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the economic burden of hospital-acquired clostridium difficile infection: a population-based matched cohort study.background high-quality cost estimates for hospital-acquired clostridium difficile infection (cdi) are vital evidence for healthcare policy and decision-making. objective to evaluate the costs attributable to hospital-acquired cdi from the healthcare payer perspective. methods we conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with cdi (those with the international statistical classification of diseases and related health problems, 1 ...201627322606
clostridium difficile infection in patients hospitalized with type 2 diabetes mellitus and its impact on morbidity, mortality, and the costs of inpatient care.type 2 diabetes mellitus (t2dm) is often complicated by infections leading to hospitalization, increased morbidity, and mortality. not much is known about the impact of clostridium difficile infection (cdi) on health outcomes in hospitalized patients with t2dm. we estimated the prevalence and temporal trends of cdi; evaluated the associations between cdi and in-hospital mortality, length of stay (los), and the costs of inpatient care; and compared the impact of cdi with that of other infections ...201627321318
[changes in the epidemiology of clostridium difficile infection during 2005-2014 in salamanca, spain].to know the most relevant epidemiological features of clostridium difficile infection (cdi) between 2005- 2014 in the province of salamanca (spain).201627318459
efficacy of oral vancomycin in preventing recurrent clostridium difficile infection in patients treated with systemic antimicrobial agents.we compared rates of recurrent clostridium difficile infection in patients receiving or not receiving oral vancomycin prophylaxis with systemic antimicrobial therapy. the incidence of c. difficile infection was significantly lower in patients receiving prophylaxis (4.2% vs 26.6% in those without prophylaxis; odds ratio, 0.12; 95% confidence interval, .04-.4; p < .001).201627318333
hospitalized patients with heart failure and common bacterial infections: a nationwide analysis of concomitant clostridium difficile infection rates and in-hospital mortality.patients with heart failure (hf) are frequently hospitalized with common bacterial infections. it is unknown whether they experience concomitant clostridium difficile infection (cdi) more frequently than patients without hf, and whether cdi affects their mortality.201627317844
reduction of antibiotic resistance genes in intestinal microbiota of patients with recurrent clostridium difficile infection after fecal microbiota transplantation. 201627317794
the cellular lipids of romboutsia.we have examined the lipids of three isolates, romboutsia lituseburensis, romboutsia ilealis, and romboutsia sp. strain frifi, of the newly described genus romboutsia by two-dimensional thin-layer chromatography (2d-tlc) and by liquid chromatography/mass spectrometry (lc/ms). we have found three phospholipids, phosphatidylglycerol (pg), cardiolipin and phosphatidic acid in all three species. a fourth phospholipid, lysyl-pg, was found in r. lituseburensis and strain frifi. polyprenyl-phosphates w ...201627317428
effects of high-pressure treatment on spores of clostridium species.this work analyzes the high-pressure (hp) germination of spores of the food-borne pathogen clostridium perfringens (with inner membrane [im] germinant receptors [grs]) and the opportunistic pathogen clostridium difficile (with no im grs), which has growing implications as an emerging food safety threat. in contrast to those of spores of bacillus species, mechanisms of hp germination of clostridial spores have not been well studied. hp treatments trigger bacillus spore germination through spores' ...201627316969
epidemiological and economic burden of clostridium difficile in the united states: estimates from a modeling approach.despite a large increase in clostridium difficile infection (cdi) severity, morbidity and mortality in the us since the early 2000s, cdi burden estimates have had limited generalizability and comparability due to widely varying clinical settings, populations, or study designs.201627316794
clostridium difficile infection control monitoring tightened.infection control teams must now report cases of clostridium difficile associated diarrhoea (cdad) in all patients aged two years and over.200727316610
positive predictive value of the immunoassay for clostridium difficile toxin a and b detection at a private hospital.clostridium difficile (c. difficile) is a gram-positive bacillus that is a common cause of diarrhea in the hospital environment, with a documented incidence of up to 10%. there are different methods to detect it, but a widely used test in our environment is the immunoassay for toxins a and b.201627316592
fecal microbiota transplantation via fluoroscopy-guided nasojejunal catheter placement: indications, technique, and the role of radiology.clostridium difficile is a well-established cause of nosocomial gastrointestinal disease. although antibiotics remain an effective first-line treatment for c. difficile colitis (cdc), relapse and recurrence are common. fmt has emerged as one of the safest and most effective known therapies available for recurrent or refractory cdc, which is likely due to restoration of the protective microbiotic barrier of the gastrointestinal tract. fmt varies greatly across institutions by route of delivery, d ...201627315076
clostridium difficile infections amongst patients with haematological malignancies: a data linkage study.identify risk factors for clostridium difficile infection (cdi) and assess cdi outcomes among australian patients with a haematological malignancy.201627314498
diagnosing clostridium difficile-associated diarrhea using enzyme immunoassay: the clinical significance of toxin negativity in glutamate dehydrogenase-positive patients.the enzyme immunoassay (eia) has lower sensitivity for clostridium difficile toxins a and b than the polymerase chain reaction in the diagnosis of c. difficile-associated diarrhea (cdad). furthermore, toxin positivity with eia performed on c. difficile isolates from stool cultures may be observed even in patients with eia glutamate dehydrogenase (gdh)-positive and toxin-negative stool specimens. it is unclear whether such patients should be treated as having cdad.201627313472
evolution of an audit and monitoring tool into an infection prevention and control process.in 2010, an infection prevention and control team in an acute hospital trust integrated an audit and monitoring tool (amt) into the management regime for patients with clostridium difficile infection (cdi).201627313140
role of binary toxin in the outcome of clostridium difficile infection in a non-027 ribotype setting - corrigendum. 201627312805
comparison of the vidas c. difficile and quik chek-60 glutamate dehydrogenase assays for the detection of clostridium difficile in faecal samples. 201627311869
a mlst clade 2 clostridium difficile strain with a variant tcdb induces severe inflammatory and oxidative response associated with mucosal disruption.the epidemiology of clostridium difficile infections is highly dynamic as new strains continue to emerge worldwide. here we present a detailed analysis of a new c. difficile strain (icc-45) recovered from a cancer patient in brazil that died from severe diarrhea. a polyphasic approach assigned a new pcr-ribotype and pfge macrorestriction pattern to strain icc-45, which is toxigenic (tcda(+), tcdb(+) and ctdb(+)) and classified as st41 from mlst clade 2 and toxinotype ixb. strain icc-45 encodes f ...201627311833
characteristics of the clostridium difficile cell envelope and its importance in therapeutics.clostridium difficile infection (cdi) is a challenging threat to human health. infections occur after disruption of the normal microbiota, most commonly through the use of antibiotics. current treatment for cdi largely relies on the broad-spectrum antibiotics vancomycin and metronidazole that further disrupt the microbiota resulting in frequent recurrence, highlighting the need for c. difficile-specific antimicrobials. the cell surface of c. difficile represents a promising target for the develo ...201727311697
evaluating the effectiveness of an antimicrobial stewardship program on reducing the incidence rate of healthcare-associated clostridium difficile infection: a non-randomized, stepped wedge, single-site, observational study.the incidence rate of healthcare-associated clostridium difficile infection (ha-cdi) is estimated at 1 in 100 patients. antibiotic exposure is the most consistently reported risk factor for ha-cdi. strategies to reduce the risk of ha-cdi have focused on reducing antibiotic utilization. prospective audit and feedback is a commonly used antimicrobial stewardship intervention (asi). the impact of this asi on risk of ha-cdi is equivocal. this study examines the effectiveness of a prospective audit a ...201627309536
immunoglobulin a vasculitis complicated with clostridium difficile infection: a rare case report and brief review of the literature.immunoglobulin a (iga) vasculitis, formerly called henoch-schönlein purpura, is a leukocytoclastic type of vasculitis affecting small vessels with a deposition of immune iga complexes, clinically characterized by the classic tetrad of nonthrombocytopenic palpable purpura, arthralgia (or arthritis), and gastrointestinal and renal involvement. although the cause of the disease remains unknown, immune complexes of iga and unidentified antigens seem to play a central pathogenic role. the diagnosis i ...201627308656
[infection control and safety culture in german hospitals].healthcare-associated infections (hai) are the most frequent adverse events in the healthcare setting and their prevention is an important contribution to patient safety in hospitals.201627306879
chlorhexidine bathing effects on health-care-associated infections.health-care-associated infections (hais), infections that patients contract during the course of their hospitalization, are receiving a growing amount of attention. heavy skin bacterial colonization aids in the transmission and development of hais. nurses frequently use bathing with chlorhexidine gluconate (chg) to reduce patients' cutaneous microbial burden. this intervention has been shown to have promising but mixed results in the prevention of hais.201727306279
active and secretory iga-coated bacterial fractions elucidate dysbiosis in clostridium difficile infection.the onset of clostridium difficile infection (cdi) has been associated with treatment with wide-spectrum antibiotics. antibiotic treatment alters the activity of gut commensals and may result in modified patterns of immune responses to pathogens. to study these mechanisms during cdi, we separated bacteria with high cellular rna content (the active bacteria) and their inactive counterparts by fluorescence-activated cell sorting (facs) of the fecal bacterial suspension. the gut dysbiosis due to th ...201627303742
incidence and outcome of clostridium difficile infection in hospitalized patients with inflammatory bowel disease in the uk.previous studies have reported that clostridium difficile infection [cdi] is more common, and has a worse outcome, in patients with inflammatory bowel disease [ibd] than in those without. we have now reassessed the incidence and outcome of cdi in in-patients with and without ibd, and the outcomes of admissions for ibd patients with and without cdi.201727302972
mucoadhesive microparticles for local treatment of gastrointestinal diseases.mucoadhesive microparticles formulated in a capsule and delivered to the gastrointestinal tract might be useful for local drug delivery. however, swelling and agglomeration of hydrophilic polymers in the gastrointestinal milieu can have a negative influence on particle retention of mucoadhesive microparticles. in this work, we investigated the impact of dry-coating with nano-sized hydrophilic fumed silica on dispersibility and particle retention of mucoadhesive microparticles. as a model for loc ...201627302556
prevention program for clostridium difficile infection: a single-centre serbian experience.clostridium difficile (c. difficile) diarrhea is a common, iatrogenic, nosocomial disease with a worldwide diffusion. recent studies reported that the incidence of c. difficile infection (cdi) is rising, due to aging of the population and to greater prevalence of hypervirulent strains. we investigated whether the application of a prevention program lead to a decline in the incidence of intrahospital cdi.201627302331
safety of high-dose doripenem in adult patients with cystic fibrosis.high doses of β-lactam antibiotics have been advocated for acute pulmonary exacerbations caused by pseudomonas aeruginosa in patients with cystic fibrosis (cf) secondary to high minimum inhibitory concentrations (mic) of the infecting organisms. some β-lactam antibiotics have increased elimination in cf patients. this case series examines the safety of high-dose doripenem (hdd), 2 g intravenously every 8 hours, which is 4 times the labeled dose, in cf patients.201627298719
inflammatory bowel disease: a descriptive study of 716 local chilean patients.to demographically and clinically characterize inflammatory bowel disease (ibd) from the local registry and update data previously published by our group.201627298570
control of clostridium difficile physiopathology in response to cysteine availability.the pathogenicity of clostridium difficile is linked to its ability to produce two toxins: tcda and tcdb. the level of toxin synthesis is influenced by environmental signals, such as phosphotransferase system (pts) sugars, biotin, and amino acids, especially cysteine. to understand the molecular mechanisms of cysteine-dependent repression of toxin production, we reconstructed the sulfur metabolism pathways of c. difficile strain 630 in silico and validated some of them by testing c. difficile gr ...201627297391
maldi-tof ms is more accurate than vitek ii anc card and api rapid id 32 a system for the identification of clostridium species.all 50 clostridium difficile strains were definitely identified by vitek2 system, rapid id 32a system, and maldi-tof. for 18 non-difficile clostridium strains, the identification results were correct in 0, 2, and 17 strains by vitek2, rapid id 32a, and maldi-tof, respectively. maldi-tof could be used as the primary tool for identification of clostridium species.201627296834
pleural empyema caused by salmonella enteritidis in a patient with non-hodgkin lymphoma.extraintestinal manifestations of nontyphoidal salmonellosis are usually seen in patients with cellular immunodeficiency. pleural empyema caused by nontyphoidal salmonella is very rare clinical presentation of salmonellosis and there are just a few cases described in a literature. we presented a very rare case of pleural empyema caused by salmonella enteritidis in a patient with non-hodgkin limphoma.201627295915
development and validation of a risk score for clostridium difficile infection in medicare beneficiaries: a population-based cohort study.to create a risk stratification score for clostridium difficile infection (cdi) in elderly adults.201627295521
[recurrences in clostridium difficile infections in cancer patients]. 201627293195
zoonotic potential of the clostridium difficile rt078 family in taiwan.clostridium difficile is the major cause of nosocomial diarrhea. we have previously demonstrated that in southern taiwan, severe c. difficile-associated diarrhea (cdad) cases were due to the c. difficile rt 126 strain infection, indicating the arrival of an epidemic c. difficile clone in southern taiwan. rt126 has a close genetic relationship with rt078. however, the rt078 family is the predominant strain of c. difficile in animals worldwide, particularly in swine. in this study, we surveyed c. ...201627292030
clostridium difficile in libya: a neglected pathogen? 201727290694
health care worker hand contamination at critical moments in outpatient care settings.the delivery of health care in outpatient settings has steadily increased over the past 40 years. the risk of infection in these settings is considered to be low. however, the increasing severity of illness and complexity of care in outpatient settings creates a need to reexamine the transmission of pathogens in this setting.201627287735
epidemiology of clostridium difficile infection in hospitalized oncology patients.the epidemiology of clostridium difficile infection (cdi) among oncology inpatients is poorly understood. in multivariate analysis we identified age, history of cdi, and prior receipt of cephalosporins, β-lactam/β-lactamase inhibitors, metronidazole, and blood transfusion as risk factors associated with cdi. reducing broad-spectrum antibiotic use, particularly among older patients and those with a cdi history and recent blood transfusions, may decrease cdi risk in this population.201627287733
long-term microbiota and virome in a zürich patient after fecal transplantation against clostridium difficile infection.fecal microbiota transplantation (fmt) is an emerging therapeutic option for clostridium difficile infections that are refractory to conventional treatment. fmt introduces fecal microbes into the patient's intestine that prevent the recurrence of c. difficile, leading to rapid expansion of bacteria characteristic of healthy microbiota. however, the long-term effects of fmt remain largely unknown. the c. difficile patient described in this paper revealed protracted microbiota adaptation processes ...201627286042
clostridium difficile ribotype 033 colitis in a patient following broad-spectrum antibiotic treatment for kpcproducing klebsiella pneumoniae infection, italy.this report describes a case of clostridium difficile ribotype 033 colitis in a patient treated with multiple antibiotics for kpc-producing klebsiella pneumoniae pancreatitis. diagnostic, clinical and therapeutic features are discussed. to the best of our knowledge, this is the first case of c. difficile ribotype 033 clinical infection reported from italy.201627284989
tolerability and pharmacokinetics of syn-004, an orally administered β-lactamase for the prevention of clostridium difficile-associated disease and antibiotic-associated diarrhea, in two phase 1 studies.syn-004 is an orally administered β-lactamase enzyme, designed to be given concurrently with certain intravenous β-lactam antibiotics like cephalosporins. syn-004 is intended to degrade residual antibiotics excreted into the intestine as a result of hepatobiliary excretion and to prevent the disruption of the gut microbiome by these excess antibiotics. preserving the gut microbiome is expected to prevent secondary infections by pathogens like clostridium difficile and protect against other antib ...201627283946
ridinilazole: a novel therapy for clostridium difficile infection.clostridium difficile infection (cdi) is the leading cause of infectious healthcare-associated diarrhoea. recurrent cdi increases disease morbidity and mortality, posing a high burden to patients and a growing economic burden to the healthcare system. thus, there exists a significant unmet and increasing medical need for new therapies for cdi. this review aims to provide a concise summary of cdi in general and a specific update on ridinilazole (formerly smt19969), a novel antibacterial currently ...201627283730
procalcitonin-guided antibiotic treatment in critically ill patients.in critically ill patients, length of antibiotic treatment can be effectively guided by procalcitonin (pct) protocols. international sepsis guidelines and guidelines on antibiotic stewardship strategies recommend pct as helpful laboratory marker for a rational use of antibiotics. a number of studies and meta-analyses have confirmed the effectiveness of pct-protocols for shortening antibiotic treatment without compromising clinical outcome in critically ill patients. but in clinical practice, the ...201727283067
evaluation of the vidas glutamate dehydrogenase assay for the detection of clostridium difficile.we evaluated the performance of the vidas gdh assay for the detection of clostridium difficile. in total, 350 fecal specimens collected from patients clinically suspected of having cdi were analyzed by c. difficile culture and enzyme-linked fluorescent immunoassay (vidas gdh); the results were compared with those of toxigenic c. difficile culture (tc), pcr (xpert c. difficile assay), and toxin ab eia (vidas cdab). the numbers of culture-positive and culture-negative samples were 108 and 242, res ...201627282799
clostridium difficile infection in a french university hospital: eight years of prospective surveillance study.the epidemiology of clostridium difficile infection (cdi) has changed with an increase in incidence and severity. prospective surveillance was therefore implemented in a french university hospital to monitor the characteristics of patients at risk and to recognize local trends. between 2007 and 2014, all hospitalized patients (≥18 years) with cdi were included. during the survey, the mean incidence rate of cdi was 2.9 per 10,000 hospital-days. in all, 590 patients were included. most of the epis ...201627281101
amelioration of clostridium difficile infection in mice by dietary supplementation with indole-3-carbinol.to determine the therapeutic effects of dietary supplementation on clostridium difficile infection (cdi).201627280500
low frequency of asymptomatic carriage of toxigenic clostridium difficile in an acute care geriatric hospital: prospective cohort study in switzerland.the role of asymptomatic carriers of toxigenic clostridium difficile (tcd) in nosocomial cross-transmission remains debatable. moreover, its relevance in the elderly has been sparsely studied.201627280019
universality of human microbial dynamics.human-associated microbial communities have a crucial role in determining our health and well-being, and this has led to the continuing development of microbiome-based therapies such as faecal microbiota transplantation. these microbial communities are very complex, dynamic and highly personalized ecosystems, exhibiting a high degree of inter-individual variability in both species assemblages and abundance profiles. it is not known whether the underlying ecological dynamics of these communities, ...201627279224
lectin binding studies on a glycopolymer brush flow-through biosensor by localized surface plasmon resonance.a localized surface plasmon resonance biosensor in a flow-through configuration was applied for investigating kinetics of lectin binding to surface-grafted glycopolymer brushes. polycarbonate filter membranes with pore sizes of 400 nm were coated with a 114-nm thick gold layer and used as substrate for surface-initiated atom-transfer radical polymerization of a glycomonomer. these grafted from glycopolymer brushes were further modified with two subsequent enzymatic reactions on the surface to yi ...201627277814
crispr/cas9-based efficient genome editing in clostridium ljungdahlii, an autotrophic gas-fermenting bacterium.acetogenic bacteria have the potential to convert single carbon gases (co and co2) into a range of bulk chemicals and fuels. realization of their full potential is being impeded by the absence of effective genetic tools for high throughput genome modification. here we report the development of a highly efficient crispr/cas9 system for rapid genome editing of clostridium ljungdahlii, a paradigm for the commercial production of ethanol from synthesis gas. following the experimental selection of tw ...201627276212
glucosylation drives the innate inflammatory response to clostridium difficile toxin a.clostridium difficile is a major, life-threatening hospital-acquired pathogen that causes mild to severe colitis in infected individuals. the tissue destruction and inflammation which characterize c. difficile infection (cdi) are primarily due to the rho-glucosylating toxins a and b. these toxins cause epithelial cell death and induce robust inflammatory signaling by activating the transcription factor nf-κb, leading to chemokine and cytokine secretion. the toxins also activate the inflammasome ...201627271747
[prevention of catheter-associated urinary tract infections].with a share of 22.4%, nosocomial urinary tract infections (nutis) are among the most frequent infections acquired in hospitals, along with surgical site infections (24.7%), pneumonia (21.5%), clostridium difficile infections (6.6%) and primary sepsis (6%) 1. 80% of all nutis are associated with indwelling urinary catheters, with 12-16% of all hospitalised patients and up to 81.8% of all intensive care patients receiving an indwelling urinary catheter during their hospital stay 2 3. therefore, p ...201627271450
differences in the molecular epidemiology and antibiotic susceptibility of clostridium difficile isolates in pediatric and adult patients.the rising incidence of clostridium difficile infections (cdis) in adults is partly related to the global spread of fluoroquinolone-resistant strains, namely, bi/nap1/027. although cdis are also increasingly diagnosed in children, bi/nap1/027 is relatively uncommon in children. little is known about the antibiotic susceptibility of pediatric cdi isolates. c. difficile was cultured from tcdb-positive stools collected from children diagnosed with cdi between december 2012 and december 2013 at an a ...201627270275
prevention of clostridium difficile infection: a systematic survey of clinical practice guidelines.background clostridium difficile infection (cdi) is the most common cause of hospital-acquired infectious diarrhea. objective to analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (cpgs) on cdi prevention. design and setting we searched medical databases and gray literature for cpgs on cdi prevention published january 2004-january 2015. three reviewers independently screened articles and rated cpg quality using the appraisal of guidelines for ...201627267201
characteristics and demographic distributions of toxigenic clostridium difficile strains in rajavithi hospital, 2009-2015.in recent years, toxigenic clostridium difficile infection (cdi) has been the cause of c. difficile-associated diseases (cdad), resulting in increasing hospitalization, community infection outbreak and mortality all over the world.201627266236
clostridium difficile infections in children: impact of the diagnostic method on infection rates.background polymerase chain reaction (pcr) assays based on the detection of the toxin b gene are replacing enzyme-linked immunosorbent assay (elisa)-based toxin production detection or cell cytotoxicity assay in most laboratories. objective to determine the proportion of pediatric patients diagnosed with clostridium difficile infection by pcr who would have also been diagnosed by elisa and to compare the clinical characteristics of pcr+/elisa+ vs pcr+/elisa- patients. methods using the microbiol ...201627263967
development of syn-004, an oral beta-lactamase treatment to protect the gut microbiome from antibiotic-mediated damage and prevent clostridium difficile infection.the gut microbiome, composed of the microflora that inhabit the gastrointestinal tract and their genomes, make up a complex ecosystem that can be disrupted by antibiotic use. the ensuing dysbiosis is conducive to the emergence of opportunistic pathogens such as clostridium difficile. a novel approach to protect the microbiome from antibiotic-mediated dysbiosis is the use of beta-lactamase enzymes to degrade residual antibiotics in the gastrointestinal tract before the microflora are harmed. here ...201627262694
newly identified bacteriolytic enzymes that target a wide range of clinical isolates of clostridium difficile.clostridium difficile has emerged as a major cause of infectious diarrhea in hospitalized patients, with increasing mortality rate and annual healthcare costs exceeding $3 billion. since c. difficile infections are associated with the use of antibiotics, there is an urgent need to develop treatments that can inactivate the bacterium selectively without affecting commensal microflora. lytic enzymes from bacteria and bacteriophages show promise as highly selective and effective antimicrobial agent ...201627260850
mdsine: microbial dynamical systems inference engine for microbiome time-series analyses.predicting dynamics of host-microbial ecosystems is crucial for the rational design of bacteriotherapies. we present mdsine, a suite of algorithms for inferring dynamical systems models from microbiome time-series data and predicting temporal behaviors. using simulated data, we demonstrate that mdsine significantly outperforms the existing inference method. we then show mdsine's utility on two new gnotobiotic mice datasets, investigating infection with clostridium difficile and an immune-modulat ...201627259475
isolation of c. difficile carriers alone and as part of a bundle approach for the prevention of clostridium difficile infection (cdi): a mathematical model based on clinical study data.clostridium difficile infection is the most common hospital-acquired infection. besides infected patients, carriers have emerged as a key player in c. difficile epidemiology. in this study, we evaluated the impact of identifying and isolating carriers upon hospital admission on the incidence of cdi incidence and hospital-acquired c. difficile colonization, as a single policy and as part of bundle approaches. we simulated c. difficile transmission using a stochastic mathematical approach, conside ...201627258068
antibiotic prophylaxis for subdural and subgaleal drains.objective the authors sought to determine the effects of eliminating the use of prolonged prophylactic systemic antibiotics (ppsas) in patients with subdural and subgaleal drains. methods using a retrospective database, the authors collected data for patients over the age of 17 years who had undergone cranial surgery at their institution between december 2013 and july 2014 (ppsas period) or between december 2014 and july 2015 (non-ppsas period) and had subdural or subgaleal drains left in place ...201727257843
'no touch' technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems.this article reviews 'no touch' methods for disinfection of the contaminated surface environment of hospitalized patients' rooms. the focus is on studies that assessed the effectiveness of ultraviolet (uv) light devices, hydrogen peroxide systems, and self-disinfecting surfaces to reduce healthcare-associated infections (hais).201627257798
severe complicated clostridium difficile infection: can the upmc proposed scoring system predict the need for surgery?clostridium difficile infection (cdi) is one of the most common health care-associated infections, and it continues to have significant morbidity and mortality. the onset of fulminant colitis often requires total abdominal colectomy with ileostomy, which has a mortality rate of 35% to 57%. university of pittsburgh medical center (upmc) developed a scoring system for severity and recommended surgical consultation for severe complicated disease. the aim of this study was to evaluate if the upmc-pr ...201627257702
the efficacy of thuricin cd, tigecycline, vancomycin, teicoplanin, rifampicin and nitazoxanide, independently and in paired combinations against clostridium difficile biofilms and planktonic cells.thuricin cd is a two-component antimicrobial, belonging to the recently designated sactibiotic subclass of bacteriocins. the aim of this study was to investigate the effects of thuricin cd, as well as the antibiotics, tigecycline, vancomycin, teicoplanin, rifampicin and nitazoxanide when used independently and when combined at low concentrations on the viability of clostridium difficile 20291 r027, tl178 r002, liv022 r106, dpc6350 and vpi10463 biofilms and planktonic cells.201627257437
estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable.health care-associated infections (hais) pose a significant health care and cost burden. this study estimates annual hai hospital costs in the us avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations).201627257390
management of candidemia in patients with clostridium difficile infection.patients with c. difficile infection (cdi) experience intestinal microflora changes that can promote the overgrowth and subsequent translocation of gut resident pathogens into the blood. consistently, cdi due to pcr-ribotype 027 strain, severe or relapsing cdi, and treatment with high-dosage vancomycin are independent risk factors for candidemia.201627254270
bacterial and fungal microbiota changes distinguish c. difficile infection from other forms of diarrhea: results of a prospective inpatient study.this study sought to characterize the bacterial and fungal microbiota changes associated with clostridium difficile infection (cdi) among inpatients with diarrhea, in order to further explain the pathogenesis of this infection as well as to potentially guide new cdi therapies. twenty-four inpatients with diarrhea were enrolled, 12 of whom had cdi. each patient underwent stool testing for cdi prior to being treated with difficile-directed antibiotics, when appropriate. clinical data was obtained ...201627252696
best practices in caring for patients infected with clostridium difficile. 201627252104
rising vancomycin-resistant enterococcus infections in hospitalized children in the united states.vancomycin-resistant enterococcus (vre) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. few data are available on the epidemiology and impact of vre infections in children. we hypothesized a significant increase in vre infections among hospitalized children. additionally, we predicted that vre infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization.201627250774
blastocystis sp. infection mimicking clostridium difficile colitis.we report an unusual case of severe diarrhea related to blastocystis sp. infection in a patient with end stage renal disease on hemodialysis. the patient was admitted due to profuse diarrhea associated with fever and leukocytosis. pertinent stool work-up such as leukocytes in stool, stool culture, clostridium difficile toxin b pcr, and serology for hepatitis a, hepatitis b, and hepatitis c and cytomegalovirus screening were all negative. ova and parasite stool examination revealed blastocystis s ...201627247810
high morbidity and mortality of clostridium difficile infection and its associations with ribotype 002 in hong kong.we aim to study the disease burden, risk factors and severity of clostridium difficile infection (cdi) in hong kong.201627246801
[antibiotic treatment of clostridial colitis].the advantages and disadvantages of various antibiotics used in the treatment of clostridium difficile infection (cdi) are compared with respect to their pharmacokinetic and pharmacodynamic properties. recommendations are made for their optimal use in clinical practice. metronidazole is suitable for the treatment of mild forms of cdi which are essentially self-limiting. vancomycin kills clostridia reliably but the treatment is encumbered with considerable risk of recurrence. this can be decrease ...201627246640
cody-dependent regulation of sporulation in clostridium difficile.clostridium difficile must form a spore to survive outside the gastrointestinal tract. the factors that trigger sporulation in c. difficile remain poorly understood. previous studies have suggested that a link exists between nutritional status and sporulation initiation in c. difficile in this study, we investigated the impact of the global nutritional regulator cody on sporulation in c. difficile strains from the historical 012 ribotype and the current epidemic 027 ribotype. sporulation frequen ...201627246573
[rational use of antibiotics].international and national campaigns draw attention worldwide to the rational use of the available antibiotics. this has been stimulated by the high prevalence rates of drug-resistant pathogens, such as methicillin-resistant staphylococcus aureus (mrsa) and vancomycin-resistant enterococci (vre), a threatening spread of development of resistance in gram-negative rod-shaped bacteria and the selection of clostridium difficile with a simultaneous clear reduction in the development of new antibiotic ...201627246321
effect of bifidobacterium upon clostridium difficile growth and toxicity when co-cultured in different prebiotic substrates.the intestinal overgrowth of clostridium difficile, often after disturbance of the gut microbiota by antibiotic treatment, leads to c. difficile infection (cdi) which manifestation ranges from mild diarrhea to life-threatening conditions. the increasing cdi incidence, not only in compromised subjects but also in traditionally considered low-risk populations, together with the frequent relapses of the disease, has attracted the interest for prevention/therapeutic options. among these, probiotics, ...201627242753
rifaximin improves clostridium difficile toxin a-induced toxicity in caco-2 cells by the pxr-dependent tlr4/myd88/nf-κb pathway.clostridium difficile infections (cdis) caused by clostridium difficile toxin a (tcda) lead to severe ulceration, inflammation and bleeding of the colon, and are difficult to treat.201627242527
bile acid sensitivity and in vivo virulence of clinical clostridium difficile isolates.clostridium difficile is an anaerobic bacterium that causes diarrheal illnesses. disease onset is linked with exposure to oral antibiotics and consequent depletion of secondary bile acids. here we investigate the relationship between in vitro secondary bile acid tolerance and in vivo disease scores of diverse c. difficile strains in mice.201627241781
antibiotic-induced alterations of the gut microbiota alter secondary bile acid production and allow for clostridium difficile spore germination and outgrowth in the large intestine.it is hypothesized that the depletion of microbial members responsible for converting primary bile acids into secondary bile acids reduces resistance to clostridium difficile colonization. to date, inhibition of c. difficile growth by secondary bile acids has only been shown in vitro. using targeted bile acid metabolomics, we sought to define the physiologically relevant concentrations of primary and secondary bile acids present in the murine small and large intestinal tracts and how these impac ...201727239562
faecal microbiota transplantation: applications and limitations in treating gastrointestinal disorders.the process of stool transfer from healthy donors to the sick, known as faecal microbiota transplantation (fmt), has an ancient history. however, only recently researchers started investigating its applications in an evidence-based manner. current knowledge of the microbiome, the concept of dysbiosis and results of preliminary research suggest that there is an association between gastrointestinal bacterial disruption and certain disorders. researchers have studied the effects of fmt on various g ...201627239328
a pilot study to assess the effectiveness and cost of routine universal use of peracetic acid sporicidal wipes in a real clinical environment.peracetic acid sporicidal wipes have been shown to be an effective disinfectant, but in controlled test environments. their high cost may restrict use.201627238941
clostridium difficile infection: early history, diagnosis and molecular strain typing methods.recognised as the leading cause of nosocomial antibiotic-associated diarrhoea, the incidence of clostridium difficile infection (cdi) remains high despite efforts to improve prevention and reduce the spread of the bacterium in healthcare settings. in the last decade, many studies have focused on the epidemiology and rapid diagnosis of cdi. in addition, different typing methods have been developed for epidemiological studies. this review explores the history of c. difficile and the current scope ...201627238460
contamination of healthcare workers' hands with bacterial spores.clostridium species and bacillus spp. are spore-forming bacteria that cause hospital infections. the spores from these bacteria are transmitted from patient to patient via healthcare workers' hands. although alcohol-based hand rubbing is an important hand hygiene practice, it is ineffective against bacterial spores. therefore, healthcare workers should wash their hands with soap when they are contaminated with spores. however, the extent of health care worker hand contamination remains unclear. ...201627236515
nitroimidazole carboxamides as antiparasitic agents targeting giardia lamblia, entamoeba histolytica and trichomonas vaginalis.diarrhoeal diseases caused by the intestinal parasites giardia lamblia and entamoeba histolytica constitute a major global health burden. nitroimidazoles are first-line drugs for the treatment of giardiasis and amebiasis, with metronidazole 1 being the most commonly used drug worldwide. however, treatment failures in giardiasis occur in up to 20% of cases and development of resistance to metronidazole is of concern. we have re-examined 'old' nitroimidazoles as a foundation for the systematic dev ...201627236016
high fecal iga is associated with reduced clostridium difficile colonization in infants.colonization of infants with clostridium difficile is on the rise. although better tolerated by infants than adults, it is a risk factor for future allergic disease. the present study describes associations between infant fecal immunoglobulin a (iga) and colonization with c. difficile in 47 infants enrolled in the canadian healthy infant longitudinal development (child) study. c. difficile colonization was observed in over half (53%) of the infants. median iga was lower in infants colonized with ...201627235197
effect of prolonged diarrhea in renal transplant recipients at a single center in taiwan.post-renal transplantation diarrhea is a common complication; however, it is easily ignored. this study aimed to determine the factors influencing graft function for renal transplant recipients with diarrhea.201627234755
misuse of antibiotics reserved for hospital settings in outpatients: a prospective clinical audit in a university hospital in southern france.some antibiotics are reserved essentially for hospital settings owing to cost effectiveness and in order to fight the emerging antibiotic resistance crisis. in some cases, antibiotics reserved exclusively for use in hospitals may be prescribed in outpatients for serious infections or in the absence of a therapeutic alternative. a 30-day prospective audit of outpatient prescriptions of antibiotics reserved exclusively for use in hospitals was performed. the objective of this study was to evaluate ...201627234677
a roadmap for gene system development in clostridium.clostridium species are both heroes and villains. some cause serious human and animal diseases, those present in the gut microbiota generally contribute to health and wellbeing, while others represent useful industrial chassis for the production of chemicals and fuels. to understand, counter or exploit, there is a fundamental requirement for effective systems that may be used for directed or random genome modifications. we have formulated a simple roadmap whereby the necessary gene systems maybe ...201627234263
fecal microbiota transplantation for severe clostridium difficile infection after left ventricular assist device implantation: a case control study and concise review on the local and regional therapies.we report herein a case of fecal microbiota transplantation (fmt) used for severe clostridium difficile infection for a 65-year-old lebanese man who underwent left ventricular assist device implantation. to the best of our knowledge this is the first case report from lebanon and the region presenting such technique.201627233894
production and characterization of chemically inactivated genetically engineered clostridium difficile toxoids.a recombinant clostridium difficile expression system was used to produce genetically engineered toxoids a and b as immunogens for a prophylactic vaccine against c. difficile-associated disease. although all known enzymatic activities responsible for cytotoxicity were genetically abrogated, the toxoids exhibited residual cytotoxic activity as measured in an in vitro cell-based cytotoxicity assay. the residual cytotoxicity was eliminated by treating the toxoids with 1-ethyl-3-(3-dimethylaminoprop ...201627233688
reduction in post-operative acute kidney injury following a change in antibiotic prophylaxis policy for orthopaedic surgery: an observational study.evidence has shown that a prophylactic antibiotic regimen of flucloxacillin and gentamicin for orthopaedic surgery was associated with increased rates of post-operative acute kidney injury (aki). this resulted in changes in the national antibiotic policy recommendation for orthopaedic surgical prophylaxis. this study aimed to assess whether this change from flucloxacillin and gentamicin to co-amoxiclav was associated with changes in the rates of aki and clostridium difficile infection (cdi).201627231276
[a novel approach to genotyping of hospital isolates of clostridium difficile].development of a novel approach in genotyping of clostridium difficile and its testing on the example of 140 hospital isolates.201627228665
clostridium difficile infection. 201627227752
crystal structures of the spoiid lytic transglycosylases essential for bacterial sporulation.bacterial spores are the most resistant form of life known on earth and represent a serious problem for (i) bioterrorism attack, (ii) horizontal transmission of microbial pathogens in the community, and (iii) persistence in patients and in a nosocomial environment. stage ii sporulation protein d (spoiid) is a lytic transglycosylase (lt) essential for sporulation. the lt superfamily is a potential drug target because it is active in essential bacterial processes involving the peptidoglycan, which ...201627226615
[fecal microbiota transplantation in relapsing clostridium difficile colitis].since the turn of the millennium there has been an alarming increase in the incidence and severity of clostridium difficile infections. stopping medication with the triggering antibiotic and switching to a recommended antibiotic leads to healing up in 80%. however, patients who relapse have a 40% risk of an additional relapse and those with 2 or more episodes face a 60% risk. fecal microbiota transplantation (fmt) is a new therapeutic option. up to now there only exist two randomized studies (un ...201627221557
chinese physicians' perceptions of fecal microbiota transplantation.to explore chinese physicians' perceptions towards fecal microbiota transplantation (fmt) and to provide information and an assessment of fmt development in china.201627217707
clostridium difficile infection following systemic antibiotic administration in randomised controlled trials: a systematic review and meta-analysis.antibiotics have been the most important risk factor for clostridium difficile infection (cdi). however, only data from non-randomised studies have been reviewed. we sought to evaluate the risk for development of cdi associated with the major antibiotic classes by analysing data from randomised controlled trials (rcts). the pubmed, cochrane and scopus databases were searched and the references of selected rcts were also hand-searched. eligible studies should have compared only one antibiotic ver ...201627216385
recurrence of clostridium difficile infection in patients with inflammatory bowel disease: the recidivism study.recurrent clostridium difficile infection (rcdi) contributes to a significant burden of disease in patients with inflammatory bowel disease (ibd). in this study, we seek to identify risk factors for rcdi in a population of ibd patients at the mount sinai hospital ibd centre.201627215924
fecal microbiota transplantation for recurrent clostridium difficile infection in hematopoietic stem cell transplant recipients.recurrent clostridium difficile infection (cdi) is a consequence of intestinal dysbiosis and is particularly common following hematopoietic stem cell transplantation (hsct). fecal microbiota transplantation (fmt) is an effective method of treating cdi by correcting intestinal dysbiosis by passive transfer of healthy donor microflora. fmt has not been widely used in immunocompromised patients, including hsct recipients, owing to concern for donor-derived infection. here, we describe initial resul ...201627214585
assessing the magnitude and trends in hospital acquired infections in canadian hospitals through sequential point prevalence surveys.healthcare acquired infections (hai) are an important public health problem in developed countries, but comprehensive data on trends over time are lacking. prevalence surveys have been used as a surrogate for incidence studies and can be readily repeated.201627213039
towards point of care testing for c. difficile infection by volatile profiling, using the combination of a short multi-capillary gas chromatography column with metal oxide sensor detection.rapid volatile profiling of stool sample headspace was achieved using a combination of short multi-capillary chromatography column (smcc), highly sensitive heated metal oxide semiconductor (mos) sensor and artificial neural network (ann) software. for direct analysis of biological samples this prototype offers alternatives to conventional gc detectors and electronic nose technology. the performance was compared to an identical instrument incorporating a long single capillary column (lscc). the a ...201427212803
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