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clostridium difficile infection: new insights into management.clostridium difficile was first described as a cause of diarrhea in 1978 and is now among the leading 3 hospital-acquired infections in the united states, along with methicillin-resistant staphylococcus aureus and vancomycin-resistant enterococci. in the past 2 decades, there has been an increase in the incidence, severity, and recurrence rates of c difficile infection, all of which are associated with poor outcomes. in addition, several novel risk factors and newer treatment methods are emergin ...201223127735
clostridium difficile infection in patients with chronic kidney disease.to examine the rate of clostridium difficile infection (cdi) and hospital-associated outcomes in a national cohort of hospitalized patients with chronic kidney disease (ckd) and assess the impact of long-term dialysis on outcome in these patients.201223127731
clostridium difficile: the emerging epidemic. 201223127729
outcome of icu patients with clostridium difficile infection.as data from clostridium difficile infection (cdi) in intensive care unit (icu) are still scarce, our objectives were to assess the morbidity and mortality of icu-acquired cdi.201223127327
antibody against tcdb, but not tcda, prevents development of gastrointestinal and systemic clostridium difficile disease.a dramatic increase in morbidity and mortality from clostridium difficile infection (cdi) due to the recent emergence of virulent, antibiotic-resistant strains has led to a search for alternatives to antibiotics, including vaccines and immune-based therapy that target the 2 key toxins-tcda and tcdb.201323125448
fecal microbiota transplantation for fulminant clostridium difficile infection in an allogeneic stem cell transplant patient.we present a case of severe clostridium difficile infection (cdi) in a non-neutropenic allogeneic hematopoietic stem cell transplant recipient who was treated successfully with fecal microbiota therapy after standard pharmacologic therapy had failed. following naso-jejunal instillation of donor stool, the patient's symptoms resolved within 48 h. bowel resection was averted. this is the first case in the literature, to our knowledge, to describe fecal microbiota therapy in a profoundly immunocomp ...201223121625
current and emerging management options for clostridium difficile infection: what is the role of fidaxomicin?until recently, treatment of clostridium difficile infection (cdi) was mainly limited to oral metronidazole and vancomycin, neither of which is optimal. up to 25% of patients with cdi experience recurrence of infection within 30 days following treatment with these agents, while c. 45-65% of these patients experience further (and sometimes multiple) recurrences. recurrent cdi represents a major treatment challenge for which new therapeutic options are sorely needed. fidaxomicin is a first-in-clas ...201223121552
can we identify patients at high risk of recurrent clostridium difficile infection?although most patients with clostridium difficile infection (cdi) can be managed effectively with discontinuation of prescribed antibiotics and additional treatment with oral metronidazole or vancomycin, up to 25% experience disease recurrence, usually within 30 days of treatment. failure to mount a systemic anti-toxin antibody response differentiates patients with cdi and recurrent cdi from symptomless carriers of toxinogenic c. difficile. the immunological senescence that accompanies ageing ma ...201223121551
overcoming barriers to effective recognition and diagnosis of clostridium difficile infection.with the frequency of cases of clostridium difficile infection (cdi) increasing in many developed countries, accurate and reliable laboratory diagnosis of cdi is more important than ever. however, the diagnosis of cdi has been handicapped by the existence of two reference standards, one of which detects c. difficile toxin (cytotoxin assay) and the other only toxigenic strains (cytotoxigenic culture). being relatively slow and laborious to perform, these reference methods were largely abandoned a ...201223121550
consequences of clostridium difficile infection: understanding the healthcare burden.clostridium difficile is the leading cause of infectious nosocomial diarrhoea in developed countries, with a measured incidence of approximately five episodes per 10,000 days of hospital stay in europe. accurate diagnosis of c. difficile infection (cdi) is a prerequisite for obtaining reliable epidemiological data, but in many european countries diagnosis is probably suboptimal. a significant percentage of cdi cases are missed because clinicians often fail to request tests for c. difficile toxin ...201223121549
breaking the cycle of recurrent clostridium difficile infections. 201223121548
time to act against clostridium difficile infection. 201223121547
c. difficile 630δerm spo0a regulates sporulation, but does not contribute to toxin production, by direct high-affinity binding to target dna.clostridium difficile is a gram positive, anaerobic bacterium that can form highly resistant endospores. the bacterium is the causative agent of c. difficile infection (cdi), for which the symptoms can range from a mild diarrhea to potentially fatal pseudomembranous colitis and toxic megacolon. endospore formation in firmicutes, including c. difficile, is governed by the key regulator for sporulation, spo0a. in bacillus subtilis, this transcription factor is also directly or indirectly involved ...201223119071
faecal microbiota transplantation for severe clostridium difficile infection in the intensive care unit.we describe a case of faecal microbiota transplantation (fmt) used for severe binary toxin-positive clostridium difficile infection in an intensive care setting. the patient was admitted to the icu of a tertiary hospital and failed traditional maximal pharmacological management. adjunctive therapy with fmt given through gastroscopy resulted in resolution of the c. difficile-related symptoms. although there is a growing experience with fmt for recurrent c. difficile infection, published evidence ...201323117471
community-acquired clostridium difficile nap1/027-associated diarrhea in an eighteen month old child.clostridium difficile infection (cdi), characterized by symptoms varying from diarrhea to life-threatening colitis, is a major complication of antibiotic therapy. studies suggested that cdi is emerging as an important cause of childhood diarrhea in community and hospital settings. this work is the first report of a documented case of community-acquired cdi by a nap1 hypervirulent strain in an eighteen month old child from latin america.201223116882
increased susceptibility of melanin-concentrating hormone-deficient mice to infection with salmonella enterica serovar typhimurium.melanin-concentrating hormone (mch) was initially identified in mammals as a hypothalamic neuropeptide regulating appetite and energy balance. however, the wide distribution of mch receptors in peripheral tissues suggests additional functions for mch which remain largely unknown. we have previously reported that mice lacking mch develop attenuated intestinal inflammation when exposed to clostridium difficile toxin a. to further characterize the role of mch in host defense mechanisms against inte ...201323115043
[current data and trends on the development of antibiotic resistance of clostridium difficile].clostridium difficile is the most common pathogen causing antibiotic-associated diarrhea. antibiotic therapy also favors the development and the epidemic spreading of multiresistant strains. in this present retrospective study clinical isolates from the university of saarland medical center and of other german isolate referring hospitals were characterized by genotyping and antibiotic resistance testing. the most prevalent strains were ribotypes 001 (18%), 014 (16%) and 027 (15%). sensitivity to ...201223114440
clostridium difficile 027-associated pseudomembranous colitis after short-term treatment with cefuroxime and cephalexin in an elderly orthopedic patient: a case report.clostridium difficile ribotype 027 has become increasingly prevalent in european countries. the clinical picture varies from self-limiting diarrhea to pseudomembranous colitis with toxic megacolon and ultimately death. use of antibiotics is the principal risk factor; others include comorbidity, advanced age and hospitalization. however even with extensive knowledge of risk factors, it remains difficult to define "minimum risk," as illustrated by the following case.201223113897
pneumatosis intestinalis in a patient with recurrent clostridium difficile infection.a 65-year-old man with long-standing diarrhoea, recurrent clostridium difficile infection (cdi) in the previous 5 months presented to the gastroenterology clinic with recurrent diarrhoea and abdominal cramping. physical examination was negative for signs of acute abdomen. stool c difficile pcr was positive. abdominal imaging demonstrated an extensive pneumatosis intestinalis involving the small bowel and a dilated small bowel loop. he was treated conservatively with oral vancomycin for recurrent ...201223112256
from natural product to marketed drug: the tiacumicin odyssey.the first members of the tiacumicin family of antibiotics, encompassing more than 40 compounds, were isolated in 1975. structurally, the core aglycon is an 18-membered macrolactone having two conjugated diene units, one isolated double bond, 5 stereogenic centers and most often, at least one glycosidic linkage. tiacumicin b, a rna synthesis inhibitor, is a narrow-spectrum antibiotic against clostridia. for the treatment of clostridium difficile infection (cdi), it has the same cure rate as vanco ...201323111588
new molecular methods for the diagnosis of clostridium difficile infections.clostridium difficile is recognized as the major agent responsible for nosocomial diarrhea in hospitalized patients. accurate diagnosis of c. difficile infection (cdi) is essential for optimal treatment and prevention but continues to be challenging. there are currently two reference assays for the diagnosis of cdi with different targets: the cytotoxicity assay that detects free toxins and the toxigenic culture which detects the organism with the potential to produce toxin. in 2009, nucleic acid ...201223110263
response failure to the treatment of clostridium difficile infection and its impact on 30-day mortality.few data are available on response failure and hospital mortality. this study aimed to evaluate the association between response failure to the treatment of cdi and 30-day mortality.201323108084
comparison of a frozen human foreskin fibroblast cell assay to an enzyme immunoassay and toxigenic culture for the detection of toxigenic clostridium difficile.this study set out to validate the hs27 readycell assay (rccna) as an alternative ccna method compared against a commonly used commercial enzyme immunoassay (eia) method and toxigenic culture (tc) reference standard. a total of 860 samples were identified from those submitted to the health protection agency microbiology laboratories over a 30-week period. rccna performed much better than eia when using tc as a gold standard, with sensitivities of 90.8% versus 78.6% and positive predictive value ...201323107315
analysis of metronidazole susceptibility in different clostridium difficile pcr ribotypes.susceptibility to metronidazole was investigated in 81 clostridium difficile strains, belonging to nine different pcr ribotypes, by three different laboratory methods.201323104495
diagnosis of clostridium difficile infection using real-time pcr.clostridium difficile is known to cause antibiotic-associated diarrhea and pseudomembranous colitis. toxinogenic strains of the bacterium produce toxins a (tcda) and b (tcdb), which are associated with the pathogenicity. the standard methods for diagnosis of c. difficile infection include the cell cytotoxicity assay and the culture of a toxinogenic strain. due to the long turnaround time of these methods, more rapid methods are preferred. enzyme immunoassays are fast, but lack sensitivity. there ...201323104294
clostridium difficile: a european perspective.clostridium difficile infection is the leading cause of diarrhoea in the industrialised world. first identified in 1935, our knowledge about the clonal population structure, toxins and pcr ribotypes is still increasing. new pcr ribotypes and sequence types are frequently added. in the last decade hypervirulent strains have emerged and been associated with increased severity of disease, high recurrence and significant mortality. although previously a primarily hospital- or health-care acquired in ...201323103666
electronic ward round: finding time for the inpatient with clostridium difficile infection. 201323103665
fecal microbiota transplantation: techniques, applications, and issues.fecal microbiota transplantation (fmt) has gained widespread recognition in light of the recent clostridium difficile infection (cdi) epidemic, responsible for almost 110,000 deaths per year. the procedure's success rate has caused experts to reflect on what other conditions may benefit. this article provides an overview of (1) description and history of fmt, (2) fmt publications in cdi, (3) the concept of the gut microbiota as a virtual organ, (4) rationale for fmt use, (5) fmt use in inflammat ...201223101687
the role of probiotics in the prevention and treatment of antibiotic-associated diarrhea and clostridium difficile colitis.clostridium difficile colitis is the most common gastrointestinal infection, exceeding all other gastrointestinal infections combined. there has been a dramatic increase in clostridium difficile infection (cdi) worldwide during the past decade. antibiotic therapy is a trigger precipitating antibiotic-associated diarrhea (aad), which may lead to cdi. the antibiotic alters the protective, diverse bacteria allowing pathogenic bacteria to cause disease. probiotics have been effective in reducing aad ...201223101686
clostridium difficile infection and partial membrane cofactor protein (cd46) deficiency. 201223101426
clostridium difficile testing: have we got it right? 201323100357
[clostridium difficile--unfairly set in the corner?]. 201223097893
vitamin d deficiency: a potential risk factor for clostridium difficile infection. 201223097616
[clostridium difficile epidemic, chile 2012: report of the chilean society for infectious diseases. a scientific historical analysis].a summary report from the chilean society for infectious diseases regarding the presence of a clostridium difficile epidemic with several fatalities in chile's premier emergency public hospital in santiago is used to make a scientific historical analysis of the situation. this summary report identifies several hygienic and sanitary shortcomings that may have played a role in triggering this major epidemic. these include deficiencies in hand washing policies, overcrowding of beds in wards, relaxa ...201223096554
[clostridium difficile associated infections: an updated view].clostridium difficile is an emerging anaerobic, spore forming pathogen, recognized as the etiological agent of ~ 30% of antibiotic associated diarrheas. clinical symptoms can fluctuate from mild to moderate diarrhea, pseudomembranous colitis and toxic megacolon. the incidence of c. difficile associated infections (cdai) is ~ 1% of total hospitalized patients. cdai has a mortality rate of ~1 to 5%, and a relapse rate of ~ 20%. the appearance of severe outbreaks of cdai could be attributed to chan ...201223096544
rifaximin in the treatment of recurrent clostridium difficile infection.clostridium difficile can cause severe antibiotic-associated colitis. conventional treatments with metronidazole and vancomycin improve symptoms, but after discontinuation of treatment, c. difficile infection (cdi) recurs in a number of patients. rifaximin is a rifamycin-based non-systemic antibiotic that has effect against c. difficile.201323095030
toward an understanding of changes in diversity associated with fecal microbiome transplantation based on 16s rrna gene deep sequencing.fecal microbiome transplantation by low-volume enema is an effective, safe, and inexpensive alternative to antibiotic therapy for patients with chronic relapsing clostridium difficile infection (cdi). we explored the microbial diversity of pre- and posttransplant stool specimens from cdi patients (n = 6) using deep sequencing of the 16s rrna gene. while interindividual variability in microbiota change occurs with fecal transplantation and vancomycin exposure, in this pilot study we note that cli ...201223093385
comparison of genexpert pcr to bd geneohm for detecting c. difficile toxin gene in gdh positive toxin negative samples.the need for rapid diagnosis of clostridium difficile (c. difficile) associated infection in a clinical microbiology laboratory has provided the stimulus for new diagnostic tests and testing protocols. a two-test algorithm has been proposed using assays such as quik chek complete, which detects both c. difficile glutamate dehydrogenase (gdh) and c. difficile toxins a and b, followed by reflex testing of samples having inconclusive results (gdh positive and toxin negative) with pcr for identifica ...201223090736
current and future challenges in the development of antimicrobial agents.micro-organisms exist to survive. even in the absence of antimicrobial agents, many have determinants of resistance that may be expressed phenotypically, should the need arise. with the advent of the antibiotic age, as more and more drugs were developed to treat serious infections, micro-organisms (particularly bacteria) rapidly developed resistance determinants to prevent their own demise.the most important determinants of resistance have been in the gram-positive and gram-negative bacteria. am ...201223090595
bacillus coagulans gbi-30, 6086 limits the recurrence of clostridium difficile-induced colitis following vancomycin withdrawal in mice.recently, we found that the probiotic strain bacillus coagulans gbi-30, 6086 (ganedenbc30) improved indices of clostridium difficile (c. difficile)-induced colitis in mice (fitzpatrick et al., gut pathogens, 2011). our goal was to determine if bc30 could also prevent the recurrence of c. difficile-induced colitis in mice, following initial treatment with vancomycin. during study days 0 through 5, mice were treated with antibiotics. on day 6, the c. difficile strain vpi 10463 was given by oro-gas ...201223088680
[clostridium-difficile-colitis: more frequent and more severe]. 201223088039
predicting recurrence of c. difficile colitis using bacterial virulence factors: binary toxin is the key.recurrent clostridium difficile colitis is common, yet the ability to predict recurrence is poorly developed.201323086451
immune responses to clostridium difficile infection.clostridium difficile is the causal agent of antibiotic-associated diarrhea and is a leading cause of hospital-acquired infections in the us. c. difficile has been known to cause severe diarrhea and colitis for more than 30 years, but the emergence of a newer, hypervirulent strain of c. difficile (bi/nap1) has further compounded the problem, and recently both the number of cases and mortality associated with c. difficile-associated diarrhea have been increasing. one of the major drivers of disea ...201223084763
impact of infectious complications after elective surgery on hospital readmission and late deaths in the u.s. medicare population.whereas the negative impact of infectious complications (ic) during the index hospitalization after elective surgery is well established, the long-term ramifications of hospital-acquired post-operative infections are not well studied. this analysis evaluated the impact of a hospital-acquired ic after open abdominal vascular surgery on the readmission rate and the mortality rates 30 and 90 days after initial discharge.201223082877
prevalence of clostridium difficile toxin in diarhoeal stool samples of patients from a tertiary hospital in north eastern penisular malaysia.this study describes the prevalence of clostridium difficile toxin (cdt) in loose stool samples from inpatients aged more than two years of a tertiary hospital. a total of 175 samples that had been examined were from stool samples that were sent to the medical microbiology & parasitology laboratory for various clinical indications. the toxin was detected by a commercial immunochromatograhic test, and the patients' demography, clinical features, treatment and outcomes were analyzed from their med ...201223082450
ageing and gut microbes: perspectives for health maintenance and longevity.the ageing process affects the human gut microbiota phylogenetic composition and its interaction with the immune system. age-related gut microbiota modifications are associated with immunosenescence and inflamm-ageing in a sort of self-sustaining loop, which allows the placement of gut microbiota unbalances among both the causes and the effects of the inflamm-ageing process. even if, up to now, the link between gut microbiota and the ageing process is only partially understood, the gut ecosystem ...201323079287
association of decreased serum protein fractions with clostridium difficile infection in the acute care setting: a case-control study.this study examines the association of decreased levels of serum proteins with the occurrence of clostridium difficile-associated diarrhea (cdad) in hospitalized patients.201223075246
[assessment of susceptibility of strictly anaerobic bacteria originated from different sources to fluoroquinolones and other antimicrobial drugs].during the past 20 years, several studies at a national level in different countries followed resistance trends for bacteroides sp. and clostridium difficile. this study analysed antimicrobial susceptibility 73 anaerobic bacteria strains of bacteroides fragilis group (bfg) and c. difficile to fluoroquinolones and other antimicrobial drugs.201223072056
retraction notice to "apoptosis of ct26 colorectal cancer cells induced by clostridium difficile toxin a stimulates potent anti-tumor immunity" [biochem. biophys. res. commun. 422 (2012) 15-21]. 201223071973
modeling the role of peroxisome proliferator-activated receptor γ and microrna-146 in mucosal immune responses to clostridium difficile.clostridium difficile is an anaerobic bacterium that has re-emerged as a facultative pathogen and can cause nosocomial diarrhea, colitis or even death. peroxisome proliferator-activated receptor (ppar) γ has been implicated in the prevention of inflammation in autoimmune and infectious diseases; however, its role in the immunoregulatory mechanisms modulating host responses to c. difficile and its toxins remains largely unknown. to characterize the role of pparγ in c. difficile-associated disease ...201223071818
succession in the gut microbiome following antibiotic and antibody therapies for clostridium difficile.antibiotic disruption of the intestinal microbiota may cause susceptibility to pathogens that is resolved by progressive bacterial outgrowth and colonization. succession is central to ecological theory but not widely documented in studies of the vertebrate microbiome. here, we study succession in the hamster gut after treatment with antibiotics and exposure to clostridium difficile. c. difficile infection is typically lethal in hamsters, but protection can be conferred with neutralizing antibodi ...201223071679
aminoacyl-trna synthetase inhibitors as antimicrobial agents: a patent review from 2006 till present.aminoacyl-trna synthetases (aarss) are one of the leading targets for development of antimicrobial agents. although these enzymes are well conserved among prokaryotes, significant divergence has occurred between prokaryotic and eukaryotic aarss, which can be exploited in the discovery of broad-spectrum antibacterial agents. although several aars inhibitors have been reported before, they failed as a result of poor selectivity and limited cell penetration.201223062029
impact of clostridium difficile colitis on 5-year health outcomes in patients with ulcerative colitis.clostridium difficile colitis (cdc) is associated with an increased short-term mortality risk in hospitalised ulcerative colitis (uc) patients. we sought to determine whether cdc also impacts long-term risks of adverse health events in this population.201223061526
acute kidney injury is an independent marker of severity in clostridium difficile infection: a nationwide survey.to examine clinical outcomes in hospitalized clostridium difficile infection (cdi) patients with acute kidney injury (aki) using the national hospital discharge survey for 2005 to 2009.201323059411
clostridium difficile postantibiotic diarrhoea diagnosis.to study the frequency of clostridium difficile in postantibiotic diarrhoea in patients admitted to the medical ward of a secondary care hospital.201223058147
diagnosis of clostridium difficile-associated disease: examination of multiple algorithms using toxin eia, glutamate dehydrogenase eia and loop-mediated isothermal amplification.the laboratory diagnosis of clostridium difficile infection (cdi) needs to be accurate and timely to ensure optimal patient management, infection control and reliable surveillance. three methods are evaluated using 810 consecutive stool samples against toxigenic culture: cdt tox a/b premier enzyme immunoassay (eia) kit (meridian bioscience, europe), premier eia for c. difficile glutamate dehydrogenase (gdh) (meridian bioscience, europe) and the illumigene kit (meridian bioscience, europe), both ...201223057158
clostridium difficile: changing epidemiology, treatment and infection prevention measures.clostridium difficile was first reported as a cause of antibiotic-associated colitis in 1978. in more recent years we have witnessed disturbing trends associated with c. difficile infection (cdi). cdi has become more common, affecting populations previously considered at low risk, more severe with an associated increase in mortality, and more difficult to treat with some patients experiencing multiple relapses and a reduced responsiveness to previously effective antibiotics. these trends have be ...201223054932
evaluation of clostridium difficile fecal load and limit of detection during a prospective comparison of two molecular tests, the illumigene c. difficile and xpert c. difficile/epi tests.in a large prospective comparison, the illumigene test detected clostridium difficile in 98% of toxin-positive and 58% of toxin-negative samples confirmed positive by other methods. the xpert was uniformly sensitive. most samples with discrepant results had c. difficile concentrations below the illumigene limit of detection. the significance of low-level c. difficile detection needs investigation.201323052320
association of relapse of clostridium difficile disease with bi/nap1/027.recurrent clostridium difficile infection (cdi) occurs in up to 35% of patients. recurrences can be due to either relapse with the same strain or reinfection with another strain. in this study, multilocus variable-number tandem-repeat analysis (mlva) was performed on c. difficile isolates from patients with recurrent cdi to distinguish relapse from reinfection. in addition, univariate and multivariate analyses were performed to identify risk factors associated with relapse. among patients with a ...201223052318
stability of vancomycin in syrspend sf.vancomycin is administered orally for the treatment of pseudomembranous colitis induced by clostridium difficile. vancomycin is marketed for this purpose by viropharma as vancocin in 125-mg and 250-mg capsules. the need for other dose form options for those patients who cannot take capsules has led compounding pharmacies to seek other alternatives, namely oral solutions and suspensions. additionally, some patients are unable to use suspending agents containing alcohol or sorbitol. the objective ...201323050329
activity of the thiopeptide antibiotic nosiheptide against contemporary strains of methicillin-resistant staphylococcus aureus.the rapid rise in antimicrobial resistance in bacteria has generated an increased demand for the development of novel therapies to treat contemporary infections, especially those caused by methicillin-resistant staphylococcus aureus (mrsa). however, antimicrobial development has been largely abandoned by the pharmaceutical industry. we recently isolated the previously described thiopeptide antibiotic nosiheptide from a marine actinomycete strain and evaluated its activity against contemporary cl ...201223047246
[clostridium difficile associated diarrhea: reliable therapy with vancomycin capsules]. 201223045940
recent changes in clostridium difficile infection.clostridium difficile is the main cause of nosocomial diarrhea. diarrhea associated with c. difficile has increased incidence, morbidity, and mortality in the last few years. the major related risk factors include use of antibiotics, elderly patients and prolonged hospital stay. many patients receive combinations of antibiotics or multiple antibiotics, which represents the main risk to develop diarrhea associated to c. difficile or its recurrence. therefore, interventions to improve antibiotic p ...201223045838
intrarectal instillation of clostridium difficile toxin a triggers colonic inflammation and tissue damage: development of a novel and efficient mouse model of clostridium difficile toxin exposure.clostridium difficile, a major cause of hospital-acquired diarrhea, triggers disease through the release of two toxins, toxin a (tcda) and toxin b (tcdb). these toxins disrupt the cytoskeleton of the intestinal epithelial cell, increasing intestinal permeability and triggering the release of inflammatory mediators resulting in intestinal injury and inflammation. the most prevalent animal model to study tcda/tcdb-induced intestinal injury involves injecting toxin into the lumen of a surgically ge ...201223045481
contribution of adenosine a(2b) receptors in clostridium difficile intoxication and infection.clostridium difficile toxins a (tcda) and b (tcdb) induce a pronounced systemic and intestinal inflammatory response. a(2b) adenosine receptors (a(2b)ars) are the predominant adenosine receptors in the intestinal epithelium. we investigated whether a(2b)ars are upregulated in human intestinal cells by tcda or tcdb and whether blockade of a(2b)ars can ameliorate c. difficile tcda-induced enteritis and alter the outcome of c. difficile infection (cdi). adenosine receptor subtype (a(1), a(2a), a(2b ...201223045479
implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital. 201223043720
an evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms.admission to a room previously occupied by a patient with certain multidrug-resistant organisms (mdros) increases the risk of acquisition. traditional cleaning strategies do not remove all environmental mdros. we evaluated the environmental and clinical impact of hydrogen peroxide vapor (hpv) room disinfection.201323042972
does candida species overgrowth protect against clostridium difficile infection? 201323042967
hospital-onset clostridium difficile infection rates in persons with cancer or hematopoietic stem cell transplant: a c3ic network report.a multicenter survey of 11 cancer centers was performed to determine the rate of hospital-onset clostridium difficile infection (ho-cdi) and surveillance practices. pooled rates of ho-cdi in patients with cancer were twice the rates reported for all us patients (15.8 vs 7.4 per 10,000 patient-days). rates were elevated regardless of diagnostic test used.201223041818
burden of clostridium difficile infection in long-term care facilities in monroe county, new york.long-term care facility (ltcf) residents are at increased risk of clostridium difficile infection (cdi). however, little is known about the incidence, recurrence, and severity of cdi in ltcfs or the extent to which acute care exposure contributes to cdi in ltcfs. we describe the epidemiology of cdi in a cohort of ltcf residents in monroe county, new york, where recent estimates suggest a cdi incidence in hospitals of 9.2 cases per 10,000 patient-days.201223041808
empirical antimicrobial prescriptions in patients with clostridium difficile infection at hospital admission and impact on clinical outcome.to determine, among patients with clostridium difficile infection (cdi) at hospital admission, the impact of concurrent use of systemic, non-cdi-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.201223041807
effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections.chlorhexidine gluconate (chg) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. the objective was to determine the effect of hospital-wide chg patient bathing on healthcare-associated infections (hais).201223041806
equal efficacy of glucoprotamin and an aldehyde product for environmental disinfection in a hematologic transplant unit: a prospective crossover trial.the inanimate hospital environment has emerged as an important reservoir of nosocomial pathogens. in particular, multidrug-resistant pathogens, such as methicillin-resistant staphylococcus aureus, acinetobacter species, and clostridium difficile, play a major role in the transmission of hospital-acquired infections. in europe, aldehydes, chlorine, and quaternary ammonium compounds have been commonly used for environmental disinfection. glucoprotamin, a newer active compound for disinfectants, ha ...201223041803
fecal microbiota transplantation: past, present and future.fecal microbiota transplantation (fmt) re-establishes a balanced intestinal flora with resultant cure of recurrent clostridium difficile infection (rcdi). fmt has also been used to treat other gastrointestinal (gi) diseases including inflammatory bowel disease (ibd), irritable bowel syndrome (ibs), and chronic constipation and a variety of non-gi disorders. the purpose of this review is to discuss the intestinal microbiota and fmt treatment of gi and non-gi diseases.201323041678
clostridium difficile in young farm animals and slaughter animals in belgium.faecal carriage of clostridium difficile in healthy animals has been reported recently, especially in piglets and calves. however there is limited data about carriage in animals just prior to slaughter in europe. the main objective of this study was to determine the presence of c. difficile in pigs and cattle at the slaughterhouse. c. difficile was isolated in 6.9% of the cattle at the slaughterhouse. none of the pig slaughter samples were positive for c. difficile after an enrichment time of 72 ...201223041559
alkaline detergent combined with a routine ward bedpan washer disinfector cycle eradicates clostridium difficile spores from the surface of plastic bedpans.the cleaning efficiency of a ward bedpan washer disinfector was evaluated using various cycle parameters and detergent to determine which conditions could effectively eliminate clostridium difficile spores from the surface of bedpans. results revealed that the regular intensive cycle with thermal conditions of 85°c for 60 seconds plus the addition of an alkaline detergent was sufficient to eradicate c difficile spores. however, these thermal conditions alone, without detergent, were not adequate ...201323040603
clinical impact of switching conventional enzyme immunoassay with nucleic acid amplification test for suspected clostridium difficile-associated diarrhea.the impact of a new clostridium difficile nucleic acid amplification test (naat) on antibiotic utilization in patients with suspected c difficile infection was assessed. this single-center, cross-sectional study of 270 patients demonstrated that the use of naat decreased antibiotic expenditure by reducing prolonged empiric days of therapy in these patients.201323040489
outcome of clostridium difficile-associated disease in solid organ transplant recipients: a prospective and multicentre cohort study.clostridium difficile-associated disease (cdad) is the most common cause of nosocomial diarrhea. information about cdad in solid organ transplant (sot) recipients is scarce. to determine its epidemiology and risk factors, we conducted a cohort study in which 4472 sot patients were prospectively included in the resitra/reipi (spanish research network for the study of infection in transplantation) database between july 2003 and july 2006. forty-two episodes of cdad were diagnosed in 36 patients. t ...201223039822
prebiotics, probiotics and digestive health.the human gastrointestinal lumen is inhabited by a wide variety of microbiota. our understanding of the intestinal microbiota and its full consequences on gastrointestinal health is still evolving. however, it is well accepted that altered colonic flora drives the pathogenesis of many disorders and diseases as seen in antibiotic-associated diarrhea and clostridium difficile infection. recent works published in the area of probiotics are reviewed here.201223037903
clostridium difficile-associated infection: a disease of varying severity.clostridium difficile-associated infection (cdi) can have varying severity from asymptomatic carriage to fulminant colitis. its incidence and virulence in north america are increasing. the increase in virulence is associated with emergence of the highly toxigenic north american pulsed field gel electrophoresis-1 strain. the major risk factor for cdi is exposure to antibiotics. another major risk factor is hospitalization. the spectrum of cdi ranges from asymptomatic carriers to fulminant disease ...201223036604
the microbiome and inflammatory bowel disease: is there a therapeutic role for fecal microbiota transplantation?one hypothesis for the etiology of inflammatory bowel disease is that an altered or pathogenic microbiota causes inflammation in a genetically susceptible individual. understanding the microbiota's role in the pathogenesis of the disease could lead to new ibd treatments aimed at shifting the bacteria in the gut back to eubiosis. probiotics have some efficacy in the treatment of ulcerative colitis (uc), but our current repertoire is limited in potency. fecal microbiota therapy (fmt) is an emergin ...201223034604
proton pump inhibitor use and association with spontaneous bacterial peritonitis in patients with cirrhosis and ascites.to evaluate the literature regarding the efficacy and safety of proton pump inhibitors (ppis) when they are used in patients with cirrhosis and ascites.201223032651
ribotyping of clostridium difficile strains associated with nosocomial transmission and relapses in a swedish county.clostridium difficile is an emerging threat in hospital environments. to analyse possible transmission and to distinguish between relapse and reinfection a collection of c. difficile isolates, sampled from 162 consecutive episodes of c. difficile infection, were pcr ribotyped. two ribotypes (001 and 012) were prone to cause nosocomial acquisition. moreover, ribotype 001 had a tendency to cause relapses as almost one in two patients with this ribotype had one or more relapses. by using pcr riboty ...201323030627
temporal differential proteomes of clostridium difficile in the pig ileal-ligated loop model.the impact of clostridium difficile infection (cdi) on healthcare is becoming increasingly recognized as it represents a major cause of nosocomial diarrhea. a rising number of cdi cases and outbreaks have been reported worldwide. here, we developed the pig ileal-ligated loop model for semi-quantitative analysis comparing temporal differential proteomes in c. difficile following in vivo incubation with in vitro growth using isobaric tags for relative and absolute quantification (itraq). proteins ...201223029131
icesp1116, the genetic element responsible for erm(b)-mediated, inducible resistance to erythromycin in streptococcus pyogenes.icesp1116, responsible for erm(b)-mediated, inducible erythromycin resistance in streptococcus pyogenes, was comprehensively characterized, and its chromosomal integration site was determined. it displayed a unique mosaic organization consisting of a scaffold, related to tngallo1 from streptococcus gallolyticus, with two inserted fragments separated by is1216. one fragment, containing erm(b), displayed high-level identity to a portion of the s. pyogenes plasmid psm19035; the other, containing a ...201223027190
c-reactive protein is a useful predictor of metronidazole treatment failure in mild-to-moderate clostridium difficile infection.to assess the ability of c-reactive (crp) protein, against the other commonly used metrics, to predict metronidazole treatment failure in clostridium difficile infection.201323026925
the role of acute care surgery in the treatment of severe, complicated clostridium difficile-associated disease.clostridium difficile associated disease (cdad) is the result of colonic bacterial overgrowth with this gram positive anaerobic organism and the production of toxins that typically induce diarrhea. most patients with cdad respond to treatment with oral metronidazole or vancomycin, but a subset of patients will develop a severe systemic illness, multiple organ failure, and death. there are no reliable combinations of clinical or laboratory findings that will distinguish patients who will respond ...201223026914
duexis(®) (ibuprofen 800 mg, famotidine 26.6 mg): a new approach to gastroprotection for patients with chronic pain and inflammation who require treatment with a nonsteroidal anti-inflammatory drug.chronic pain conditions affect at least 116 million us adults and more than one-third of adults worldwide. nonsteroidal anti-inflammatory drugs (nsaids) are used extensively for the treatment of chronic pain due to their efficacy as anti-inflammatory and analgesic agents. gastrointestinal toxicity is the most well known adverse effect of nsaid therapy and it may manifest as dyspepsia, ulcers, or bleeding. current guidelines for the management of patients who require nsaids for chronic pain and i ...201223024710
fidaxomicin "chaser" regimen following vancomycin for patients with multiple clostridium difficile recurrences. 201323024296
the utility of repeat enzyme immunoassay testing for the diagnosis of clostridium difficile infection: a systematic review of the literature.over the last 20 years, the prevalence of healthcare-associated clostridium difficile (c. diff) disease has increased. while multiple tests are available for the diagnosis of c. diff infection, enzyme immunoassay (eia) testing for toxin is the most used. repeat eia testing, although of limited utility, is common in medical practice. to assess the utility of repeat eia testing to diagnose c. diff infections. systematic literature review. eligible studies performed >1 eia test for c. diff toxin an ...201523023352
results from the second scottish national prevalence survey: the changing epidemiology of healthcare-associated infection in scotland.healthcare-associated infections (hais) are a recognized public health problem worldwide. point prevalence surveys (ppss) can be used to measure the burden of all hai types.201223022370
wide variation in adoption of screening and infection control interventions for multidrug-resistant organisms: a national study.we performed a survey of national healthcare safety network hospitals in 2008 to describe adoption of screening and infection control policies aimed at multidrug-resistant organisms (mdro) in intensive care units (icus) and identify predictors of their presence, monitoring, and implementation.201223021413
associations between nosocomial meticillin-resistant staphylococcus aureus and nosocomial clostridium difficile-associated diarrhoea in 89 german hospitals.clostridium difficile is mainly considered as a hospital-acquired pathogen causing diarrhoea in healthcare settings.201223021304
the burden of clostridium difficile-associated disease following digestive tract surgery in japan.although surgery is considered a risk for clostridium difficile-associated disease (cdad), large-scale data on outcomes of postsurgical cdad are rare.201223021129
modification of plant rac/rop gtpase signalling using bacterial toxin transgenes.bacterial protein toxins which modify rho gtpase are useful for the analysis of rho signalling in animal cells, but these toxins cannot be taken up by plant cells. we demonstrate in vitro deamidation of arabidopsis rop4 by escherichia coli cytotoxic necrotizing factor 1 (cnf1) and glucosylation by clostridium difficile toxin b. expression of the catalytic domain of cnf1 caused modification and activation of co-expressed arabidopsis rop4 gtpase in tobacco leaves, resulting in hypersensitive-like ...201323020817
[epidemiology, diagnosis, complications and surgery in inflammatory bowel disease].in digestive disease week 2012, held in san diego, numerous studies were presented on the epidemiology of inflammatory bowel disease. some of these studies were population-based, providing greater information on known risk factors and helping to eliminate proposed risk factors for which there is no known evidence. in this meeting, special attention was paid to the natural history of the disease as well as surgery in patients aged more than 65 years old who should clearly be treated as a separate ...201223018008
clostridium difficile clinical isolates exhibit variable susceptibility and proteome alterations upon exposure to mammalian cationic antimicrobial peptides.clostridium difficile is a leading cause of hospital-acquired bacterial infections in the united states, and the increased incidence of recurrent c. difficile infections is particularly problematic. the molecular mechanisms of c. difficile colonization, including its ability to evade host innate immune responses, is poorly understood. we hypothesized that epidemic-associated c. difficile clinical isolates would exhibit increased resistance to mammalian, gut-associated, cationic antimicrobial pep ...201223017940
attributing cause of death for patients with clostridium difficile infection. 201223017180
multicenter clinical evaluation of the portrait toxigenic c. difficile assay for detection of toxigenic clostridium difficile strains in clinical stool specimens.we compared the portrait toxigenic c. difficile assay, a new semiautomated sample-to-result molecular test, to a toxigenic bacterial culture/cell cytotoxin neutralization assay (tbc/ccna) for the detection of toxigenic clostridium difficile in 549 stool specimens. stool specimens were also tested by one of three alternative fda-cleared molecular tests for toxigenic c. difficile (xpert c. difficile, illumigene c. difficile, or geneohm cdiff). the sensitivities and specificities of the molecular t ...201223015667
impact of the type of diagnostic assay on clostridium difficile infection and complication rates in a mandatory reporting program.most clostridium difficile infection (cdi) surveillance programs neither specify the diagnostic method to be used nor stratify rates accordingly. we assessed the difference in healthcare-associated cdi (ha-cdi) incidence and complication rates obtained by 2 validated diagnostic methods.201323011147
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