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clostridium difficile associated reactive arthritis: case report and literature review.extra-gastro-intestinal tract manifestations associated with clostridium difficile infection (cdi), including reactive arthritis (rea), are uncommon.201626743187
the first two clostridium difficile ribotype 027/st1 isolates identified in beijing, china-an emerging problem or a neglected threat?clostridium difficile hyper-virulent ribotype 027 strain has become a significant concern globally, but has rarely been reported in asian countries including china. recently, a retrospective single-center study in beijing, china, detected two ribotype 027 c. difficile isolates from two patients coming for outpatient visits in 2012 and 2013. we performed a systematic investigation of the two isolates (and patients). both c. difficile isolates had the typical pcr ribotype 027 profile; were positiv ...201626740150
the use of an iv to po clinical intervention form to improve antibiotic administration in a community based hospital.antimicrobials are among the most commonly prescribed medications in acute care settings, with 50% of antimicrobial use deemed inappropriate. antimicrobial stewardship programs (asp) aim to optimize antibiotic use in order to improve patient clinical outcomes while minimizing unwanted effects of therapy including clostridium difficile infection (cdi) and the emergence of resistant organisms. antimicrobial stewardship involves a coordinated set of interventions that ensure patients who require an ...201526734367
improving management of constipation in an inpatient setting using a care bundle.constipation is a common occurrence on geriatric in-patient wards. it can result in delirium and other complications including bowel obstruction. over treatment with laxatives can result in iatrogenic diahorrea, which can lead to dehydration, delirium, and the false positive labeling and unnecessary treatment of clostridium difficile carriers. this can result in increased morbidity and mortality, and a longer stay in hospital. this means that improving the assessment and treatment of constipatio ...201426734278
mutant generation by allelic exchange and genome resequencing of the biobutanol organism clostridium acetobutylicum atcc 824.clostridium acetobutylicum represents a paradigm chassis for the industrial production of the biofuel biobutanol and a focus for metabolic engineering. we have previously developed procedures for the creation of in-frame, marker-less deletion mutants in the pathogen clostridium difficile based on the use of pyre and coda genes as counter selection markers. in the current study we sought to test their suitability for use in c. acetobutylicum.201626732067
risk factors for recurrent clostridium difficile infection in allogeneic hematopoietic cell transplant recipients.clostridium difficile infection (cdi) is one of the leading causes of hospital-acquired infections in recent times. hematopoietic stem cell transplantation (hsct) confers increased risk for cdi because of prolonged hospital stay, immunosuppression, the need to use broad-spectrum antibiotics and a complex interplay of preparative regimen and gvhd-induced gut mucosal damage. our study evaluated risk factors (rf) for recurrent cdi in hsct recipients given the ubiquity of traditional rf for cdi in t ...201626726944
research in review: driving critical care practice change.during the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. this article summarizes some of this important work and considers it in the context of previous research and practice. examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma. care challenges addressed include eth ...201626724298
functional anatomy of the colonic bioreactor: impact of antibiotics and saccharomyces boulardii on bacterial composition in human fecal cylinders.sections of fecal cylinders were analyzed using fluorescence in situ hybridization targeting 180 bacterial groups. samples were collected from three groups of women (n=20 each) treated for bacterial vaginosis with ciprofloxacin+metronidazole. group a only received the combined antibiotic regimen, whereas the a/sb group received concomitant saccharomyces boulardii cncm i-745 treatment, and the a_sb group received s. boulardii prophylaxis following the 14-day antibiotic course. the number of stool ...201626723852
identification of oligosaccharides in human milk bound onto the toxin a carbohydrate binding site of clostridium difficile.the oligosaccharides in human milk constitute a major innate immunological mechanism by which breastfed infants gain protection against infectious diarrhea. clostridium difficile is the most important cause of nosocomial diarrhea, and the c-terminus of toxin a with its carbohydrate binding site, tcda-f2, demonstrates specific abolishment of cytotoxicity and receptor binding activity upon diethylpyrocarbonate modification of the histidine residues in tcda. tcda-f2 was cloned and expressed in e. c ...201626718473
structural characterization of zinc-bound zmp1, a zinc-dependent metalloprotease secreted by clostridium difficile.proteases are commonly secreted by microorganisms. in some pathogens, they can play a series of functional roles during infection, including maturation of cell surface or extracellular virulence factors, interference with host cell signaling, massive host tissue destruction, and dissolution of infection-limiting clots through degradation of the host proteins devoted to the coagulation cascade. we previously reported the identification and characterization of zmp1, a zinc-dependent metalloproteas ...201626711661
evaluation of xpert c. difficile, bd max cdiff, imdx c. difficile for abbott m2000, and illumigene c. difficile assays for direct detection of toxigenic clostridium difficile in stool specimens.we evaluated the performance of four commercial nucleic acid amplification tests (naats: xpert c. difficile, bd max cdiff, imdx c. difficile for abbott m2000, and illumigene c. difficile) for direct and rapid detection of clostridium difficile toxin genes.201626709260
clostridium difficile-related hospitalizations in madrid (spain) between 2003 and 2014, a rising trend. 201626709248
[identifying gaps between guidelines and clinical practice in clostridium difficile infection].the first aim was to determine whether patients are being treated in accordance with the society for healthcare epidemiology of america and the infectious diseases society of america (idsa/shea) clostridium difficile guidelines and whether adherence impacts patient outcomes. the second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation.201626708998
clostridium difficile-mediated effects on human intestinal epithelia: modelling host-pathogen interactions in a vertical diffusion chamber.clostridium difficile infection is one of the leading causes of healthcare associated diarrhoea in the developed world. although the contribution of c. difficile toxins to disease pathogenesis is now well understood, many facets of host-pathogen interactions between the human intestinal epithelia and the c. difficile bacterium that may contribute to asymptomatic carriage and/or clinical disease remain less clear. herein, we tested the hypothesis that c. difficile strains mediate intestinal epith ...201626708704
synergistic efficacy of 405 nm light and chlorinated disinfectants for the enhanced decontamination of clostridium difficile spores.the ability of clostridium difficile to form highly resilient spores which can survive in the environment for prolonged periods causes major contamination problems. antimicrobial 405 nm light is being developed for environmental decontamination within hospitals, however further information relating to its sporicidal efficacy is required. this study aims to establish the efficacy of 405 nm light for inactivation of c. difficile vegetative cells and spores, and to establish whether spore susceptib ...201626708703
sentinel community clostridium difficile infection (cdi) surveillance in scotland, april 2013 to march 2014.surveillance of clostridium difficile infection (cdi) in scotland does not currently distinguish between cdi cases from hospitals and the community. therefore, the incidence of cdi in the community is unknown, and the burden of disease and the relationship with the hospital/healthcare setting is not well understood. a one-year sentinel community surveillance programme was initiated in collaboration with five scottish health boards in 2013 (representing 36% of all cdi cases reported in scotland). ...201626708405
comparison of a novel chemiluminescent based algorithm to three algorithmic approaches for the laboratory diagnosis of clostridium difficile infection.rapid commercial assays, including nucleic acid amplification tests and immunoassays for clostridium. difficile toxins, have replaced the use of older assays. they are included in a two-step algorithm diagnosis, including first the detection of the glutamate dehydrogenase (gdh) as a screening method and second the detection of toxins as a confirmatory method. although assays that detect the presence of free toxins in feces are known to lack sensitivity, they are preferable to confirm infection. ...201526705425
the uncertain benefits of combination therapy for clostridium difficile infection. 201626703863
disruption of the gut microbiome: clostridium difficile infection and the threat of antibiotic resistance.clostridium difficile is well recognized as the leading cause of antibiotic-associated diarrhea, having a significant impact in both health-care and community settings. central to predisposition to c. difficile infection is disruption of the gut microbiome by antibiotics. being a gram-positive anaerobe, c. difficile is intrinsically resistant to a number of antibiotics. mobile elements encoding antibiotic resistance determinants have also been characterized in this pathogen. while resistance to ...201526703737
25-hydroxyvitamin d concentrations and clostridium difficile infection: a meta-analysis.well-known risk factors for clostridium difficile infection (cdi) are exposure to antibiotics and gastric acid suppressants. recent studies have provided some evidence of an association between hypovitaminosis d and the risk of cdi. therefore, this meta-analysis aimed to pool all the existing evidence to investigate the association between 25-hydroxyvitamin d (25[oh]d) and cdi.201526701764
susceptibility of clostridium difficile to the food preservatives sodium nitrite, sodium nitrate and sodium metabisulphite.clostridium difficile is an important enteric pathogen of humans and food animals. recently it has been isolated from retail foods with prevalences up to 42%, prompting concern that contaminated foods may be one of the reasons for increased community-acquired c. difficile infection (ca-cdi). a number of studies have examined the prevalence of c. difficile in raw meats and fresh vegetables; however, fewer studies have examined the prevalence of c. difficile in ready-to-eat meat. the aim of this s ...201626700884
spectrum of clostridium difficile infections: particular clinical situations.incidence, pathogenesis, diagnostic techniques and therapeutic management of cdi have prompted abundant and adequate recent literature. however, report on clinical manifestations of cdi is frequently biased by the type of patients selected, the retrospective nature of many papers, the epidemic or endemic characteristics of the population reported. this article seeks to review some less discussed clinical and epidemiological aspects of cdi trying to include the clinical manifestations of this dis ...201626700883
nonclinical safety assessment of syn-004: an oral β-lactamase for the protection of the gut microbiome from disruption by biliary-excreted, intravenously administered antibiotics.syn-004 is a first in class, recombinant β-lactamase that degrades β-lactam antibiotics and has been formulated to be administered orally to patients receiving intravenous β-lactam antibiotics including cephalosporins. syn-004 is intended to degrade unmetabolized antibiotics excreted into the intestines and thus has the potential to protect the gut microbiome from disruption by these antibiotics. protection of the gut microbiome is expected to protect against opportunistic enteric infections suc ...201626700136
comparison of multilocus sequence typing and the xpert c. difficile/epi assay for identification of clostridium difficile 027/nap1/bi.clostridium difficile 027/nap1/bi is the most common c. difficile strain in the united states. the xpert c. difficile/epi assay allows rapid, presumptive identification of c. difficile nap1. we compared xpert c. difficile/epi to multilocus sequence typing for identification of c. difficile nap1 and found "very good" agreement at 97.9% (κ = 0.86; 95% confidence interval, 0.80 to 0.91).201626699700
clinical features and characteristics of clostridium difficile pcr-ribotype 176 infection: results from a 1-year university hospital internal ward study.clostridium difficile infection (cdi) is a major cause of antibiotic-associated diarrhoea. given an increasing cdi incidence and global spread of epidemic ribotypes, a 1-year study was performed to analyse the molecular characteristics of c. difficile isolates and associated clinical outcomes from patients diagnosed with cdi in the internal medicine department at university hospital motol, prague from february 2013 to february 2014.201526698842
molecular characteristics of clostridium difficile strains from patients with a first recurrence more than 8 weeks after the primary infection.nearly all published studies of recurrent clostridium difficile infections (cdi) report recurrent cdi within 8 weeks after the primary infection. this study explored the molecular characteristics of c. difficile isolates from the first recurrent cdi more than 8 weeks after the primary infection.201526698688
self-administered home series fecal "minitransplants" for recurrent clostridium difficile infection on a rectal remnant.a fecal microbiota transplant has proved to be an extremely effective method for patients with recurrent infections with clostridium difficile. we present the case of a 65-year-old female patient with multiple clostridium difficile infection (cdi) relapses on the rectal remnant, post-colectomy for a cdi-related toxic megacolon. the patient also evidenced associated symptomatic clostridium difficile vaginal infection. she was successfully treated with serial fecal "minitransplants" (self-administ ...201526697583
clostridium difficile infection in hospitalized cirrhotic patients with hepatic encephalopathy.patients with liver cirrhosis are at-risk population for clostridium difficile infection (cdi). there is a paucity of data on the incidence of cdi in cirrhotics with hepatic encephalopathy (he). the aim of the study was to evaluate the incidence and risk factors for cdi in cirrhotics hospitalized with he.201526697567
development of gut inflammation in mice colonized with mucosa-associated bacteria from patients with ulcerative colitis.disturbances in the intestinal microbial community (i.e. dysbiosis) or presence of the microbes with deleterious effects on colonic mucosa has been linked to the pathogenesis of inflammatory bowel diseases. however the role of microbiota in induction and progression of ulcerative colitis (uc) has not yet been fully elucidated.201526697117
nutritional keys for intestinal barrier modulation.the intestinal tract represents the largest interface between the external environment and the human body. nutrient uptake mostly happens in the intestinal tract, where the epithelial surface is constantly exposed to dietary antigens. since inflammatory response toward these antigens may be deleterious for the host, a plethora of protective mechanisms take place to avoid or attenuate local damage. for instance, the intestinal barrier is able to elicit a dynamic response that either promotes or i ...201526697008
epidemiology, outcomes, and predictors of mortality in hospitalized adults with clostridium difficile infection.studies have demonstrated an increasing clostridium difficile infection (cdi) incidence in hospitals and the community, with increasing morbidity and mortality. in this study, we analyzed data from the national hospital discharge survey (nhds) to evaluate cdi epidemiology, outcomes, and predictors of mortality in hospitalized adults. we identified cases of cdi (and associated comorbid conditions) from nhds data from 2005 through 2009 using icd-9 codes. weighted univariate and multivariate analys ...201626694494
reducing overutilization of testing for clostridium difficile infection in a pediatric hospital system: a quality improvement initiative.study objectives included addressing overuse of clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing.201626692547
high occurrence of fusobacterium nucleatum and clostridium difficile in the intestinal microbiota of colorectal carcinoma patients.colorectal carcinoma is considered the fourth leading cause of cancer deaths worldwide. several microorganisms have been associated with carcinogenesis, including enterococcus spp., helicobacter pylori, enterotoxigenic bacteroides fragilis, pathogenic e. coli strains and oral fusobacterium. here we qualitatively and quantitatively evaluated the presence of oral and intestinal microorganisms in the fecal microbiota of colorectal cancer patients and healthy controls. seventeen patients (between 49 ...201626691472
the spoiiq-spoiiiah complex of clostridium difficile controls forespore engulfment and late stages of gene expression and spore morphogenesis.engulfment of the forespore by the mother cell is a universal feature of endosporulation. in bacillus subtilis, the forespore protein spoiiq and the mother cell protein spoiiiah form a channel, essential for endosporulation, through which the developing spore is nurtured. the two proteins also form a backup system for engulfment. unlike in b. subtilis, spoiiq of clostridium difficile has intact lytm zinc-binding motifs. we show that spoiiq or spoiiiah deletion mutants of c. difficile result in a ...201626690930
the effect of lactobacillus plantarum 299v on the incidence of clostridium difficile infection in high risk patients treated with antibiotics.lactobacillus plantarum 299v (lp299v) has been used in order to reduce gastrointestinal symptoms during antibiotic exposure. however, it remains controversial whether or not probiotics are effective in the prevention of clostridium difficile infections (cdi) among patients receiving antibiotics. the aim of this study was to analyze the cdi among patients receiving antibiotics and hospitalized in the period before and after starting routine use of lp299v as a prevention of this infection.201526690209
clostridium difficile infection in pediatric inflammatory bowel disease.children with inflammatory bowel disease (ibd) are disproportionately susceptible to clostridium difficile infection (cdi) and the incidence is increasing. there has also been growing recognition of asymptomatic c. difficile colonization in pediatric ibd, which can sometimes be very difficult to distinguish from symptomatic c. difficile-associated disease in this population. in this study, we discuss the current knowledge of c. difficile infection in children with ibd, reviewing epidemiology, ri ...201626689599
immunogenicity and protective efficacy of clostridium difficile spore proteins.clostridium difficile is a spore-forming, anaerobic, gram-positive organism that is the leading cause of antibiotic-associated infectious diarrhea, commonly known as c. difficile infection (cdi). c. difficile spores play an important role in the pathogenesis of cdi. spore proteins, especially those that are surface-bound may play an essential role in the germination, colonization and persistence of c. difficile in the human gut. in our current study, we report the identification of two surface-b ...201626688279
clostridium difficile: the more we learn, the less we know. 201626687712
contamination of australian newborn calf carcasses at slaughter with clostridium difficile.in north america and europe, reports of a genetic overlap between toxigenic strains of clostridium difficile isolated from humans, livestock and retail meat suggest that food-borne transmission may be occurring. we investigated the prevalence, concentration and genetic diversity of c. difficile on the carcasses (n = 300) and in the faeces (n = 30) of neonatal veal calves at three abattoirs in australia in 2013. selective culture (both direct and enrichment) was performed, and all isolates were c ...201626686811
clostridium difficile infections in veterans health administration long-term care facilities.a nationwide initiative was implemented in february 2014 to decrease clostridium difficile infections (cdi) in veterans affairs (va) long-term care facilities. we report a baseline of national cdi data collected during the 2 years before the initiative.201626686361
impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital.the role of contaminated environments in the spread of hospital-associated infections has been well documented. this study reports the impact of a pulsed xenon ultraviolet no-touch disinfection system on infection rates in a community care facility.201626684369
postdischarge decontamination of mrsa, vre, and clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-c-emitting devices.two ultraviolet-c (uvc)-emitting devices were evaluated for effectiveness in reducing methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), and clostridium difficile (cd).201626684367
crystal structure of the ctp1l endolysin reveals how its activity is regulated by a secondary translation product.bacteriophages produce endolysins, which lyse the bacterial host cell to release newly produced virions. the timing of lysis is regulated and is thought to involve the activation of a molecular switch. we present a crystal structure of the activated endolysin ctp1l that targets clostridium tyrobutyricum, consisting of a complex between the full-length protein and an n-terminally truncated c-terminal cell wall binding domain (cbd). the truncated cbd is produced through an internal translation sta ...201626683375
genome-based infection tracking reveals dynamics of clostridium difficile transmission and disease recurrence.accurate tracking of clostridium difficile transmission within healthcare settings is key to its containment but is hindered by the lack of discriminatory power of standard genotyping methods. we describe a whole-genome phylogenetic-based method to track the transmission of individual clones in infected hospital patients from the epidemic c. difficile 027/st1 lineage, and to distinguish between the 2 causes of recurrent disease, relapse (same strain), or reinfection (different strain).201626683317
editorial commentary: whole-genome sequencing of clostridium difficile: exquisitely sensitive but not yet optimally applied. 201626683316
the sos response master regulator lexa is associated with sporulation, motility and biofilm formation in clostridium difficile.the lexa regulated sos network is a bacterial response to dna damage of metabolic or environmental origin. in clostridium difficile, a nosocomial pathogen causing a range of intestinal diseases, the in-silico deduced lexa network included the core sos genes involved in the dna repair and genes involved in various other biological functions that vary among different ribotypes. here we describe the construction and characterization of a lexa clostron mutant in c. difficile r20291 strain. the mutat ...201526682547
two patients with fulminant clostridium difficile enteritis who had not undergone total colectomy: a case series and review of the literature.introduction. clostridium difficile is the most common cause of healthcare associated infectious diarrhea, and its most common clinical manifestation is pseudomembranous colitis. small bowel enteritis is reported infrequently in the literature and typically occurs only in patients who have undergone ileal pouch anastomosis due to inflammatory bowel disease or total abdominal colectomy for other reasons. presentation of cases. we report here two cases in which patients developed small bowel c. di ...201526682082
time-resolved amino acid uptake of clostridium difficile 630δerm and concomitant fermentation product and toxin formation.clostridium difficile is one of the major nosocomial threats causing severe gastrointestinal infections. compared to the well documented clinical symptoms, little is known about the processes in the bacterial cell like the regulation and activity of metabolic pathways. in this study, we present time-resolved and global data of extracellular substrates and products. in a second part, we focus on the correlation of fermentation products and substrate uptake with toxin production.201526680234
a novel, sporicidal formulation of ethanol for glove decontamination to prevent clostridium difficile hand contamination during glove removal.decontamination of gloves before removal could reduce the risk for contamination of hands of personnel caring for patients with clostridium difficile infection. we demonstrated that a novel sporicidal formulation of ethanol rapidly reduced c. difficile spores on gloved hands without adverse odor, respiratory irritation, or staining of clothing.201626679745
clostridium difficile infection incidence: impact of audit and feedback programme to improve room cleaning.audit and feedback programmes (afps) using fluorescent marking lead to improvements in room cleaning but have not been linked to reduced clostridium difficile infection (cdi) incidence.201626679727
increased toxin expression in a clostridium difficile mfd mutant.the symptoms of clostridium difficile infection are mediated primarily by two toxins, tcda and tcdb, the expression of which is governed by a multitude of factors including nutrient availability, growth phase and cell stress. several global regulators have been implicated in the regulation of toxin expression, such as ccpa and cody.201526679502
persistence of clostridium difficile rt 237 infection in a western australian piggery.clostridium difficile is commonly associated with healthcare-related infections in humans, and is an emerging pathogen in food animal species. there is potential for transmission of c. difficile from animals or animal products to humans. this study aimed to determine if c. difficile rt 237 had persisted in a western australian piggery or if there had been a temporal change in c. difficile diversity. c. difficile carriage in litters with and without diarrhea was investigated, as was the acquisiti ...201626679487
biomedical applications of nisin.nisin is a bacteriocin produced by a group of gram-positive bacteria that belongs to lactococcus and streptococcus species. nisin is classified as a type a (i) lantibiotic that is synthesized from mrna and the translated peptide contains several unusual amino acids due to post-translational modifications. over the past few decades, nisin has been used widely as a food biopreservative. since then, many natural and genetically modified variants of nisin have been identified and studied for their u ...201626678028
impact of variations in test method parameters on in vitro activity of surotomycin against clostridium difficile and surotomycin quality control limits for broth microdilution and agar dilution susceptibility testing.test parameter variations were evaluated for their effects on surotomycin mics. calcium concentration was the only variable that influenced mics; therefore, 50 μg/ml (standard for lipopeptide testing) is recommended. quality control ranges for clostridium difficile (0.12 to 1 μg/ml) and eggerthella lenta (broth, 1 to 4 μg/ml; agar, 1 to 8 μg/ml) were approved by the clinical and laboratory standards institute based on these data.201626677246
a catalytic dna activated by a specific strain of bacterial pathogen.pathogenic strains of bacteria are known to cause various infectious diseases and there is a growing demand for molecular probes that can selectively recognize them. here we report a special dnazyme (catalytic dna), rfd-cd1, that shows exquisite specificity for a pathogenic strain of clostridium difficile (c. difficile). rfd-cd1 was derived by an in vitro selection approach where a random-sequence dna library was allowed to react with an unpurified molecular mixture derived from this strain of c ...201526676768
clostridium difficile ribotypes in humans and animals in brazil.clostridium difficile is an emerging enteropathogen responsible for pseudomembranous colitis in humans and diarrhoea in several domestic and wild animal species. despite its known importance, there are few studies about c. difficile polymerase chain reaction (pcr) ribotypes in brazil and the actual knowledge is restricted to studies on human isolates. the aim of the study was therefore to compare c. difficile ribotypes isolated from humans and animals in brazil. seventy-six c. difficile strains ...201526676318
optimal screening and donor management in a public stool bank.fecal microbiota transplantation is an effective treatment for recurrent clostridium difficile infection and is being investigated as a treatment for other microbiota-associated diseases. to facilitate these activities, an international public stool bank has been created, which screens donors and processes stools in a standardized manner. the goal of this research is to use mathematical modeling and analysis to optimize screening and donor management at the stool bank.201526675010
coxiella burnetii phagocytosis is regulated by gtpases of the rho family and the rhoa effectors mdia1 and rock.the gtpases belonging to the rho family control the actin cytoskeleton rearrangements needed for particle internalization during phagocytosis. rock and mdia1 are downstream effectors of rhoa, a gtpase involved in that process. coxiella burnetii, the etiologic agent of q fever, is internalized by the host´s cells in an actin-dependent manner. nevertheless, the molecular mechanism involved in this process has been poorly characterized. this work analyzes the role of different gtpases of the rho fa ...201526674774
the susceptibility of celiac disease intestinal microbiota to clostridium difficile infection. 201526673511
discovery and development of surotomycin for the treatment of clostridium difficile.the primary challenge for treating clostridium difficile infections (cdi) is maintenance of clinical response after the end of treatment (sustained clinical response). disease recurrence following a positive clinical response occurs in approximately 6-25 % of patients after the first episode and in up to 65 % for subsequent recurrences. surotomycin, a novel cyclic lipopeptide antibiotic with a core derived by streptomyces roseosporus fermentation, disrupts c. difficile cellular membrane activity ...201626670919
clostridium difficile infection in chilean patients submitted to hematopoietic stem cell transplantation.patients submitted to hematopoietic stem cell transplantation have an increased risk of clostridium difficile infection and multiple risk factors have been identified. published reports have indicated an incidence from 9% to 30% of transplant patients however to date there is no information about infection in these patients in chile.201726670401
clostridium difficile infection is a frequent but well-controlled event after hematopoietic cell transplantation. 201726670398
reexamining the germination phenotypes of several clostridium difficile strains suggests another role for the cspc germinant receptor.clostridium difficile spore germination is essential for colonization and disease. the signals that initiate c. difficile spore germination are a combination of taurocholic acid (a bile acid) and glycine. interestingly, the chenodeoxycholic acid class (cdca) bile acids competitively inhibit taurocholic acid-mediated germination, suggesting that compounds that inhibit spore germination could be developed into drugs that prophylactically prevent c. difficile infection or reduce recurring disease. ...201526668265
diagnostic yield of routine enteropathogenic stool tests in pediatric ulcerative colitis.it can be important to exclude infectious etiologies prior to adjusting immunosuppressive therapy in patients with ulcerative colitis (uc) exacerbation. we sought to determine the diagnostic yield of routine infectious stool studies in pediatric uc patients.201526663793
systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for clostridium difficile infection.clostridium difficile infection is a major cause of nosocomial diarrhoea.201626662643
peri-transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant.clostridium difficile infections (cdi) remain the leading cause of infectious diarrhea among hospitalized patients in this country. patients with hematologic malignancies, especially those who undergo hematopoietic progenitor cell transplants are particularly at risk for developing cdi. one hundred and forty seven consecutive allogeneic hematopoietic progenitor cell transplants were analyzed for peri-transplant clostridium difficile infections (pt-cdi). sixteen patients (11%) developed pt-cdi (m ...201626661725
persistence of clostridium difficile in wastewater treatment-derived biosolids during land application or windrow composting.to determine the persistence of clostridium difficile spores in biosolids during composting or when amended into soil and held under natural environmental climatic conditions.201626661445
the impact of the introduction of fidaxomicin on the management of clostridium difficile infection in seven nhs secondary care hospitals in england: a series of local service evaluations.clostridium difficile infection (cdi) is associated with high mortality. reducing incidence is a priority for patients, clinicians, the national health service (nhs) and public health england alike. in june 2012, fidaxomicin (fdx) was launched for the treatment of adults with cdi. the objective of this evaluation was to collect robust real-world data to understand the effectiveness of fdx in routine practice. in seven hospitals introducing fdx between july 2012 and july 2013, data were collected ...201626661400
effect of an antimicrobial stewardship bundle for patients with clostridium difficile infection.the study objective was to determine whether there was an improvement in compliance with recommended clostridium difficile infection (cdi) treatment after introduction of an institutional cdi bundle with daily antimicrobial stewardship assessment.201626661392
ultrasensitive detection and quantification of toxins for optimized diagnosis of clostridium difficile infection.recently developed ultrasensitive and quantitative methods for detection of clostridium difficile toxins provide new tools for diagnosis and, potentially, for management of c. difficile infection (cdi). compared to methods that detect toxigenic organism, ultrasensitive toxin detection may allow diagnosis of cdi with increased clinical specificity, without sacrificing clinical sensitivity; measurement of toxin levels may also provide information relevant to disease prognosis. this minireview prov ...201626659205
the role of glutamate dehydrogenase (gdh) testing assay in the diagnosis of clostridium difficile infections: a high sensitive screening test and an essential step in the proposed laboratory diagnosis workflow for developing countries like china.the incidence and severity of clostridium difficile infection (cdi) in north america and europe has increased significantly since the 2000s. however, cdi is not widely recognized in china and other developing countries due to limited laboratory diagnostic capacity and low awareness. most published studies on laboratory workflows for cdi diagnosis are from developed countries, and thus may not be suitable for most developing countries. therefore, an alternative strategy for developing countries i ...201526659011
probiotics in digestive diseases: focus on lactobacillus gg.probiotics are becoming increasingly important in basic and clinical research, but they are also a subject of considerable economic interest due to their expanding popularity. they are live micro-organisms which, when administered in adequate amounts, confer a health benefit to the host. from this very well-known definition, it is clear that, unlike drugs, probiotics might be useful in healthy subjects to reduce the risk of developing certain diseases or to optimise some physiological functions. ...201526657927
proton pump inhibitors affect the gut microbiome.proton pump inhibitors (ppis) are among the top 10 most widely used drugs in the world. ppi use has been associated with an increased risk of enteric infections, most notably clostridium difficile. the gut microbiome plays an important role in enteric infections, by resisting or promoting colonisation by pathogens. in this study, we investigated the influence of ppi use on the gut microbiome.201626657899
subinhibitory concentrations of metronidazole increase biofilm formation in clostridium difficile strains.resistance mechanism to metronidazole is still poorly understood, even if the number of reports on clostridium difficile strains with reduced susceptibility to this antibiotic is increasing. in this study, we investigated the ability of the c. difficile strains 7032994, 7032985 and 7032989, showing different susceptibility profiles to metronidazole but all belonging to the pcr ribotype 010, to form biofilm in vitro in presence and absence of subinhibitory concentrations of metronidazole. the qua ...201626656887
clostridium difficile-diagnostic and clinical challenges. 201626656133
the insect peptide copa3 increases colonic epithelial cell proliferation and mucosal barrier function to prevent inflammatory responses in the gut.the epithelial cells of the gut form a physical barrier against the luminal contents. the collapse of this barrier causes inflammation, and its therapeutic restoration can protect the gut against inflammation. egf enhances mucosal barrier function and increases colonocyte proliferation, thereby ameliorating inflammatory responses in the gut. based on our previous finding that the insect peptide copa3 promotes neuronal growth, we herein tested whether copa3 could increase the cell proliferation o ...201626655716
prevention of infections in nursing homes: antibiotic prophylaxis versus infection control and antimicrobial stewardship measures.because of the lack of structural and human resources for implementing more effective and safe preventive procedures, antimicrobial prophylaxis is often used to prevent infections in nursing homes. however, if data on the efficacy of antibiotic prophylaxis in nursing homes are null, there is a plenty of evidence that the inappropriate use of antimicrobials in this setting is associated with a high rate of colonization and infection with multi-drug-resistant organisms (mdros), and of clostridium ...201626655286
an intervention to reduce health care personnel hand contamination during care of patients with clostridium difficile infection.in a quasi-experimental study, an educational intervention to improve the technique for personal protective equipment (ppe) removal in conjunction with disinfection of gloves before removal of ppe reduced acquisition of clostridium difficile spores on the hands of health care personnel caring for patients with c difficile infection.201526654239
hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce clostridium difficile infection, methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase.we report a statistically significant reduction in clostridium difficile infection (from 1.38 to 0.90 cases per 1,000 patient days), vancomycin-resistant enterococci (from 0.21 to 0.01 cases per 1,000 patient days), and extended-spectrum β-lactamase-producing gram-negative bacteria (from 0.16 to 0.01 cases per 1,000 patient days) associated with the introduction of hydrogen peroxide vapor for terminal decontamination of patient rooms and improvements in hand hygiene compliance.201526654237
association of clostridium difficile infection in hospital mortality: a systematic review and meta-analysis.the purpose of this study was to evaluate whether clostridium difficile infection (cdi) contributed to hospital mortality and whether the correlation between intensive care units (icus) and surgical wards in hospital cdi risk still remain controversial.201526654234
colectomy in pediatric ulcerative colitis: a single center experience of indications, outcomes, and complications.there is a paucity of data on outcomes and complications of colectomy for pediatric ulcerative colitis (uc). this study reports the experience of a regional center for 18years.201626653944
clostridium difficile infection in texas hospitals, 2007-2011. 201626651237
clostridium difficile infection: a rarity in patients receiving chronic antibiotic treatment for crohn's disease.prolonged antibiotic use is limited by several adverse effects, one of which is clostridium difficile infection (cdi). the aim of this study was to determine the incidence of cdi in patients receiving chronic antibiotic treatment for crohn's disease (cd).201626650148
clinical significance of clostridium difficile in children less than 2 years old: a case-control study.the significance of clostridium difficile (cd) in the stools of children 2 years old or younger remains unclear. the aim of this study was to investigate risk factors and clinical evolution of diarrheic children ≤2 years old with or without cd in their stools.201626650114
clostridium difficile infections among adults and children in mwanza/tanzania: is it an underappreciated pathogen among immunocompromised patients in sub-saharan africa?little is known regarding the epidemiology clostridium difficile in developing countries. fresh stool samples from patients with diarrhoea were cultured anaerobically. c. difficile was detected in nine (6.4%) of 141 (95% confidence interval 4.2-13.1), of which seven (77.8%) were from children. hiv infection, prolonged hospitalization and antibiotic use were independent factors associated with the occurrence of c. difficile in the gastrointestinal tract. two of the toxigenic isolates were typed a ...201526649183
novel approaches to treating clostridium difficile-associated colitis.clostridium difficile is being recognized as a growing threat to many health-care systems. epidemiology data shows that infection rates are soaring and the disease burden is increasing. despite the efficacy of standard treatments, it is becoming evident that novel therapeutics will be required to tackle this disease. these new treatments aim to enhance the intestinal microbial barrier, activate the immune system and neutralize the toxins that mediate this disease. many of these therapies are sti ...201626643655
bacteriophage combinations significantly reduce clostridium difficile growth in vitro and proliferation in vivo.the microbiome dysbiosis caused by antibiotic treatment has been associated with both susceptibility to and relapse of clostridium difficile infection (cdi). bacteriophage (phage) therapy offers target specificity and dose amplification in situ, but few studies have focused on its use in cdi treatment. this mainly reflects the lack of strictly virulent phages that target this pathogen. while it is widely accepted that temperate phages are unsuitable for therapeutic purposes due to their transduc ...201626643348
antimicrobial therapy of acute diarrhoea: a clinical review.diarrhoea is one of the most commonly occurring diseases. this article presents a review of the current state of the treatment of acute infectious diarrhoea, as well as of the most important pathogens. the general principles of the therapy of diarrhoea are exemplified, followed by a description of the targeted antimicrobial therapy of the most important bacterial gastrointestinal infections, including salmonellosis, shigellosis and campylobacter infections, as well as infections with pathogenic ...201626641310
[microbiological diagnosis of clostridium difficile infection].the clinical microbiology laboratory plays an essential role in the management of clostri- dium difficile infections, showing an increase in frequency and severity. many tests (culture, eia, pcr), detecting bacteria or their antigens, toxin genes or free toxins, allow the microbio- logist to provide the clinician and the infection control specialist with a reliable diagnosis as- sistance, which meet essential criteria for ra- pidity, sensitivity and specificity. this review presents the diagnost ...201526638514
metagenomic approach for identification of the pathogens associated with diarrhea in stool specimens.the potential to rapidly capture the entire microbial community structure and/or gene content makes metagenomic sequencing an attractive tool for pathogen identification and the detection of resistance/virulence genes in clinical settings. here, we assessed the consistency between pcr from a diagnostic laboratory, quantitative pcr (qpcr) from a research laboratory, 16s rrna gene sequencing, and metagenomic shotgun sequencing (mss) for clostridium difficile identification in diarrhea stool sample ...201626637379
implementation of an antimicrobial stewardship program targeting residents with urinary tract infections in three community long-term care facilities: a quasi-experimental study using time-series analysis.asymptomatic bacteriuria in the elderly commonly results in antibiotic administration and, in turn, contributes to antimicrobial resistance, adverse drug events, and increased costs. this is a major problem in the long-term care facility (ltcf) setting, where residents frequently transition to and from the acute-care setting, often transporting drug-resistant organisms across the continuum of care. the goal of this study was to assess the feasibility and efficacy of antimicrobial stewardship pro ...201526634119
clostridium difficile carriage in healthy pregnant women in china.infection with clostridium difficile has been shown to have particularly poor outcomes for pregnant women, including an increased risk of death. the purpose of this study was to investigate the prevalence, genotypic distribution, and characterization of c. difficile strains isolated from pregnant women without diarrhea in china. as part of this study, 3.7% (37 out of 1009) of samples acquired from pregnant females tested positive for c. difficile. of these positive samples, 27.0% (10) were toxig ...201626633756
the role of rho gtpases in toxicity of clostridium difficile toxins.clostridium difficile (c. difficile) is the main cause of antibiotic-associated diarrhea prevailing in hospital settings. in the past decade, the morbidity and mortality of c. difficile infection (cdi) has increased significantly due to the emergence of hypervirulent strains. toxin a (tcda) and toxin b (tcdb), the two exotoxins of c. difficile, are the major virulence factors of cdi. the common mode of action of tcda and tcdb is elicited by specific glucosylation of rho-gtpase proteins in the ho ...201526633511
[clostridium difficile associated diarrhea in children].clostridium difficile is the most commonly isolated organism in antimicrobial and health care-associated diarrhea and is growing in relevance in community-acquired infections. it is a gram-positive bacillus acquired via the fecal-oral route in the community and in hospital setting.201526633112
[clinic and epidemiologic description of clostridium difficile infection in a pediatric population].clostridium difficile (cuj-associated disease (cdad) and the role of the hypervirulent strain nap1 have not been well characterized in pediatrics.201526633108
good's syndrome patients hospitalized for infections: a single-center retrospective study.good's syndrome (gs) is a rare combination of thymoma and hypogammaglobulinemia, resulting in immunodeficiency. patients with gs are highly susceptible to bacterial infection, particularly encapsulated bacterial infection in upper and lower respiratory tracts. good's syndrome patients with moderate-to- severe infection are often hospitalized. clinical features of gs patients remain to be characterized.patients with the discharge diagnosis of gs and simultaneous infection from peking union medica ...201526632723
[clinical characteristics of metronidazole-induced encephalopathy: a report of two cases and a review of 32 japanese cases in the literature].metronidazole is an antibiotic classically used against most anaerobic bacteria and protozoa. because an intravenous form of metronidazole has recently entered the market, the use of this antibiotic is attracting renewed interest in many clinical settings in japan. however, neurotoxicity is a major adverse event: in the central nervous system metronidazole-induced encephalopathy is a rare but serious condition. we performed a literature review of 34 cases including 2 of our cases, 25 from domest ...201526630786
establishing a fecal microbiota transplant service for the treatment of clostridium difficile infection.recurrent or refractory clostridium difficile infection (cdi) has become an increasing problem in the past decade. fecal microbiota transplant (fmt) is a highly efficacious treatment for recurrent cdi; however, a number of technical, logistical, and regulatory issues have hampered the development of an fmt capability at many hospitals. the development of a frozen stool bank of screened donor stool is an important step in the standardization of the procedure. this gives clinicians rapid access to ...201626628567
problems after restorative proctocolectomy: assessment and therapy.restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. although the surgical procedure significantly improves the patients' quality of life, complications are common. mechanical or structural complications related to surgical techniques as well as chronic pouchitis are common after the procedure.201626628102
variation in risk of hospital-onset clostridium difficile infection across β-lactam antibiotics in children with new-onset acute lymphoblastic leukemia.antibiotic exposure is common among children with leukemia. however, limited data exist regarding the risk of clostridium difficile infection (cdi) across anti-pseudomonal β-lactam antibiotics commonly used for fever and neutropenia.201426625453
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