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unnecessary repeat clostridium difficile pcr testing in hospitalized adults with c. difficile-negative diarrhea.the aim of this study was to determine the extent and associated costs of repeat clostridium difficile stool polymerase chain reaction (pcr) assays in patients with initially negative pcrs. c. difficile stool pcrs were done on adult hospitalized patients with diarrhea. the number/time course of repeat pcrs on initially negative pcr patients was determined. of 5,027 c. difficile stool pcrs, 814 (16.2 %) were positive and 4,213 (83.8 %) were negative. ninety-seven of the initially pcr-negative pat ...201323010903
proton pump inhibitors: potential adverse effects.this review summarizes adverse effects of potential proton pump inhibitors (ppis), including nutritional deficiencies (b12 and magnesium), rebound acid hypersecretion, acute interstitial nephritis, gastric carcinoid tumor, cardiovascular risk with clopidogrel and ppi coprescription, bone fractures, enteric infections and pneumonia. an epidemiologic framework is applied to assess clinical relevance and reinforce best practice recommendations.201223010681
a pilot randomised controlled trial in intensive care patients comparing 7 days' treatment with empirical antibiotics with 2 days' treatment for hospital-acquired infection of unknown origin.management of cardiac intensive care unit (icu) sepsis is complicated by the high incidence of systemic inflammatory response syndrome, which mimics sepsis but without an infective cause. this pilot randomised trial investigated whether or not, in the icu, 48 hours of broad-spectrum antibiotic treatment was adequate to safely treat suspected sepsis of unknown and unproven origin and also the predictive power of newer biomarkers of sepsis.201223010339
outcomes in patients tested for clostridium difficile toxins.clostridium difficile testing is shifting from toxin detection to c. difficile detection. yet, up to 60% of patients with c. difficile by culture test negative for toxins and it is unclear whether they are infected or carriers. we reviewed medical records for 7046 inpatients with a c. difficile toxin test from 2005 to 2009 to determine the duration of diarrhea and rate of complications and mortality among toxin-positive (toxin+) and toxin- patients. overall, toxin- patients had less severe diarr ...201223009731
ppi therapy and albumin are better predictors of recurrent clostridium difficile colitis than choice of antibiotics.recurrent clostridium difficile colitis (rcdc) is common, but data regarding recurrence rates and predisposing factors are sparse.201223007285
[adverse events associated with long-term use of proton pump inhibitors].proton pump inhibitors (ppi) remain the leading therapy for acid-related disorders. long-term ppi use increases the risk of pneumonia and enteric bacterial infections and of nosocomial clostridium difficile-associated diarrhoea. ppis do not lead to vitamin b12 or iron deficiencies and do not induce malignancies or increase the risk of major birth defects. prolonged ppi use may be a weak risk factor for certain fractures and results in hypergastrinaemia and parietal cell hyperplasia leading to re ...201223006222
different antibiotic resistance and sporulation properties within multiclonal clostridium difficile pcr ribotypes 078, 126, and 033 in a single calf farm.clostridium difficile strains were sampled periodically from 50 animals at a single veal calf farm over a period of 6 months. at arrival, 10% of animals were c. difficile positive, and the peak incidence was determined to occur at the age of 18 days (16%). the prevalence then decreased, and at slaughter, c. difficile could not be isolated. six different pcr ribotypes were detected, and strains within a single pcr ribotype could be differentiated further by pulsed-field gel electrophoresis (pfge) ...201223001653
the impact of mechanical bowel preparation on postoperative complications for patients undergoing cystectomy and urinary diversion.the benefit of routine mechanical bowel preparation for patients undergoing radical cystectomy is not well established. we compared postoperative complications in patients who did or did not undergo mechanical bowel preparation before radical cystectomy.201222999697
comparison of antigen and two molecular methods for the detection of clostridium difficile toxins.clostridium difficile (cd) is considered an important cause of diarrhoea associated with the antimicrobial treatment of infections. the pathogenicity of cd is due to toxins a and b, produced by toxigenic cd strains.201322998479
severe anaphylaxis caused by orally administered vancomycin to a patient with clostridium difficile infection.we report the first case of anaphylaxis to oral vancomycin in a cystic fibrosis patient with severe and relapsing clostridium difficile infection (cdi) refractory to metronidazole. the patient's colitis has been successfully treated with a combination of intravenous metronidazole and tigecycline.201322996384
electrospray ionization-induced protein unfolding.electrospray ionization mass spectrometry (esi-ms) measurements were performed under a variety of solution conditions on a highly acidic sub-fragment (b3c) of the c-terminal carbohydrate-binding repeat region of clostridium difficile toxin b, and two mutants (b4a and b4b) containing fewer acidic residues. esi-ms measurements performed in negative ion mode on aqueous ammonium acetate solutions of b3c at low ionic strength (i < 80 mm) revealed evidence, based on the measured charge state distribut ...201222993046
patient attitudes toward the use of fecal microbiota transplantation in the treatment of recurrent clostridium difficile infection.fecal microbiota transplantation (fmt), a safe, effective alternative therapy for recurrent clostridium difficile infection (cdi), is infrequently used, in part because of an assumption that patients are unwilling to consider fmt because of its unappealing nature.201222990849
electronic screening of patients for predisposition to clostridium difficile infection in a community hospital.clostridium difficile infection (cdi) continues to cause significant morbidity and mortality among hospitalized patients. early diagnosis, contact precautions, and prompt therapy are crucial to the control of the disease and its spread. this study aims to develop an electronic screening tool to help identify patients who are at risk of cdi.201322990298
clostridium difficile colitis: review of the therapeutic approach.clostridium difficile infection (cdi) is the leading cause of antibiotic-associated and nosocomial infectious diarrhea. presenting as clostridium difficile colitis, it is a significant cause of morbidity and mortality. metronidazole is regarded as the agent of choice for cdl therapy and also for the first recurrence in most patients with mild to moderate cdi. vancomycin is recommended as an initial therapy for patients with severe cdi. with recent food and drug administration-approval fidaxomici ...201622990077
global transcriptional control by glucose and carbon regulator ccpa in clostridium difficile.the catabolite control protein ccpa is a pleiotropic regulator that mediates the global transcriptional response to rapidly catabolizable carbohydrates, like glucose in gram-positive bacteria. by whole transcriptome analyses, we characterized glucose-dependent and ccpa-dependent gene regulation in clostridium difficile. about 18% of all c. difficile genes are regulated by glucose, for which 50% depend on ccpa for regulation. the ccpa regulon comprises genes involved in sugar uptake, fermentation ...201222989714
collateral impact of a hospital outbreak of clostridium difficile: an unrecognized surge event requiring a system-level response.this paper discusses a unique surge event caused by an outbreak of clostridium difficile, resulting not from an increase in the demands on the healthcare system but, rather, from a substantial decrease in the capacity to provide care when the medical capacity in the facility was decreased by 50% due to bed closures. approaches to managing the situation using the staff, stuff and space paradigm are presented as strategies to prevent future adverse medical events.201222986569
development of a consensus method for culture of clostridium difficile from meat and its use in a survey of u.s. retail meats.three previously described methods for culture of clostridium difficile from meats were evaluated by microbiologists with experience in c. difficile culture and identification. a consensus protocol using bhi broth enrichment followed by ethanol shock and plating to selective and non-selective media was selected for use, and all participating laboratories received hands-on training in the use of this method prior to study initiation. retail meat products (n = 1755) were cultured for c. difficile ...201222986214
novel high-molecular-weight, r-type bacteriocins of clostridium difficile.clostridium difficile causes one of the leading nosocomial infections in developed countries, and therapeutic choices are limited. some strains of c. difficile produce phage tail-like particles upon induction of the sos response. these particles have bactericidal activity against other c. difficile strains and can therefore be classified as bacteriocins, similar to the r-type pyocins of pseudomonas aeruginosa. these r-type bacteriocin particles, which have been purified from different strains, e ...201222984261
rapid detection of sequence variation in clostridium difficile genes using late-pcr with multiple mismatch-tolerant hybridization probes.a novel molecular assay for clostridium difficile was developed using linear-after-the-exponential polymerase chain reaction (late-pcr). single-stranded dna products generated by late-pcr were detected and distinguished by hybridization to fluorescent mismatch-tolerant probes, as the temperature was lowered after amplification in 5(°)c intervals between 65°c and 25°c. single-tube multiplex reactions for tcda, tcdb, tcdc, and cdtb (binary toxin) sequences were initially optimized using synthetic ...201222982259
knowledge, attitudes and practice regarding clostridium difficile: a survey of physicians in an academic medical center.using current guidelines, we surveyed physicians at our hospital to ascertain knowledge, attitudes, and practice regarding clostridium difficile infection. the survey identified significant gaps in knowledge and practice. infection control professionals should include physician education on clostridium difficile infection diagnosis, isolation precautions, and treatment as part of a comprehensive control program.201322981165
clostridium difficile ribotype does not predict severe infection.studies of clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. a growing number of studies challenge the validity of this hypothesis.201222972866
systematic review and meta-analysis of outcomes following emergency surgery for clostridium difficile colitis.only a small proportion of patients with severe clostridium difficile infection (cdi) undergo emergency surgery, the timing and nature of which is unclear. the aim of this study was to describe the operations performed and to identify factors predictive of death following emergency surgery for cdi.201222972525
in vivo detection of mucosal healing-involved histiocytes by confocal laser endomicroscopy.histiocytes have a pivotal role in wound repair and intestinal epithelial recovery - the most important goal to sustain gut functionality. yet, an in vivo description of colonic histiocytes by confocal laser endomicroscopy (cle) is missing. here, we report the case of a 45-years-old male patient who was referred to our clinic with weight loss and a history of two consecutive clostridium difficile colitis episodes, the latter cured 3 wk before present admission. stool microbiology was negative. c ...201222969212
comparison of bacterial quantities in left and right colon biopsies and faeces.to compare quantities of predominant and pathogenic bacteria in mucosal and faecal samples.201222969206
proton pump inhibitors are associated with a high rate of serious infections in veterans with decompensated cirrhosis.there is increasing evidence that proton pump inhibitors (ppis) increase the rate of infections in patients with decompensated cirrhosis.201222966967
rifaximin therapy and hepatic encephalopathy: pros and cons.hepatic encephalopathy (he) is the second most common major complication in cirrhotics and it significantly impacts quality of life. therapeutic approaches for he treatment and prevention mainly continue to rely on ammonia-lowering strategies and non-absorbable disaccharides are currently considered the cornerstone therapy. non-absorbable antibiotics, such as neomycin and paramomycin, are effective in treatment of acute he episodes but their prolonged use for recurrence prevention is hampered by ...201222966484
evaluation of nvb302 versus vancomycin activity in an in vitro human gut model of clostridium difficile infection.first-line treatment options for clostridium difficile infection (cdi) are limited. nvb302 is a novel type b lantibiotic under evaluation for the treatment of cdi. we compared the responses to nvb302 and vancomycin when used to treat simulated cdi in an in vitro gut model.201322966180
a first-in-human, randomized, double-blind, placebo-controlled, single- and multiple-ascending oral dose study to assess the safety and tolerability of lff571 in healthy volunteers.clostridium difficile is the leading cause of hospital-acquired infectious diarrhea. lff571 is a novel inhibitor of the prokaryotic translation elongation factor tu and is active against a range of bacterial species, including c. difficile. this first-in-human study investigated the safety and pharmacokinetics of single and multiple ascending oral doses of lff571 in healthy subjects. this was a randomized, double-blind, placebo-controlled study. except for one cohort, lff571 was given with a hig ...201222964250
reducing adverse effects of proton pump inhibitors.proton pump inhibitors effectively treat gastroesophageal reflux disease, erosive esophagitis, duodenal ulcers, and pathologic hypersecretory conditions. proton pump inhibitors cause few adverse effects with short-term use; however, long-term use has been scrutinized for appropriateness, drug-drug interactions, and the potential for adverse effects (e.g., hip fractures, cardiac events, iron deficiency, clostridium difficile infection, pneumonia). adults 65 years and older are more vulnerable to ...201222962914
the impact of infection on population health: results of the ontario burden of infectious diseases study.evidence-based priority setting is increasingly important for rationally distributing scarce health resources and for guiding future health research. we sought to quantify the contribution of a wide range of infectious diseases to the overall infectious disease burden in a high-income setting.201222962601
daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers' hands.in a randomized nonblinded trial, we demonstrated that daily disinfection of high-touch surfaces in rooms of patients with clostridium difficile infection and methicillin-resistant staphylococcus aureus colonization reduced acquisition of the pathogens on hands after contacting high-touch surfaces and reduced contamination of hands of healthcare workers caring for the patients.201222961024
epidemiology and healthcare costs of incident clostridium difficile infections identified in the outpatient healthcare setting.to describe the epidemiology and healthcare costs of clostridium difficile infection (cdi) identified in the outpatient setting.201222961023
in vitro evaluation of the antimicrobial activity of a range of probiotics against pathogens: evidence for the effects of organic acids.the aim of this study was to investigate the antimicrobial properties of fifteen selected strains belonging to the lactobacillus, bifidobacterium, lactococcus, streptococcus and bacillus genera against gram-positive and gram-negative pathogenic bacteria. in vitro antibacterial activity was initially investigated by an agar spot method. results from the agar spot test showed that most of the selected strains were able to produce active compounds on solid media with antagonistic properties against ...201222959627
national institute of allergy and infectious disease (niaid) funding for studies of hospital-associated bacterial pathogens: are funds proportionate to burden of disease? 201222958856
mortality and clostridium difficile infection: a review. 201222958425
antimicrobial stewardship in scotland: impact of a national programme.the scottish antimicrobial prescribing group (sapg) was established by the scottish government in 2008 to lead the first national initiative to actively address antimicrobial stewardship. healthcare associated infection (hai) is a priority in scotland and the work of sapg contributes to the national hai delivery plan. sapg's early work has focused on restricting the use of antibiotics associated with a high risk of clostridium difficile infection (cdi) and development of national prescribing ind ...201222958296
prolongation of length of stay and clostridium difficile infection: a review of the methods used to examine length of stay due to healthcare associated infections. 201222958238
clostridium difficile spore-macrophage interactions: spore survival.clostridium difficile is the main cause of nosocomial infections including antibiotic associated diarrhea, pseudomembranous colitis and toxic megacolon. during the course of clostridium difficile infections (cdi), c. difficile undergoes sporulation and releases spores to the colonic environment. the elevated relapse rates of cdi suggest that c. difficile spores has a mechanism(s) to efficiently persist in the host colonic environment.201222952726
comparison of bd geneohm cdiff and seegene seeplex ace pcr assays using toxigenic clostridium difficile culture for direct detection of tcdb from stool specimens.we evaluated the performances of 2 pcr assays (bd geneohm and seegene ace) for direct detection of tcdb from stool specimens. the concordance rate between bd and seegene was 96.3%. the sensitivities, specificities, positive predictive values (ppvs), and negative predictive values (npvs) of bd and seegene were 95.7%, 96.5%, 91.8%, and 98.2% and 90.0%, 97.1%, 92.6%, and 96.0%, respectively.201222952270
a novel use of rectal swab to test for clostridium difficile infection by real-time pcr. 201222951884
clostridium difficile detection: identification of colonization, subclinical and overt disease. 201222951306
prevalence and distribution of clostridium difficile pcr ribotypes in cats and dogs from animal shelters in thuringia, germany.clostridium difficile is an important cause of nosocomial diarrhoea in humans. pet animals and livestock are discussed as potential natural reservoirs and sources of infection. in this study faecal samples from dogs and cats were collected at 10 animal shelters in thuringia, germany. c. difficile was isolated from 9 out of 165 (5.5%) canine and 5 out of 135 (3.7%) feline samples. five pcr ribotypes (010, 014/020, 039, 045, slo 066) were identified. pcr ribotypes 010 and 014/020 were detected in ...201222951303
evaluation of the xpert clostridium difficile assay for the diagnosis of clostridium difficile infection.infection with clostridium difficile is a growing concern because of the increasing prevalence and spread of nosocomial infections. emergence of the hypervirulent 027/nap1/bi strain is also notable. existing diagnostic methods have low sensitivity or are time-consuming. therefore, establishing a rapid and accurate microbiological diagnostic assay is needed. we evaluated the xpert c. difficile assay (xpert cd assay; cepheid, usa) to detect toxigenic c. difficile. this assay is a real-time multipl ...201222950071
clostridium difficile colitis and neutropenic fever associated with docetaxel chemotherapy in a patient with advanced extramammary paget's disease.extramammary paget's disease is a rare cutaneous malignant neoplasm. previous studies indicated the efficacy of docetaxel in advanced cases. the common side effects of docetaxel are usually tolerable and seldom life-threatening. we experienced a case of severe pseudomembranous colitis and neutropenic fever that developed just after the first cycle of docetaxel chemotherapy. to the best of our knowledge, there are few reports of pseudomembranous colitis associated with docetaxel administration fo ...201222949901
morbidity and mortality associated with clostridium difficile ribotype 078: a case-case study.the morbidity and mortality associated with clostridium difficile ribotype 078 were examined by comparison with other known outbreak strains. a healthcare interaction within eight weeks of a positive specimen significantly increased the likelihood of ribotype 078 compared with ribotype 027. individuals with ribotype 078 also tended to come from community sources, have a hospital stay post specimen similar to ribotype 027 and a lower 30-day mortality, but these differences were not statistically ...201222947650
[risk factors of clostridium difficile-associated diarrhea in children].to explore the risk factors of clostridium difficile-associated diarrhea (cdad) in children.201222944235
prebiotic-non-digestible oligosaccharides preference of probiotic bifidobacteria and antimicrobial activity against clostridium difficile.bifidobacterium breve 46, bifidobacterium lactis 8:8 and bifidobacterium longum 6:18 and three reference strains b. breve ccug 24611, b. lactis jcm 10602, and bifidobacterium pseudocatenulatum jcm 1200 were examined for acid and bile tolerance, prebiotic utilization and antimicrobial activity against four clostridium difficile (cd) strains including the hypervirulent strain, pcr ribotype nap1/027. b. lactis 8:8 and b. lactis jcm 10602 exhibited a high tolerance in mrsc broth with ph 2.5 for 30 m ...201222940065
improved detection of toxigenic clostridium difficile using the cepheid xpert c difficile assay and impact on c difficile infection rates in a tertiary hospital: a double-edged sword.recent recommendations suggest implementation of a 2-step diagnostic algorithm for the laboratory detection of toxigenic clostridium difficile. we found that the rate of toxigenic c difficile detection in our laboratory doubled after the introduction of an algorithm that incorporated polymerase chain reaction testing. this led to an abrupt 70% increase in the overall rate of c difficile infection in our institution.201322939418
fecal microbiota transplantation for treating recurrent clostridium difficile infection. 201222937601
enteric pathogens through life stages.enteric infections and diarrheal diseases constitute pervasive health burdens throughout the world, with rates being highest at the two ends of life. during the first 2-3 years of life, much of the disease burden may be attributed to infection with enteric pathogens including salmonella, rotavirus, and many other bacterial, viral, and protozoan organisms; however, infections due to clostridium difficile exhibit steady increases with age. still others, like campylobacter infections in industriali ...201222937528
twenty-three-hour stay loop ileostomy closures: a pilot study.in uk in 2010-2011, 4,463 ileostomy closures were performed (35,442 bed days) with a median inpatient stay of 5 days (hospital episode statistics data). this seems anomalous when there are reports of 23-h stay colectomies. we present our early experience of 23-h discharge for loop ileostomy closures.201322936588
clostridium difficile: an emerging pathogen in children.clostridium difficile is emerging as an important enteric pathogen in children. historically considered as an asymptomatic colonizer of the gastrointestinal tract, c. difficile infection (cdi) has not been well-studied in pediatric populations. while asymptomatic carriage remains high among infants, recent epidemiological surveillance has demonstrated a rise in the prevalence of cdi in both healthcare and community settings, particularly in children 1-5 years of age. the pathogenesis of pediatri ...201222935207
determination of serum antibodies to clostridium difficile toxin b in patients with inflammatory bowel disease.clostridium difficile infection has increased in prevalence among patients with inflammatory bowel disease (ibd). serum antibodies against c. difficile toxins have been detected in susceptible populations and may be protective; however, such antibodies have not been previously characterized in ibd patients. this study measured immunoglobulin g antibody levels to c. difficile toxin b in serum from ibd patients in remission and ibd patients in relapse. ibd patients demonstrated significantly highe ...201222933861
[treatment of refractory or recurrent clostridium difficile infection].the incidence and severity of clostridium difficile infection (cdi) has increased over the past decades. it is related to the emergence of hypervirulent strains and increased use of antibiotics. the incidence of refractory cdi to standard therapies and the risk for recurrent cdi are also increasing. current guidelines recommend the first recurrence to be treated with the same agent used for the initial episode. however, data are lacking to support any particular treatment strategy for severe ref ...201222926117
prevalence and genotypic characterization of clostridium difficile from ruminants in switzerland.clostridium difficile is an emerging enteric pathogen of humans and animals with a known main reservoir in the intestinal tract of various warm-blooded animals. this study was carried out to evaluate the prevalence of c. difficile in 150 rectal swab samples collected from cattle and goats in switzerland. the overall prevalence of c. difficile was 6.6%. the isolates belonged to the pcr ribotypes 033, 066, 070, 003, 001 and 137. in addition, the occurrence of c. difficile in faecal samples collect ...201222925279
contribution of spores to the ability of clostridium difficile to adhere to surfaces.clostridium difficile is the commonest cause of hospital-acquired infection in the united kingdom. we characterized the abilities of 21 clinical isolates to form spores; to adhere to inorganic and organic surfaces, including stainless steel and human adenocarcinoma cells; and to germinate. the composition of culture media had a significant effect on spore formation, as significantly more spores were produced in brain heart infusion broth (student's t test; p = 0.018). the spore surface relative ...201222923404
evidence of in vivo prophage induction during clostridium difficile infection.prophages contribute to the evolution and virulence of most bacterial pathogens, but their role in clostridium difficile is unclear. here we describe the isolation of four myoviridae phages, φmmp01, φmmp02, φmmp03, and φmmp04, that were recovered as free viral particles in the filter-sterilized stool supernatants of patients suffering from c. difficile infection (cdi). furthermore, identical prophages were found in the chromosomes of c. difficile isolated from the corresponding fecal samples. we ...201222923402
risk factors for development of clostridium difficile infection due to bi/nap1/027 strain: a meta-analysis.to identify risk factors for the development of clostridium difficile infection (cdi) due to c. difficile bi/nap1/027 strain.201222921930
cost-effectiveness of a modified two-step algorithm using a combined glutamate dehydrogenase/toxin enzyme immunoassay and real-time pcr for the diagnosis of clostridium difficile infection.the analytical performance and cost-effectiveness of the wampole toxin a/b eia, the c. diff. quik chek complete (cdqcc) (a combined glutamate dehydrogenase antigen/toxin enzyme immunoassay), two rt-pcr assays (progastro cd and bd geneohm) and a modified two-step algorithm using the cdqcc reflexed to rt-pcr for indeterminate results were compared. the sensitivity of the wampole toxin a/b eia, cdqcc (gdh antigen), bd geneohm and progastro cd rt-pcr were 85.4%, 95.8%, 100% and 93.8%, respectively. ...201422921803
toward a structural understanding of clostridium difficile toxins a and b.clostridium difficile is a toxin-producing bacterium that is a frequent cause of hospital-acquired and antibiotic-associated diarrhea. the incidence, severity, and costs associated with c. difficile associated disease are substantial and increasing, making c. difficile a significant public health concern. the two primary toxins, tcda and tcdb, disrupt host cell function by inactivating small gtpases that regulate the actin cytoskeleton. this review will discuss the role of these two toxins in pa ...201222919620
"community-acquired clostridium difficile infection: an emerging entity". 201222918999
the continually evolving clostridium difficile species.clostridium difficile is a spore-forming gram-positive bacterium that causes chronic diarrhea and sometimes life-threatening disease mainly in elderly and hospitalized patients. the reported incidence of c. difficile infection has changed dramatically over the last decade and has been related to the emergence of distinct clonal lineages that appear more transmissible and cause more severe infection. these include pcr ribotypes 027, 017 and more recently 078. population biology studies using mult ...201222913354
molecular basis of early stages of clostridium difficile infection: germination and colonization.clostridium difficile infections (cdis) occur when antibiotic therapy disrupts the gastrointestinal flora, favoring infected c. difficile spores to germinate, outgrow, colonize and produce toxins. during cdi, c. difficile vegetative cells initiate the process of sporulation allowing a fraction of the spores to remain adhered to the intestinal surfaces. these spores, which are unaffected by antibiotic therapy commonly used for cdis, then germinate, outgrow and recolonize the host's gi tract causi ...201222913353
tcdc does not significantly repress toxin expression in clostridium difficile 630δerm.in the past decade, clostridium difficile has emerged as an important gut pathogen. symptoms of c. difficile infection range from mild diarrhea to pseudomembranous colitis, sometimes resulting in colectomy or death. the main virulence factors of c. difficile are toxin a and toxin b. besides the genes encoding these toxins (tcda and tcdb), the pathogenicity locus (paloc) also contains genes encoding a sigma factor (tcdr) and a putative anti-sigma factor (tcdc). the important role of tcdr as a sig ...201222912837
utility of perirectal swab specimens for diagnosis of clostridium difficile infection.for 139 patients tested for clostridium difficile infection by polymerase chain reaction, the sensitivity, specificity, positive predictive value, and negative predictive value of testing perirectal swabs vs stool specimens were 95.7%, 100%, 100%, and 99.1%, respectively. for selected patients, perirectal swabs provide an accurate toxigenic c. difficile detection strategy.201222911648
acp journal club: review: proton-pump inhibitors are associated with increased risk for clostridium difficile infection. 201222910967
in vivo selection of rifamycin-resistant clostridium difficile during rifaximin therapy.we report the selection of clostridium difficile resistant to the rifamycin class of antibiotics in a patient within 32 h of receiving rifaximin for the treatment of recurrent c. difficile diarrhea. resistance was associated with single nucleotide substitutions within rpob.201222908175
empiric antibiotics pending bronchoalveolar lavage data in patients without pneumonia significantly alters the flora, but not the resistance profile, if a subsequent pneumonia develops.ventilator-associated pneumonia (vap) occurs in up to 25% of mechanically ventilated patients, with an associated mortality up to 50%. early diagnosis and appropriate empiric antibiotic coverage of vap are crucial. given the multitude of noninfectious clinical and radiographic anomalies within trauma patients, microbiology from bronchioalveolar lavage (bal) is often needed. empiric antibiotics are administered while awaiting bal culture data. little is known about the effects of these empiric an ...201322906560
clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with clostridium difficile 027.clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial c. difficile transmission.201222902081
an evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of clostridium difficile infection in hospital settings.to evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital clostridium difficile infection (cdi) incidence rates. a secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool.201222899806
oritavancin does not induce clostridium difficile germination and toxin production in hamsters or a human gut model.to evaluate the relative propensities of oritavancin and vancomycin to induce clostridium difficile infection (cdi) in hamster and in vitro human gut models.201222899803
clinical and economic outcomes of a prospective antimicrobial stewardship program.a pre-post analysis of an antimicrobial stewardship program (asp) involving the use of data-mining software to prospectively identify cases for asp intervention was conducted.201222899745
modeling host-pathogen interactions: h. sapiens as a host and c. difficile as a pathogen.many complex mechanisms in immunological studies cannot be measured by experiments, but can be analyzed by mathematical simulations. using theoretical modeling techniques, general principles of host-pathogen system interactions can be explored and clinical treatment schedules can be optimized to lower the microbial toxin burden and side effects in the host system. in this study, we use a computational modeling technique that aims to explain the host-pathogen interactions and suggests how the hos ...201222899591
lactic acid production by streptococcus thermophilus alters clostridium difficile infection and in vitro toxin a production.antibiotic treatment to treat specific infections has the potential to effectively target the offending microbe as well as other microbes that colonize sites within a host. antibiotic-associated diarrhea (aad) is a classic example resulting from disruption of host microbial communities; 20% of patients with aad are likely to become colonized with clostridium difficile. restoration of a "normal" microbial community within the host using probiotic bacteria is one approach to circumvent aad and c. ...201722895082
the rise of carbapenem-resistant acinetobacter baumannii.acinetobacter spp. are gram-negative bacteria that have become one of the most difficult pathogens to treat. the species a. baumannii, largely unknown 30 years ago, has risen to prominence particularly because of its ability to cause infections in immunocompromised patients. it is now a predominant pathogen in many hospitals as it has acquired resistance genes to virtually all antibiotics capable of treating gram-negative bacteria, including the fluoroquinolones and the cephalosporins. some memb ...201322894617
suppression of clostridium difficile in the gastrointestinal tracts of germfree mice inoculated with a murine isolate from the family lachnospiraceae.the indigenous microbial community of the gastrointestinal (gi) tract determines susceptibility to clostridium difficile colonization and disease. previous studies have demonstrated that antibiotic-treated mice challenged with c. difficile either developed rapidly lethal c. difficile infection or were stably colonized with mild disease. the gi microbial community of animals with mild disease was dominated by members of the bacterial family lachnospiraceae, while the gut community in moribund ani ...201222890996
protective role of commensals against clostridium difficile infection via an il-1β-mediated positive-feedback loop.clostridium difficile is a gram-positive obligate anaerobic pathogen that causes pseudomembranous colitis in antibiotic-treated individuals. commensal bacteria are known to have a significant role in the intestinal accumulation of c. difficile after antibiotic treatment, but little is known about how they affect host immunity during c. difficile infection. in this article, we report that c. difficile infection results in translocation of commensals across the intestinal epithelial barrier that i ...201222888139
isolation and characterization of clostridium difficile toxin-specific single-domain antibodies.camelidae single-domain antibodies (vhhs) are a unique class of small binding proteins that are promising inhibitors of targets relevant to infection and immunity. with vhh selection from hyperimmunized phage display libraries now routine and the fact that vhhs possess long, extended complementarity-determining region (cdr3) loop structures that can access traditionally immunosilent epitopes, vhh-based inhibition of targets such as bacterial toxins are being explored. toxin a and toxin b are hig ...201222886255
burden of gastrointestinal disease in the united states: 2012 update.gastrointestinal (gi) diseases account for substantial morbidity, mortality, and cost. statistical analyses of the most recent data are necessary to guide gi research, education, and clinical practice. we estimate the burden of gi disease in the united states.201222885331
engaging patients in the prevention of health care-associated infections: a survey of patients' awareness, knowledge, and perceptions regarding the risks and consequences of infection with methicillin-resistant staphylococcus aureus and clostridium difficile.methicillin-resistant staphylococcus aureus (mrsa) infections and clostridium difficile infections (cdi) are major health care-associated infections (hais). little is known about patients' knowledge of these hais. therefore, we surveyed patients to determine awareness, knowledge, and perceptions of mrsa infections and cdi.201322884494
toxic megacolon from fulminant clostridium difficile infection induced by topical silver sulphadiazine.pseudomembranous colitis and toxic megacolon (tm) are well-known complications of clostridium difficile infections. systemic antibiotic is considered as the major risk factor for the development of c difficile colitis. however, topical antibiotics are rarely associated with the infection. as previously thought, the use of topical antibiotic is capable of systemic absorption in damaged and denuded skin; sufficient enough to suppress the normal bowel flora. here, we present an unusual case of tm f ...201222878997
sensitivity of pathogenic and commensal bacteria from the human colon to essential oils.the microbiota of the intestinal tract plays an important role in colonic health, mediating many effects of dietary components on colonic health and during enteric infections. in the context of the increasing incidence of antibiotic resistance in gut bacteria, complementary therapies are required for the prevention and treatment of enteric infections. here we report the potential application of essential oils (eo) and pure eo compounds to improve human gut health. nerolidol, thymol, eugenol and ...201222878397
impact of toxigenic clostridium difficile colonization and infection among hospitalized adults at a district hospital in southern taiwan.the impact of toxigenic clostridium difficile colonization (tcdc) in hospitalized patients is not clear.201222876321
fidaxomicin (dificid), a novel oral macrocyclic antibacterial agent for the treatment of clostridium difficile-associated diarrhea in adults. 201222876085
novel management strategies in the treatment of severe clostridium difficile infection.cdi is increasing in incidence and severity. clinicians must have a low threshold to consider the diagnosis and to treat patients with the clinical syndrome and risk factors before laboratory confirmation of the diagnosis. in patients who have signs of advanced disease, escalation of care with antimicrobial strategies and multidisciplinary care including surgical consultation is necessary. furthermore, lowering the threshold for surgery compared with traditional approaches likely results in impr ...201222873036
in vitro and in vivo activities of the novel ketolide rbx 14255 against clostridium difficile.the mic(90) of rbx 14255, a novel ketolide, against clostridium difficile was 4 μg/ml (mic range, 0.125 to 8 μg/ml), and this drug was found to be more potent than comparator drugs. an in vitro time-kill kinetics study of rbx 14255 showed time-dependent bacterial killing for c. difficile. furthermore, in the hamster model of c. difficile infection, rbx 14255 demonstrated greater efficacy than metronidazole and vancomycin, making it a promising candidate for c. difficile treatment.201222869573
fidaxomicin: a new option for the treatment of clostridium difficile infection.the two drugs currently recommended for the treatment of clostridium difficile infection (cdi), namely vancomycin and metronidazole, are both associated with high rates of recurrence of infection. hence there is a need for new treatment options. the novel oral macrocyclic antibiotic fidaxomicin (previously known as par-101, opt-80 and difimicin) was recently approved in the usa and in europe for the treatment of cdi. clinical trials have shown non-inferiority with regard to clinical cure when co ...201222865382
is primary prevention of clostridium difficile infection possible with specific probiotics?the efficacy of probiotics for the prevention of clostridium difficile infection (cdi) is highly controversial, particularly with regard to the prevention of recurrent cdi. we hypothesize that primary prevention of cdi among patients receiving antibiotics might be a more achievable goal for probiotics than prevention in patients with previous cdi where the host flora is markedly altered.201222863358
comparative transcriptional analysis of clinically relevant heat stress response in clostridium difficile strain 630.clostridium difficile is considered to be one of the most important causes of health care-associated infections worldwide. in order to understand more fully the adaptive response of the organism to stressful conditions, we examined transcriptional changes resulting from a clinically relevant heat stress (41 °c versus 37 °c) in c. difficile strain 630 and identified 341 differentially expressed genes encompassing multiple cellular functional categories. while the transcriptome was relatively resi ...201222860125
surveillance of infection severity: a registry study of laboratory diagnosed clostridium difficile.changing clinical impact, as virulent clones replace less virulent ones, is a feature of many pathogenic bacterial species and can be difficult to detect. consequently, innovative techniques monitoring infection severity are of potential clinical value.201222859914
knowledge of clostridium difficile infection among uk health-care workers: development of a knowledge assessment tool.doctors' knowledge provides the basis to support good practice in infection prevention and control. however, there exists a paucity of validated knowledge assessment tools that can be reliably employed to identify poor knowledge levels of clostridium difficile infection (cdi) within populations of doctors, preventing the effective identification of knowledge deficiencies and focused targeting of educational interventions. here, we describe a development process to validate a novel cdi knowledge ...201222859801
probiotics for infectious diseases: more drugs, less dietary supplementation.according to current definitions, probiotics are live microorganisms that, when ingested in adequate quantities, exert a health benefit to the host. the action of probiotics in the host is exerted by three mechanisms: modulation of the content of gut microbiota; maintenance of the integrity of the gut barrier and prevention of bacterial translocation; and modulation of the local immune response by the gut-associated immune system. regarding their role for the prevention and treatment of infectio ...201222858373
use of uv-c radiation to disinfect non-critical patient care items: a laboratory assessment of the nanoclave cabinet.the near-patient environment is often heavily contaminated, yet the decontamination of near-patient surfaces and equipment is often poor. the nanoclave cabinet produces large amounts of ultraviolet-c (uv-c) radiation (53 w/m2) and is designed to rapidly disinfect individual items of clinical equipment. controlled laboratory studies were conducted to assess its ability to eradicate a range of potential pathogens including clostridium difficile spores and adenovirus from different types of surface ...201222856652
improving the quality of antibiotic prescribing in the nhs by developing a new antimicrobial stewardship programme: start smart--then focus.there has been dramatic change in antibiotic use in english hospitals. data from 2004 and 2009 show that the focus on reducing fluoroquinolone and second- and third-generation cephalosporin use seems to have been heeded in nhs secondary care, and has been associated with a substantial decline in hospital clostridium difficile rates. however, there has been a substantial increase in use of co-amoxiclav, carbapenems and piperacillin/tazobactam. in primary care, antibiotic prescribing fell markedly ...201222855879
current challenges in antimicrobial resistance and healthcare-associated infections: role and organization of arhai.the uk government specialist advisory committee on antimicrobial resistance and healthcare-associated infections (arhai) was established in 2007. it has responsibility for providing practical and scientific advice to government on healthcare-associated infections (hcais) and to maintain the effectiveness of antimicrobial agents in the treatment and prevention of infection in man and animals. the manner in which this has been approached by arhai is described. in essence, key themes have been defi ...201222855877
recommendations for surveillance priorities for healthcare-associated infections and criteria for their conduct.surveillance and feedback of results to clinical teams is central to performance improvement in managing healthcare-acquired infections. a major role of the advisory committee on antimicrobial resistance and healthcare-associated infections (arhai) is to advise on surveillance priorities. a sub-committee was set up to systematically review existing uk surveillance schemes. the following three systems were examined in detail: mandatory reporting of methicillin-resistant staphylococcus aureus (mrs ...201222855875
policy development for clostridium difficile.the advisory committee on antimicrobial resistance and healthcare associated infection (arhai) was created at the height of the incidence of clostridium difficile infection (cdi). this article describes the role of arhai in the evaluation of laboratory testing for cdi, a related consultation on the legal requirements for manufacturers of in vitro diagnostic medical devices, a cdi healthcare bundle and surveillance of cdi in children.201222855874
pediatric physicians' knowledge, attitudes, and beliefs regarding clostridium difficile-associated disease prevention, testing, and treatment. 201222854381
repeat stool testing for clostridium difficile using enzyme immunoassay in patients with inflammatory bowel disease increases diagnostic yield.the incidence and severity of clostridium difficile infection (cdi) in patients with inflammatory bowel disease (ibd) is increasing. cdi is diagnosed by toxin enzyme immunoassay (eia) or real-time polymerase chain reaction (pcr) performed on stool samples. an earlier study evaluating eia in ibd patients with cdi suggested that more than one stool sample be tested to increase diagnostic yield. we investigated whether repeat stool testing improves diagnostic accuracy for cdi in hospitalized ibd pa ...201222852871
modulation of toxin production by the flagellar regulon in clostridium difficile.we show in this study that toxin production in clostridium difficile is altered in cells which can no longer form flagellar filaments. the impact of inactivation of flic, cd0240, flif, flig, flim, and flhb-flir flagellar genes upon toxin levels in culture supernatants was assessed using cell-based cytotoxicity assay, proteomics, immunoassay, and immunoblotting approaches. each of these showed that toxin levels in supernatants were significantly increased in a flic mutant compared to that in the ...201222851750
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