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identification of a pseudo-outbreak of clostridium difficile infection (cdi) and the effect of repeated testing, sensitivity, and specificity on perceived prevalence of cdi.to describe a pseudo-outbreak of clostridium difficile infection (cdi) caused by a faulty toxin assay lot and to determine the effect of sensitivity, specificity, and repeated testing for c. difficile on perceived cdi burden, positive predictive value, and false-positive results.200919848606
[to be or not to be for cefuroxime]. 200919848348
evaluation of a new commercial taqman pcr assay for direct detection of the clostridium difficile toxin b gene in clinical stool specimens.the progastro cd assay (prodesse, inc., waukesha, wi) is a new commercial taqman pcr assay that detects tcdb. the progastro cd assay was compared to the wampole clostridium difficile toxin b test (tox-b test; techlab, blacksburg, va), a cell culture cytotoxicity neutralization assay (cccna), and to anaerobic toxigenic bacterial culture, as the "gold standard," for 285 clinical stool specimens. assays were independently performed according to manufacturers' directions. a 1.0-ml sample was removed ...200919846637
clostridium difficile is associated with poor outcomes in patients with cirrhosis: a national and tertiary center perspective.clostridium difficile-associated disease (cdad) is associated with antibiotic use, acid suppression, and hospitalization, all of which occur frequently in cirrhosis. the aim was to define the effect of cdad on outcomes and identify risk factors for its development in cirrhosis.201019844204
detection of gyra and gyrb mutations in clostridium difficile isolates by real-time pcr.fluoroquinolone (fq)-resistance in clostridium difficile has been associated with mutations in the quinolone-resistance determining region (qrdr) of gyr genes. in particular, the majority of resistant clinical isolates show mutations in codon 82 of gyra or in codon 426 of gyrb. a real-time pcr method was developed to identify these mutations in fq-resistant c. difficile strains. twenty-one clinical isolates, selected as representative of the different gyr alleles known up to date, and 20 clinica ...201019837154
rare extraintestinal infection caused by toxin-producing clostridium difficile.toxigenic clostridium difficile is a well known cause of antibiotic-associated diarrhea mainly among hospitalized patients, at the same time we have little information about extraintestinal infections caused by this bacterium. we report here on rare extraintestinal infection caused by toxigenic c. difficile: 31-year-old male, accident victim was admitted to the hospital because of polytrauma. microbiological examination of the pus revealed a toxin-producing c. difficile as an etiologic factor of ...201019835967
[diagnostic guideline of ulcerative colitis].ulcerative colitis is a chronic inflammatory disorder causing mucosal inflammation of the colorectum with crypt abnormality on biopsy. it affects the rectum and a variable extent of the colon in continuity. ulcerative colitis is characterized by a relapsing and remitting course. it arises from an interaction between genetic and environmental factors, but the precise etiology is unknown. the incidence and prevalence in korea are still low compared with those of western countries, but have increas ...200919835217
clostridium difficile toxin cdt induces formation of microtubule-based protrusions and increases adherence of bacteria.clostridium difficile causes antibiotic-associated diarrhea and pseudomembranous colitis by production of the rho gtpase-glucosylating toxins a and b. recently emerging hypervirulent clostridium difficile strains additionally produce the binary adp-ribosyltransferase toxin cdt (clostridium difficile transferase), which adp-ribosylates actin and inhibits actin polymerization. thus far, the role of cdt as a virulence factor is not understood. here we report by using time-lapse- and immunofluoresce ...200919834554
impact of an intervention to control clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis.strategies to reduce rates of clostridium difficile infection (cdi) generally recommend isolation or cohorting of active cases and the reduced use of cephalosporin and quinolone antibiotics. data supporting these recommendations come predominantly from the setting of epidemic disease caused by ribotype 027 strains. we introduced an initiative involving a restrictive antibiotic policy and a cdi-cohort ward at an acute, 820-bed teaching hospital where ribotype 027 strains account for only one quar ...201019832710
antimicrobial resistance in clostridium difficile.clostridium difficile is the leading cause of hospital-acquired diarrhoea and the number of outbreaks has risen markedly since 2003. the emergence and spread of resistance in c. difficile is complicating treatment and prevention. most isolates are still susceptible to vancomycin and metronidazole (mtz), however transient and heteroresistance to mtz have been reported. the prevalence of resistance to other antimicrobial agents is highly variable in different populations and in different countries ...200919828299
clostridium difficile and inflammatory bowel disease: more questions than answers? 201019827137
evidence-based review of probiotics for antibiotic-associated diarrhea and clostridium difficile infections.probiotics are living microbes taken to confer a health benefit on the host. although probiotics have a long history of use in europe and asia and have been on the u.s. market for over 14 years, there is still confusion about how to effectively use them. the use of probiotics for the prevention of antibiotic-associated diarrhea (aad) and the treatment of clostridium difficile infections (cdi) has been tested in randomized controlled clinical trials. this paper will review the evidence supporting ...200919825425
diversity of moxifloxacin resistance during a nosocomial outbreak of a predominantly ribotype aru 027 clostridium difficile diarrhea.to characterize the extent and diversity of moxifloxacin resistance among clostridium difficile isolates recovered during a predominantly anaerobe reference unit (aru) ribotype 027-associated nosocomial outbreak of antibiotic associated diarrhea we measured the susceptibility of 34 field isolates and 6 laboratory strains of c. difficile to moxifloxacin. we ribotyped the isolates as well as assaying them by pcr for the metabolic gene, gdh, and the virulence genes, tcda, tcdb, tcdc, cdta and cdtb. ...200919818865
pros and cons of antibiotic therapy for pouchitis.restorative proctocolectomy with ileal pouch-anal anastomosis has become the surgical treatment of choice for patients with medically refractory ulcerative colitis or ulcerative colitis with dysplasia and for the majority of patients with familial adenomatous polyposis. however, pouchitis and other pouch-associated complications frequently occur following surgery. pouchitis is the most common long-term complication of ileal pouch-anal anastomosis in patients with ulcerative colitis, with a cumul ...200919817675
modulation of pathogen-induced ccl20 secretion from ht-29 human intestinal epithelial cells by commensal bacteria.human intestinal epithelial cells (iecs) secrete the chemokine ccl20 in response to infection by various enteropathogenic bacteria or exposure to bacterial flagellin. ccl20 recruits immature dendritic cells and lymphocytes to target sites. here we investigated iec responses to various pathogenic and commensal bacteria as well as the modulatory effects of commensal bacteria on pathogen-induced ccl20 secretion. ht-29 human iecs were incubated with commensal bacteria (bifidobacterium infantis or la ...200919814810
cwp84, a surface-associated cysteine protease, plays a role in the maturation of the surface layer of clostridium difficile.clostridium difficile is a major and growing problem as a hospital-associated infection that can cause severe, recurrent diarrhea. the mechanism by which the bacterium colonizes the gut during infection is poorly understood but undoubtedly involves protein components within the surface layer (s-layer), which play a role in adhesion. in c. difficile, the s-layer is composed of two principal components, the high and low molecular weight s-layer proteins, which are formed from the post-translationa ...200919808679
single immunoglobulin infusion can reverse hemodynamic failure associated with severe clostridium difficile colitis. 200919806111
effects of subinhibitory concentrations of antibiotics on colonization factor expression by moxifloxacin-susceptible and moxifloxacin-resistant clostridium difficile strains.recent outbreaks of clostridium difficile infection have been related to the emergence of the nap1/027 epidemic strain. this strain demonstrates increased virulence and resistance to the c-8-methoxyfluoroquinolones gatifloxacin and moxifloxacin. these antibiotics have been implicated as major c. difficile infection-inducing agents. we investigated by real-time reverse transcription-pcr the impact of subinhibitory concentrations of ampicillin, clindamycin, ofloxacin, and moxifloxacin on the expre ...200919805572
use of international classification of diseases, ninth revision, clinical modification codes and medication use data to identify nosocomial clostridium difficile infection.the international classification of diseases, ninth revision, clinical modification (icd-9-cm) code for clostridium difficile infection (cdi) is used for surveillance of cdi. however, the icd-9-cm code alone cannot separate nosocomial cases from cases acquired outside the institution. the purpose of this study was to determine whether combining the icd-9-cm code with medication treatment data for cdi in hospitalized patients could enable us to distinguish between patients with nosocomial cdi and ...200919803724
use of longitudinal surveillance data to assess the effectiveness of infection control in critical care.a simple method for quantifying nosocomial infection and colonization with multidrug-resistant organisms is described. this method is applied to the intensive care unit of an academic medical center where longitudinal surveillance data have been used to assess the impact of infection control interventions and antibiotic use.200919803721
growth-inhibiting activities of phenethyl isothiocyanate and its derivatives against intestinal bacteria.the growth-inhibiting activities of sinapis alba l. seed-derived materials were examined on the growth of bifidobacterium bifidum, b. breve, b. longum, clostridium difficile, c. perfringens, escherichia coli, lactobacillus acidophilus, and l. casei. the active component of s. alba seeds was purified using silica gel column chromatography and hplc and was identified as phenethyl isothiocyanate by various spectroscopic analyses. the antimicrobial activity of phenethyl isothiocyanate varied accordi ...200919799675
antiapoptotic proteins bcl-2 and bcl-xl inhibit clostridium difficile toxin a-induced cell death in human epithelial cells.it has been well established that clostridium difficile toxin a (tcda) induces cell death in human epithelial cells. however, the mechanism of tcda-induced cell death remains to be fully characterized. here, we show that tcda induces dose-dependent cell death in ovarian carcinoma and colonic carcinoma cell lines. tcda-mediated cell death, as well as caspase 8 and caspase 3 activation, were specifically abrogated by anti-toxin antibodies. although caspase 8 and caspase 3 were activated by tcda in ...200919797069
unusual manifestations of clostridium difficile infection.clostridium difficile infection (cdi) is an increasing nosocomial problem. new, more-virulent strains of c. difficile have spread across north america and europe. health care institutions now face a greater incidence of disease, often with greater severity. a need for surgical management for control of infection is on the increase. the clinical appearance of cdi is changed.201019795991
laboratory markers as predictors of mortality in patients with clostridium difficile infection.previous studies have identified laboratory markers for severe clostridium difficile infection (cdi). the most consistent of these markers is the presence of marked leukocytosis. we examined the validity of these markers as predictors of mortality in patients with cdi. we excluded patients with preexisting hematologic conditions that would be expected to impair their ability to demonstrate leukocytosis. on univariate analysis, marked leukocytosis (p = 0.02), thrombocytopenia (p = 0.008), and inc ...201019794314
comparison of a rapid molecular method, the bd geneohm cdiff assay, to the most frequently used laboratory tests for detection of toxin-producing clostridium difficile in diarrheal feces.six hundred diarrheal stool specimens were collected from inpatients and outpatients at local university hospitals for the detection of toxigenic clostridium difficile using three parallel methods, the bd geneohm cdiff assay, the tissue culture cytotoxicity assay, and a commercially available enzyme-linked fluorescence immunoassay (elfa) (vidas c. difficile toxin a and b assay; biomérieux). toxigenic c. difficile culture was also performed to further clarify discordant results. during a 3-month ...200919794052
pka and epac cooperate to augment bradykinin-induced interleukin-8 release from human airway smooth muscle cells.airway smooth muscle contributes to the pathogenesis of pulmonary diseases by secreting inflammatory mediators such as interleukin-8 (il-8). il-8 production is in part regulated via activation of gq-and gs-coupled receptors. here we study the role of the cyclic amp (camp) effectors protein kinase a (pka) and exchange proteins directly activated by camp (epac1 and epac2) in the bradykinin-induced il-8 release from a human airway smooth muscle cell line and the underlying molecular mechanisms of t ...200919788733
a systems ergonomics analysis of the maidstone and tunbridge wells infection outbreaks.this paper describes a systems ergonomics analysis of the recent outbreaks of clostridium difficile, which occurred over the period 2005-07 within the uk maidstone and tunbridge wells nhs trust. the analysis used documents related to the outbreak, alongside the construction of a system model in order to probe deeper into the nature of contributory factors within the trust. the findings from the analysis demonstrate the value of looking further at cross-level and whole-system aspects of infection ...200919787500
tales from the c. difficile trenches. 200919786472
treatment of irritable bowel syndrome with probiotics. an etiopathogenic approach at last?irritable bowel syndrome (ibs) is the most common functional digestive disorder, and may affect 11-20% of the adult population in industrialized countries. in accordance with rome iii criteria (2006) ibs involves abdominal pain and bowel habit disturbance, which are not explained by structural or biochemical abnormalities. several hypotheses attempt to account for the pathophysiology of ibs, but the etiology still remains uncertain or obscure, perhaps multifactorial. abnormalities in colonic mic ...200919785495
characterization of the sporulation initiation pathway of clostridium difficile and its role in toxin production.clostridium difficile is responsible for significant mortality and morbidity in the hospitalized elderly. c. difficile spores are infectious and are a major factor contributing to nosocomial transmission. the spo0a response regulator is the master regulator for sporulation initiation and can influence many other cellular processes. using the clostron gene knockout system, we inactivated genes encoding spo0a and a putative sporulation-associated sensor histidine kinase in c. difficile. inactivati ...200919783633
comparative genome and phenotypic analysis of clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium.the continued rise of clostridium difficile infections worldwide has been accompanied by the rapid emergence of a highly virulent clone designated pcr-ribotype 027. to understand more about the evolution of this virulent clone, we made a three-way genomic and phenotypic comparison of an 'historic' non-epidemic 027 c. difficile (cd196), a recent epidemic and hypervirulent 027 (r20291) and a previously sequenced pcr-ribotype 012 strain (630).200919781061
the a, b, bi, and cs of clostridium difficile. 200919780660
molecular epidemiology of clostridium difficile over the course of 10 years in a tertiary care hospital.the molecular epidemiology of endemic and outbreak clostridium difficile strains across time is not well known.200919780659
the use of new and better antibiotics for bacterial infections in patients with leukemia.bacterial infection is the most common complication of chemotherapy-induced neutropenia particularly in patients with hematologic malignancies. bacterial infections predominate during the initial phases of neutropenic episodes. the spectrum of bacterial infection continues to evolve globally and locally at the institutional level, as do patterns of antimicrobial susceptibility/resistance. these trends are often associated with local treatment practices (eg, use of antimicrobial prophylaxis, open ...200919778864
varied prevalence of clostridium difficile in an integrated swine operation.the objectives of this study were to compare the prevalence of clostridium difficile (cd) among different age and production groups of swine in a vertically integrated swine operation in texas in 2006 and to compare our isolates to other animal and human isolates. results are based on 131 cd isolates from 1008 swine fecal samples and pork trim samples (overall prevalence of 13%). the prevalence (number positive/number tested in production type) of cd was different between the groups (p<or=0.001) ...200919778624
fecal bacteriotherapy for recurrent clostridium difficile infection.clostridium difficile infection (cdi) has emerged as a major complication associated with the use of systemic antimicrobial agents. broad-spectrum antimicrobial agents disrupt the ecological bacterial balance in the colon and create an opportunity for c. difficile overgrowth with attendant production of toxins and clinical symptoms of colitis. recommended therapies for cdi include oral administration of metronidazole or vancomycin for 10-14 days. however, 5% to 35% of patients experience infecti ...200919778623
bacteriophage-mediated toxin gene regulation in clostridium difficile.clostridium difficile has been identified as the most important single identifiable cause of nosocomial antibiotic-associated diarrhea and colitis. virulent strains of c. difficile produce two large protein toxins, toxin a and toxin b, which are involved in pathogenesis. in this study, we examined the effect of lysogeny by phicd119 on c. difficile toxin production. transcriptional analysis demonstrated a decrease in the expression of pathogenicity locus (paloc) genes tcda, tcdb, tcdr, tcde, and ...200919776116
high prevalence of tcdc deletion-carrying clostridium difficile and lack of association with disease severity.we assessed the prevalence of tcdc deletion-carrying clostridium difficile using a stool polymerase chain reaction (pcr) assay that detects previously described 18- and 39-bp deletions (j. clin. microbiol. 2008;46:1996). we divided inpatients into 2 groups, those for whom the assay detected a deletion in tcdc and those for whom no deletion was detected. we compared risk factors (antibiotic use, hospitalization, nursing home stay, immunocompromise, age >65 years), complications (pseudomembranous ...201019775847
fulminant clostridium difficile colitis isolated to the ascending colon by a diverting transverse loop colostomy. 200919774963
deaths involving clostridium difficile: england and wales, 2008. 200919774833
infection control and iv therapy in patients with clostridium difficile.clostridium difficile is a spore-forming anaerobe belonging to the family clostridium, with the bacteria being found in low numbers in approximately 5% of the healthy adult population. together with meticillin-resistant staphylococcus aureus, it is a major healthcare-associated infection and is responsible for considerable morbidity and mortality. antibiotics administered to patients can alter normal gut flora, allowing the proliferation of c. difficile and causing antibiotic-associated diarrhoe ...200919773686
comparison of vidas cdab and cda immunoassay for the detection of clostridium difficile in a tcda- tcdb+ c. difficile prevalent area.enzyme immunoassays for tcda and/or tcdb are widely used for diagnosis of c. difficile infection. this study compared the performance of the new vidas c. difficile toxin a & b assay (cdab) with that of the existing vidas c. difficile toxin a ii assay (cda) in a tcda(-)tcdb(+) prevalent area. a total of 555 fecal samples were cultured and tested using cdab and cda. c. difficile was isolated in 150 samples and the concordance rate was 81.8% (454/555) between cdab and cda. pcr assays for tcda and/o ...200919772927
relationship between antibiotic consumption and clostridium difficile-associated diarrhea: an epidemiological note. 200919770290
public reports of infection rates urged. 200919770253
preventing healthcare-associated infection: risks, healthcare systems and behaviour.more than 177 000 potentially preventable healthcare-associated infections (hais) occur per annum in australia with sizable attributable mortality. organizational systems to protect against hai in hospitals in australia are relatively poorly developed. awareness and practice of infection control by medical and other healthcare staff are often poor. these lapses in practice create significant risk for patients and staff from hai. excessive patient exposure to antimicrobials is another key factor ...200919769680
infections in patients with multiple myeloma in the era of high-dose therapy and novel agents.the introduction of stem cell transplantation and the novel anti-myeloma agents, bortezomib, thalidomide, and lenalidomide, have improved the outcome of patients with multiple myeloma. these advances have transformed myeloma into a chronic condition, with multiple relapses and salvage therapies, all of which result in cumulative immunosuppression and higher risk of infection. in addition to the immunodeficiency related to myeloma and its complications, the type of anti-myeloma therapy used also ...200919769539
nmr-based metabonomics analysis of mouse urine and fecal extracts following oral treatment with the broad-spectrum antibiotic enrofloxacin (baytril).the human gastrointestinal tract is home to hundreds of species of bacteria and the balance between beneficial and pathogenic bacteria plays a critical role in human health and disease. the human infant, however, is born with a sterile gut and the complex gastrointestinal host/bacterial ecosystem is only established after birth by rapid bacterial colonization. composition of newborn gut flora depends on several factors including type of birth (ceasarian or natural), manner of early feeding (brea ...200919768747
infections caused by gram-positive bacteria: a review of the global challenge.infections caused by multidrug-resistant gram-positive bacteria represent a major public health burden, not just in terms of morbidity and mortality, but also in terms of increased expenditure on patient management and implementation of infection control measures. staphylococcus aureus and enterococcus spp. are established pathogens in the hospital environment, and their frequent multidrug resistance complicates therapy. the archetypal hospital "superbug", methicillin-resistant s. aureus (mrsa), ...200919766888
responsibility for managing healthcare-associated infections: where does the buck stop?the prevention and control of healthcare-associated infections (hcais) requires a tripartite partnership between clinicians and carers, managers and government/department of health (doh) across the whole health and social care community. mandatory surveillance of meticillin-resistant staphylococcus aureus bacteraemia and clostridium difficile infection has shown a significant fall from peak numbers in 2003/04 and 2006, respectively, and there is now a zero tolerance approach to preventable infec ...200919765862
a comprehensive surveillance, control and management programme for clostridium difficile infection. 201019765860
evolving concepts in clostridium difficile colitis.clostridium difficile infection (cdi) is the most important cause of nosocomial diarrhea. the emergence of a hypervirulent strain and other factors including antibiotic overuse contribute to the increasing incidence and severity of this potentially lethal infection. cdi has been reported in persons previously considered as low risk, such as young healthy persons without exposure to health care settings or antibiotics, peripartum women, and children. in patients with inflammatory bowel disease, t ...200919765368
chronic hepatitis, hepatic dysplasia, fibrosis, and biliary hyperplasia in hamsters naturally infected with a novel helicobacter classified in the h. bilis cluster.we recently described helicobacter-associated progressive, proliferative, and dysplastic typhlocolitis in aging (18- to 24-month-old) syrian hamsters. other pathogens associated with typhlocolitis in hamsters, clostridium difficile, lawsonia intracellularis, and giardia spp., were not indentified. the presence of helicobacter genus-specific dna was noted by pcr in cecal and paraffin-embedded liver samples from aged hamsters by the use of helicobacter-specific pcr primers. by 16s rrna analysis, t ...200919759229
secondary pouchitis: those with identifiable etiopathogenetic or triggering factors.restorative proctocolectomy with ileal pouch-anal anastomosis (ipaa) is the surgical treatment of choice for the majority of patients with medically refractory ulcerative colitis (uc) or uc with dysplasia, or familial adenomatous polyposis. various forms of pouchitis frequently occur after surgery. in fact, pouchitis is the most frequent long-term complication of ipaa in patients with uc, with a cumulative prevalence of up to 50%. the etiology and pathogenesis of pouchitis are not entirely clear ...201019755972
epidemiology of opportunistic infections and its correlation with cd4 t-lymphocyte counts and plasma viral load among hiv-positive patients at a tertiary care hospital in india.the study was conducted to find the correlation of cd4 counts and plasma viral load (pvl) with opportunistic infections (ois) in hiv-positive patients. a total of 43 drug-naive patients enrolled in the study. absolute cd4 counts and pvl were measured. on the basis of symptoms, sputum, stool, and blood samples were obtained for laboratory tests. oral swabs were obtained from all the patients. pneumocystis jiroveci pneumonia was found in 45.2% patients (odds ratio [or] = 12.8 for cd4 counts <or=10 ...200919755619
clostridium difficile infection: historic review. 200919755167
typing and susceptibility of bacterial isolates from the fidaxomicin (opt-80) phase ii study for c. difficile infection.clostridium difficile infection (cdi) has been increasing in incidence and severity in recent years, coincident with the spread of a "hypervirulent" strain, rea type bi (ribotype 027, pfge nap 1). exacerbating the problem has been the observation that metronidazole may be showing decreased effectiveness, particularly in the more severe cases. fidaxomicin is an 18-membered macrocycle currently in phase 3 trials for the treatment of c. difficile infection (cdi). an open-label, phase ii study in cd ...200919755166
clostridium difficile infection: a re-emerging threat.clostridium difficile infection is an important health care-associated infection. the incidence and severity of c. difficile infection are increasing. recent c. difficile infection outbreaks with high proportions of severe outcomes have been linked to an emerging, hypervirulent strain of c. difficile. recently recognized risk factors of c. difficile infection include fluoroquinolone exposure and gastric acid suppression. effective prevention measures for c. difficile infection include contact pr ...200919753922
clostridium difficile infection in the elderly.the aging society and the advanced of supportive treatment means that large numbers of elderly patients with risk factors for c difficile enterocolitis will continue to receive care in intensive care unit. antibiotic resistance and older, sicker patients means that combination antibiotic therapy will become a trend in clinical setting. age, several co-morbidities, and gastrointestinal surgery appear to be specific risk factors for c difficile infection. diarrhea which is the only symptom in hosp ...200919752488
distinctive profiles of infection and pathology in hamsters infected with clostridium difficile strains 630 and b1.currently, the golden syrian hamster is widely considered an important model of clostridium difficile disease, as oral infection of this animal pretreated with antibiotics reproduces many of the symptoms observed in humans. two c. difficile strains, b1 and 630, showed significant differences in the progression and severity of disease in this model. b1-infected hamsters exhibited more severe pathology and a shorter time to death than hamsters infected with 630. histological changes in the gut did ...200919752031
proposed checklist of hospital interventions to decrease the incidence of healthcare-associated clostridium difficile infection.the incidence and severity of clostridium difficile infection (cdi) are increasing, and previously described interventions for controlling the spread of cdi are not easily generalized to multiple healthcare institutions.200919751156
motility and flagellar glycosylation in clostridium difficile.in this study, intact flagellin proteins were purified from strains of clostridium difficile and analyzed using quadrupole time of flight and linear ion trap mass spectrometers. top-down studies showed the flagellin proteins to have a mass greater than that predicted from the corresponding gene sequence. these top-down studies revealed marker ions characteristic of glycan modifications. additionally, diversity in the observed masses of glycan modifications was seen between strains. electron tran ...200919749038
infectious agents detected in the feces of diarrheic foals: a retrospective study of 233 cases (2003-2008).diarrhea is common in foals but there are no studies investigating the relative prevalence of common infectious agents in a population of hospitalized diarrheic foals.200919747192
toxic megacolon complicating a clostridium difficile infection in a pregnant woman.clostridium difficile infection (cdi) in non-hospitalized patients has been reported with increased frequency, whereas an association between cdi and pregnancy has not been highlighted. we report a case of toxic megacolon complicating a severe cdi during the second trimester of pregnancy in a patient without traditional risk factors, such as antibiotic use, immunodeficiency, and prolonged and recent hospitalization.201019745034
comparison of a commercial multiplex real-time pcr to the cell cytotoxicity neutralization assay for diagnosis of clostridium difficile infections.a commercial multiplex real-time pcr assay (cepheid xpert c. difficile assay) for the diagnosis of clostridium difficile infection was evaluated. the sensitivity and specificity of the cepheid assay were 97.1% and 93.0% for fresh stools, using the cell cytotoxicity neutralization assay as the reference. using pcr ribotyping as the reference for ribotype 027 strains, the corresponding figures were 100% and 98.1%, respectively.200919741082
swine flu and antibiotics.health services worldwide are likely to be hard-pressed by swine flu-related illness in the months ahead. secondary infections with streptococcus pneumoniae, other streptococci (e.g. streptococcus pyogenes), haemophilus influenzae and staphylococcus aureus are likely to be important causes of morbidity and mortality. the uk department of health recently published clinical pathways for the management of swine flu. suggested severity criteria have not been validated in respiratory infection and ar ...200919740909
importance of culture for detection of clostridium difficile toxin from stool samples to report true incidence and mortality related to c. difficile in hospitals. 200919739961
the utility of repeated stool toxin testing for diagnosing clostridium difficile colitis.clostridium difficile is diagnosed using the enzyme-linked immunoassay (eia) with the specificity and sensitivity ranging from 50-90% and 70-95%, respectively. due to the wide ranges, there is considerable confusion regarding the value of the eia toxin test. we undertook this study to evaluate the benefit of repeat stool toxin testing.200919738547
repeated stool toxin testing for diagnosing difficile colitis is still valid. 200919738536
clostridium difficile: controversies and approaches to management.the increasing incidence of clostridium difficile infection (cdi) is confronting us with two major problems in cdi management that presently remain unsolved: refractoriness to therapy and recurrence of disease. this review focuses on recent insights in antimicrobial therapy of cdi, as well as advances in alternative treatment modalities.200919738464
distribution of clostridium difficile strains from a north american, european and australian trial of treatment for c. difficile infections: 2005-2007.clostridium difficile is a widely distributed pathogen with multiple strain types as determined by restriction endonuclease analysis (rea) and by pcr ribotyping, two well-characterized typing systems. in this study, rea typing was performed on 894c. difficile isolates from patients enrolled from 16 countries on three continents in two large, recently conducted clinical treatment trials of c. difficile infection. rea group bi (ribotype 027) isolates were the most common strains identified and wer ...200919737618
a quality committee's evaluation of surgical intervention for clostridium difficile infection.clostridium difficile (c diff) is an anaerobic bacterium that causes antibiotic-associated colitis, which can progress to a life-threatening illness for some patients. clostridium difficile is highly transmissible in health care settings and has high morbidity and mortality rates. the increased prevalence of this bacterium and the consequences of infection necessitate an understanding of its transmission and use of stringent infection control practices. a two-year retrospective evaluation was pe ...200919736671
established and potential risk factors for clostridum difficile infection.clostridium difficile is the aetiological agent for almost all cases of pseudo membranous colitis and 15-25% of antibiotic associated diarrhoea. in recent years, c. difficile associated disease (cdad) has been increasing in frequency and severity due to the emergence of virulent strains. severe cases of toxic mega colon may be associated with mortality rates of 24-38%. the prevalence of cdad is global and the incidence varies considerably from place to place. in the initial stages of its discove ...200919736396
clostridium difficile-related death rates in texas 1999-2005.increased incidence of clostridium difficile infection and deaths from us hospitals has occurred from 1996 to 2005.200919735673
influence of early gut microbiota on the maturation of childhood mucosal and systemic immune responses.among sensitized infants, those with high, as compared with low levels, of salivary secretory iga (siga) are less likely to develop allergic symptoms. also, early colonization with certain gut microbiota, e.g. lactobacilli and bifidobacterium species, might be associated with less allergy development. although animal and in vitro studies emphasize the role of the commensal gut microbiota in the development of the immune system, the influence of the gut microbiota on immune development in infants ...200919735274
in vitro susceptibility to 17 antimicrobials of clinical clostridium difficile isolates collected in 1993-2007 in sweden.this study investigated the mics of 17 antimicrobials, for 606 toxigenic clinical isolates of clostridium difficile collected between 1993 and 2007 in sweden. low mic(90) values were found for metronidazole (0.5 mg/l), vancomycin (1.0 mg/l), teicoplanin (0.125 mg/l), fusidic acid (1.0 mg/l), linezolid (2.0 mg/l), daptomycin (2.0 mg/l) and tigecycline (0.064 mg/l). three isolates (0.5%) had elevated mics for vancomycin (4-8 mg/l); however, these isolates originated from the same patient, who was ...201019732094
population-based surveillance of clostridium difficile infection in manitoba, canada, by using interim surveillance definitions.to apply interim surveillance definitions of clostridium difficile infection (cdi) cases to 1 year of data from the provincewide surveillance system of manitoba, canada, to determine the epidemiology of cdi incident cases in a population.200919732008
[new antibiotics: small or big advances?].this contribution summarizes the "state-of-the-art" in the field of new antibiotics. on the one hand interesting new substances are discussed, on the other hand areas of interest for more research are shown. doripenem is a new broad-spectrum antibiotic which proved superior to other carbapenems as far as gram-negative bacilli were concerned and also showed less development of resistance. for the treatment of methicillin-resistant staphylococcus aureus (mrsa), linezolid, tigecyclin and daptomycin ...200919727633
intake of lactobacillus plantarum reduces certain gastrointestinal symptoms during treatment with antibiotics.to examine if intake of lactobacillus plantarum can prevent gastrointestinal side effects in antibiotic-treated patients.201019727002
faecal transplant for recurrent clostridium difficile-associated diarrhoea: a uk case series.clostridium difficile-associated diarrhoea (cdad) is an increasingly common and life threatening consequence of modern medical practice. recurrent disease is seen in up to one-third of patients and there is no consensus on optimal therapy. restoration of normal colonic flora addresses the underlying pathogenic mechanism in cdad.200919726581
the role of environmental cleaning in the control of hospital-acquired infection.increasing numbers of hospital-acquired infections have generated much attention over the last decade. the public has linked the so-called 'superbugs' with their experience of dirty hospitals but the precise role of environmental cleaning in the control of these organisms remains unknown. until cleaning becomes an evidence-based science, with established methods for assessment, the importance of a clean environment is likely to remain speculative. this review will examine the links between the h ...200919726106
hospital-based epidemiology: a strategy for 'dealing with clostridium difficile'.clostridium difficile-associated diarrhoea (cdad) remains a major infection control problem. uncertainty remains over methods of diagnosis and definitions for ascertaining provenance of cases. we undertook a prospective epidemiological study to better ascertain local epidemiology of 275 new cases (general practitioner and hospital) diagnosed in a large teaching hospital in the uk. the highest incidence of cases was found in haematology and critical care and a surprisingly high proportion, 29%, o ...201019726105
bacteremia with a large clostridial toxin-negative, binary toxin-positive strain of clostridium difficile.bacteremia caused by clostridium difficile is rare. in this report, we describe a case of c. difficile bacteremia caused by an unusual strain of c. difficile. the isolate contained neither toxin a nor b genes, however, binary toxin genes were present (tcda(-), tcdb(-), cdta(+), cdtb(+)) and a 7.2-kb element unrelated to the paloc was found inserted within the paloc integration site. the clinical relevance of the isolate could not be determined.200919723585
low occurrence of clostridium difficile in retail ground meat in sweden.this pilot study was conducted to evaluate the occurrence of clostridium difficile in samples of ground meat in sweden. from april to september 2008, 82 meat samples were collected from randomly selected retail shops in uppsala county (central sweden). c. difficile was isolated from 2 (2.4%; both ground beef) of the 82 meat samples. no c. difficile was detected in pork, hamburger, sheep, poultry, or other type of meat samples. the two c. difficile isolates produced both toxin a and toxin b. thes ...200919722410
the impact of a change in antibacterial prophylaxis from ceftazidime to levofloxacin in allogeneic hematopoietic cell transplantation.antibiotic prophylaxis has been used during the initial phases of myeloablative hematopoietic cell transplantation (hct) for more than two decades. however, the optimal regimen in terms of both cost and clinical effectiveness is unclear. we retrospectively compared the clinical and microbiological impact of a change in antibiotic prophylaxis practice from ceftazidime (n=216 patients with hct in 2000-2002) to levofloxacin (n=219 patients, august 2002-2005) in patients receiving myeloablative cond ...201019718062
stethoscopes: potential vectors of clostridium difficile. 200919716204
hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of clostridium difficile.to evaluate common hand hygiene methods for efficacy in removing clostridium difficile.200919715426
does ppi therapy predispose to clostridium difficile infection?clostridium difficile infection (cdi) has emerged as a problem of epidemic proportions. previous exposure to broad-spectrum antibiotics remains the most important predisposing factor for the disease. however, ppis are increasingly being overprescribed and recent research has, therefore, focused on the association between ppi therapy and cdi. while the data remain observational, increasing evidence exists for at least a modest association between ppi use and cdi.200919713988
clostridium difficile infections among jordanian adult hospitalized patients.this prospective study investigated the important epidemiologic aspects of clostridium difficile infections (cdis) among jordanian adult hospitalized patients. a total of 300 stool specimens were investigated using culture and polymerase chain reaction methods for detection of c difficile, its toxins, and fluoroquinolone resistance. c difficile-positive cultures were found in 13.7% of the patients, and 73% of the isolates carried tcda and/or tcdb toxin genes, and all c difficile isolates were ne ...200919712999
struggling with recurrent clostridium difficile infections: is donor faeces the solution?patients with recurrent clostridium difficile infections (cdi) in hospitals and the community constitute an increasing treatment problem. while most patients with a first infection respond to either metronidazole or oral vancomycin, therapy in recurrent c. difficile infections tends to fail repeatedly. lack of alternative treatment options can be a tremendous burden, both to patients and their treating physicians. most guidelines recommend prolonged oral vancomycin pulse and or tapering schedule ...200919712646
effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit.controlled studies that took place in medical intensive care units (micus) have demonstrated that bathing patients with chlorhexidine gluconate (chg) can reduce skin colonization with potential pathogens and can lessen the risk of central venous catheter (cvc)-associated bloodstream infection (bsi).200919712033
native joint septic arthritis caused by clostridium difficile in an 11-year old with hemoglobin ss disease. 200919710591
comparison of nine commercially available clostridium difficile toxin detection assays, a real-time pcr assay for c. difficile tcdb, and a glutamate dehydrogenase detection assay to cytotoxin testing and cytotoxigenic culture methods.the continuing rise in the incidence of clostridium difficile infection is a cause for concern, with implications for patients and health care systems. laboratory diagnosis largely relies on rapid toxin detection kits, although assays detecting alternative targets, including glutamate dehydrogenase (gdh) and toxin genes, are now available. six hundred routine diagnostic diarrheal samples were tested prospectively using nine commercial toxin detection assays, cytotoxin assay (cyt), and cytotoxige ...200919710274
elevated levels of intestinal inflammation in clostridium difficile infection associated with fluoroquinolone-resistant c. difficile. 200919709778
serine-71 phosphorylation of rac1/cdc42 diminishes the pathogenic effect of clostridium difficile toxin a.clostridium difficile toxin a and b (tcda/tcdb) are glucosyltransferases that glucosylate gtpases of the rho family. the epidermal growth factor (egf) positively modulates c. difficile toxin-induced disturbance of the intestinal barrier function by an unknown mechanism. we found that egf-treated caco-2 monolayers were less susceptible to tcda-catalysed glucosylation of rac1 but not of rhoa, which correlated with phosphorylation of rac1 at ser-71. phospho-rac1/phospho-cdc42 (ser-71) still bound t ...200919709124
[clostridium difficile associated diarrhoea--problem of oncological patient?].clostridium difficile associated diarrhoea / disease (cdad) is an inflammatory disease of the colon. it affects patients who have been exposed to wide-spectrum antibiotics and long-term in-patient care, with immunosuppression. the most difficult form of this disease is manifested as pseudomembranous enterocolitis, it runs fulminantly in significantevents. in recent years there has been an increase in the incidence of this disease worldwide. several serious epidemics caused by virulent strains of ...200919708545
clostridium difficile infection--not just a burden anymore. 200919708320
resolution of recurrent clostridium difficile-associated diarrhea using staggered antibiotic withdrawal and kefir.eight patients, each of whom experienced recurrent episodes of clostridium difficile-associated diarrhea, were treated with staggered and tapered oral metronidazole or vancomycin combined with daily intake of kefir, an over-the-counter liquid probiotic dairy product. all eight successfully resolved their infection and did not experience any further diarrhea after completion of treatment. further studies will be needed to determine whether gradual antibiotic withdrawal combined with kefir is a va ...200919708314
review article: anti-inflammatory mechanisms of action of saccharomyces boulardii.saccharomyces boulardii, a well-studied probiotic, can be effective in inflammatory gastrointestinal diseases with diverse pathophysiology, such as inflammatory bowel disease (ibd), and bacterially mediated or enterotoxin-mediated diarrhoea and inflammation.200919706150
prevalence of clostridium difficile infection in polish pediatric patients with inflammatory bowel disease. 201019705416
first isolation of clostridium difficile pcr ribotype 027 from a patient with severe persistent diarrhoea in hungary.a recent supplement to clinical microbiology and infection entitled 'infection control measures to limit the spread of c. difficile' pointed out that the incidence of c. difficile-associated diarrhoea (cdad) has been increasing worldwide, and stressed the importance of research in the fields of epidemiology and infection control [1]. since 2003, one of the main causes of the increasing prevalence of cdad has been claimed to be the emergence of pcr ribotype 027/nap1, which has caused epidemics in ...200919702592
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