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faecal shedding of antimicrobial-resistant clostridium difficile strains by dogs.to longitudinally assess the shedding of antimicrobial resistant clostridium difficile strains by clinically healthy dogs raised at breeding facilities.201525483272
influence of sequence mismatches on the specificity of recombinase polymerase amplification technology.recombinase polymerase amplification (rpa) technology relies on three major proteins, recombinase proteins, single-strand binding proteins, and polymerases, to specifically amplify nucleic acid sequences in an isothermal format. the performance of rpa with respect to sequence mismatches of closely-related non-target molecules is not well documented and the influence of the number and distribution of mismatches in dna sequences on rpa amplification reaction is not well understood. we investigated ...201525481659
detection of clostridium difficile toxin genes by pcr: sequence variation may cause false-negative results. 201525480881
analysis of interventions to reduce the incidence of clostridium difficile infection at a london teaching hospital trust, 2003-2011.since 2008 there has been a substantial fall in the incidence of clostridium difficile infection (cdi) in the uk, though it is unclear what contribution local and governmental interventions have made to this reduction.201525480022
low vitamin d level and impact on severity and recurrence of clostridium difficile infections.clostridium difficile infection (cdi) has recently markedly increased, incurring greater health care-associated costs and hospitalizations especially in vitamin d deficient patients. accordingly, the aim of this study was to evaluate the relationship between low vitamin d levels and the severity and recurrence of cdi.201525479065
implementation of polymerase chain reaction to rule out clostridium difficile infection is associated with reduced empiric antibiotic duration of therapy.the polymerase chain reaction (pcr) test has higher sensitivity and a faster turnaround time than the enzyme immunoassay (eia) for identification of clostridium difficile, although the clinical implications of these variables are not well described.201425477583
the importance of considering different healthcare settings when estimating the burden of clostridium difficile.traditional surveillance methods may underestimate the true burden of clostridium difficile infection (cdi) because they fail to capture cases brought to medical attention in outpatient settings or diagnosed during non-face-to-face patient-provider interactions.201525477426
development of a sporicidal test method for clostridium difficile.disinfectants with claimed activity against clostridium difficile must be evaluated to ensure efficacy against the spores that comprise an environmental source of patient infection. unfortunately there is, at present, no generally accepted method for evaluating these disinfectants. in the absence of such a method, laboratories have to adapt protocols that were not designed for products used in medical environments and consequently may use inappropriate test organisms, exposure times, and pass cr ...201525477061
the impact of horizontal gene transfer on the biology of clostridium difficile.clostridium difficile infection (cdi) is now recognised as the main cause of healthcare associated diarrhoea. over the recent years there has been a change in the epidemiology of cdi with certain related strains dominating infection. these strains have been termed hyper-virulent and have successfully spread across the globe. many c. difficile strains have had their genomes completely sequenced allowing researchers to build up a very detailed picture of the contribution of horizontal gene transfe ...201425476764
survival of clostridium difficile spores at low temperatures.clostridium difficile's presence has been reported in meat products stored typically at low temperatures. this study evaluated the viability in phosphate buffer saline (pbs) of spores from epidemic c. difficile strain r20291 (4.6 log cfu/ml) and m120 (7.8 log cfu/ml). viability was assessed during 4 months at -80 °c, -20 °c, 4 °c (refrigeration), and 23 °c (room temperature), and after 10 freeze (-20 °c)/thaw (+23 °c) cycles. although spore viability decreased, significant viability was still ob ...201525475288
[recommendations for the use of faecal microbiota transplantation "stool transplantation": consensus of the austrian society of gastroenterology and hepatology (öggh) in cooperation with the austrian society of infectious diseases and tropical medicine].the intestinal microbiota has a pivotal role in the maintenance of health of the human organism, especially in the defense against pathogenic microorganisms. alterations in the microbiota, also termed dysbiosis, seem to be involved in the pathogenesis of a variety of intestinal and extraintestinal diseases. fecal microbiota transplantation (fmt), also known as stool transplantation, is a therapeutic procedure aiming at restoring an altered intestinal microbiota by administration of stool microor ...201425474284
safety and clinical outcomes of carbapenem de-escalation as part of an antimicrobial stewardship programme in an esbl-endemic setting.to evaluate the safety and clinical outcomes of patients who received carbapenem de-escalation as guided by an antimicrobial stewardship programme (asp) in a setting where esbl-producing enterobacteriaceae are endemic.201525473028
vitamin d deficiency is associated with community-acquired clostridium difficile infection: a case-control study.clostridium difficile infection (cdi) is increasingly recognized as an important community acquired pathogen causing disease (ca-cdi). vitamin d [25(oh)d] has immune modulatory effects and plays an important role in intestinal immunity. the role of vitamin d in ca-cdi has not been examined previously.201425471926
molecular epidemiology and antimicrobial susceptibility of clostridium difficile isolated from a university teaching hospital in japan.clostridium difficile infection control strategies require an understanding of its epidemiology. in this study, we analysed the toxin genotypes of 130 non-duplicate clinical isolates of c. difficile from a university hospital in tokyo, japan. multilocus sequence typing (mlst) and eburst analysis were performed for these isolates and nine strains previously analysed by polymerase chain reaction (pcr) ribotyping. minimum inhibitory concentrations (mics) were determined for six antibiotics, and the ...201525471195
clostridium perfringens enterotoxin and clostridium difficile toxin a/b do not play a role in acute haemorrhagic diarrhoea syndrome in dogs.although an association between clostridial pathogens and canine idiopathic acute haemorrhagic diarrhoea syndrome (ahds) has been described, the relevance of those bacteria and their toxins remains unclear. the aim of this study was to evaluate the association between severity of clinical signs and presence of clostridium perfringens enterotoxin (cpe) and clostridium difficile toxin a/b (cdt a/b) in faeces of dogs with ahds. faecal samples of 54 dogs with idiopathic ahds were tested by qualitati ...201525467148
restrictive reporting of selected antimicrobial susceptibilities influences clinical prescribing.cascade and restrictive reporting are useful strategies to enhance antibiotic stewardship programs.201625466592
tigecycline for the treatment of severe and severe complicated clostridium difficile infection.clostridium difficile infection (cdi) is a common cause of nosocomial diarrhea. metronidazole and vancomycin are the primary treatment options for cdi, but increasing rates of antimicrobial resistance and severe, refractory disease have prompted the need for alternative agents. tigecycline has previously demonstrated favorable in vitro activity against c. difficile isolates, but clinical data on its use in the treatment of cdi are severely lacking. the objective of this study was to describe our ...201425466443
portable uv light as an alternative for decontamination.we evaluated the capability of a commercially available hand-held device that emits ultraviolet (uv) light to disinfect plain surfaces. eight bacterial species were tested, including clostridium difficile ribotype 027 and 3 other spore-forming species. even bacterial spores could be successfully inactivated within a few seconds of irradiation. uv light may provide an alternative for the decontamination of medical products, such as mobile phones or tablet computers, that cannot be treated otherwi ...201425465267
comparative performance of the genexpert c. difficile pcr assay and c. diff quik chek complete kit assay for detection of clostridium difficile antigen and toxins in symptomatic community-onset infections.to evaluate the performance of the genexpert c. difficile assay and c. diff quik chek complete (qcc) kit for the detection of toxins from fecal specimens and cooked meat broth (cmb) culture using toxigenic stool culture as reference method, for the diagnosis of c. difficile infection (cdi) in a community setting.201425462186
novel receptors for bacterial protein toxins.while bacterial effectors are often directly introduced into eukaryotic target cells by various types of injection machines, toxins enter the cytosol of host cells from endosomal compartments or after retrograde transport via golgi from the er. a first crucial step of toxin-host interaction is receptor binding. using optimized protocols and new methods novel toxin receptors have been identified, including metalloprotease adam 10 for staphylococcus aureus α-toxin, laminin receptor lu/bcam for esc ...201525461573
single domain antibody coated gold nanoparticles as enhancer for clostridium difficile toxin detection by electrochemical impedance immunosensors.this work presents a sandwich-type electrochemical impedance immunosensor for detecting clostridium difficile toxin a (tcda) and toxin b (tcdb). single domain antibody conjugated gold nanoparticles were applied to amplify the detection signal. gold nanoparticles (au nps) were characterized by transmission electron microscopy and uv–vis spectra. the electron transfer resistance (ret) of the working electrode surface was used as a parameter in the measurement of the biosensor. with the increase of ...201525460611
development of fecal microbiota transplantation suitable for mainstream medicine.fecal microbiota transplantation has emerged as an increasingly common treatment for patients with refractory clostridium difficile infection. although it can be relatively simple to perform, a number of challenges need to be overcome before this procedure is widely accepted in mainstream clinical practice. most of the solutions to these challenges already exist, but some need further optimization and testing. standardized fecal microbiota is being developed as a therapeutic agent, although it c ...201525460566
underdiagnosis of clostridium difficile across europe: the european, multicentre, prospective, biannual, point-prevalence study of clostridium difficile infection in hospitalised patients with diarrhoea (euclid).variations in testing for clostridium difficile infection can hinder patients' care, increase the risk of transmission, and skew epidemiological data. we aimed to measure the underdiagnosis of c difficile infection across europe.201425455988
hidden burden of undiagnosed clostridium difficile infection. 201425455970
[fecal microbiota transplantation].bacteria can no longer be seen as an enemy. nowadays, there is enough evidence to place the microbiota as a key element in human homeostasis. despite initial skepticism, fecal microbiota transplantation (fmt) is a real therapeutic alternative for patients with recurrent clostridium difficile infection. moreover, this procedure has shown promising results in ulcerative colitis and other non-gastrointestinal disorders. there is still a lack of knowledge and clinical trials with long- term follow-u ...201525454597
missed diagnosis of clostridium difficile infection; a prospective evaluation of unselected stool samples.clostridium difficile infection (cdi) is the leading cause of hospital-acquired diarrhoea in developed countries, however a high proportion of cdi episodes go undiagnosed, either because physicians do not request identification of toxigenic c. difficile or microbiologists do not perform the appropriate tests.201525452039
broad coverage of genetically diverse strains of clostridium difficile by actoxumab and bezlotoxumab predicted by in vitro neutralization and epitope modeling.clostridium difficile infections (cdis) are the leading cause of hospital-acquired infectious diarrhea and primarily involve two exotoxins, tcda and tcdb. actoxumab and bezlotoxumab are human monoclonal antibodies that neutralize the cytotoxic/cytopathic effects of tcda and tcdb, respectively. in a phase ii clinical study, the actoxumab-bezlotoxumab combination reduced the rate of cdi recurrence in patients who were also treated with standard-of-care antibiotics. however, it is not known whether ...201525451052
severity and frequency of community-onset clostridium difficile infection on an australian tertiary referral hospital campus.clostridium difficile infection (cdi) is increasingly being found in populations without traditional risk factors. we compared the relative frequency, risk factors, severity, and outcomes of community-onset cdi with hospital-acquired infection.201425449250
outbreak of clostridium difficile ribotype 027 in a residential home.this article reports a significant outbreak of clostridium difficile ribotype 027 infection in a residential care home in the uk. five of six affected residents died within one month of diagnosis. investigation of the facility revealed problems with hand hygiene and environmental cleaning. affected residents had received a mean of 2.7 antibiotic courses in the two months preceding diagnosis. it is important to recognize that c. difficile outbreaks can occur in residential homes. there is a need ...201425447200
integration of metabolism and virulence in clostridium difficile.synthesis of the major toxin proteins of the diarrheal pathogen, clostridium difficile, is dependent on the activity of tcdr, an initiation (sigma) factor of rna polymerase. the synthesis of tcdr and the activation of toxin gene expression are responsive to multiple components in the bacterium's nutritional environment, such as the presence of certain sugars, amino acids, and fatty acids. this review summarizes current knowledge about the mechanisms responsible for repression of toxin synthesis ...201425445566
development of antimicrobial resistance in the normal anaerobic microbiota during one year after administration of clindamycin or ciprofloxacin.thirty healthy subjects (15 males and 15 females) were randomly assigned in three groups and clindamycin (150 mg qid) or ciprofloxacin (500 mg bid) or placebo was given for a 10-day period. skin, nasal, saliva, faeces samples were collected at day - 1, day 11, 1 month, 2 months, 4 months and 12 months post administration for microbiological analysis. ciprofloxacin or clindamycin had no impact on the anaerobic skin microbiota and the proportions of antibiotic resistant anaerobic bacteria were sim ...201525445201
long-term efficacy of a self-disinfecting coating in an intensive care unit.cleaning and disinfecting fomites can effectively remove/kill pathogens on surfaces, but studies have shown that more than one-half the time, surfaces are not adequately cleaned or are recontaminated within minutes. this study evaluated a product designed to create a long-lasting surface coating that provides continuous disinfecting action.201425444265
sporicides for clostridium difficile—do they do what it says on the tin? 201525443502
invited commentary on clostridium difficile increases the risk for venous thromboembolism. 201425441599
excess length of stay and mortality due to clostridium difficile infection: a multi-state modelling approach.the burden of healthcare-associated infections, such as healthcare-acquired clostridium difficile (ha-cdi), can be expressed in terms of additional length of stay (los) and mortality. however, previous estimates have varied widely. although some have considered time of infection onset (time-dependent bias), none considered the impact of severity of ha-cdi; this was the primary aim of this study.201425441017
characterization of a multidrug resistant c. difficile meat isolate.clostridium difficile is a pathogen of significant public health concern causing a life-threatening, toxin-mediated enteric disease in humans. the incidence and severity of the disease associated with c. difficile have increased in the us with the emergence of hypervirulent strains and community associated outbreaks. the detection of genotypically similar and identical c. difficile strains implicated from human infections in foods and food animals indicates the potential role of food as a source ...201525440554
clostridium difficile infection: prevention, treatment, and surgical management.clostridium difficile is increasing in both incidence and severity. although metronidazole and vancomycin remain the gold standard for medical management, and surgical colectomy the gold standard for surgical management, new treatment alternatives, including the creation of a diverting loop ileostomy along with colonic lavage and vancomycin enemas, are being investigated that may lead to changes in the current treatment algorithms. the most exciting development in the treatment options for c dif ...201425440127
review of the emerging treatment of clostridium difficile infection with fecal microbiota transplantation and insights into future challenges.clostridium difficile infection (cdi) is one of the most common health care-associated infections in the united states. currently, there are no standardized methods to prepare or deliver the fecal microbiota transplantation (fmt). various methods are used to prepare the fmt, which is usually administered via nasogastric tube, colonoscopy, or by enema. several clinical trials are underway to assess the true efficacy and safety of fmt for cdi. these trials include cdi studies assessing fmt via col ...201425439277
the impact of proton pump inhibitors on the human gastrointestinal microbiome.potent gastric acid suppression using proton pump inhibitors (ppis) is common in clinical practice but may have important effects on human health that are mediated through changes in the gastrointestinal microbiome. in the esophagus, ppis change the normal bacterial milieu to decrease distal esophageal exposure to inflammatory gram-negative bacteria. in the stomach, ppis alter the abundance and location of gastric helicobacter pylori and other bacteria. in the small bowel, ppis cause polymicrobi ...201425439276
[clostridium difficile in visceral surgery].for surgeons the early identification of patients with clostridium difficile infections (cdi) is important, because the incidence and virulence of this potentially life-threatening disease are increasing.201525432576
total synthesis of the protected aglycon of fidaxomicin (tiacumicin b, lipiarmycin a3).fidaxomicin, also known as tiacumicin b or lipiarmycin a3, is a novel macrocyclic antibiotic that is used in hospitals for the treatment of clostridium difficile infections. this natural product has also been shown to have excellent bactericidal activity against multidrug-resistant mycobacterium tuberculosis. in spite of its attractive biological activity, no total synthesis has been reported to date. the enantioselective synthesis of the central 18-membered macrolactone is reported herein. the ...201525431322
recurrent clostridium difficile infection treated with home fecal transplantation: a case report.clostridium difficile infection causes severe diarrhea, abdominal pain and weight loss. a course of metronidazole is the initial treatment; however up to 40% of patients have at least one recurrence. some patients have recurrent infections requiring further treatment with vancomycin, others need multiple courses of expensive treatment. fecal transplantation has been proposed as an effective treatment option for patients with recurrences. we report the case of a patient with recurrent clostridium ...201425430511
right hemicolectomy in a severely anemic jehovah's witness patient with an extremely low preoperative hemoglobin level and the decision to operate.severe anemia is associated with high mortality, and patients with this condition are typically treated with packed blood red cells. patients of jehovah's witness faith, however, do not accept blood transfusion therapy. the authors report the case of a jehovah's witness patient who presented with lower gastrointestinal bleeding secondary to clostridium difficile colitis. because the patient refused blood transfusion therapy, he underwent a right hemicolectomy with a preoperative hemoglobin level ...201425429083
a new type of toxin a-negative, toxin b-positive clostridium difficile strain lacking a complete tcda gene.toxins a and b are the main virulence factors of clostridium difficile and are the targets for molecular diagnostic tests. here, we describe a new toxin a-negative, toxin b-positive, binary toxin cdt (clostridium difficile transferase)-negative (a(-) b(+) cdt(-)) toxinotype (xxxii) characterized by a variant type of pathogenicity locus (paloc) without tcda and with atypical organization of the paloc integration site.201525428159
which severity indices for clostridium difficile infection. 201525426981
prolonged use of a proton pump inhibitor reduces microbial diversity: implications for clostridium difficile susceptibility.the role of the gut microbiome in arresting pathogen colonization and growth is important for protection against clostridium difficile infection (cdi). observational studies associate proton pump inhibitor (ppi) use and cdi incidence. we hypothesized that ppi use affected the distal gut microbiome over time, an effect that would be best explored by time-longitudinal study of healthy subjects on ppi in comparison to treatment-naïve cdi subjects. this study enrolled nine healthy human subjects and ...201425426290
comparative structural and functional analysis of staphylococcus aureus glucokinase with other bacterial glucokinases.glucokinase is classified in bacteria based upon having atp binding site and 'repressor/open reading frames of unknown function/sugar kinases' motif, the sequence of glucokinase gene (jn645812) of staphylococcus aureus atcc12600 showed presence of atp binding site and 'repressor/open reading frames of unknown function/sugar kinases' motif. we have earlier observed glucokinase of s. aureus has higher affinity towards the substrate compared to other bacterial glucokinase and under anaerobic condit ...201425425757
antibiotic stewardship in orthopaedic surgery: principles and practice.a thorough knowledge of the principles of antibiotic stewardship is a crucial part of high-quality orthopaedic surgical care. these principles include (1) determining appropriate indications for antibiotic administration, (2) choosing the correct antibiotic based on known or expected pathogens, (3) determining the correct dosage, and (4) determining the appropriate duration of treatment. antibiotic stewardship programs have a multidisciplinary staff that can help guide antibiotic selection and d ...201425425612
antibiotic susceptibility of clostridium difficile is similar worldwide over two decades despite widespread use of broad-spectrum antibiotics: an analysis done at the university hospital of zurich.clostridium difficile infection (cdi) remains a major health problem worldwide. antibiotic use, in general, and clindamycin and ciprofloxacin, in particular, have been implicated in the pathogenesis of cdi. here, we hypothesized that antibiotics that are highly active in vitro against c. difficile are less frequently associated with cdi than others. the primary goals of our study were to determine if antibiotic susceptibility and cdi are associated and whether the antimicrobial susceptibility of ...201425425433
is fecal microbiota transplantation (fmt) an effective treatment for patients with functional gastrointestinal disorders (fgid)?despite its high prevalence and significant effect on quality of life, the etiology of functional gastrointestinal disorders (fgid), and specifically irritable bowel syndrome (ibs), has yet to be fully elucidated. while alterations in immunity, motility, and the brain-gut axis have been implicated in disease pathogenesis, the intestinal microbiota are increasingly being shown to play a role and numerous studies have demonstrated significant differences from normal in the intestinal flora of pati ...201525424663
stability and recovery of dificid(®) (fidaxomicin) 200-mg crushed tablet preparations from three delivery vehicles, and administration of an aqueous dispersion via nasogastric tube.fidaxomicin is approved for the treatment of adults with clostridium difficile-associated diarrhea, many of whom have difficulty swallowing an intact tablet. the study objective was to evaluate the stability and recovery of crushed dificid(®) (fidaxomicin) 200-mg tablets dispersed in water, applesauce, or ensure(®) brand liquid nutritional supplement, and to determine the recovery of fidaxomicin from the administration of an aqueous dispersion of a crushed dificid(®) tablet through a nasogastric ...201425424419
safety issues and drug-drug interactions with commonly used quinolones.quinolones are widely used antimicrobials with good efficacy and favourable safety. recently, forms of quinolone toxicity such as peripheral neuropathy, retinal detachment or qtc-prolongation have attracted attention.201525423877
proton pump inhibitors and histamine-2 receptor antagonists in the intensive care setting: focus on therapeutic and adverse events.histamine-2 receptor antagonists (h2ra) and proton pump inhibitors (ppi) are frequently used to prevent stress-related mucosal bleeding (srmb). a paucity of data implicates these agents with pneumonia and clostridium difficile infection (cdi).201525423448
lack of evidence for an unmet need to treat clostridium difficile infection in infants aged <2 years: expert recommendations on how to address this issue.the role of clostridium difficile in causing disease in infants is unclear, and the existence of c. difficile infection (cdi) in this population is controversial. as part of the drug licensing process for new cdi therapies, a pediatric investigation plan is required to define studies in infants aged <2 years. this assumes an unmet medical need, even though clinical trials in this age group may not be feasible. three pharmaceutical companies developing cdi treatments came together to seek advice ...201525422389
concomitant pseudomembranous colitis in colonic resection for acute diverticulitis.diverticulitis and clostridium difficile infection (cdi) are common conditions in the surgical population. however, they are usually 2 distinct clinical entities. here, we report the case of acute diverticulitis with concomitant pseudomembranous colitis, presumably due to cdi. the clinical course as well as gross and microscopic pathology findings are discussed. a literature search revealed a single previous report of these findings concomitant in a surgical specimen. a brief discussion of the p ...201525421617
diagnosis of clostridium difficile: real-time pcr detection of toxin genes in faecal samples is more sensitive compared to toxigenic culture.the diagnosis of clostridium difficile infection (cdi) requires the detection of toxigenic c. difficile or its toxins and a clinical assessment. we evaluated the performance of four nucleic acid amplification tests (naats) detecting toxigenic c. difficile directly from faeces compared to routine toxigenic culture. in total, 300 faecal samples from danish hospitalised patients with diarrhoea were included consecutively. culture was performed in duplicate (routine and 'expanded toxigenic culture': ...201525421216
occurrence of clostridium difficile in seasoned hamburgers and seven processing plants in iran.the recent increment of the incidence of community associated clostridium difficile infection (ca)-cdi has led to speculation that this disease is associated to foodborne transmission. therefore it is critical to establish the community sources of cdi in order to implement the appropriate interventions. the present study was conducted to evaluate the prevalence of c. difficile in seasoned hamburger and examine the sources of c. difficile dispersal in hamburger processing plants. a total of 211 s ...201425420512
international patents granted for clostridium difficile program. 201425420285
clostridium difficile infection in hospitalized patients with cystic fibrosis. 201425419780
disproportionate rise in clostridium difficile-associated hospitalizations among us youth with inflammatory bowel disease, 1997-2011.our aim was to characterize the temporal changes in burden that clostridium difficile infection (cdi) added to the hospital care of children and young adults with inflammatory bowel disease (ibd) in the united states.201525419679
antimicrobial peptide resistance mechanisms of gram-positive bacteria.antimicrobial peptides, or amps, play a significant role in many environments as a tool to remove competing organisms. in response, many bacteria have evolved mechanisms to resist these peptides and prevent amp-mediated killing. the development of amp resistance mechanisms is driven by direct competition between bacterial species, as well as host and pathogen interactions. akin to the number of different amps found in nature, resistance mechanisms that have evolved are just as varied and may con ...201425419466
nosocomial bacteriuria in elderly inpatients may be leading to considerable antibiotic overuse: an audit of current management practice in a secondary level care hospital in new zealand.bacteriuria in the form of symptomatic urinary tract infection (uti) and asymptomatic bacteriuria (asb) is common in the elderly. there is no clinical benefit obtained by treating elderly individuals with asb. however, its high prevalence leads to the overdiagnosis of uti and unnecessary antibiotic use, which can result in adverse events, including clostridium difficile diarrhea and reinfection with antibiotic-resistant organisms.201425419149
characterization of comorbid factors in hip fracture related in-hospital mortality.it is important to delineate factors which influence in-hospital mortality rates following a hip fracture. the current study aimed to identify the nature and frequency of comorbidities prevalent in this patient cohort. a retrospective chart review of cases of in-patient mortality following admission for a hip fracture was performed. these cases (n=127) were characterized for comorbidities, complications, medical status indicators, and other contributory factors. cardiovascular 104 (81.9%), respi ...201425417388
visual detection of bacterial pathogens via pna-based padlock probe assembly and isothermal amplification of dnazymes.we have developed a self-reporting isothermal system for visual bacterial pathogen detection with single base resolution. the new dna diagnostic is based on combination of peptide nucleic acid (pna) technology, rolling circle amplification (rca) and dnazymes. pnas are used as exceedingly selective chemical tools that bind genomic dna at a predetermined sequence under nondenaturing conditions. after assembly of the pna-dna construct a padlock probe is circularized on the free strand. the probe in ...201425415469
whole genome sequencing reveals potential spread of clostridium difficile between humans and farm animals in the netherlands, 2002 to 2011.farm animals are a potential reservoir for human clostridium difficile infection (cdi), particularly pcr ribotype 078 which is frequently found in animals and humans. here, whole genome single-nucleotide polymorphism (snp) analysis was used to study the evolutionary relatedness of c. difficile 078 isolated from humans and animals on dutch pig farms. all sequenced genomes were surveyed for potential antimicrobial resistance determinants and linked to an antimicrobial resistance phenotype. we sequ ...201425411691
dna microarray-based pcr ribotyping of clostridium difficile.this study presents a dna microarray-based assay for fast and simple pcr ribotyping of clostridium difficile strains. hybridization probes were designed to query the modularly structured intergenic spacer region (isr), which is also the template for conventional and pcr ribotyping with subsequent capillary gel electrophoresis (seq-pcr) ribotyping. the probes were derived from sequences available in genbank as well as from theoretical isr module combinations. a database of reference hybridization ...201525411174
risk factors associated with clostridium difficile infection in adult oncology patients.clostridium difficile infection (cdi) prevention is particularly important for cancer patients, because diarrhea often results in dose reductions or delays of chemotherapy or radiotherapy. we conducted this study to better ascertain the incidence, susceptibility, and risk factors for cdi in cancer patients receiving chemotherapy at our hospital.201525410088
electrical injuries. biological values measurements as a prediction factor of local evolution in electrocutions lesions.taking into account the incidence and the severity of electrocutions, we consider it extremely necessary to find effective, appropriate and particularized therapeutic solutions aimed at improving the survival, decreasing the mortality, ensuring a superior functional and aesthetic effect and facilitating the social reintegration. given the severity of the general condition of the electrically injured patient and the fact that any worsening of the lesions has a systemic echo, the selection of the ...201425408731
predictors and outcomes of readmission for clostridium difficile in a national sample of medicare beneficiaries.rates of clostridium difficile (cd) infections are increasing. elderly patients may be at particular risk of recurrent cd infection. little is known about the risk for cd readmission specifically in this age group.201525408315
tigecycline for the treatment of clostridium difficile infection refractory to metronidazole in haematopoietic stem cell transplant recipients. 201525407220
clostridium difficile infection: guideline-based diagnosis and treatment.clostridium difficile (c. difficile) is the pathogen that most commonly causes nosocomial and antibiotic-associated diarrheal disease. optimized algorithms for diagnosis, treatment, and hygiene can help lower the incidence, morbidity, and mortality of c. difficile infection (cdi).201425404529
critical roles of clostridium difficile toxin b enzymatic activities in pathogenesis.tcdb is one of the key virulence factors of clostridium difficile that is responsible for causing serious and potentially fatal colitis. the toxin contains at least two enzymatic domains: an effector glucosyltransferase domain for inactivating host rho gtpases and a cysteine protease domain for the delivery of the effector domain into host cytosol. here, we describe a novel intrabody approach to examine the role of these enzymes of tcdb in cellular intoxication. by screening a single-domain heav ...201525404023
antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use.antibiotic use is an important quality improvement target. nearly 50% of antibiotic use is unnecessary or inappropriate. to combat overuse, the centers for disease control and prevention (cdc) proposed "time-outs" to reevaluate antibiotics.201425402404
the effect of clostridium difficile infection on cardiac surgery outcomes.clostridium difficile (cd) is a common cause of healthcare-associated infectious colitis that complicates about 1% of all hospital stays in the u.s. the impact of cd on outcomes after coronary artery bypass grafting (cabg) and valvular surgery (vs) is not well known.201525402213
clostridium difficile infection in the postcolectomy patient.clostridium difficile infection (cdi) after total colectomy has been increasingly recognized over the past decade. c. difficile enteritis (cde) is a rare occurrence, whereas c. difficile pouchitis (cdp) has been reported in approximately 10% of symptomatic patients seen at a referral center for pouch dysfunction. similar to colonic cdi in the general population, antibiotic use and comorbid diseases may be risk factors for cde. in contrast, the postoperative use of antibiotics does not seem to be ...201425401722
quantitative fecal lactoferrin as a biomarker for severe clostridium difficile infection in hospitalized patients.the incidence and severity of clostridium difficile infection (cdi) have increased over the past decade, especially among hospitalized patients. in this study, we determined the value of published criteria for severe cdi in predicting 3 month mortality, as well as the utility of fecal lactoferrin as a biomarker for severe cdi.201425401164
the role of gr-1(+) cells and tumour necrosis factor-α signalling during clostridium difficile colitis in mice.the host response to clostridium difficile infection in antibiotic-treated mice is characterized by robust recruitment of gr-1(+) cells, increased expression of inflammatory cytokines including tumour necrosis factor-α (tnf-α), and the development of severe epithelial damage. to investigate the role of gr-1(+) cells and tnf-α during c. difficile colitis, we treated infected mice with monoclonal antibodies against gr-1 or tnf-α. mice were challenged with vegetative cells of c. difficile strain vp ...201525399934
the molecular basis of clostridium difficile disease and host response.clostridium difficile infection (cdi) ranges from asymptomatic colonization to severe colitis and death. the physiologic and molecular mechanisms determining disease outcome are thus far poorly understood. here, we review recent advances in the relationship between host response to infection and disease outcome. furthermore, we review recent studies on the relationship between intestinal microbial ecology and pathogenesis of cdi.201525394235
spoiiid-mediated regulation of σk function during clostridium difficile sporulation.the spore-forming bacterial pathogen clostridium difficile is a leading cause of health-care-associated diarrhea worldwide. although c. difficile spore formation is essential for disease transmission, the regulatory pathways that control this developmental process have only been partially characterized. in the well-studied spore-former bacillus subtilis, the highly conserved σ(e) , spoiiid and σ(k) regulatory proteins control gene expression in the mother cell to ensure proper spore formation. t ...201525393584
evaluation of an online program to teach microbiology to internal medicine residents.microbiology rounds are an integral part of infectious disease consultation service. during microbiology rounds, we highlight microbiology principles using vignettes. we created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology onl ...201425392364
comparison of genomera c. difficile and xpert c. difficile as confirmatory tests in a multistep algorithm for diagnosis of clostridium difficile infection.we compared two multistep diagnostic algorithms based on c. diff quik chek complete and, as confirmatory tests, genomera c. difficile and xpert c. difficile. the sensitivity, specificity, positive predictive value, and negative predictive value were 87.2%, 99.7%, 97.1%, and 98.3%, respectively, for the genomera-based algorithm and 89.7%, 99.4%, 95.5%, and 98.6%, respectively, for the xpert-based algorithm. genomera represents an alternative to xpert as a confirmatory test of a multistep algorith ...201525392360
alert microorganisms isolated from patients hospitalized in małopolskie province in 2010-2012.healthcare centers undertake supervisory activities to control health care-associated infections (hcais) by elaborating procedures, identifying alert microorganisms and analyzing data collected. the aim of the study was to analyze the prevalence of alert microorganisms in hospital wards in 2010-2012.201425391008
factors associated with clostridium difficile diarrhea in a hospital in beijing, china.clostridium difficile is the most common cause of hospital-acquired diarrhea in patients treated with antibiotics, chemotherapeutic agents, and other drugs that alter the normal equilibrium of the intestinal flora. a better understanding of the risk factors for c. difficile-associated disease (cdad) could be used to reduce the incidence of cdad and the costs associated with its treatment. the aim of this study was to identify the risk factors for cdad in a cohort of chinese patients in a beijing ...201425387676
intestinal microbiota in health and disease: role of bifidobacteria in gut homeostasis.the pool of microbes inhabiting our body is known as "microbiota" and their collective genomes as "microbiome". the colon is the most densely populated organ in the human body, although other parts, such as the skin, vaginal mucosa, or respiratory tract, also harbour specific microbiota. this microbial community regulates some important metabolic and physiological functions of the host, and drives the maturation of the immune system in early life, contributing to its homeostasis during life. alt ...201425386066
toxin-mediated paracellular transport of antitoxin antibodies facilitates protection against clostridium difficile infection.the exotoxins tcda and tcdb are the major virulence factors of clostridium difficile. circulating neutralizing antitoxin antibodies are protective in c. difficile infection (cdi), as demonstrated, in part, by the protective effects of actoxumab and bezlotoxumab, which bind to and neutralize tcda and tcdb, respectively. the question of how systemic igg antibodies neutralize toxins in the gut lumen remains unresolved, although it has been suggested that the fc receptor fcrn may be involved in acti ...201525385797
infection: microbiota reconstitution for resistance to clostridium difficile infection--fight fire with fire? 201525385229
in vitro antibacterial activity of azd0914, a new spiropyrimidinetrione dna gyrase/topoisomerase inhibitor with potent activity against gram-positive, fastidious gram-negative, and atypical bacteria.azd0914 is a new spiropyrimidinetrione bacterial dna gyrase/topoisomerase inhibitor with potent in vitro antibacterial activity against key gram-positive (staphylococcus aureus, staphylococcus epidermidis, streptococcus pneumoniae, streptococcus pyogenes, and streptococcus agalactiae), fastidious gram-negative (haemophilus influenzae and neisseria gonorrhoeae), atypical (legionella pneumophila), and anaerobic (clostridium difficile) bacterial species, including isolates with known resistance to ...201425385112
clostridium difficile isolates with high linezolid mics harbor the multiresistance gene cfr.we studied the molecular mechanisms of linezolid resistance in 9 isolates of toxigenic clostridium difficile with high linezolid mics. the activity of linezolid was determined against 891 clinical isolates of toxigenic c. difficile. the mic50 and mic90 of linezolid were 0.75 μg/ml and 1.5 μg/ml, respectively. nine strains (1%) showed high linezolid mics (6 μg/ml to 16 μg/ml) and also were resistant to clindamycin, erythromycin, and chloramphenicol. these strains were selected for molecular studi ...201525385106
the complexity and diversity of the pathogenicity locus in clostridium difficile clade 5.the symptoms of clostridium difficile infection are caused by two closely related toxins, tcda and tcdb, which are encoded by the 19.6 kb pathogenicity locus (paloc). the paloc is variably present among strains, and in this respect it resembles a mobile genetic element. the c. difficile population structure consists mainly of five phylogenetic clades designated 1-5. certain genotypes of clade 5 are associated with recently emergent highly pathogenic strains causing human disease and animal infec ...201425381663
hyperimmune bovine colostrum as a novel therapy to combat clostridium difficile infection.clostridium difficile is a primary cause of antibiotic-associated diarrhea that typically develops when gut microbiota is altered. conventional treatment for c. difficile infection (cdi) is additional antimicrobial administration, which further disrupts normal intestinal microbiota, often resulting in poor treatment outcomes.201525381448
strategies to prevent clostridium difficile infections in acute care hospitals: 2014 update. 201425376069
metronidazole-induced encephalopathy in a patient with end-stage liver disease.purpose. metronidazole-induced encephalopathy (mie) has been rarely reported. we report a case in a patient with end-stage liver disease (esld). summary. a 63-year-old male with esld secondary to hepatitis c virus presented with progressively worsening fatigue, slurred speech, aphasia, vomiting, and left-sided facial droop after completing a 2-week course of metronidazole for recurrent clostridium difficile-associated diarrhea. he completed a previous course of metronidazole 3 weeks prior to pre ...201225374704
long-term clinical outcome of clostridium difficile infection in hospitalized patients: a single center study.antibiotic usage and increasingly aging populations have led to increased incidence of clostridium difficile infection (cdi) in worldwide. recent studies in korea have also reported increasing cdi incidence; however, there have been no reports on the long-term outcomes of cdi. we therefore investigated the long-term clinical outcomes of patients with cdi, including delayed recurrence, associated risk factors and mortality.201425374496
risk factors for delayed recurrence of clostridium difficile infection. 201425374490
icu-onset clostridium difficile infection in a university hospital in china: a prospective cohort study.a prospective study was conducted to investigate the incidence, clinical profiles and outcome of icu-onset cdi in a 50-bed medical icu at a university hospital in china. stools were collected from patients who developed icu-onset diarrhea and was screened for tcda (toxin a gene) and tcdb (toxin b gene) by pcr. cdi cases were compared with the icu-onset non-cdi diarrhea cases for demographics, comorbidities, potential risk factors, major laboratory findings and outcomes. stool samples from cdi ca ...201425372033
real-time microfluidic recombinase polymerase amplification for the toxin b gene of clostridium difficile on a slipchip platform.clostridium difficile is one of the key bacterial pathogens that cause infectious diarrhoea both in the developed and developing world. isothermal nucleic acid amplification methods are increasingly used for identification of toxinogenic infection by clinical labs. for this purpose, we developed a low-cost microfluidic platform based on the slipchip concept and implemented real-time isothermal recombinase polymerase amplification (rpa). the on-chip rpa assay targets the clostridium difficile tox ...201525371968
the role of local and systemic cytokines in patients infected with clostridium difficile.it is widely accepted that the pathogenesis of clostridium difficile infection (cdi) is multifactorial, dependent on pathogen virulence factors produced by the organism as well as disorders of the gastrointestinal tract, the alteration in intestinal flora and the immune response of the host. in particular, the immune response in the course of cdi and the involvement of cytokines in the pathogenesis of cdi is not fully understood. the aim of our study was to evaluate the relationship between proi ...201425371529
diagnostic yields in solid organ transplant recipients admitted with diarrhea.although diarrhea is a frequent complaint among solid organ transplant recipients, the contribution of infectious etiologies remains incompletely defined. we sought to define the etiologies of diarrhea and the yields of testing at our institution.201425371488
jama patient page. clostridium difficile infection. 201425369506
[sensory aphasia during therapy with metronidazole--an important differential diagnosis of acute cerebral ischemia].a 74-year old man was admitted after neurosurgical treatment of a lumbar vertebral fracture. he had a slight paresis of the right leg in combination with bladder dysfunction.201425369045
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