all other anaerobic bacterial species tested.	1985	3847274
the influence of single dose intravenous antibiotics on faecal flora and emergence of clostridium difficile.	the influence of a single intravenous dose of antibiotic on faecal flora and the emergence of clostridium difficile was studied in volunteers. seventy-eight volunteers (13 groups of 6 receiving 5 penicillins and 8 cephalosporins) were given a single intravenous dose of antibiotic. results were compared with a control group of 6 volunteers who did not receive an antibiotic. changes in the faecal flora were monitored over two weeks. only cephalosporins were associated with emergence of cl. diffici ...	1985	3846592
[the isolation of clostridium difficile and the detection of its cytotoxin from the hamster colitis model].		1985	3837547
[clostridium difficile colitis in patients with blood diseases].		1986	3827004
faecal carriage of clostridium difficile in cystic fibrosis patients.		1986	3827000
epidemiology of an outbreak of clostridium difficile-associated-diarrhoea. application of a typing system.		1986	3826999
[the immunoenzyme system in research on e. coli enterotoxin lt and c. difficile toxins].		1986	3826991
prevention of clostridium difficile induced mortality in gnotobiotic mice by saccharomyces boulardii.	oral preventive treatment of gnotobiotic mice by saccharomyces boulardii significantly decreased mortality following clostridium difficile infection. a single s. boulardii ingestion protected 16% of mice, whereas 56% were protected when s. boulardii was given continuously in the drinking water. no direct antagonistic effect of the yeast on c. difficile numbers was detected, whereas a modulation of fecal cytotoxin production was demonstrated.	1986	3815159
[clostridium difficile infections].		1986	3810620
[clostridium difficile infections].		1986	3810619
a comparison of the clinico-pathological features with stool pathogens in patients hospitalised with the symptom of diarrhoea.	the clinico-pathological features of 515 adult patients admitted to a major regional infectious diseases unit in united kingdom with the symptom complex of diarrhoea were compared to the pathogens detected in their stool specimens. routine clinical examination supported by basic pathological and laboratory investigations identified 138 (28%) in whom the cause of diarrhoea was extragastrointestinal or non-infectious gastrointestinal. of the 351 patients (72%) with infectious gastroenteritis 72 (2 ...	1986	3810049
fever due to clostridium difficile during hemodialytic treatment.	a ten-year-old on hemodialysis had a prolonged unexplained fever secondary to clostridium difficile antibiotic-associated colitis and posed a great diagnostic challenge.	1986	3804581
nosocomial diarrhoeas in a surgical division hyperendemic for clostridium difficile: epidemiologic aspects emerging from an analysis of clinical records.	having previously shown that clostridium difficile was responsible for an intense and protracted endemic of nosocomial diarrhoeas in the surgical division of a tuscan hospital, we started a retrospective analysis on all records from the affected division, to cover a period of 15 months. a statistical description is given of a large series of nosocomial diarrhoeas, as well as direct estimates of their incidence rates in selected high risk subgroups. the situation described is epidemiologically un ...	1986	3803539
in vitro activity of efrotomycin, ciprofloxacin, and six other antimicrobials against clostridium difficile.	the susceptibility of 69 clinical isolates of clostridium difficile from the minneapolis veterans administration medical center and 29 c. difficile strains from other hospitals to efrotomycin, ciprofloxacin, and six other antimicrobials was tested in vitro by agar dilution. ciprofloxin (mic50 and mic90 = 8 mcg/ml) was only moderately active whereas efrotomycin (mic50 = 0.125, mic90 = 0.25 mcg/ml) was highly active against c. difficile.	1987	3802745
isolation of clostridium difficile from various colonies of laboratory mice.	an attempt was made to isolate clostridium difficile from a total of 565 mice from nine different conventional mouse colonies and six different specified-pathogen-free mouse colonies. c. difficile was isolated from all the conventional colonies but from none of the specified-pathogen-free colonies. ampicillin injected intraperitoneally increased the isolation rate of c. difficile from mouse faeces to 63.6% compared with 19.4% from untreated mice.	1986	3795866
purification and characterization of clostridium sordellii lethal toxin and cross-reactivity with clostridium difficile cytotoxin.	lethal toxin (lt) was purified from clostridium sordellii ip82 by deae-trisacryl, ultrogel aca3-4 gel filtration, and hydroxyapatite column chromatography. the molecular weight of purified lt was estimated to be 240,000 to 250,000, and the pi was at ph 4.55. lt was lethal for mice by intraperitoneal injection (3.4 x 10(5) mouse lethal doses per mg of protein), cytotoxic for vero cells (6.1 x 10(4) cytotoxic units per mg of protein), erythematous and edematous by intradermal injection in guinea p ...	1987	3793234
prairie dog model for antimicrobial agent-induced clostridium difficile diarrhea.	we have noted that prairie dogs given cefoxitin develop diarrhea and lose weight yet survive for periods of up to 4 weeks. therefore, we tested the hypothesis that cefoxitin causes clostridium difficile cecitis in prairie dogs. six prairie dogs were given a single intramuscular dose of 100 mg of cefoxitin per kg of body weight, and six control animals received saline; both groups were sacrificed 1 week later. controls had no diarrhea and lost 2% of their body weight, whereas cefoxitin-treated an ...	1987	3793229
a role for colonic stasis in the pathogenesis of disease related to clostridium difficile.	the records of 133 consecutive patients (65 men, 68 women; age range, 15 months to 88 years; median, 57 years) with either a positive clostridium difficile stool culture or toxin assay from 1982 to 1984 were reviewed in order to assess the pattern of this disease in a large hospital and to examine the type of patient at risk. all patients had diarrhea and/or bloody stools (121 and 36, respectively). less specific symptoms were common. most patients had been exposed to multiple antibiotics, but o ...	1986	3792161
[clostridium difficile in the feces of children with and without diarrhea].		1986	3790227
comparison of serogrouping and polyacrylamide gel electrophoresis for typing clostridium difficile.	a typing scheme for clostridium difficile based on slide agglutination with rabbit antisera was previously described. it allows the differentiation of 10 serogroups designated a, b, c, d, f, g, h, i, k, and x. we studied the correlation between serogrouping and polyacrylamide gel electrophoresis (page) of whole-cell proteins. a total of 202 isolates from different sources were analyzed by page after ultrasonic disintegration of cells from an 18-h liquid culture and treatment with sodium dodecyl ...	1986	3782463
faecal metronidazole concentrations during oral and intravenous therapy for antibiotic associated colitis due to clostridium difficile.	faecal metronidazole and hydroxymetronidazole concentrations measured by high pressure liquid chromatography are reported during 10 episodes of clostridium difficile colitis in nine patients. bactericidal faecal concentrations were present in all patients with acute disease receiving oral or intravenous metronidazole, and all responded to therapy. metronidazole and hydroxymetronidazole concentrations fell as the diarrhoea improved and neither substance was detectable in the faeces of five patien ...	1986	3781329
gastrointestinal features of culture-positive yersinia enterocolitica infection.	yersinia enterocolitica was cultured from feces of 122 symptomatic adults in a single facility using selective culture media; all isolates were confirmed in an independent reference laboratory. of 128 isolates, multiple serotypes were defined and all were biochemically typical for yersinia enterocolitica. other agents were seen in 20 patients; of these, seven were yersinia fredriksenii and six were clostridium difficile. diarrhea (80%) and abdominal pain (64%) were common, whereas other features ...	1987	3781177
clostridium difficile culture-positive toxin-negative diarrhea.	antibiotic-associated colitis (aac) is confirmed by the isolation of clostridium difficile cytotoxin from stool in patients with diarrhea. culture of the organism has not been required to confirm the diagnosis. a review of cases of c. difficile culture-positive patients was performed in an attempt to clarify the significance of culture-positive toxin-negative (cptn) compared to culture-positive toxin-positive (cptp) disease. during an 11-month period, 45 patients were identified who had stool cu ...	1986	3766495
clostridium difficile antibiotic-associated colitis.		1986	3766494
fecal bacterial microflora of newborn infants during intensive care management and treatment with five antibiotic regimens.	aerobic and anaerobic fecal bacterial flora of normal newborn infants, of preterm newborn infants without other health problems and of five groups of newborn infants treated with combinations of benzylpenicillin, cloxacillin, flucloxacillin, ampicillin, cefuroxime, cefoxitin and gentamicin were compared. preterm birth alone was associated with growth of klebsiella which could be attributed to a higher rate of cesarean section in preterm than in term infants. all antibiotic regimens led to a pron ...	1986	3763418
[role of clostridium difficile toxins in pseudomembranous colitis with special reference to experimental studies using germfree rats].		1986	3761681