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relatedness of human and animal clostridium difficile pcr ribotype 078 isolates determined on the basis of multilocus variable-number tandem-repeat analysis and tetracycline resistance.totals of 102 and 56 clostridium difficile type 078 strains of human and porcine origins, respectively, from four european countries were investigated by an optimized multilocus variable-number tandem-repeat analysis (mlva) and for tetracycline susceptibility. eighty-five percent of all isolates were genetically related, irrespective of human or porcine origin. human strains were significantly more resistant to tetracycline than porcine strains. all tetracycline-resistant strains contained the t ...201020686080
is repeat pcr needed for diagnosis of clostridium difficile infection?patients with diarrhea, defined as loose or watery stool, and two or more clostridium difficile tcdb pcr tests within 14 days of each other were investigated. repeat pcr for 293 patients with a prior negative result yielded negative results in 396 (97.5%) of 406 tests. ten new positives were detected, including one false positive. repeat pcr within 7 days appears rarely useful, except for patients with evidence of a new infection.201020686078
use of intravenous co-trimoxazole to treat bacterial infection: analysis of 50 treatment episodes.co-trimoxazole is infrequently prescribed in the uk due to concerns regarding adverse events. however, it has a low association with clostridium difficile-associated disease (cdad) and may represent an alternative to higher-risk agents. this retrospective study examines the efficacy and safety of intravenous co-trimoxazole in treatment of bacterial infection in a uk inpatient population of 50 inpatients. outcome was determined to be successful in 58% of treatment episodes; in hospital-acquired p ...201020685632
clostridium difficile colitis: a call for aggressive management. 201020679044
clostridium difficile bacteremia, taiwan.to determine clinical characteristics and outcome of patients with clostridium difficile bacteremia (cdb), we identified 12 patients with cdb in 2 medical centers in taiwan; all had underlying systemic diseases. five had gastrointestinal diseases or conditions, including pseudomembranous colitis (2 patients); 4 recalled diarrhea, but only 5 had recent exposure to antimicrobial drugs. ten available isolates were susceptible to metronidazole and vancomycin. five isolates had c. difficile toxin a o ...201020678312
the growing incidence and severity of clostridium difficile infection in inpatient and outpatient settings.clostridium difficile infection (cdi) is a leading cause of nosocomial infections, with disease severity ranging from mild diarrhea to fulminant colitis. the incidence and severity of cdi has been on the rise over the last 10-20 years, with cdi being increasingly described outside healthcare settings and in populations previously thought to be at low risk. there has also been an increase in the morbidity, mortality and economic burden associated with cdi in the last several years. this increasin ...201020678014
epidemiological patterns and hospital characteristics associated with increased incidence of clostridium difficile infection in quebec, canada, 1998-2006.to explore epidemiological patterns of the incidence of clostridium difficile infection (cdi) and hospital characteristics associated with increased incidence during nonepidemic and epidemic years.201020677973
rifaximin for the treatment of recurrent clostridium difficile infection after liver transplantation: a case series.previous data have suggested that the nonsystemic antibiotic rifaximin may be effective for the treatment of clostridium difficile infection (cdi). this single-center retrospective study evaluated the efficacy of rifaximin for the treatment of cdi refractory to standard treatments in patients who had received liver transplants. among 205 patients who had received liver transplants between july 2001 and december 2007, 3 patients with a confirmed diagnosis of c. difficile experienced recurrent dia ...201020677286
characterization of bacterial infections in allogeneic hematopoietic stem cell transplant recipients who received prophylactic levofloxacin with either penicillin or doxycycline.to describe the effect of a combination prophylactic regimen of levofloxacin, a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class, with either penicillin or doxycycline on the changing epidemiology of bacterial infections and antimicrobial resistance patterns of isolated organisms in the allogeneic hematopoietic stem cell transplant (hsct) patient population.201020675508
human hypervirulent clostridium difficile strains exhibit increased sporulation as well as robust toxin production.toxigenic clostridium difficile strains produce two toxins (tcda and tcdb) during the stationary phase of growth and are the leading cause of antibiotic-associated diarrhea. c. difficile isolates of the molecular type nap1/027/bi have been associated with severe disease and hospital outbreaks worldwide. it has been suggested that these "hypervirulent" strains produce larger amounts of toxin and that a mutation in a putative negative regulator (tcdc) allows toxin production at all growth phases. ...201020675495
inhibiting the initiation of clostridium difficile spore germination using analogs of chenodeoxycholic acid, a bile acid.to cause disease, clostridium difficile spores must germinate in the host gastrointestinal tract. germination is initiated upon exposure to glycine and certain bile acids, e.g., taurocholate. chenodeoxycholate, another bile acid, inhibits taurocholate-mediated germination. by applying michaelis-menten kinetic analysis to c. difficile spore germination, we found that chenodeoxycholate is a competitive inhibitor of taurocholate-mediated germination and appears to interact with the spores with grea ...201020675492
evaluation of a rapid molecular screening approach for the detection of toxigenic clostridium difficile in general and subsequent identification of the tcdc δ117 mutation in human stools.we have developed and validated a rapid molecular screening protocol for toxigenic clostridium difficile, that also enables the identification of the hypervirulent epidemic 027/nap1 strain. we describe a multiplex real-time pcr assay, which detects the presence of the tcda and tcdb genes directly in stool samples. in case of positive pcr results, a separate multiplex real-time pcr typing assay was performed targeting the tcdc gene frame shift mutation at position 117. we prospectively compared t ...201020674616
[clostridium difficile infections. not just a hospital problem]. 201020672581
glutamate dehydrogenase for laboratory diagnosis of clostridium difficile infection. 201020668302
laboratory diagnosis of clostridium difficile infection. 201020668301
the role of toxin a and toxin b in clostridium difficile-associated disease: past and present perspectives.recently, we constructed and characterized isogenic tcda and tcdb mutants of a virulent clostridium difficile strain and used a hamster model of disease to demonstrate that toxin b, not toxin a, is essential for virulence of this emerging pathogen. earlier studies had shown that purified toxin a alone was able to induce c. difficile disease pathology and that purified toxin b was not effective unless it was co-administered with toxin a, suggesting that the toxins act synergistically. in this add ...201020664812
antibiotic prophylaxis. mrsa and clostridium difficile are falling. 201020663825
results of faecal donor instillation therapy for recurrent clostridium difficile-associated diarrhoea.we report a success rate of 83% with faecal donor instillation therapy (fdit) in this retrospective study of 40 patients with recurrent clostridium difficile-associated diarrhoea (cdad), treated at a medium sized norwegian hospital from 1994 through 2008. the stool transplant was instilled either in the duodenum through a gastroscope or in the colon through a colonoscope with next of kin or other household member as donor. in 29 cases (73%) the first treatment was successful, with no documented ...201020662620
reducing clostridium difficile infection in acute care by using an improvement collaborative.in 2006, despite a focus on infection control, salford royal had the fourth highest rate of clostridium difficile infection in north west england.201020659985
correlation of the detection of clostridium difficile toxins in stools and presence of the clostridia in tissues of children.clostridium difficile toxin is frequently found in the stool of children; however, pseudomembranous colitis is rare. studying the usefulness of clostridium difficile toxin assays in pediatrics is required. we performed a correlation between presence of clostridium difficile toxin in stool and evidence of clostridium difficile in gastrointestinal pediatric tissue samples using immunohistochemistry (with a pan-clostridial antibody) and polymerase chain reaction (with primers for toxin genes). we s ...201020656321
[intestinal flora and antibiotics]. 201020654929
proton pump inhibitors as a risk factor for recurrence of clostridium-difficile-associated diarrhea.to investigate the risk factors for clostridium-difficile-associated diarrhea (cdad) recurrence, and its relationship with proton pump inhibitors (ppis).201020653067
recognition and prevention of hospital-associated enteric infections in the intensive care unit.the objectives of this article were to review the causes and extent of hospital-associated infectious diarrhea and associated risks in the general hospital ward and intensive care unit (icu), to compare microorganisms with similar symptoms to aid in recognition that will lead to timely and appropriate treatment and control measures, and to propose infection prevention protocols that could decrease human process errors in the icu. this literature review describes epidemiology, comparison of micro ...201020647790
hand hygiene in the intensive care unit.healthcare-associated infections affect 1.4 million patients at any time worldwide, as estimated by the world health organization. in intensive care units, the burden of healthcare-associated infections is greatly increased, causing additional morbidity and mortality. multidrug-resistant pathogens are commonly involved in such infections and render effective treatment challenging. proper hand hygiene is the single most important, simplest, and least expensive means of preventing healthcare-assoc ...201020647787
diagnosis, management, and prevention of clostridium difficile infection in long-term care facilities: a review.clostridium difficile is a significant healthcare-associated pathogen and the major cause of antibiotic-associated diarrhea. the incidence and severity of c. difficile infection have increased in many parts of north america and europe in the past few years with the widespread dissemination of a hypervirulent strain of c. difficile, referred to as north american pulsed-field type 1, polymerase chain reaction ribotype 027 (nap1/027). c. difficile infection appears to affect older adults disproport ...201020646106
clostridium difficile-related pancolitis in lung-transplanted patients with cystic fibrosis.c. difficile (c. d.) is the main cause of antibiotic-associated diarrhea and colitis. it is shown in literature a high asymptomatic carriage rate of c. d. in patients with cystic fibrosis (cf), though c. d.-related colitis is an uncommon complication in these patients, despite the use of multiple high-dose antibiotic regimes and the frequency of hospital admissions. lung transplantation with the associated immunosuppression and aggressive antibiotic therapy may increase the risk of the clinical ...201120642799
interpreting adverse drug reaction (adr) reports as hospital patient safety incidents.what is already known about this subject: adverse drug reactions (adrs) are a reporting category in the national patient safety agency (npsa) incident reporting system, though the medicines and healthcare products regulatory agency (mhra) pharmacovigilance system is the more established method for collecting adr data.201020642552
clostridium difficile in food and domestic animals: a new foodborne pathogen?clostridium difficile infection is increasingly recognized as a cause of diarrhea in outpatients and persons with no apparent health care facility contacts. in contrast to c. difficile infection acquired in health care settings, few risk factors for development of community-associated c. difficile infection are known. foodborne transmission of c. difficile has been hypothesized as a possible source for community-associated infections; however, the evidence to confirm or refute this hypothesis is ...201020642351
clostridium difficile: (re)emergence of zoonotic potential. 201020642350
[approach to the treatment of intestinal infectious diseases caused by clostridium difficile].the treatment of infections caused by clostridium difficile requires a comprehensive approach. the administration of antibiotics of choice (vancomycin or metronidazole) is crucial. the choice of particular agents is based on the severity and course of the disease. besides antibiotics, alternative approaches continue to be of interest, especially in forms inadequately responding to antibiotic therapy and in case of recurring infections.201020640987
[experience with the use of new tests for detecting clostridium difficile].in recent years, clostridium difficile has been among the most important nosocomial pathogens. it causes intestinal infectious diseases detectable by numerous laboratory methods. given the severity of the diseases, some tests have proved inadequately sensitive. the article summarizes the first experience with the latest kits for early and sensitive detection of toxic strains of clostridium difficile.201020640986
[practical experience with the detection clostridium difficile].clostridium difficile is an important pathogen causing nosocomial diarrhoea and colitis which, in severe cases, may result in pseudomembranous colitis and eventually death. the main pathogenicity factors for c. difficile are toxins referred to as a and b. the diagnosis of diseases caused by c. difficile is based on detection of the toxins, together with culture and determination of susceptibility of c. difficile strains to antibiotics. the article reports results of tests of kits for detecting c ...201020640985
clostridium difficile-associated disease acquired in the cardiothoracic intensive care unit.to determine the prevalence, severity, and outcome associated with clostridium difficile-associated disease (cdad) acquired while in the cardiothoracic intensive care unit (cticu).201120638863
prospective assessment of two-stage testing for clostridium difficile.commonly used immunoassays have limitations as stand-alone tests for the diagnosis of clostridium difficile infection (cdi). in particular, the specificity of these assays means that these tests generate a relatively large number of false-positive results. we introduced a two-stage regimen for cdi as routine. unformed stool samples received in our laboratory were initially tested with a meridian premier enzyme immunoassay (eia) and positive samples were retested with reference testing methods (t ...201020638749
audit of the laboratory diagnosis of clostridium difficile infection in the uk.a uk-wide audit of the laboratory diagnosis of clostridium difficile infection (cdi) was undertaken by the association of clinical pathologists and the royal college of pathologists, in conjunction with keele university. a postal questionnaire was sent out to all consultant microbiologists, with eighty responses available for analysis. there was considerable variation in laboratory practices. in particular, only 56% of laboratories gave guidance on follow-up testing of toxin-negative samples, 68 ...201020635470
fulminant clostridium difficile colitis in a post-liver transplant patient. 201020635145
comparison of resistance against erythromycin and moxifloxacin, presence of binary toxin gene and pcr ribotypes in clostridium difficile isolates from 1990 and 2008.worldwide increasing rates of clostridium difficile infections (cdi) with severe courses and outbreaks have been reported. this change in cdi epidemiology has on one hand been related to the spread of specific pcr ribotypes (e.g. 027) and on the other hand to increased prevalence of resistant c. difficile strains. this single-centre retrospective analysis characterized resistance against erythromycin and moxifloxacin, presence of binary toxin gene and ribotypes in 73 c. difficile isolates from 2 ...201020632051
[first symposium of the bavarian lare (statewide working group on multiresistant pathogens)]. 201020631971
community-acquired clostridium difficile-associated diarrhea in a patient on chronic peritoneal dialysis.a 66-year-old woman on chronic peritoneal dialysis was admitted because of intermittent diarrhea and abdominal pain, and anorexia for 1 month. she had not been given antibiotics nor hospitalized for at least 6 months prior to the onset of symptoms. clostridium difficile and its toxin were detected in the stool and clostridium difficile-associated diarrhea (cdad) was diagnosed. colonoscopic examination revealed pseudomembrane formation and colitis in the whole colon. clostridium difficile and its ...201020630134
clostridium difficile infection of the small bowel--two case reports with a literature survey.diseases associated with clostridium difficile range from antibiotic-related diarrhea to pseudomembranous enterocolitis, and are serious nosocomial infections with high morbidity and mortality. the c. difficile infection has thus far been regarded as a disease typically affecting the colon. however, the literature contains an increasing number of reports describing infections of the small bowel with fulminant clinical courses and high mortality rates of 60-83%. we think this situation is not ver ...201120628882
extended spectrum beta-lactamase-producing bacteria and clostridium difficile in patients with pouchitis.treatment with fluoroquinolones is associated with the development of clostridium difficile and extended spectrum beta-lactamase-producing bacteria (esbl). clostridium difficile and esbl are resistant to many antibiotics and each may cause pouchitis after restorative proctocolectomy (rpc) refractory to empirical antibiotic therapy.201020626734
structural organization of the functional domains of clostridium difficile toxins a and b.clostridium difficile toxins a and b are members of an important class of virulence factors known as large clostridial toxins (lcts). toxin action involves four major steps: receptor-mediated endocytosis, translocation of a catalytic glucosyltransferase domain across the membrane, release of the enzymatic moiety by autoproteolytic processing, and a glucosyltransferase-dependent inactivation of rho family proteins. we have imaged toxin a (tcda) and toxin b (tcdb) holotoxins by negative stain elec ...201020624955
detection of cross-infection associated to a brazilian pcr-ribotype of clostridium difficile in a university hospital in rio de janeiro, brazil.clostridium difficile is an important nosocomial enteric pathogen and is the etiological agent of pseudomembranous colites. recently, the rates of c. difficile infection (cdi) have increased worldwide, but in brazil few data about this situation and the incidence of clonal types of c. difficile exist. this study aimed to isolate and characterize c. difficile strains from samples obtained of a university hospital (hucff) in rio de janeiro city, brazil. cdi was identified by elisa in 27.1% of hucf ...201120623188
empiric therapy for gram-negative pathogens in nosocomial and health care-associated pneumonia: starting with the end in mind.nosocomial pneumonia is a major cause of morbidity and mortality for hospitalized patients. antimicrobial resistance is increasing, creating a strain between ensuring the provision of adequate empiric therapy and slowing the development of antimicrobial resistance. excessive antimicrobial therapy places patients are at greater risk of drug interactions, adverse events, and superinfections. ways to maximize adequate empiric therapy include (1) categorizing each patient's risk of being infected wi ...201020622257
infection due to c. difficile ribotype 078: first report of cases in the republic of ireland.clostridium difficile is an important healthcare-associated pathogen. hypervirulent strains such as those belonging to ribotype 027 have been widely reported in recent years. a second strain associated with hypervirulence is ribotype 078 and the prevalence of clostridium difficile infection (cdi) due to this ribotype appears to be increasing. this report describes an outbreak, in which 15cases of cdi due to ribotype 078 were detected in an irish hospital and from a nursing home in the hospital's ...201020621236
peritoneal fluid culture in appendicitis: review in changing times.appendicectomy is one of the commoner operations with a lifetime risk as high as 12% or 23% in males or females, respectively. since the 1940s intra-operative intra-peritoneal swabs have commonly been taken from the appendix site, the spectrum of infecting organisms and their antibiotic sensitivity may be gauged from the culture results. this approach remains common but in recent years, studies have claimed that intra-peritoneal swabs are unnecessary; however, they relied upon retrospective pati ...201020621208
repetitive domain of clostridium difficile toxin b exhibits cytotoxic effects on human intestinal epithelial cells and decreases epithelial barrier function.we have used recombinant repetitive domain of clostridium difficile toxin b obtained from two different strains, rec-tcdb3(10463) and rec-tcdb3(8864) and a model intestinal epithelial cell line(s) to characterize their cytotoxic and cytopathic effect and influence on tight-junction organization. both recombinant receptor binding domains caused intestinal epithelial cell damage, decreased transepithelial electrical resistance and induced translocation of zo-1 from tight-junction proteins although ...201020620216
disseminated intravascular coagulation, meningococcal infection, and ischemic changes affecting the lower extremities: a case study.a middle-aged woman presented from an outside hospital with a diagnosis of neisseria meningitidis and meningococcemia. a nonpalpable purpuric skin rash evolved into multiple wounds, with gradual necrosis of bilateral lower and upper extremities. throughout the course of hospitalization, the patient developed ventricular tachycardia, normocytic anemia, thrombocytosis, clostridium difficile infection, depression, and transient right eye blindness. the finding of decreased ch50 in the complement ca ...201020619693
[changing epidemiology of infections in the netherlands in 2008/'09].to describe the epidemiological characteristics of clostridium difficile infection (cdi) in the netherlands.201020619033
effect of broad- and narrow-spectrum antimicrobials on clostridium difficile and microbial diversity in a model of the distal colon.vancomycin, metronidazole, and the bacteriocin lacticin 3147 are active against a wide range of bacterial species, including clostridium difficile. we demonstrate that, in a human distal colon model, the addition of each of the three antimicrobials resulted in a significant decrease in numbers of c. difficile. however, their therapeutic use in the gastrointestinal tract may be compromised by their broad spectrum of activity, which would be expected to significantly impact on other members of the ...201120616009
evaluation of an automated ultraviolet radiation device for decontamination of clostridium difficile and other healthcare-associated pathogens in hospital rooms.environmental surfaces play an important role in transmission of healthcare-associated pathogens. there is a need for new disinfection methods that are effective against clostridium difficile spores, but also safe, rapid, and automated.201020615229
the changing epidemiology of clostridium difficile infections.the epidemiology of clostridium difficile infection (cdi) has changed dramatically during this millennium. infection rates have increased markedly in most countries with detailed surveillance data. there have been clear changes in the clinical presentation, response to treatment, and outcome of cdi. these changes have been driven to a major degree by the emergence and epidemic spread of a novel strain, known as pcr ribotype 027 (sometimes referred to as bi/nap1/027). we review the evidence for t ...201020610822
obesity as a risk factor for nosocomial infections in trauma patients.obesity, like multiple trauma, is associated with an inflammatory condition that leads to an immunodeficient state. obese trauma patients are thus thought to be at higher risk of infection compared to patients of normal body mass. despite this risk, studies to date have not defined obesity as an independent risk factor for infection in trauma patients.201020610250
chronic kidney disease as a risk factor for clostridium difficile infection.clostridium difficile-associated diarrhoea (cdad) is the most common cause of nosocomial diarrhoea in the usa. in this study, we sought to determine the association between chronic kidney disease (ckd) and cdad.201020609100
prevention of endemic healthcare-associated clostridium difficile infection: reviewing the evidence.clostridium difficile is the most common infectious cause of healthcare-associated diarrhea. because of the increasing incidence and severity of endemic c. difficile infection (cdi), interventions to prevent healthcare-associated cdi are essential. we undertook a systematic review of interventions to reduce healthcare-associated cdi.201020606676
barriers to implementing infection prevention and control guidelines during crises: experiences of health care professionals.communicable disease crises can endanger the health care system and often require special guidelines. understanding reasons for nonadherence to crisis guidelines is needed to improve crisis management. we identified and measured barriers and conditions for optimal adherence as perceived by 4 categories of health care professionals.201020605262
pseudo-outbreak of clostridium difficile associated diarrhea (cdad) in a tertiary-care hospital.the objective of this study was to describe a pseudo-outbreak of c. difficile in a hospital, following a change in the method used to detect the toxin. in february 2002, there were two cases of cdad and in march 7 occurred, coinciding with a change of the test (from detection of toxin a to toxin a/b). an outbreak was suspected. active surveillance and education of staff were started. a cdad case was defined as a patient with acute onset of diarrhea (> or = three episodes of liquid stools) and a ...201020602022
fecal bacteriotherapy, fecal transplant, and the microbiome. 201020601895
evaluation of candidate reference genes in clostridium difficile for gene expression normalization.quantitative real-time polymerase chain reaction (qpcr) is a sensitive, efficient and reproducible technique for studying gene expression. identification of stably expressed reference genes is required to avoid bias in these studies yet mostly unvalidated reference genes are used in studying gene expression in clostridium difficile. here, we sought to identify a set of stable reference genes used to normalize c. difficile expression data comparing exponential versus stationary phases of growth. ...201020599622
death due to community-associated clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected lyme disease. 201020597684
dirty ducting poses significant risks.richard norman, managing director of ventilation system cleaning specialist indepth hygiene, discusses the importance of ensuring that such systems are properly cleaned in healthcare facilities, especially, he argues, as dust and debris on internal surfaces of ducting are potentially "ideal nutrients" for the growth of microorganisms such as mrsa and clostridium difficile. in addition he warns that, if not properly and regularly cleaned, grease extract ventilation systems linked to catering faci ...201020597385
clostridium difficile: an intestinal infection on the rise. 201020597186
methods for working with the mouse model.mouse models have been developed to study the pathogenic process of clostridium difficile infections, first the intestinal colonization and second the toxin production. these models have also been used to test the role of environmental conditions that modulate infection. different mouse models have been used successfully to study c. difficile infections such as conventional mice, gnotobiotic mouse models including the monoxenic c. difficile mouse model, and the human microbiota-associated mouse ...201020597013
refinement of the hamster model of clostridium difficile disease.the golden syrian hamster is widely regarded as the most relevant small animal model of clostridium difficile disease as oral infection of animals pre-treated with antibiotics reproduces many of the symptoms observed in man. these include diarrhoea, histological damage, colonisation of the large bowel and sporulation of the organism at the terminal stage of the disease. however, infection results in a fatal outcome, which in the past has been used as an experimental endpoint. more recently, atte ...201020597012
transposon mutagenesis in clostridium difficile.genetic manipulation of clostridium difficile is notoriously difficult, currently there is only one reliable method for generating random mutations in the organism and that is to use the conjugative transposon tn916. tn916 enters the genome of most strains of c. difficile with no obvious target site preference. in order to use the genome strain c. difficile 630 for transposon mutagenesis a erythromycin-sensitive derivative c. difficile 630deltaerm was constructed and the tn916 derivative, tn916d ...201020597011
methods for gene cloning and targeted mutagenesis.clostridium difficile is the causative agent of a range of intestinal diseases, collectively referred to as clostridium difficile-associated disease (cdad). the recent emergence of "hypervirulent" strains associated with increased rates of mortality and severity of disease in humans has highlighted the need to study this organism at the molecular level. these studies will increase our knowledge of the mechanisms by which c. difficile causes disease and facilitate the rational design of new and i ...201020597010
clostron-targeted mutagenesis.members of the genus clostridium have long been recognised as important to humankind and its animals, both in terms of the diseases they cause and the useful biological processes they undertake. this has led to increasing efforts directed at deriving greater information on their basic biology, most notably through genome sequence. accordingly, annotated sequences of all of the most important species are now available. however, full exploitation of the data generated has been hindered by the lack ...201020597009
clostridium difficile using dna microarrays.clostridium difficile is a pathogen on the move, as evidenced by the rapid transcontinental spread of the so-called hypervirulent 027 strains, followed by the emergence of further pcr ribotypes such as 017, 078 and 106. this provides a rare opportunity to study the evolution of virulence in action. however, to fully exploit this opportunity, robust phylogenetic methods on a diverse set of characterised strains are required to provide a reference evolutionary framework to study c. difficile epide ...201020597008
human intestinal epithelial response(s) to clostridium difficile.clostridium difficile is a gram-positive, spore-forming, toxin-producing anaerobic bacillus that is being increasingly implicated as the leading cause of diarrhea and colitis, particularly in hospitalized, elderly patients. studies to date suggest that c. difficile toxins a and b play a major role in the observed colonic inflammation and associated disease pathogenesis; however, the role of other potential bacterial factors at present remains unknown. early effects of c. difficile on host intest ...201020597007
dissecting the cell surface.the bacterial cell surface is an important structure as it mediates interactions with the external environment. in the case of pathogens like clostridium difficile, the cell wall and its components also have to mediate interactions with the host cells and their products. in this chapter we discuss the various methods used for dissecting the cell surface and the biochemical and immunological procedures that are commonly used to analyse the properties of the proteins within the cell wall. a major ...201020597006
molecular methods to study transcriptional regulation of clostridium difficile toxin genes.toxin a (tcda) and toxin b (tcdb) are the major virulence factors that contribute to the pathogenesis of clostridium difficile-associated diarrhoea (cdad). these enterotoxins act by glucosylation of members of the rho protein family of small gtp-binding proteins. this leads to the disorganization of the host cell actin cytoskeleton (cytopathic effect) and apoptosis (cytotoxic effect). due to their glucosyltransferase activity, they are referred as "clostridial glucosylating toxins". the severe f ...201020597005
multilocus sequence typing for clostridium difficile.multilocus sequence typing (mlst), a nucleotide sequence-based characterization of allelic polymorphism of housekeeping genes, has been proposed as a new approach for population and evolutionary genetics and global epidemiology of bacterial pathogens. mlst provides unambiguous sequence data that can be generated from various laboratories and should be shared in a common web database. here are presented most of materials, methods, and programs or software necessary to perform mlst on clostridium ...201020597004
clostridium difficile toxinotyping.clostridium difficile shows considerable variability in the paloc region encoding two main virulence factors, toxins tcda and tcdb. strains with changes in paloc are defined as variant toxinotypes and currently 27 such groups are recognized (i to xxvii). toxinotype 0 includes strains with paloc identical to the reference laboratory strain vpi 10463. toxinotyping is a rflp-pcr-based method using a combination of restriction patterns of part of tcdb and tcda genes for determination of toxinotype. ...201020597003
molecular typing methods for clostridium difficile: pulsed-field gel electrophoresis and pcr ribotyping.molecular typing methods for clostridium difficile are based on gel electrophoresis of restriction fragments (endonuclease restriction analysis, rea; pulsed field gel electrophoresis pfge; toxinotyping), pcr amplification (pcr ribotyping, arbitrarily primed pcr, multilocus variable-number tandem-repeat analysis mlva), and sequence analysis (multilocus sequence typing mlst; slpa typing, tandem repeat sequence typing). we will describe two standard methods (pcr ribotyping predominantly used throug ...201020597002
clostridium difficile isolation and culture techniques.clostridium difficile infection (cdi) occurs as a disease with a spectrum of severity ranging from mild, self-limiting diarrhoea to a severe colitis, pseudomembraneous colitis or toxic megacolon. the disease arises as a major complication of antibiotic therapy and is most commonly acquired in hospital. the laboratory investigation of faecal samples is supportive of a clinical suspicion that a patient has the disease. currently the mainstay of diagnosis is the demonstration of c. difficile toxins ...201020597001
clostridium difficile and the disease it causes.clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. frequent and early colonization of the human intestinal flora is common and often asymptomatic. antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin a and b it precipitates c. difficile infection (cdi). the enterocytic detachment and bowel inflammation provoke c. difficile-associated diarrhoea (cdad) sometimes developing ...201020597000
clostridium difficile: no longer an enigmatic pathogen?never before has there been a more timely opportunity to investigate the molecular genetics of clostridium difficile. over the last few years the perception of c. difficile has changed from an obscure, and often under-researched, bacterium to one of major clinical importance, at least in industrialized nations. coupled with the increased interest in this organism researchers now have a greater understanding of its genetic content and molecular epidemiology; a direct consequence of the multiple c ...201020596999
clostridium difficile in patients undergoing primary hip and knee replacement.antibiotic prophylaxis is routinely administered during joint replacement surgery and may predispose patients to clostridium difficile-associated disease (cdad). the primary aim of this study was to determine the incidence of this following joint replacement, using a cefuroxime-based regimen. patients developing cdad were compared with a control group of patients without cdad. the incidence of the former was 1.7 per 1000 primary joint replacements. those patients prescribed additional antibiotic ...201020595121
investigation of a large outbreak of clostridium difficile pcr-ribotype 027 infections in northern france, 2006-2007 and associated clusters in 2008-2009.in 2006 and 2007, a large outbreak of clostridium difficile infections (cdis) with pcr-ribotype 027 was identified in northern france. overall, 38 healthcare facilities notified 529 cdis over a 22-month period, including 281 laboratory-confirmed cdi 027 and 248 non-confirmed cdi 027 cases (incidence rate per 10,000 elective bed days: 1.63, range: 0.07 to 7.94). the cases occurred mainly in long-term care hospital facilities and nursing homes, near the border between france and belgium. an active ...201020587362
physiologic reference ranges for captive black-tailed prairie dogs (cynomys ludovicianus).the black-tailed prairie dog (cynomys ludovicianus) is a member of the order rodentia and the family sciuridae. ecologically, prairie dogs are a keystone species in prairie ecology. this species is used as an animal model for human gallbladder disease and diseases caused by infection with clostridium difficile, yersinia pestis, francisella tularensis, and most recently, orthopoxvirus. despite increasing numbers of prairie dogs used in research and kept as pets, few data are available on their ba ...201020587156
increase in use of vancomycin for clostridium difficile infection in us hospitals. 201020586649
avoiding colectomy during surgical management of fulminant clostridium difficile colitis.clostridium difficile is the most common cause of nosocomial diarrhea in adults. over the last decade, there has been a substantial increase in the disease-associated morbidity and mortality rate from this infection accompanied by identification of new hypervirulent strains. fulminant colitis, a severe and complicated form of the disease that frequently necessitates surgical intervention, occurs in 3-8% of patients infected with c. difficile. the postoperative mortality rate for fulminant coliti ...201020583866
clostridium difficile infection in general surgery patients; identification of high-risk populations.risk factors associated with clostridium difficile infection (cdi) in general surgical patients are poorly characterised. this study aimed to characterise the incidence and associations of c. difficile positivity (cdp) in general surgical inpatients to aid in the design of future policies regarding focused screening and risk-stratification mechanisms in this patient subpopulation.201020580865
the food glycome: a source of protection against pathogen colonization in the gastrointestinal tract.trillions of microbes inhabit the gastrointestinal tract of humans with significant differences in the composition and distribution of intestinal flora along its length. normally there is a symbiotic relationship between the intestinal microflora and the host, with mutual advantages for both partners. when this relationship is altered, commensal bacteria can rapidly shift toward pathogenicity resulting in the onset and progression of gastrointestinal infection. pathogen adhesion and colonization ...201020580113
clostridium difficile infection in polish pediatric outpatients with inflammatory bowel disease.the prevalence of clostridium difficile infection (cdi) in pediatric patients with inflammatory bowel disease (ibd) is still not sufficiently recognized. we assessed the prevalence of cdi and recurrences in outpatients with ibd. in addition, the influence of ibd therapy on cdi and antimicrobial susceptibility of the potentially causative c. difficile strains was assessed. this was a prospective, single-center, observational study. all specimens were obtained between january 2005 and january 2007 ...201020577773
enteric bacterial pathogens with zoonotic potential isolated from farm-raised deer.the raising of captive white-tailed deer (odocoileus virginianus) is a growing agricultural industry in ohio as it is in several other areas of the united states and around the world. pooled fecal samples were collected from 30 white-tailed deer confinement facilities. samples were cultured for five enteric bacterial pathogens. premise prevalence rates were as follows: escherichia coli o157, 3.3%; listeria monocytogenes, 3.3%; salmonella enterica, 0%; yersinia enterocolitica, 30%; and clostridiu ...201020575673
letter in response to the article "optimum timing of blood tests for monitoring patients with clostridium difficile-associated diarrhea" (j investig med.2010;58[4]:621-624). 201020571442
role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, clostridium difficile, and acinetobacter species.health care-associated infections (hai) remain a major cause of patient morbidity and mortality. although the main source of nosocomial pathogens is likely the patient's endogenous flora, an estimated 20% to 40% of hai have been attributed to cross infection via the hands of health care personnel, who have become contaminated from direct contact with the patient or indirectly by touching contaminated environmental surfaces. multiple studies strongly suggest that environmental contamination plays ...201020569853
array comparative hybridisation reveals a high degree of similarity between uk and european clinical isolates of hypervirulent clostridium difficile.clostridium difficile is a gram-positive, anaerobic, spore-forming bacterium that is responsible for c. difficile associated disease in humans and is currently the most common cause of nosocomial diarrhoea in the western world. this current status has been linked to the emergence of a highly virulent pcr-ribotype 027 strain. the aim of this work was to identify regions of sequence divergence that may be used as genetic markers of hypervirulent pcr-ribotype 027 strains and markers of the sequence ...201020565959
[prevalence of clostridium difficile in the gastrointestinal tract of hospitalized children under two years of age].the aim of this study was to determine prevalence of c. difficile in the gastrointestinal tract of hospitalized children under two years of age and a comparison of phenotypic and genotypic features. hundred and seventy-eight samples collected from the faecal samples of children aged 2 months to 2 years, hospitalized in 2003-2006 were examined for the presence of toxin a/b of c. difficile. toxigenicity of strains was confirmed using pcr. susceptibility to antimicrobials was determined using e-tes ...201020564974
kinetic evidence for the presence of putative germination receptors in clostridium difficile spores.clostridium difficile is a spore-forming bacterium that causes clostridium difficile-associated disease (cdad). intestinal microflora keeps c. difficile in the spore state and prevents colonization. following antimicrobial treatment, the microflora is disrupted, and c. difficile spores germinate in the intestines. the resulting vegetative cells are believed to fill empty niches left by the depleted microbial community and establish infection. thus, germination of c. difficile spores is the first ...201020562307
clostridium difficile colitis in children following lung transplantation.risk factors for clostridium difficile diarrhea are antibiotic exposure, hospitalization, extreme ages, and immunodeficiency. patients with cf have a high rate of colonization with c. difficile. we performed a retrospective chart review of patients at texas children's hospital who underwent lung transplantation since the inception of our program in october 2002 until october 2008. there were 78 pediatric lung transplants performed at our institution during the study period. four patients develop ...201020561346
clostridium difficile isolates resistant to fluoroquinolones in italy: emergence of pcr ribotype 018.recent evidence strongly suggests an association between the use of fluoroquinolones and clostridium difficile infection (cdi). resistance to fluoroquinolones has been described not only in the hypervirulent strain 027, but also in other important pcr ribotypes circulating in hospital settings. in a european prospective study conducted in 2005, strains resistant to moxifloxacin represented 37.5% of c. difficile clinical isolates. in this study, we investigated a sample of 147 toxigenic c. diffic ...201020554809
fecal bacteriotherapy for relapsing clostridium difficile infection in a child: a proposed treatment protocol.clostridium difficile infection (cdi) is a potentially serious emerging infectious disease. the incidences of cdi in childhood and cdi cases complicated by relapses have increased by 50% or more in north america during the past 2 decades. we report here the case of a 2-year-old child with relapsing cdi caused by the epidemic strain bi/nap1/o27 that was refractory to saccharomyces boulardii and lactobacillus rhamnosus gg probiotics and to intensive therapy with traditional (metronidazole, vancomy ...201020547640
hospital adverse events and control charts. 201020547431
the emergence of 'hypervirulence' in clostridium difficile.the impact of clostridium difficile-associated disease (cdad) in healthcare settings throughout the developed world is considerable in terms of mortality, morbidity, and disease management. the incidence of cdad has risen dramatically since the turn of this century, concomitant with the emergence of so-called hypervirulent strains which are thought to cause a more severe disease, higher relapse rates, and increased mortality. pre-eminent amongst hypervirulent strains are those belonging to ribot ...201020547099
clostridium difficile infections in a tertiary hospital: value of surveillance. 201020542596
detection of toxigenic clostridium difficile in diarrheal stools by rapid real-time polymerase chain reaction.the cepheid xpert polymerase chain reaction assay (sunnyvale, ca) had a sensitivity of 100%, specificity of 96.7%, and positive and negative predictive values of 90.5% and 100%, respectively, compared with toxigenic culture for the laboratory diagnosis of clostridium difficile in diarrheal stool samples. this test appears to be a significant improvement to poorly performing enzyme immunoassays.201020542211
the potential value of clostridium difficile vaccine: an economic computer simulation model.efforts are currently underway to develop a vaccine against clostridium difficile infection (cdi). we developed two decision analytic monte carlo computer simulation models: (1) an initial prevention model depicting the decision whether to administer c. difficile vaccine to patients at-risk for cdi and (2) a recurrence prevention model depicting the decision whether to administer c. difficile vaccine to prevent cdi recurrence. our results suggest that a c. difficile vaccine could be cost-effecti ...201020541582
the occurrence and high diversity of clostridium difficile genotypes in rivers.clostridium difficile is mainly associated with nosocomial infections but can be present also in other environments. in this study we compared three methods (culturing with and without ethanol shock and real-time pcr) for detection of c. difficile in water and have used them on a series of river water samples. c. difficile was present in 17 of 25 rivers tested (68.0%) and in 42 of 69 water samples tested (60.9%). positive sampling sites correlated with increased population densities. isolates we ...201020541023
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