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fidaxomicin: a minimally absorbed macrocyclic antibiotic for the treatment of clostridium difficile infections.fidaxomicin was approved for the treatment of clostridium difficile infections in 2011. it has a novel mechanism of action and narrow spectrum of activity that makes it unique among the currently used therapies for this disease. phase iii clinical studies demonstrated a benefit of fidaxomicin over vancomycin for the outcomes of recurrence and global cure or sustained clinical response. this observation was confirmed within specific populations, including those of older age, immunocompromised due ...201323977933
clostridium difficile infection caused by binary toxin-positive strains. 201323977836
current status of surgical treatment for fulminant clostridium difficile colitis.mortality rates attributable to fulminant clostridium difficile (c. difficile) colitis remain high and are reported to be 38%-80%. historically, the threshold for surgical intervention has been judged empirically because level i evidence to guide decision making is lacking. studies of the surgical management of c. difficile infection have been limited by small sample size and the lack of a standard definition of fulminancy. multiple small and medium-sized series have examined the surgical manage ...201323977418
[drug therapy of infectious diarrhea: part 1: acute diarrhea].diarrhea is one of the most commonly occurring diseases.201323974914
investigating the candidacy of a lipoteichoic acid-based glycoconjugate as a vaccine to combat clostridium difficile infection.a lipoteichoic acid has recently been shown to be conserved in the majority of strains from clostridium difficile and as such is being considered as a possible vaccine antigen. in this study we examine the candidacy of the conserved lipoteichoic acid by demonstrating that it is possible to elicit antibodies against c. difficile strains following immunisation of rabbits and mice with glycoconjugates elaborating the conserved lipoteichoic acid antigen. the present study describes a conjugation str ...201323974722
presence of clostridium difficile in pigs and cattle intestinal contents and carcass contamination at the slaughterhouse in belgium.the objective of this study was to evaluate the presence of clostridium difficile in intestinal and carcass samples collected from pigs and cattle at a single slaughterhouse. c. difficile was isolated in 1% and 9.9% of the pig and cattle intestinal contents and in 7.9% and 7% of cattle and pig carcass samples respectively. a total of 19 different pcr-ribotypes were identified, among them types 078 and 014. seven of 19 ribotypes correlated with the pcr-ribotypes involved in human c. difficile inf ...201323973837
[clostridium difficile infection: epidemiology, risk factors, pathogenesis, clinical features, diagnosis and therapy].clostridium difficile is a gram-positive, spore-forming anaerobic bacterium. c.difficile is the leading cause of antibiotic associated diarrhea and colitis. the clinical spectrum of c.difficile infection (cdi) is highly variable, ranging from mild diarrhea to severe forms of intestinal illness including toxic megacolon, ileus, bowel perforation, and pseudomembranous colitis. advanced age, long duration of hospitalization, and exposure to certain antimicrobial agents are the most common risk fact ...201323971935
fecal transplant for recurrent clostridium difficile infection.clostridium difficile infection (cdi) results in clinical manifestations ranging from mild diarrhea to life-threatening pseudomembranous colitis. infection is most often initiated by antimicrobial therapy which causes an imbalance in normal colonic microflora. the pathogenesis of c. difficile is predominantly controlled by the production of its two cytotoxins, a and b, which damage the intestinal mucosa. in recent years a nationwide increase in the rate of cdi has been noted as well as an increa ...201323967542
one-day point prevalence of emerging bacterial pathogens in a nationwide sample of 62 german hospitals in 2012 and comparison with the results of the one-day point prevalence of 2010.antibiotic resistance of bacterial pathogens is an emerging problem worldwide. to combat multidrug resistant organisms (mrdos) networks of care providers have been established in all states in germany. the hicare-network, a project to combat mrdos, founded by the federal ministry of education and research, has published data from 2010 of a voluntary, german-wide, multicenter point-prevalence survey in 2011 conducted in collaboration with the german society of hospital hygiene. the aim of the pre ...201323967398
correlation between clostridium difficile bacterial load, commercial real-time pcr cycle thresholds, and results of diagnostic tests based on enzyme immunoassay and cell culture cytotoxicity assay.the impact of clostridium difficile fecal loads on diagnostic test results is poorly understood, but it may have clinical importance. in this study, we investigated the relationship between c. difficile fecal load and the results of four assays: a glutamate dehydrogenase (gdh) enzyme immunoassay (eia), a toxin a/b antigen eia (toxab), a cell culture cytotoxicity assay (cca), and pcr targeting the tcdb gene. we also compared the pcr cycle threshold (ct) with the results of quantitative culture us ...201323966497
fecal microbiota transplantation and emerging treatments for clostridium difficile infection.due to the increased incidence and recurrence of clostridium difficile infection, health care providers are seeking new and alternative treatments to the standard antibiotic therapy. the objective of this article is to present a review on the background, microbiologic efficacy, clinical efficacy, and safety of fecal microbiota transplantation and to provide an overview of emerging treatment options currently under investigation. emerging treatment options discussed include the use of monoclonal ...201323966282
acute gastroenteritis.acute gastroenteritis is a common infectious disease syndrome, causing a combination of nausea, vomiting, diarrhea, and abdominal pain. there are more than 350 million cases of acute gastroenteritis in the united states annually and 48 million of these cases are caused by foodborne bacteria. traveler's diarrhea affects more than half of people traveling from developed countries to developing countries. in adult and pediatric patients, the prevalence of clostridium difficile is increasing. contac ...201323958366
asymptomatic carriage of toxigenic clostridium difficile by hospitalized patients.asymptomatic carriage of clostridium difficile is common in hospitals, but the risk for transmission by carriers is unclear. in this point prevalence culture survey of asymptomatic hospitalized patients, 18 of 149 (12%) were carriers of toxigenic c. difficile. by comparison with c. difficile infection (cdi) patients, the prevalence of skin and/or environmental contamination was significantly lower in asymptomatic carriers (3/18, 17% versus 5/6, 83%; p = 0.007), but carriers outnumbered cdi patie ...201323954113
clostridium difficile infection after lung transplantation: are we really doing everything possible? 201323953917
is clostridium difficile infection influenced by antimicrobial use density in wards?this study was performed to elucidate the relationship between antimicrobial use density (aud) and clostridium difficile infection (cdi) manifesting as antimicrobial-associated diarrhea (aad) in hospital wards during a 4-year period. case definition of cdi was an adult exhibiting aad with a daily stool frequency of three or more, arising at least 48 hours after ward admission, and fecal samples testing positive for toxin (a and/or b). metronidazole or vancomycin was orally administered as treatm ...201323951727
global analysis of the sporulation pathway of clostridium difficile.the gram-positive, spore-forming pathogen clostridium difficile is the leading definable cause of healthcare-associated diarrhea worldwide. c. difficile infections are difficult to treat because of their frequent recurrence, which can cause life-threatening complications such as pseudomembranous colitis. the spores of c. difficile are responsible for these high rates of recurrence, since they are the major transmissive form of the organism and resistant to antibiotics and many disinfectants. des ...201323950727
clostridium difficile--special collection. 201323950217
clostridium difficile exposure as an insidious source of infection in healthcare settings: an epidemiological model.clostridium difficile is the leading cause of infectious diarrhea in hospitalized patients. its epidemiology has shifted in recent years from almost exclusively infecting elderly patients in whom the gut microbiota has been disturbed by antimicrobials, to now also infecting individuals of all age groups with no recent antimicrobial use.201323947736
severe hemorrhagic colitis in a patient with chronic myeloid leukemia in the blastic phase after dasatinib use.dasatinib is a second-line tyrosine kinase inhibitor used in patients with imatinib resistant or intolerant chronic myeloid leukemia (cml) and philadelphia chromosome-positive acute leukemia. gastrointestinal bleeding may occur in up to 7% of patients using dasatinib, although, severe dasatinib-related acute colitis had rarely been reported. here, we present the case of a 36-year-old female who progressed to acute myeloid leukemia after fourteen months of receiving imatinib for cml in the chroni ...201323946889
probiotics for the treatment of clostridium difficile associated disease.the purpose of this review paper is to update the current and potential future role of probiotics for clostridium difficile-associated disease (cdad). included in this review, is an update on the testing of newer probiotics (e.g., bacillus coagulans gbi-30, 6086) in animal models of cdad. there is a focus on the modulation of signal transduction pathways (i.e., transcription factors like camp response element-binding, activator protein 1, and nuclear factor kappa b), as well as the inhibition of ...201323946887
antimicrobial stewardship and clostridium difficile-associated diarrhea.antimicrobial stewardship programs are essential to health care institutions to promote the appropriate use of antibiotics not only to decrease antimicrobial resistance but to prevent the spread and infection of clostridium difficile. clostridium difficile-associated diarrhea is increasing rapidly in the united states and is now considered a major public health problem that poses an immediate threat to the health of patients prescribed antibiotics, more so than antimicrobial resistance. clostrid ...201323946208
[severe eosinophilia in a patient with clostridium colitis and gastric cancer].a case of a 77-year-old male repeatedly hospitalized with the diagnosis of clostridium difficile colitis associated with eosinophilia is presented. the percentage and number of eosinophils achieved maximal values (54 %, 5.4 times 1.000.000.000/l) during repeated treatment with metronidazole. eosinophilia was accompanied by significant elevation of serum ige and presence of charcot-leyden crystals in stool. helminth infections and hemoblastosis were ruled out as the cause and a working diagnosis ...201323945831
evaluation of a new immunochromatography test for rapid and simultaneous detection of clostridium difficile antigen and toxins.clostridium difficile infection is considered the most common cause of nosocomial infectious diarrhea among adults in the developed world. it is responsible for virtually all cases of pseudomembranous colitis. the tox a/b enzyme immunoassay (eia) is the most widely used test for the detection of c. difficile toxins a and b. however, it is associated with poor sensitivity and an unacceptable high rate of false-negative results.201323943984
recurrent clostridium difficile infection. 201323943969
antimicrobial selection and its impact on the incidence of clostridium difficile-associated diarrhea.the study objective was to determine which antimicrobials place patients at a higher risk for clostridium difficile-associated diarrhea (cdad) and which interventions can reduce their risk. all patients with diarrhea and a positive toxin assay for clostridium difficile for 3 months were included in the study. patients were broken down into either community-acquired infection or health care-associated infection based on symptom onset, antibiotic usage prior to admission, and where the patient was ...201323940122
the role of vancomycin and metronidazole for the treatment of clostridium difficile-associated diarrhea.for the treatment of clostridium difficile-associated diarrhea (cdad), metronidazole and vancomycin remain the most commonly used agents. the major advantage of metronidazole is its low cost, while the advantage of oral vancomycin is a more favorable pharmacokinetic profile. the epidemiology and clinical severity of cdad have changed due to the emergence of a hypervirulent strain (bi/nap1/027). in 2010, the infectious diseases society of america/society for health care epidemiology of america ex ...201323940121
nontoxigenic clostridium difficile protects hamsters against challenge with historic and epidemic strains of toxigenic bi/nap1/027 c. difficile.nontoxigenic clostridium difficile (ntcd) has been shown to prevent fatal c. difficile infection in the hamster model when hamsters are challenged with standard toxigenic c. difficile strains. the purpose of this study was to determine if ntcd can prevent c. difficile infection in the hamster model when hamsters are challenged with restriction endonuclease analysis group bi c. difficile strains. groups of 10 hamsters were given oral clindamycin, followed on day 2 by 10(6) cfu of spores of ntcd s ...201323939887
depression and use of antidepressants is associated with increased risk of clostridium difficile infection. 201323939678
risk factors of fecal toxigenic or non-toxigenic clostridium difficile colonization: impact of toll-like receptor polymorphisms and prior antibiotic exposure.this study is to investigate the significance and risk factors of fecal toxigenic (tcdc) or non-toxigenic clostridium difficile colonization (ntcdc) among hospitalized patients.201323936050
clostridium difficile 027/bi/nap1 encodes a hypertoxic and antigenically variable form of tcdb.the clostridium difficile exotoxin, tcdb, which is a major virulence factor, varies between strains of this pathogen. herein, we show that tcdb from the epidemic bi/nap1/027 strain of c. difficile is more lethal, causes more extensive brain hemorrhage, and is antigenically variable from tcdb produced by previously studied strains of this pathogen (tcdb003). in mouse intoxication assays, tcdb from a ribotype 027 strain (tcdb027) was at least four fold more lethal than tcdb003. tcdb027 caused a pr ...201323935501
importance of toxin a, toxin b, and cdt in virulence of an epidemic clostridium difficile strain.clostridium difficile infection is the main cause of healthcare-acquired diarrhea in the developed world. in addition to the main virulence factors toxin a and b, epidemic, pcr ribotype 027 strains, such as r20291, produce a third toxin, cdt. to develop effective medical countermeasures, it is important to understand the importance of each toxin. accordingly, we created all possible combinations of isogenic toxin mutants of r20291 and assessed their virulence. we demonstrated that either toxin a ...201423935202
inappropriate use of antibiotics and clostridium difficile infection.we assessed appropriateness of preceding and concurrent antibiotics in 126 consecutive patients with hospital-associated clostridium difficile infection. in 93 (73.8%) episodes, at least 1 preceding course of antibiotics was inappropriate. we provided feedback on concurrent antibiotics on the day of diagnosis during the final 8 months: 17 of 74 (23.0%) patients were on inappropriate antibiotics. our recommendations were well received. reviewing c difficile-infected patients allowed for identific ...201323932828
lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and clostridium difficile diarrhoea in older inpatients (placide): a randomised, double-blind, placebo-controlled, multicentre trial.antibiotic-associated diarrhoea (aad) occurs most frequently in older (≥65 years) inpatients exposed to broad-spectrum antibiotics. when caused by clostridium difficile, aad can result in life-threatening illness. although underlying disease mechanisms are not well understood, microbial preparations have been assessed in the prevention of aad. however, studies have been mostly small single-centre trials with varying quality, providing insufficient data to reliably assess effectiveness. we aimed ...201323932219
advanced techniques for detection and identification of microbial agents of gastroenteritis.gastroenteritis persists as a worldwide problem, responsible for approximately 2 million deaths annually. traditional diagnostic methods used in the clinical microbiology laboratory include a myriad of tests, such as culture, microscopy, and immunodiagnostics, which can be labor intensive and suffer from long turnaround times and, in some cases, poor sensitivity. [corrected]. this article reviews recent advances in genomic and proteomic technologies that have been applied to the detection and id ...201323931837
impact of adding prophylactic probiotics to a bundle of standard preventative measures for clostridium difficile infections: enhanced and sustained decrease in the incidence and severity of infection at a community hospital.in 2003, hospitals in quebec, canada experienced an increase of nap1/027 clostridium difficile infections following antibiotic administration (cdiaa). at pierre-le gardeur hospital (plgh), the incidence increased from 10 to over 25 cases per 1000 patient admissions.201323931498
treatment of an initial infection with clostridium difficile in patients with inflammatory bowel disease.: although the incidence of clostridium difficile-associated diarrhea in the general population has increased dramatically over the past decade, an even greater rate of infection exists in patients with inflammatory bowel disease. susceptibility in this population is likely inherent to the pathophysiology and treatment of these diseases. c. difficile infection can cause serious complications and death. consequently, early diagnosis and initiation of effective antibacterial therapy is imperative. ...201323929262
healthcare-associated infections studies project: an american journal of infection control and national healthcare safety network data quality collaboration-labid clostridium difficile event 2013.this is the first in a series of case studies that will be published in american journal of infection control following the centers for disease control and prevention/national healthcare safety network (nhsn) surveillance definition update of 2013. these cases reflect some of the complex patient scenarios infection professionals encounter during daily surveillance of health care-associated infections using nhsn definitions. answers to the questions posed and immediate feedback in the form of ans ...201323928030
perils and pitfalls of long-term effects of proton pump inhibitors.this review summarizes the literature regarding long-term adverse effects of proton pump inhibitors (ppis). a pubmed search (1966 to february 2013) for english language studies was conducted using key terms ppi: omeprazole, esomeprazole, pantoprazole, lansoprazole, dexlansoprazole, rabeprazole, pneumonia, clostridium difficile, osteoporosis, risk of fractures, thrombocytopenia, rhabdomyolysis, anemia, iron deficiency, hypomagnesemia, vitamin b₁₂ and nephritis. the risk of pneumonia was increased ...201323927671
clostridium difficile pcr ribotype 046 is common among neonatal pigs and humans in sweden.clostridium difficile pcr ribotype 046 was found in 67% of neonatal piglets (45/67) sampled from three separate pig-breeding farms in sweden. sows from the same farms were tested and 50% were colonized in faeces and 30% were colonized on skin. an environmental source was suggested because identical pcr ribotypes were isolated from faeces as well as externally. human c. difficile infection outbreaks in southern sweden by the identical pcr ribotype 046 indicate its zoonotic potential.201423927574
comparison of perirectal versus rectal swabs for detection of asymptomatic carriers of toxigenic clostridium difficile.for long-term care and spinal cord injury patients, the sensitivity, specificity, and positive and negative predictive values of perirectal versus rectal cultures for detection of asymptomatic carriers of clostridium difficile were 95%, 100%, 100%, and 97%, respectively. perirectal cultures provide an accurate method to detect asymptomatic carriers of c. difficile.201323926162
fecal transplantation for the treatment of recurrent clostridium difficile infection.clostridium difficile infection (cdi) is currently a leading cause of antibiotic and health care-related diarrhea. the incidence and the severity of cdi-related diarrhea have increased dramatically in the usa and europe in the past few decades. the emergence of multidrug-resistant hypervirulent strains of c. difficile has led to an increase in mortality. fecal microbiota transplantation (fmt) (also known as fecal bacteriotherapy) has been utilized sporadically since the 1950s; and currently, the ...201323923106
clostridium difficile modulates host innate immunity via toxin-independent and dependent mechanism(s).clostridium difficile infection (cdi) is the leading cause of hospital and community-acquired antibiotic-associated diarrhoea and currently represents a significant health burden. although the role and contribution of c. difficile toxins to disease pathogenesis is being increasingly understood, at present other facets of c. difficile-host interactions, in particular, bacterial-driven effects on host immunity remain less studied. using an ex-vivo model of infection, we report that the human gastr ...201323922820
stool therapy may become a preferred treatment of recurrent clostridium difficile?fecal enemas were first reported to successfully treat life threatening enterocolitis in 1958, but fecal therapy to treat clostridium difficile (c. difficile) infection has remained esoteric and not well investigated until recently. in the past few years, systematic reviews of case series and case reports of fecal microbiota transplant for recurrent c. difficile infection have become available and validate use of fecal transplant for c. difficile enterocolitis. methods of fecal transplant report ...201323922461
antidepressant drugs and infectious disease.clostridium difficile (c.difficile) infection (cdi) is a common and clinically significant cause of diarrhea associated with the use of antibiotic drugs. two observational studies have suggested that antidepressant drug use is associated with an increased risk of developing cdi. because of the potential public health significance of this finding, this article critically evaluates the methodology of these studies and provides evidence to question the plausibility and validity of this finding. the ...201323919230
detection of mixed populations of clostridium difficile from symptomatic patients using capillary-based polymerase chain reaction ribotyping.to investigate the simultaneous occurrence of more than 1 clostridium difficile ribotype in patients' stool samples at the time of diagnostic testing.201323917911
evaluation of a commercial real-time polymerase chain reaction assay for detection of environmental contamination with clostridium difficile.contaminated environmental surfaces are an important source for transmission of clostridium difficile. however, there are no efficient and easy methods to assess contamination. the performance of a commercial real-time polymerase chain reaction (pcr) assay was evaluated for detection of environmental toxigenic c. difficile in comparison with anaerobic culture followed by toxin testing of isolates. for 66 sites sampled, pcr had a sensitivity of 17.39%, specificity 100%, positive predictive value ...201323916890
clostridium difficile infection after adult autologous stem cell transplantation: a multicenter study of epidemiology and risk factors.we sought to describe the epidemiology of clostridium difficile infection (cdi) among adult recipients of autologous hematopoietic stem cell transplantation (auto-hsct) within the first year after hsct in centers with variable epidemiology of hypertoxigenic strains. a multicenter, retrospective nested case-control study was conducted among 873 auto-hsct recipients at johns hopkins hospital (jhh) and hôpital maisonneuve-rosemont (hmr) between january 2003 and december 2008. despite center differe ...201323916741
genetically diverse clostridium difficile strains harbouring abundant prophages in an estuarine environment.clostridium difficile is the leading cause of antibiotic-associated diarrhoeal disease in healthcare settings across the world. despite its pathogenic capacity, it can be carried asymptomatically and has been found in terrestrial and marine ecosystems outside hospital environments. less is known about these environmental strains and few studies have been conducted on estuarine systems. although prophage abundance and diversity is known within in clinical strains, prophage carriage within environ ...201323913427
norovirus gastroenteritis after fecal microbiota transplantation for treatment of clostridium difficile infection despite asymptomatic donors and lack of sick contacts. 201323912408
is the prevalence of clostridium difficile in animals underestimated?reported prevalence rates of clostridium difficile infection in animals differ considerably depending on the nature of the study and the population surveyed. the methods used to recover this organism from faecal samples may account for some of the prevalence variation. the objective of this study was to assess the performance of two different methods of detecting c. difficile in animal faeces in comparison with a conventional isolation procedure ('ethanol shock' of faecal samples followed by cul ...201323911042
fecal microbiota transplant for recurrent clostridium difficile infection: mayo clinic in arizona experience.to report the initial experience of treating recurrent clostridium difficile infection (cdi) with fecal microbiota transplant (fmt) at mayo clinic in arizona.201323910407
influence of cohorting patients with clostridium difficile infection on risk of symptomatic recurrence.cohorting of patients with clostridium difficile infection (cdi) is recommended when single side-rooms are unavailable. although patients may remain infectious after cessation of diarrhoea, continued cohorting may place them at increased risk of reinfection.201323910403
clostridium difficile infection outbreak in a male rehabilitation ward, hong kong special administrative region (china), 2011. 201223908942
temporal phenome analysis of a large electronic health record cohort enables identification of hospital-acquired complications.to develop methods for visual analysis of temporal phenotype data available through electronic health records (ehr).201323907284
[laboratory diagnosis of clostridium difficile infection].for the diagnosis of clostridium difficile infection (cdi), it is necessary to obtain microbiological evidence of toxigenic c. difficile with a compatible clinical picture (diarrhoea or ileus). two gold standards exist: cell culture cytotoxicity neutralization assay (specific, but less sensitive than previously acknowledged) and toxigenic culture (very sensitive but less specific because it also detects asymptomatic colonization). these gold standards are not used routinely because at least 2 or ...201323906566
molecular epidemiology of clostridium difficile infection in a major chinese hospital: an underrecognized problem in asia?clostridium difficile infection is almost unrecognized in mainland china. we have undertaken a study in a large chinese teaching hospital in changsha, hunan, china, to identify cases of c. difficile, record patient characteristics, and define the molecular epidemiology with respect to ribotype distribution and cross-infection. between april 2009 and february 2010, we examined fecal samples from 70 hospitalized patients with diarrhea who were receiving or had received antibiotics within the previ ...201323903542
[largest eu prevalence studies of clostridium difficile infection reveals that perhaps more than one-fifth of the patient are wrongly diagnosed]. 201323901614
a severe case of rat lungworm disease in hawa'i.a 23-year-old man living on the island of hawa'i developed a life threatening case of eosinophilic meningitis caused by infection with angiostrongylus cantonensis (rat lungworm disease: rlwd). he was comatose for 3 months, incurring brain and nerve damage sufficiently extensive that he was not expected to recover. the case was complicated by secondary infections of methicillin-resistant staphylococcus aureus, clostridium difficile, and pneumonia, which resulted in an empyema requiring a thoracos ...201323900708
establishment of the intestinal microbiota and its role for atopic dermatitis in early childhood.perturbations in the intestinal microbiota may disrupt mechanisms involved in the development of immunologic tolerance. the present study aimed to examine the establishment of the infant microbiota and its association to the development of atopic dermatitis (ad).201323900058
effect of nucleic acid amplification testing on population-based incidence rates of clostridium difficile infection.nucleic acid amplification testing (naat) is increasingly being adopted for diagnosis of clostridium difficile infection (cdi). data from 3 states conducting population-based cdi surveillance showed increases ranging from 43% to 67% in cdi incidence attributable to changing from toxin enzyme immunoassays to naat. cdi surveillance requires adjustment for testing methods.201323899677
alteration of intestinal dysbiosis by fecal microbiota transplantation does not induce remission in patients with chronic active ulcerative colitis.in patients with ulcerative colitis (uc), alterations of the intestinal microbiota, termed dysbiosis, have been postulated to contribute to intestinal inflammation. fecal microbiota transplantation (fmt) has been used as effective therapy for recurrent clostridium difficile colitis also caused by dysbiosis. the aims of the present study were to investigate if patients with uc benefit from fmt and if dysbiosis can be reversed.201323899544
in vivo physiological and transcriptional profiling reveals host responses to clostridium difficile toxin a and toxin b.toxin a (tcda) and toxin b (tcdb) of clostridium difficile cause gross pathological changes (e.g., inflammation, secretion, and diarrhea) in the infected host, yet the molecular and cellular pathways leading to observed host responses are poorly understood. to address this gap, we evaluated the effects of single doses of tcda and/or tcdb injected into the ceca of mice, and several endpoints were analyzed, including tissue pathology, neutrophil infiltration, epithelial-layer gene expression, chem ...201323897615
adaptive strategies and pathogenesis of clostridium difficile from in vivo transcriptomics.clostridium difficile is currently the major cause of nosocomial intestinal diseases associated with antibiotic therapy in adults. in order to improve our knowledge of c. difficile-host interactions, we analyzed the genome-wide temporal expression of c. difficile 630 genes during the first 38 h of mouse colonization to identify genes whose expression is modulated in vivo, suggesting that they may play a role in facilitating the colonization process. in the ceca of the c. difficile-monoassociated ...201323897605
clostridium difficile colitis: is severity increased with previous appendectomy? 201323896227
outpatient healthcare settings and transmission of clostridium difficile.recent reports suggest that community-associated clostridium difficile infection (cdi) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. we hypothesized that outpatient clinics could be an important source for acquisition of community-associated cdi.201323894609
biofilm formation by clostridium difficile.clostridium difficile infection (cdi) is a major healthcare-associated disease worldwide. recurring infections and increasing antibiotic resistance have complicated treatment of cdi. while c. difficile spores are important for transmission and persistence of cdi, other factors such as gut colonization and formation of bacterial communities in the gut may also contribute to pathogenesis and persistence, but have not been well investigated. recently, we reported that important clinical c. difficil ...201523892245
clostridium difficile infection increases mortality risk in lung transplant recipients.clostridium difficile infection (cdi) and associated mortality in solid organ transplant recipients is rising, but data are scarce in lung transplant recipients. we aimed to characterize cdi and its effect on mortality in a large cohort of lung transplant recipients.201323891145
risk factors associated with clostridium difficile infection after kidney and pancreas transplantation.clostridium difficile infection (cdi) is a common cause of nosocomial antibiotic-associated diarrhea with an increased incidence reported in solid organ transplant recipients. we sought to determine if kidney and/or pancreas transplant recipients possess unique risk factors for cdi.201323890202
the effects of statins on the clinical outcomes of clostridium difficile infection in hospitalised patients.an association between exposure to statin drugs and favourable treatment outcomes for various types of infections has been established.201323888883
the anticancer drug tirapazamine has antimicrobial activity against escherichia coli, staphylococcus aureus and clostridium difficile.rapidly increasing bacterial resistance to existing therapies creates an urgent need for the development of new antibacterials. tirapazamine (tpz, 3-amino-1,2,4-benzotriazine 1,4 dioxide) is a prodrug undergoing clinical trials for various types of cancers. in this study, we showed that tpz has antibacterial activity, particularly at low oxygen levels. with escherichia coli, tpz was bactericidal under both aerobic and anaerobic conditions. escherichia coli mutants deficient in homologous recombi ...201323888874
[outcomes of clostridium difficile enterocolitis after administration of antibiotics along with probiotic supplement].clostridium difficile enterocolitis is a potentially fatal disease showing increasing incidence in hospital environment. therapeutic approach in the management of clostridium difficile enterocolitis is highly complex, particularly because of its tendency to relapse and reinfection. the study was aimed at investigating the factors influencing the development of clostridium difficile enterocolitis and outcomes of enterocolitis after administration of standard antimicrobial therapy combined with pr ...201323888728
reducing clostridium difficile incidence, colectomies, and mortality in the hospital setting: a successful multidisciplinary approach.health care associated clostridium difficile infections are a major cause of morbidity and mortality in hospitals. in the united states, from 2000 through 2009, discharge diagnoses from hospitals in the united states that included c. difficile increased from 139,000 to 336,600, and the yearly national excess hospital cost associated with hospital-onset c. difficile is estimated to be upwards of $1.3 billion.201323888639
molecular test to determine toxigenic capabilities in gdh-positive, toxin-negative samples: evaluation of the portrait toxigenic c. difficile assay.new recommendations for testing and reporting of clostridium difficile were introduced in the nhs in 2012. these guidelines have improved identification of potential c. difficile infection (cdi) cases, but questions remain around the management of glutamate dehydrogenase (gdh)-positive, toxin-negative patients. this study aims to assess the introduction of the portrait c. difficile assay as the third step to identify the presence of the toxigenic c. difficile b (tcdb) gene and thus determine tox ...201323888607
presumably hospital-transmitted clostridium difficile infections based on epidemiological linkage.given the traditionally low cdad (clostridium difficile associated diarrhoea) prevalence in switzerland, cdad patients are not routinely contact-isolated in our institution. in light of the globally changing c. difficile epidemiology, we sought to determine our institutional cdad rate and to detect possible hospital transmission by means of epidemiological linkage.201323888435
in vitro selection, via serial passage, of clostridium difficile mutants with reduced susceptibility to fidaxomicin or vancomycin.current treatments for clostridium difficile infection include vancomycin, metronidazole and fidaxomicin. lff571 is an experimental agent undergoing evaluation in humans for the treatment of moderate c. difficile infection. reduced susceptibility of c. difficile to fidaxomicin or lff571 in vitro can be mediated by single point mutations in genes encoding the targets, whereas the mechanism(s) mediating reduced susceptibility to vancomycin in vitro remains elusive. to further characterize mechanis ...201423887866
diarrhoea in the icu: respective contribution of feeding and antibiotics.diarrhoea is frequently reported in the icu. little is known about diarrhoea incidence and the role of the different risk factors alone or in combination. this prospective observational study aims at determining diarrhoea incidence and risk factors in the first 2 weeks of icu stay, focusing on the respective contribution of feeding, antibiotics, and antifungal drugs.201323883438
the identification and epidemiology of meticillin-resistant staphylococcus aureus and clostridium difficile in patient rooms and the ward environment.research has indicated that the environment may play an important role in the transmission of meticillin-resistant staphylococcus aureus (mrsa) and clostridium difficile in healthcare facilities. despite the significance of this finding, few data exist from longitudinal studies investigating mrsa and c. difficile contamination, concurrently, in both patient rooms and the general ward environment. the objectives of this study were to determine the prevalence of mrsa and c. difficile contamination ...201323883171
hemolytic uremic syndrome and clostridium difficile colitis.hemolytic uremic syndrome (hus) can be associated with different infectious etiologies, but the relationship between pseudomembranous colitis and hus was first described in the 1970s in some childhood patients. there is very limited published literature on clostridium difficile-associated hus. we report a case of c. difficile-related hus in an adult patient and provide a review of the literature.201223882375
editorial commentary: looking to the future: vertical vs horizontal prevention of clostridium difficile infections. 201323881152
use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in clostridium difficile transmission.previous studies have suggested that asymptomatic carriers of toxigenic clostridium difficile are a source of hospital-associated (ha) infections. multilocus variable number of tandem repeats analysis (mlva) is a highly discriminatory molecular subtyping tool that helps to determine possible transmission sources.201323881150
a surview of recent patents on anti-infective therapy for clostridium difficile.clostridium difficile has become the most common infectious cause of healthcare-associated diarrhea, with serious morbidity, prolonged hospitalization and even death. treatment of the disease utilizing today's therapies does not guarantee a successful outcome. in the past decade, many new ideas and inventions have surfaced exploring different treatment strategies of clostridium difficile associated diarrhea (cdad). these treatments include antitoxins, novel antimicrobials, immunoglobulins and la ...201323879822
clinical approach to fever in the neurosurgical intensive care unit: focus on drug fever.as fever is one of the cardinal signs of infection, the presence of fever in a patient in the neurosurgical intensive care unit (nsicu) raises the question of whether it is infectious in etiology. infectious and noninfectious causes of fever in the nsicu may be determined based upon assessment of clinical signs and symptoms, the degree of temperature elevation, the relationship of the pulse to the fever (e.g., an infectious process resulting in hyperpyrexia and bradycardia), and when the fever o ...201323878765
comparative in vitro activities of smt19969, a new antimicrobial agent, against clostridium difficile and 350 gram-positive and gram-negative aerobic and anaerobic intestinal flora isolates.the comparative in vitro activity of smt19969, a novel, narrow-spectrum, nonabsorbable agent, was studied against 50 ribotype-defined clostridium difficile strains, 174 gram-positive and 136 gram-negative intestinal anaerobes, and 40 gram-positive aerobes. smt19969 was one dilution more active against c. difficile isolates (mic range, 0.125 to 0.5 μg/ml; mic90, 0.25 μg/ml), including ribotype 027 strains, than fidaxomicin (range, 0.06 to 1 μg/ml; mic90, 0.5 μg/ml) and two to six dilutions lower ...201323877700
[infections caused by clostridium difficile. addendum]. 201323876975
comparison of treatment outcomes with vancomycin alone versus combination therapy in severe clostridium difficile infection.the recommended treatment for severe clostridium difficile infection (cdi) is oral vancomycin alone. combination therapy with metronidazole is only recommended in cases complicated by shock, ileus, or toxic megacolon. however, patients with severe infection are often treated with combination therapy despite a lack of data supporting this practice.201323876778
[clostridium difficile infection: epidemiology, disease burden and therapy].c. difficile causes 25 percent of the antibiotic associated infectious nosocomial diarrhoeas. c. difficile infection is a high-priority problem of public health in each country. the available literature of c. difficile infection's epidemiology and disease burden is limited.201323876616
high prevalence of the epidemic clostridium difficile pcr ribotype 078 in iberian free-range pigs.previous studies in intensively raised piglets have detected a high prevalence of the epidemic clostridium difficile pcr ribotype 078. in this article we present a longitudinal survey of c. difficile colonisation in a population of iberian pigs reared under a free-range system. a total of 160 faecal samples from 20 piglets belonging to different litters were obtained by weekly sampling. c. difficile was recovered from samples collected at different times throughout the survey from a 90% of pigle ...201323876331
infections and inflammatory bowel disease: challenges in asia.the diagnosis and management of inflammatory bowel disease (ibd) in asia can be challenging as certain infections can mimic ibd and lead to a misdiagnosis. colitis can be caused by bacterial infections, ileitis can result from yersinia and salmonella infections and ileocolonic ulcers can be seen in intestinal tuberculosis and amebiasis. in addition, cytomegalovirus and clostridium difficile infection may mimic a flare of ibd and their presence is associated with an increased risk of colectomy an ...201323875824
the complex dynamics of antimicrobial activity in the human gastrointestinal tract.the human gastrointestinal tract is a complex environment of mutualistic associations. as bacteria form a major component of fecal content, the natural balance of the colon can be significantly altered by exposure to antimicrobial agents. however, the effects of antimicrobial therapy on fecal content are difficult to predict and can at times be quite surprising. the emergence and spread of vancomycin-resistant enterococci are cases in point. resistance to the glycopeptide vancomycin emerged in e ...201323874016
identification and characterization of clostridium sordellii toxin gene regulator.toxigenic clostridium sordellii causes uncommon but highly lethal infections in humans and animals. recently, an increased incidence of c. sordellii infections has been reported in women undergoing obstetric interventions. pathogenic strains of c. sordellii produce numerous virulence factors, including sordellilysin, phospholipase, neuraminidase, and two large clostridial glucosylating toxins, tcsl and tcsh. recent studies have demonstrated that tcsl toxin is an essential virulence factor for th ...201323873908
fulminant clostridium difficile colitis: a complication of perioperative antibiotic prophylaxis.antibiotic prophylaxis for maxillofacial surgical wounds remains common practice. surgeons must weigh the risks (e.g., clostridium difficile colitis) against the benefits before administering antibiotics for any reason and the relative risk and morbidity of c difficile colitis against those of a potential postoperative wound infection. in addition, the possibility of c difficile infection as a complication of perioperative antibiotic prophylaxis should be discussed with patients before surgery, ...201323871314
reducing health care-associated infections: patients want to be engaged and learn about infection prevention.multidrug-resistant organisms (mdros) are common in health care-associated infection (hai). the aim of this study was to examine patient's willingness to learn about mdros and hais and their preferred ways of education about mdro hais.201323870794
disruption of intrinsic motions as a mechanism for enzyme inhibition.clostridium difficile (c. diff) is one of the most common and most severe hospital-acquired infections; its consequences range from lengthened hospital stay to outright lethality. c. diff causes cellular damage through the action of two large toxins tcda and tcdb. recently, there has been increased effort toward developing antitoxin therapies, rather than antibacterial treatments, in hopes of mitigating the acquisition of drug resistance. to date, no analysis of the recognition mechanism of tcda ...201323870270
fecal transplantation for recurrent clostridium difficile infection in older adults: a review.recurrent clostridium difficile infection (cdi) is a common nosocomial infection that has a large effect on morbidity and quality of life in older adults in hospitals and long-term care facilities. because antibiotics are often unsuccessful in curing this disease, fecal transplantation has emerged as a second-line therapy for treatment of recurrent cdi. a comprehensive literature search of pubmed, embase, and web of science regarding fecal transplantation for cdi was performed to further evaluat ...201323869970
is clostridium difficile associated with relapse of inflammatory bowel disease? results from a retrospective and prospective cohort study in the netherlands.although clostridium difficile may be associated with exacerbations in inflammatory bowel diseases (ibd), prospective studies identifying the role of c. difficile in disease activity are currently lacking. we examined the prevalence of c. difficile in feces of (1) symptomatic ibd patients retrospectively and (2) consecutive outpatients in relation to disease activity prospectively.201323867869
bacteriotherapy for the treatment of intestinal dysbiosis caused by clostridium difficile infection.faecal microbiota transplantation (fmt) has been used for more than five decades to treat a variety of intestinal diseases associated with pathological imbalances within the resident microbiota, termed dysbiosis. fmt has been particularly effective for treating patients with recurrent clostridium difficile infection who are left with few clinical options other than continued antibiotic therapy. our increasing knowledge of the structure and function of the human intestinal microbiota and c. diffi ...201323866975
indeterminate tcdb using a clostridium difficile pcr assay: a retrospective cohort study.c. difficile (cd) real-time polymerase chain reaction (pcr) for toxin b gene (tcdb) is more sensitive, and reduces turnaround time when compared to toxin immunoassay. we noted typical amplification curves with high tcdb cycle thresholds (ct) and low endpoints (ept) that are labeled negative by the xpert(®) c. difficile assay (cepheid) and undertook this study to determine their significance.201323865713
the protective effect of recombinant lactococcus lactis oral vaccine on a clostridium difficile-infected animal model.oral immunization with vaccines may be an effective strategy for prevention of clostridium difficile infection (cdi). however, application of previously developed vaccines for preventing cdi has been limited due to various reasons. here, we developed a recombinant lactococcus lactis oral vaccine and evaluated its effect on a c. difficile-infected animal model established in golden hamsters in attempt to provide an alternative strategy for cdi prevention.201323865596
clostridium difficile infection: a multicenter study of epidemiology and outcomes in mechanically ventilated patients.clostridium difficile is a leading cause of hospital-associated infection in the united states. the purpose of this study is to assess the prevalence of c. difficile infection among mechanically ventilated patients within the icus of three academic hospitals and secondarily describe the influence of c. difficile infection on the outcomes of these patients.201323863229
horizontal gene transfer in human pathogens.horizontal gene transfer has a tremendous impact on the genome plasticity, adaptation and evolution of bacteria. horizontally transferred mobile genetic elements are involved in the dissemination of antibiotic resistance and virulence genes, thus contributing to the emergence of novel "superbugs". this review provides update on various mechanisms of horizontal gene transfer and examines how horizontal gene transfer contributes to the evolution of pathogenic bacteria. special focus is paid to the ...201523862575
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