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the prevention and management of infections due to multidrug resistant organisms in haematology patients.infections due to resistant and multidrug resistant (mdr) organisms in haematology patients and haematopoietic stem cell transplant recipients are an increasingly complex problem of global concern. we outline the burden of illness and epidemiology of resistant organisms such as gram-negative pathogens, vancomycin-resistant enterococcus faecium (vre), and clostridium difficile in haematology cohorts. intervention strategies aimed at reducing the impact of these organisms are reviewed: infection p ...201524341410
an analysis of risk factors of clostridiumdifficile infection in patients hospitalized in the teaching hospital in 2008.the last decade saw an increase in the incidence of clostridium difficile infections.approximately 80% of these infections occur in hospitalized patients. there are ongoing studies on the increase in the incidence of infections with this microorganism.201324340558
inhaled colistin for treatment of pneumonia due to colistin-only-susceptible acinetobacter baumannii.colistin is used for the treatment of pneumonia associated with multidrug- resistant acinetobacter baumannii and pseudomonas aeruginosa. however, the best route of administration and dosage is not known. we report our experience with aerosolized colistin in twelve patients with pneumonia caused by colistin-only-susceptible (cos) a. baumannii.201324339296
postoperative clostridium difficile infection with pcr ribotype 078 strain identified at necropsy in five thoroughbred racehorses.clostridium difficile is an important cause of acute enterocolitis in horses. we describe five cases of c difficile infection occurring postoperatively in thoroughbred racehorses. following diarrhoea or colic accompanied by a marked increase in packed cell volume (to ≥60 per cent) and leucopenia (≤4000 cells/μl) within two to four days after surgery in all five horses, four of them died or were euthanased because of colitis or severe diarrhoea. in these four horses, necrotising entero-typhlo-col ...201324336792
evolutionary history of the clostridium difficile pathogenicity locus.the symptoms of clostridium difficile infection are caused by toxins expressed from its 19 kb pathogenicity locus (paloc). stable integration of the paloc is suggested by its single chromosomal location and the clade specificity of its different genetic variants. however, the paloc is variably present, even among closely related strains, and thus resembles a mobile genetic element. our aim was to explain these apparently conflicting observations by reconstructing the evolutionary history of the ...201424336451
microbial and metabolic interactions between the gastrointestinal tract and clostridium difficile infection.antibiotics disturb the gastrointestinal tract microbiota and in turn reduce colonization resistance against clostridium difficile. the mechanism for this loss of colonization resistance is still unknown but likely reflects structural (microbial) and functional (metabolic) changes to the gastrointestinal tract. members of the gut microbial community shape intestinal metabolism that provides nutrients and ultimately supports host immunity. this review will discuss how antibiotics alter the struct ...201324335555
analysis of the intestinal microbiome of a recovered clostridium difficile patient after fecal transplantation.clostridium difficile infections upon antibiotic disruption of the gut microbiota are potentially lethal. fecal microbiota transplantation (fmt) is a promising treatment option for recurrent c. difficile-associated disease (cdad). here, we present a patient with recurrent cdad that received fmt, leading to full recovery for what has now been 3 years. we performed metagenomic sequencing on stool samples to assess if there are indications for recolonization with c. difficile and changes in the gut ...201324335204
long term effect of infection control practices and associated factors during a major clostridium difficile outbreak in costa rica.the c. difficile bi/nap 1 hyper virulent strain has been responsible for the nosocomial outbreaks in several countries. the present study describes the infection control strategies utilized to achieve outbreak control as well as the factors associated with a c. difficile bi/nap 1 hyper virulent strain outbreak in costa rica.201324334937
identification of clostridium difficile ribotype 027 for the first time in mainland china. 201424334809
increased clostridium difficile recurrences following combined proton pump inhibitor-metronidazole therapy. 201424334808
active surveillance for carbapenem-resistant enterobacteriaceae using stool specimens submitted for testing for clostridium difficile.active surveillance to identify asymptomatic carriers of carbapenem-resistant enterobacteriaceae (cre) is a recommended strategy for cre control in healthcare facilities. active surveillance using stool specimens tested for clostridium difficile is a relatively low-cost strategy to detect cre carriers. further evaluation of this and other risk factor-based active surveillance strategies is warranted.201324334803
a mathematical model to evaluate the routine use of fecal microbiota transplantation to prevent incident and recurrent clostridium difficile infection.fecal microbiota transplantation (fmt) has been suggested as a new treatment to manage clostridium difficile infection (cdi). with use of a mathematical model of c. difficile within an intensive care unit (icu), we examined the potential impact of routine fmt.201424334794
healthcare workers' hands and clostridium difficile spores: making progress? 201424334793
contamination of healthcare workers' hands with clostridium difficile spores after caring for patients with c. difficile infection.we determined the percentage of healthcare workers' (hcws') hands contaminated with clostridium difficile spores after caring for patients with c. difficile infection (cdi) and risk factors associated with contamination.201424334792
quantifying sources of bias in national healthcare safety network laboratory-identified clostridium difficile infection rates.to assess the effect of multiple sources of bias on state- and hospital-specific national healthcare safety network (nhsn) laboratory-identified clostridium difficile infection (cdi) rates.201424334790
[clostridium difficile infection due to ribotype 027: description of an imported case in spain]. 201424332712
penicillin allergy as a public health measure. 201424332220
antimicrobial effects of virgin coconut oil and its medium-chain fatty acids on clostridium difficile.clostridium difficile is the leading cause of hospital-acquired antibiotic-associated diarrhea worldwide; in addition, the proliferation of antibiotic-resistant c. difficile is becoming a significant problem. virgin coconut oil (vco) has been shown previously to have the antimicrobial activity. this study evaluates the lipid components of vco for the control of c. difficile. vco and its most active individual fatty acids were tested to evaluate their antimicrobial effect on c. difficile in vitro ...201324328700
how enteric pathogens know they hit the sweet spot.ng km, ferreyra ja, higginbottom sk et al. microbiota-liberated host sugars facilitate post-antibiotic expansion of enteric pathogens. nature 502(7469), 96-99 (2013). the human gut microbiota is a complex system of commensal microorganisms required for normal host physiology. disruption of this protective barrier by antibiotics creates opportunities for enteric pathogens to establish infections. although the correlation between the use of antibiotics and enteric infections have been known for so ...201424328376
could fecal microbiota transplantation cure all clostridium difficile infections? 201424328373
medication risk factors associated with healthcare-associated clostridium difficile infection: a multilevel model case-control study among 64 us academic medical centres.the main objective of this study was to determine patient- and hospital-level medication risk factors associated with clostridium difficile infection (cdi) occurrence among patients clustered within hospitals using a multilevel model.201424327619
antibiotics and hospital-acquired clostridium difficile infection: update of systematic review and meta-analysis.to update the evidence for associations between antibiotic classes and hospital-acquired clostridium difficile infection (ha-cdi).201424324224
severe mucositis and clostridium difficile infection in adult autologous stem cell recipients: another question of the chicken or the egg? 201424321748
comparison of antimicrobial susceptibility among clostridium difficile isolated from an integrated human and swine population in texas.clostridium difficile can be a major problem in hospitals because the bacterium primarily affects individuals with an altered intestinal flora; this largely occurs through prolonged antibiotic use. proposed sources of increased community-acquired infections are food animals and retail meats. the objective of this study was to compare the antimicrobial resistance patterns of c. difficile isolated from a closed, integrated population of humans and swine to increase understanding of the bacterium i ...201424320797
development of a novel method for detection of clostridium difficile using hs-spme-gc-ms.a novel method has been developed that allows successful differentiation between clostridium difficile culture-positive and culture-negative stool samples based on volatile organic compound (voc) evolution and detection by headspace solid-phase microextraction coupled with gas chromatography mass spectrometry (hs-spme-gc-ms).201424320174
histological damage of colonic epithelium is associated with clinical severity and outcome in colectomized critically ill patients.severe intestinal mucosal damage and organ failure has been associated in experimental models. our purpose was to determine whether there is any association between histopathological findings and postoperative mortality among icu patients undergoing emergency colectomies for various illnesses.201424318408
carriage of clostridium difficile by wild urban norway rats (rattus norvegicus) and black rats (rattus rattus).clostridium difficile is an important cause of enteric infections in humans. recently, concerns have been raised regarding whether animals could be a source of c. difficile spores. although colonization has been identified in a number of domestic species, the ability of commensal pests to serve as a reservoir for c. difficile has not been well investigated. the objective of this study was to determine whether urban rats (rattus spp.) from vancouver, canada, carry c. difficile. clostridium diffic ...201424317079
closure of a broncho-pleural fistula using an atrial septal defect occluder.broncho-pleural fistulae (bpf) are recognised as a rare complication following pneumonectomy. we describe a patient, who after failing conservative treatment, underwent closure of a persistent fistula with an atrial septal defect (asd) occluder. additionally we review the literature regarding management of bpf and the emerging role of cardiac defect closure devices as a possible treatment option.201424315634
structural basis for antibody recognition in the receptor-binding domains of toxins a and b from clostridium difficile.clostridium difficile infection is a serious and highly prevalent nosocomial disease in which the two large, rho-glucosylating toxins tcda and tcdb are the main virulence factors. we report for the first time crystal structures revealing how neutralizing and non-neutralizing single-domain antibodies (sdabs) recognize the receptor-binding domains (rbds) of tcda and tcdb. surprisingly, the complexes formed by two neutralizing antibodies recognizing tcda do not show direct interference with the pre ...201424311789
prevention and treatment of diarrhoea with saccharomyces boulardii in children with acute lower respiratory tract infections.the aim of this study was to determine whether saccharomyces boulardii prevents and treats diarrhoea and antibiotic-associated diarrhoea (aad) in children. a total of 333 hospitalised children with acute lower respiratory tract infection were enrolled in a 2-phase open randomised controlled trial. during the 1st phase, all children received intravenous antibiotics (ab). they were randomly allocated to group a (s. boulardii 500 mg/day + ab, n=167) or group b (ab alone, n=166) and followed for 2 w ...201324311316
proton pump inhibitor therapy and potential long-term harm.this review summarizes the recent literature on the potential side-effects of proton pump inhibitors (ppis) and known interactions with the metabolism/absorption of other drugs.201424310148
a high-dose preparation of lactobacilli and bifidobacteria in the prevention of antibiotic-associated and clostridium difficile diarrhoea in older people admitted to hospital: a multicentre, randomised, double-blind, placebo-controlled, parallel arm trial (placide).antibiotic-associated diarrhoea (aad) occurs most commonly in older people admitted to hospital and within 12 weeks of exposure to broad-spectrum antibiotics. although usually a mild and self-limiting illness, the 15-39% of cases caused by clostridium difficile infection [c. difficile diarrhoea (cdd)] may result in severe diarrhoea and death. previous research has shown that probiotics, live microbial organisms that, when administered in adequate numbers, are beneficial to health, may be effecti ...201324309198
portrait toxigenic clostridium difficile assay, an isothermal amplification assay detects toxigenic c. difficile in clinical stool specimens.the portrait toxigenic clostridium difficile assay is a rapid, qualitative assay for the detection of the tcdb gene of c. difficile in stool specimens from patients suspected of c. difficile infections, and received 510(k) clearance by the us fda in march 2012. the portrait toxigenic c. difficile assay combines novel blocked-primer-mediated helicase-dependent multiplex amplification (bphda) technology and chip-based detection in an automated sample-to-result format. the assay requires minimal sa ...201424308336
[clostridium difficile infections, specific issues in the elderly].clostridium difficile is a well-established cause of infectious nosocomial diarrhea in adults. each time diarrhea is observed in a patient receiving antibiotic treatment, clostridium colitis should be suspected; diagnosis should be confirmed by the identification of toxin in the patient's stools. its incidence is increasing due to growing use of several classes of antibiotics, and is associated with a high relapse rate and a significant case-fatality rate. the elderly are particularly at risk fo ...201324308141
predictors of clostridium difficile infection severity in patients hospitalised in medical intensive care.to describe and analyse factors associated with clostridium difficile infection (cdi) severity in hospitalised medical intensive care unit patients.201324307797
microbiota dynamics in patients treated with fecal microbiota transplantation for recurrent clostridium difficile infection.clostridium difficile causes antibiotic-associated diarrhea and pseudomembraneous colitis and is responsible for a large and increasing fraction of hospital-acquired infections. fecal microbiota transplantation (fmt) is an alternate treatment option for recurrent c. difficile infection (rcdi) refractory to antibiotic therapy. it has recently been discussed favorably in the clinical and scientific communities and is receiving increasing public attention. however, short- and long-term health conse ...201324303043
identification of a novel zinc metalloprotease through a global analysis of clostridium difficile extracellular proteins.clostridium difficile is a major cause of infectious diarrhea worldwide. although the cell surface proteins are recognized to be important in clostridial pathogenesis, biological functions of only a few are known. also, apart from the toxins, proteins exported by c. difficile into the extracellular milieu have been poorly studied. in order to identify novel extracellular factors of c. difficile, we analyzed bacterial culture supernatants prepared from clinical isolates, 630 and r20291, using liq ...201324303041
immunization using groel decreases clostridium difficile intestinal colonization.clostridium difficile is a pathogen which is responsible for diarrhea and colitis, particularly after treatment with antibiotics. clinical signs are mainly due to two toxins, tcda and tcdb. however, the first step of pathogenesis is the colonization process. we evaluated c. difficile surface proteins as vaccine antigens in the hamster model to prevent intestinal colonization. this vaccination induced a partial protection of hamsters against death after a c. difficile challenge. a proteomic analy ...201324303034
improved detection of gastrointestinal pathogens using generalised sample processing and amplification panels.we aimed to streamline the diagnosis of gastrointestinal disease by producing multiplexed real time polymerase chain reaction (pcr) panels employing universal sample processing for dna and rna containing pathogens. a total of 487 stored, previously characterised stool samples comprising bacterial, viral, protozoan and clostridium difficile positive samples were tested using four multiplexed real time pcr panels. a further 81 pre-selected clinical samples from a teaching hospital were included to ...201424300711
cost-effectiveness of fidaxomicin for clostridium difficile treatment. 201424300043
[recurrent clostridium difficile infections: the importance of the intestinal microbiota].clostridium difficile infections (cdi) represent 20-30% of diarrhea caused by antibiotics and relapse in more than 25% of cases after treatment with metronidazole or vancomycin. given the high prevalence of cdi and the significant rate of recurrence despite successful initial treatment, cdi therapy represents a real challenge. a better understanding of the intestinal microbiota and its role in cdi opens the way to promising new therapeutic approaches, such as fecal transplantation. the studies p ...201324298714
proton pump inhibitors: clostridium difficile infections.data on the adverse effect profile of proton pump inhibitors continue to accumulate. in addition to increasing the risk of bacterial pneumonia, proton pump inhibitors appear to increase the risk of intestinal clostridium difficile infection. a meta-analysis of epidemiological studies showed a statistically significant increase in c. difficile infection among patients taking proton pump inhibitors, most of whom were hospital patients.the estimated relative risk was 1.7 for primary infections (95% ...201324298587
a rare case intractable diarrhea secondary to clostridium difficile and cytomegalovirus coinfection.male, 63 final diagnosis: cytomegalo virus (cmv) infection symptoms: diarrhea medication:- clinical procedure:- specialty: infectious diseases.201324298304
faecal microbiota transplantation in 2013: developing human gut microbiota as a class of therapeutics.although the idea of faecal transplantation dates back many decades, only with advances in scientific technologies can we begin systematic development of this new class of therapeutics. the primary focus remains on treatment of clostridium difficile infection—new applications are beginning to emerge, but a long journey remains ahead.201424296579
variations in virulence and molecular biology among emerging strains of clostridium difficile.clostridium difficile is a gram-positive, spore-forming organism which infects and colonizes the large intestine, produces potent toxins, triggers inflammation, and causes significant systemic complications. treating c. difficile infection (cdi) has always been difficult, because the disease is both caused and resolved by antibiotic treatment. for three and a half decades, c. difficile has presented a treatment challenge to clinicians, and the situation took a turn for the worse about 10 years a ...201324296572
surgical management of clostridium difficile colitis.clostridium difficile infection (cdi) will progress to fulminant disease in 3 to 5% of cases. with the emergence of hypervirulent, multidrug-resistant strains, the incidence and severity of disease are continuing to rise. prompt identification, early resuscitation, and treatment are critical in preventing morbidity and mortality in this increasingly common condition. discontinuation of antibiotics and treatment with oral vancomycin and intravenous or oral metronidazole are first-line treatments, ...201224294121
probiotics reduce symptoms of antibiotic use in a hospital setting: a randomized dose response study.probiotics are known to reduce antibiotic associated diarrhea (aad) and clostridium difficile associated diarrhea (cdad) risk in a strain-specific manner. the aim of this study was to determine the dose-response effect of a four strain probiotic combination (howaru(®) restore) on the incidence of aad and cdad and severity of gastrointestinal symptoms in adult in-patients requiring antibiotic therapy. patients (n=503) were randomized among three study groups: howaru(®) restore probiotic 1.70×10(1 ...201424291194
the emergence of community-onset clostridium difficile infection in a tertiary hospital in singapore: a cause for concern.increasing rates of clostridium difficile infection (cdi) among those without traditional risk factors have been reported mainly in europe and north america. here we describe the epidemiology, clinical features and ribotypes of cdi at national university hospital (nuh), a 1000-bed tertiary care hospital in singapore, from december 2011 to may 2012. all laboratory-confirmed cdi cases ≥21 years old who gave informed consent were included. clinical data were collected prospectively and participants ...201424290727
the prolongation of length of stay because of clostridium difficile infection.clostridium difficile infection (cdi) possibly extends hospital length of stay (los); however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. the aim of this study was to determine whether cdi increases los after managing this bias.201424290226
to the editor: molecular epidemiology of toxigenic clostridium difficile isolates in korea. 201424290036
bioavailability of the anti-clostridial bacteriocin thuricin cd in gastrointestinal tract.thuricin cd is a two component narrow spectrum bacteriocin comprising two peptides with targeted activity against clostridium difficile. this study examined the bioavailability of thuricin with a view to developing it as an effective antimicrobial against intestinal infection. one of the peptides, trn-β, was found to be degraded by the gastric enzymes pepsin and α-chymotrypsin both in vitro and in vivo, whereas trn-α was resistant to digestion by these enzymes and hence was detected in the intes ...201424287693
spread of epidemic clostridium difficile nap1/027 in latin america: case reports in panama.the rate and severity of clostridium difficile infection (cdi) have been linked to the emergence and spread of the hypervirulent toxigenic strain nap1/027. this strain has been responsible for large outbreaks in healthcare facilities in north america and europe and most recently in latin america. this is the first report of the nap1 strain in panama. it suggests that the spread of c. difficile nap1 throughout latin america could be a possibility as evidenced in the following case reports. five i ...201424287669
aptamer biosensor for sensitive detection of toxin a of clostridium difficile using gold nanoparticles synthesized by bacillus stearothermophilus.a sensitive electrochemical biosensor was developed to detect toxin a (toa) of clostridium difficile based on an aptamer selected by the systematic evolution of ligands using exponential enrichment and gold nanoparticles (gnps) synthesized by bacillus stearothermophilus. the thiolated single-stranded dna used as the capture probe (cp) was first self-assembled on a nafion-thionine-gnps-modified screen-printed electrode (spe) through an au-thiol interaction. the horseradish peroxidase (hrp)-labele ...201424287407
patients with cystic fibrosis have a high carriage rate of non-toxigenic clostridium difficile.thirty-year-old observations report frequent asymptomatic clostridium difficile carriage among cystic fibrosis (cf) patients. in this case-control study, we found more carriers among cf patients than controls (47% versus 11%), but most strains carried by cf patients were non-toxigenic (77% versus 17%). among cf patients, carriers were younger, with more severe pulmonary disease than non-carriers. strains belonged to multiple pcr-ribotypes, suggesting that these cf patients did not acquire strain ...201424286342
environmental contaminants in hospital settings and progress in disinfecting techniques.medical devices, such as stethoscopes, and other objects found in hospital, such as computer keyboards and telephone handsets, may be reservoirs of bacteria for healthcare-associated infections. in this cross-over study involving an italian teaching hospital we evaluated microbial contamination (total bacterial count (tbc) at 36°c/22°c, staphylococcus spp., moulds, enterococcus spp., pseudomonas spp., e. coli, total coliform bacteria, acinetobacter spp., and clostridium difficile) of these devic ...201324286078
the changing epidemiology of clostridium difficile infection.clostridium difficile infection (cdi) is a growing concern and has a substantial impact on morbidity and mortality. epidemiology of cdi has dramatically changed over the last decade. diagnostic and treatment strategies are even more complicated given the wide variety of available diagnostic methods and the emergence of refractory or recurrent cdi. this review is intended to provide information on current cdi epidemiology and guidance for evidence-based diagnosis and management strategies.201424285002
microbiota transplantation restores normal fecal bile acid composition in recurrent clostridium difficile infection.fecal microbiota transplantation (fmt) has emerged as a highly effective therapy for refractory, recurrent clostridium difficile infection (cdi), which develops following antibiotic treatments. intestinal microbiota play a critical role in the metabolism of bile acids in the colon, which in turn have major effects on the lifecycle of c. difficile bacteria. we hypothesized that fecal bile acid composition is altered in patients with recurrent cdi and that fmt results in its normalization. general ...201424284963
cags clinical practice committee report: the science of clostridium difficile and surgery. 201324284142
risk factors of mild rectal bleeding in very low birth weight infants: a case control study.mild rectal bleeding (mrb) is a particular clinical entity different from necrotizing enterocolitis, which significantly influences neonatal care in preterm infants. we aimed to determine the risk factors and to evaluate prospectively the clinical course of mrb.201324283213
clostridium difficile and inflammatory bowel disease: role in pathogenesis and implications in treatment.clostridium difficile (c. difficile) is the leading cause of antibiotic associated colitis and nosocomial diarrhea. patients with inflammatory bowel disease (ibd) are at increased risk of developing c. difficile infection (cdi), have worse outcomes of cdi-including higher rates of colectomy and death, and experience higher rates of recurrence. however, it is still not clear whether c. difficile is a cause of ibd or a consequence of the inflammatory state in the intestinal environment. the burden ...201324282348
[new treatment options for infections with clostridium difficile].currently available broad spectrum antibiotics are not sufficiently effective against recurrent clostridium difficile infections (cdi). donor faecal microbiota transplantation is a very effective treatment for second and recurrent infection but is time-consuming and requires careful screening of donors. the new narrow spectrum antibiotic fidaxomicin is a good alternative in a first cdi or a first recurrence, but treatment is expensive and there are no data on its effectiveness in a second or lat ...201324279951
more on antidepressant drugs and infectious disease.three observational studies have suggested that depression and/or antidepressant drug use is associated with an increased risk of developing clostridium difficile (c. difficile) infection (cdi), which is a clinically significant cause of diarrhea typically associated with the use of antibiotic drugs. establishing causality from observed associations requires evidence from a variety of different scientific perspectives. the authors of these studies do not consider the complex relationship among d ...201324278963
in vitro evaluation of antimicrobial activity of lactic acid bacteria against clostridium difficile.clostridium difficile infection (cdi) has become a significant threat to public health. although broad-spectrum antibiotic therapy is the primary treatment option for cdi, its use has evident limitations. probiotics have been proved to be effective in the treatment of cdi and are a promising therapeutic option for cdi. in this study, 4 strains of lactic acid bacteria (lab), namely, lactobacillus rhamnosus (lr5), lactococcuslactis (sl3), bifidobacterium breve (br3), and bifidobacterium lactis (bl ...201324278635
the p2y6 receptor mediates clostridium difficile toxin-induced cxcl8/il-8 production and intestinal epithelial barrier dysfunction.c. difficile is a gram-positive spore-forming anaerobic bacterium that is the leading cause of nosocomial diarrhea in the developed world. the pathogenesis of c. difficile infections (cdi) is driven by toxin a (tcda) and toxin b (tcdb), secreted factors that trigger the release of inflammatory mediators and contribute to disruption of the intestinal epithelial barrier. neutrophils play a key role in the inflammatory response and the induction of pseudomembranous colitis in cdi. tcda and tcdb alt ...201324278446
a simulation-based assessment of strategies to control clostridium difficile transmission and infection.clostridium difficile is one of the most common and important nosocomial pathogens, causing severe gastrointestinal disease in hospitalized patients. although "bundled" interventions have been proposed and promoted, optimal control strategies remain unknown.201324278304
investigations of the mode of action and resistance development of cadazolid, a new antibiotic for treatment of clostridium difficile infections.cadazolid is a new oxazolidinone-type antibiotic currently in clinical development for the treatment of clostridium difficile-associated diarrhea. here, we report investigations on the mode of action and the propensity for spontaneous resistance development in c. difficile strains. macromolecular labeling experiments indicated that cadazolid acts as a potent inhibitor of protein synthesis, while inhibition of dna synthesis was also observed, albeit only at substantially higher concentrations of ...201424277035
in vitro and in vivo antibacterial evaluation of cadazolid, a new antibiotic for treatment of clostridium difficile infections.clostridium difficile is a leading cause of health care-associated diarrhea with significant morbidity and mortality, and new options for the treatment of c. difficile-associated diarrhea (cdad) are needed. cadazolid is a new oxazolidinone-type antibiotic that is currently in clinical development for treatment of cdad. here, we report the in vitro and in vivo antibacterial evaluation of cadazolid against c. difficile. cadazolid showed potent in vitro activity against c. difficile with a mic rang ...201424277020
probing the metal specificity mechanism of superoxide dismutase from human pathogen clostridium difficile.the molecular mechanism of the metal specificity to superoxide dismutase from human pathogen c. difficile (sodcd) was investigated by x-ray crystallography, spectroscopy, sod activity assay, electrochemistry, and dft calculations, and the results indicate that the cognate metal characters tuned by the metal micro-environment dominate the metal specificity of the sodcd.201424275896
emerging infectious colitis.the present review will highlight recent advances in the knowledge of emerging pathogens causing infectious colitis and provide a description of the most important food-borne outbreaks.201424275672
fecal microbiota transplantation for clostridium difficile infection: benefits and barriers.the incidence and severity of clostridium difficile infection (cdi) have increased worldwide in the past two decades. a principal function of the gut microbiota is to protect the intestine against colonization by exogenous pathogens. increasingly, the gut microbiota have been shown to influence susceptibility to other genetic and environmentally acquired conditions. transplantation of healthy donor fecal material in patients with cdi may re-establish the normal composition of the gut microbiota ...201424275671
multiplex molecular testing for management of infectious gastroenteritis in a hospital setting: a comparative diagnostic and clinical utility study.laboratory diagnosis and clinical management of inpatients with diarrhoea is complex and time consuming. tests are often requested sequentially and undertaken in different laboratories. this causes prolonged unnecessary presumptive isolation of patients, because most cases are non-infectious. a molecular multiplex test (luminex(®) gastrointestinal pathogen panel (gpp)) was compared with conventional testing over 8 months to determine diagnostic accuracy, turnaround times, laboratory costs, use o ...201424274687
identification of clostridium difficile: evaluation of genotypic, phenotypic and proteomic methods. 201324273901
investigating clostridium difficile. 201324273764
clostridium difficile toxins facilitate bacterial colonization by modulating the fence and gate function of colonic epithelium.the contribution of clostridium difficile toxin a and b (tcda and tcdb) to cellular intoxication has been studied extensively, but their impact on bacterial colonization remains unclear. by setting up 2- and 3-dimensional in vitro models of polarized gut epithelium, we investigated how c. difficile infection is affected by host cell polarity and whether tcda and tcdb contribute to such events. indeed, we observed that c. difficile adhesion and penetration of the mucosal barrier are substantially ...201424273043
use of proton pump inhibitors for the provision of stress ulcer prophylaxis: clinical and economic consequences.the provision of stress ulcer prophylaxis (sup) for the prevention of clinically significant bleeding is widely recognized as a crucial component of care in critically ill patients. nevertheless, sup is often provided to non-critically ill patients despite a risk for clinically significant bleeding of roughly 0.1 %. the overuse of sup therefore introduces added risks for adverse drug events and cost, with minimal expected benefit in clinical outcome. historically, histamine-2-receptor antagonist ...201424271943
characterization of the collagen-like exosporium protein, bcla1, of clostridium difficile spores.spores of clostridium difficile are essential for infection, persistence and transmission of c. difficile infections (cdi). proteins of the surface of c. difficile spores are thought to be essential for initiation and persistence of cdi. in this work, we demonstrate that three c. difficile collagen-like exosporium proteins (bcla) encoded in the c. difficile 630 genome are expressed during sporulation and localize to the spore via their n-terminal domains. using polyclonal antibodies against the ...201424269655
clostridium difficile infection in the elderly.clostridium difficile-associated illness is an increasingly prevalent and morbid condition. the elderly population is at a disproportionate risk of developing symptomatic disease and associated complications, including progression to severe or fulminant disease, and development of recurrent infections. this article analyzes the factors that influence c difficile disease propensity and severity, with particular attention directed toward features relevant to the rapidly aging population.201424267604
acute inflammatory surgical disease.infectious and inflammatory diseases comprise some of the most common gastrointestinal disorders resulting in hospitalization in the united states. accordingly, they occupy a significant proportion of the workload of the acute care surgeon. this article discusses the diagnosis, management, and treatment of appendicitis, acute cholecystitis/cholangitis, acute pancreatitis, diverticulitis, and clostridium difficile colitis.201424267493
diagnosis of clostridium difficile infection: the molecular approach.diagnosis of clostridium difficile infection is based on clinical presentation and laboratory tests. although numerous laboratory methods are now available, the diagnosis of c. difficile infection remains challenging. nucleic acid amplification tests (naats) are the most recent marketed methods. these methods detect genes for toxins a and/or b. they are very sensitive compared with the reference method (toxigenic culture) and are thus very promising, despite their cost. however, a positive naat ...201324266358
clinical and microbiologic characteristics of clostridium difficile infection caused by binary toxin producing strain in korea.binary toxin-producing clostridium difficile infections (cdi) are known to be more severe and to cause higher case fatality rates than those by binary toxin-negative isolates. there has been few data of binary toxin-producing cdi in korea. objective of the study is to characterize clinical and microbiological trait of cdi cause by binary-toxin producing isolates in korea.201324265965
asymptomatic clostridium difficile colonisation and onward transmission.combined genotyping/whole genome sequencing and epidemiological data suggest that in endemic settings only a minority of clostridium difficile infection, cdi, is acquired from other cases. asymptomatic patients are a potential source for many unexplained cases.201324265690
surface-layer protein a (slpa) is a major contributor to host-cell adherence of clostridium difficile.clostridium difficile is a leading cause of antibiotic-associated diarrhea, and a significant etiologic agent of healthcare-associated infections. the mechanisms of attachment and host colonization of c. difficile are not well defined. we hypothesize that non-toxin bacterial factors, especially those facilitating the interaction of c. difficile with the host gut, contribute to the initiation of c. difficile infection. in this work, we optimized a completely anaerobic, quantitative, epithelial-ce ...201324265687
pseudomembranous colitis associated with a triple therapy for helicobacter pylori eradication.helicobacter pylori (h. pylori) is one of the most common chronic bacterial infections in humans, affecting half of world's population. therapy for h. pylori infection has proven to be both effective and safe. the one-week triple therapy including proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate h. pylori infection in countries with low clarithromycin resistance. generally, this therapy is well-tolerated, with onl ...201324259981
mortality following rasburicase-induced methemoglobinemia.to report a case of mortality following rasburicase-induced methemoglobinemia.201324259700
therapeutic faecal microbiota transplantation: current status and future developments.faecal microbiota transplantation (fmt) has undergone dramatic progression over the past year and continues to evolve as knowledge of the gastrointestinal microbiota (gimb) develops. this review summarizes therapeutic advances in fmt, latest fmt therapies and presents the potential of fmt therapeutics in other gastrointestinal and extra-intestinal conditions.201424257037
gastrointestinal infections after transplantation.recipients of both solid organ transplant and hematopoietic stem cell transplantation are at increased risk for infectious morbidity and mortality after transplantation due to on-going immunosuppression. gastrointestinal infections have been increasingly reported in these populations.201424257036
phage ϕc2 mediates transduction of tn6215, encoding erythromycin resistance, between clostridium difficile strains.in this work, we show that clostridium difficile phage ϕc2 transduces erm(b), which confers erythromycin resistance, from a donor to a recipient strain at a frequency of 10(-6) per pfu. the transductants were lysogenic for ϕc2 and contained the erm(b) gene in a novel transposon, tn6215. this element is 13,008 bp in length and contains 17 putative open reading frames (orfs). it could also be transferred at a lower frequency by filter mating.201324255122
clostridium difficile binary toxin cdt: mechanism, epidemiology, and potential clinical importance.binary toxin (cdt) is frequently observed in clostridium difficile strains associated with increased severity of c. difficile infection (cdi). cdt belongs to the family of binary adp-ribosylating toxins consisting of two separate toxin components: cdta, the enzymatic adp-ribosyltransferase which modifies actin, and cdtb which binds to host cells and translocates cdta into the cytosol. cdtb is activated by serine proteases and binds to lipolysis stimulated lipoprotein receptor. adp-ribosylation i ...201524253566
[severe colitis due to community-acquired ribotype 027 clostridium difficile]. 201424252599
comparative in vitro activities of smt19969, a new antimicrobial agent, against 162 strains from 35 less frequently recovered intestinal clostridium species: implications for clostridium difficile recurrence.we determined the comparative activity of smt19969 (smt) against 162 strains representing 35 well-characterized clostridium species in clusters i to xix and 13 clostridium species that had no 16s rrna match. smt mics ranged from 0.06 to >512 μg/ml and were not species related. smt might have less impact on normal gut microbiota than other clostridium difficile infection (cdi) antimicrobials.201424247123
prospects and challenges for intestinal microbiome therapy in pediatric gastrointestinal disorders.fecal microbiome (microbiota) transplantation is an emerging treatment not only for refractory/recurrent clostridium difficile infections and chronic gastrointestinal diseases, but also for metabolic syndrome, and even possibly for neurological disorders. this non-conventional therapy has been perhaps more appropriately designated as fecal bacteriotherapy (fb) as well. the employment of fb is spreading into pediatric gastroenterology. this focused review highlights the pediatric applications of ...201324244876
bile salt inhibition of host cell damage by clostridium difficile toxins.virulent clostridium difficile strains produce toxin a and/or toxin b that are the etiological agents of diarrhea and pseudomembranous colitis. treatment of c. difficile infections (cdi) has been hampered by resistance to multiple antibiotics, sporulation, emergence of strains with increased virulence, recurrence of the infection, and the lack of drugs that preserve or restore the colonic bacterial flora. as a result, there is new interest in non-antibiotic cdi treatments. the human conjugated b ...201324244530
differential stress transcriptome landscape of historic and recently emerged hypervirulent strains of clostridium difficile strains determined using rna-seq.c. difficile is the most common cause of nosocomial diarrhea in north america and europe. genomes of individual strains of c. difficile are highly divergent. to determine how divergent strains respond to environmental changes, the transcriptomes of two historic and two recently isolated hypervirulent strains were analyzed following nutrient shift and osmotic shock. illumina based rna-seq was used to sequence these transcriptomes. our results reveal that although c. difficile strains contain a la ...201324244315
fecal microbiota transplantation: facts and controversies.to review the current evidence on fecal microbiota transplantations (fmts) for recurrent clostridium difficile infections (cdis), metabolic syndrome and inflammatory bowel disease.201424241245
progress in the discovery of treatments for c. difficile infection: a clinical and medicinal chemistry review.clostridium difficile is an anaerobic, gram-positive pathogen that causes c. difficile infection, which results in significant morbidity and mortality. the incidence of c. difficile infection in developed countries has become increasingly high due to the emergence of newer epidemic strains, a growing elderly population, extensive use of broad spectrum antibiotics, and limited therapies for this diarrheal disease. because treatment options currently available for c. difficile infection have some ...201424236721
discrepancies among three laboratory methods for clostridium difficile detection and a proposal for their optimal use.clostridium difficile is the major cause of nosocomial diarrhoea. several detection methods are available for the laboratory diagnosis of c. difficile, but these vary in terms of sensitivity and specificity. in this study, we compared the performance of three following laboratory tests to detect c. difficile: in-house real-time pcr aiming for toxin b gene (tcdb), eia for detection of toxins a and b (premier toxins a & b) and c. difficile culture in selective medium (biomerieux). our results were ...201424236508
spo0a differentially regulates toxin production in evolutionarily diverse strains of clostridium difficile.clostridium difficile is an important pathogen of humans and animals, representing a significant global healthcare problem. the last decade has seen the emergence of epidemic bi/nap1/027 and ribotype 078 isolates, associated with the onset of more severe disease and higher rates of morbidity and mortality. however, little is known about these isolates at the molecular level, partly due to difficulties in the genetic manipulation of these strains. here we report the development of an optimised tn ...201324236153
all-cause mortality in hospitalized patients with infectious diarrhea: clostridium difficile versus other enteric pathogens in austria from 2008 to 2010.clostridium difficile infection is the leading cause of gastroenteritis-associated deaths in the industrialized world, followed by infection with norovirus.201624231157
role of lactobacillus in the prevention of clostridium difficile-associated diarrhea: a meta-analysis of randomized controlled trials.clostridium difficile-associated diarrhea (cdad) is a major public health problem because of significant morbidity and mortality, and many clinicians pay attention to lactobacillus as a potentially effective treatment. the purpose of this meta-analysis was to evaluate the efficacy of lactobacillus in the prevention of cdad.201324229690
comparison of simplexa universal direct pcr with cytotoxicity assay for diagnosis of clostridium difficile infection: performance, cost, and correlation with disease.simplexa clostridium difficile universal direct pcr, a real-time pcr assay for the detection of the c. difficile toxin b (tcdb) gene using the 3m integrated cycler, was compared with a two-step algorithm which includes the c. diff chek-60 glutamate dehydrogenase (gdh) antigen assay followed by cytotoxin neutralization. three hundred forty-two liquid or semisolid stools submitted for diagnostic c. difficile testing, 171 gdh antigen positive and 171 gdh antigen negative, were selected for the stud ...201424226924
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