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application of nuclear magnetic resonance to detect toxigenic clostridium difficile from stool specimens: a proof of concept.we evaluated the performance of an early prototype core molecular mirroring nuclear magnetic resonance detection platform (mentor-100) to detect toxigenic clostridium difficile from stool. this technology uses customized nanoparticles bound to target specific oligonucleotide probes that form binaries in the presence of nucleic acid from the target microorganism. liquid patient stool specimens were seeded with c. difficile or other clostridium species to determine the analytical sensitivity and s ...201728081922
call for probe into deaths from superbug.the scottish labour party is calling for a scotland-wide investigation into deaths caused by clostridium difficile.200928080755
clostridium difficile infection and risk of colectomy in patients with inflammatory bowel disease: a bias-adjusted meta-analysis.clostridium difficile infection (cdi) is a common complication of inflammatory bowel diseases (ibds) and is associated with worse outcome. variable rates of colectomy have been reported among ibd complicated by cdi. we conducted a systematic review and meta-analysis of studies to assess the association between cdi and colectomy among patients with ibd.201728079620
clostridium difficile infection in cystic fibrosis: an uncommon but life-threatening complication.adults with cystic fibrosis (cf) have significant rates of asymptomatic clostridium difficile carriage and are frequently exposed to risk factors for c. difficile infection (cdi). despite this, the rate of reported cdi in cf is low. we describe three cases of near fatal cdi in adults with cf and review the literature regarding presentation, management, and recurrence prevention. early recognition is important as the clinical presentation may be atypical and the illness can be severe and even lif ...201728078087
point-counterpoint: what is the optimal approach for detection of clostridium difficile infection?introductionin 2010, we published an initial point-counterpoint on the laboratory diagnosis of clostridium difficile infection (cdi). at that time, nucleic acid amplification tests (naats) were just becoming commercially available, and the idea of algorithmic approaches to cdi was being explored. now, there are numerous naats in the marketplace, and based on recent proficiency test surveys, they have become the predominant method used for cdi diagnosis in the united states. at the same time, the ...201728077697
laboratory testing of donors and stool samples for fecal microbiota transplantation for recurrent clostridium difficile infection.fecal microbiota transplantation is an efficacious and inexpensive therapy for recurrent clostridium difficile infection, yet its safety is thought to depend on appropriate fecal donor screening. fda guidance for regulation of this procedure is in flux, but screening and manufacture of fecal material from asymptomatic donors present many challenges to clinical laboratories. this minireview summarizes fda regulatory changes, principles of donor selection, and recommended laboratory screening prac ...201728077694
clostridium difficile infection in older adults: systematic review of efforts to reduce occurrence and improve outcomes.provide a systematic review of the primary literature on efforts to reduce clostridium difficile infection (cdi) occurrence and improve outcomes in older adults.201728077203
surveillance of clostridium difficile infections: results from a six-year retrospective study in nine hospitals of a north italian local health authority.clostridium difficile is an emerging cause of healthcare associated infections. in nine hospitals of an italian local health authority the episodes of c. difficile infection (cdi) were identified using the data registered by the centralized laboratory information system, from 2010 to 2015. cdi incidence (positive patients for a and/or b toxins per patients-days) was analysed per year, hospital, and ward. a number of cases approximately equivalent to the mean of identified cases per year were stu ...201728075419
noncontiguous finished genome sequence and description of prevotella phocaeensis sp. nov., a new anaerobic species isolated from human gut infected by clostridium difficile.prevotella phocaeensis sp. nov. strain sn19(t) (= dsm 103364) is a new species isolated from the gut microbiota of patient with colitis due to clostridium difficile. strain sn19(t) is gram-negative rod-shaped bacteria, strictly anaerobic, nonmotile and non-endospore forming. the predominance fatty acid is hexadecanoic acid. its 16s rrna showed a 97.70% sequence identity with its phylogenetically closest species, prevotella oralis. the genome is 2 922 117 bp long and contains 2486 predicted genes ...201728070336
manual curation and reannotation of the genomes of clostridium difficile 630δerm and clostridium difficile 630.we resequenced the genome of clostridium difficile 630δerm (dsm 28645), a model strain commonly used for the generation of insertion mutants. the genome sequence was obtained by a combination of single-molecule real-time (smrt) and illumina sequencing technology. detailed manual curation and comparison to the previously published genomic sequence revealed sequence differences including inverted regions and the presence of plasmid pcd630. manual curation of our previously deposited genome sequenc ...201728068217
a quaternary ammonium disinfectant containing germinants reduces clostridium difficile spores on surfaces by inducing susceptibility to environmental stressors.exposing clostridium difficile spores to germinants in a quaternary ammonium matrix was an effective method to reduce environmental contamination by sensitizing the spores, leaving them susceptible to ambient conditions and enhancing killing by acid, high-intensity visible light, and radiation.201628066792
functional intestinal bile acid 7α-dehydroxylation by clostridium scindens associated with protection from clostridium difficile infection in a gnotobiotic mouse model.bile acids, important mediators of lipid absorption, also act as hormone-like regulators and as antimicrobial molecules. in all these functions their potency is modulated by a variety of chemical modifications catalyzed by bacteria of the healthy gut microbiota, generating a complex variety of secondary bile acids. intestinal commensal organisms are well-adapted to normal concentrations of bile acids in the gut. in contrast, physiological concentrations of the various intestinal bile acid specie ...201628066726
the power of poop: fecal microbiota transplantation for clostridium difficile infection.the human gut is colonized with 200 to 1,000 bacterial species. administration of antibiotics reduces the diversity of the intestinal microbiota, reduces colonization resistance, and can lead to infection with clostridium difficile. these infections have become more prevalent and increasingly patients are experiencing multiple recurrences that are incurable with standard treatment. although fecal microbiota transplantation (fmt) has been used for centuries in human and veterinary medicine, only ...201628066039
clostridium difficile contamination of health care workers' hands and its potential contribution to the spread of infection: review of the literature.clostridium difficile infection (cdi) can be transmitted from patient to patient by the hands of health care workers (hcws); however, the relative importance of this route in the spread of c difficile in the hospital is currently unknown. our aim was to review studies examining hcws' hand carriage and its potential role in cdi transmission.201728065332
asymptomatic carriers contribute to nosocomial clostridium difficile infection: a cohort study of 4508 patients.nosocomial infections with clostridium difficile present a considerable problem despite numerous attempts by health care workers to reduce risk of transmission. asymptomatic carriers of c difficile can spread their infection to other patients. we investigated the effects of asymptomatic carriers on nosocomial c difficile infections.201728063955
the association between gaba-modulators and clostridium difficile infection - a matched retrospective case-control study.recently, metabolomics studies have suggested that the neurotransmitter γ-amino butyric acid (gaba) may modulate c. difficile infection (cdi) pathogenesis. in the present study, we investigated the association between gaba-modulating pharmaceuticals and cdi development.201728060888
clostridium difficile colonization in preoperative colorectal cancer patients.the entire process of clostridium difficile colonization to infection develops in large intestine. however, the real colonization pattern of c. difficile in preoperative colorectal cancer patients has not been studied. in this study, 33 c. difficile strains (16.1%) were isolated from stool samples of 205 preoperative colorectal cancer patients. c. difficile colonization rates in lymph node metastasis patients (22.3%) were significantly higher than lymph node negative patients (10.8%) (or=2.314, ...201728060753
cefoperazone-treated mouse model of clinically-relevant clostridium difficile strain r20291.clostridium difficile is an anaerobic, gram-positive, spore-forming enteric pathogen that is associated with increasing morbidity and mortality and consequently poses an urgent threat to public health. recurrence of a c. difficile infection (cdi) after successful treatment with antibiotics is high, occurring in 20-30% of patients, thus necessitating the discovery of novel therapeutics against this pathogen. current animal models of cdi result in high mortality rates and thus do not approximate t ...201628060346
production, crystallization and structure determination of c. difficile ppep-1 via microseeding and zinc-sad.new therapies are needed to treat clostridium difficile infections that are a major threat to human health. the c. difficile metalloprotease ppep-1 is a target for future development of inhibitors to decrease the virulence of the pathogen. to perform biophysical and structural characterization as well as inhibitor screening, large amounts of pure and active protein will be needed. we have developed a protocol for efficient production and purification of ppep-1 by the use of e. coli as the expres ...201628060332
fecal microbial transplantation as a therapeutic option in patients colonized with antibiotic resistant organisms.despite increasing interest in fecal microbiota transplantation (fmt), its full therapeutic potential has yet to be determined. since its increase in popularity, fmt has been shown to be highly effective in the treatment of both clostridium difficile infection (cdi) and its recurrent form. interest in fmt now expands well beyond the treatment of cdi to other processes with known associations to the microbiota such as antibiotic resistant infections, inflammatory bowel disease (ibd), hepatic ence ...201728059612
fecal microbial transplant for the treatment of pediatric inflammatory bowel disease.the role of fecal microbial transplant (fmt) in the treatment of pediatric gastrointestinal disease has become increasingly popular among pediatric practitioners, patients, and parents. the success of fmt for the treatment of recurrent clostridium difficile infection (rcdi) has bolstered interest in its potential application to other disease states, such as inflammatory bowel disease (ibd). fmt has particular interest in pediatrics, given the concerns of patients and parents about rates of adver ...201628058011
impact of targeted educational interventions on clostridium difficile infection treatment in critically ill adults.background: clostridium difficile infection (cdi) is a growing clinical and economic burden throughout the world. pharmacists often are members of the primary care team in the intensive care unit (icu) setting; however, the impact of pharmacists educating other health care providers on appropriateness of cdi treatment has not been previously examined. objective: this study was performed to determine the impact of structured educational interventions on cdi treatment on appropriateness of cdi tre ...201628057949
lactobacillus reuteri dsm 17938 in the prevention of antibiotic-associated diarrhoea in children: protocol of a randomised controlled trial.administration of some probiotics appears to reduce the risk of antibiotic-associated diarrhoea (aad). the effects of probiotics are strain-specific, thus, the efficacy and safety of each probiotic strain should be established separately. we aim to assess the effects of lactobacillus reuteri dsm 17938 administration for the prevention of diarrhoea and aad in children.201728057659
predictors of failure after single faecal microbiota transplantation in patients with recurrent clostridium difficile infection: results from a 3-year, single-centre cohort study.faecal microbiota transplantation (fmt) is an effective treatment for recurrent clostridium difficile infection (cdi). although a single faecal infusion is usually sufficient to eradicate cdi, a considerable number of patients need multiple infusions to be cured. the aim of this study was to identify predictors of failure after single faecal infusion in patients with recurrent cdi.201728057560
acid-suppression medications and bacterial gastroenteritis: a population-based cohort study.to investigate whether acid-suppression medicines (asms) increase the risk of bacterial gastroenteritis.201728054368
procalcitonin is a poor predictor of non-infectious fever in the neurocritical care unit.fever is a common occurrence in the neurocritical care unit (nccu). it is reported that up to 50 % of these fevers are associated with a non-infectious source. as this is a diagnosis of exclusion, a complete fever evaluation must be done to rule out infection. procalcitonin (pct) has been identified as a possible biomarker to distinguish infectious from non-infectious etiologies of fever. we hypothesized that pct could be used as a predictor of infectious fever in febrile patients with intracran ...201728054289
the oral β-lactamase syn-004 (ribaxamase) degrades ceftriaxone excreted into the intestine in phase 2a clinical studies.syn-004 (ribaxamase) is a β-lactamase designed to be orally administered concurrently with intravenous β-lactam antibiotics, including most penicillins and cephalosporins. ribaxamase's anticipated mechanism of action is to degrade excess β-lactam antibiotic that is excreted into the small intestine. this enzymatic inactivation of excreted antibiotic is expected to protect the gut microbiome from disruption and thus prevent undesirable side effects, including secondary infections such as clostrid ...201728052855
analysis of gut microbiota - an ever changing landscape.in the last two decades, the field of metagenomics has greatly expanded due to improvement in sequencing technologies allowing for a more comprehensive characterization of microbial communities. the use of these technologies has led to an unprecedented understanding of human, animal, and environmental microbiomes and have shown that the gut microbiota are comparable to an organ that is intrinsically linked with a variety of diseases. characterization of microbial communities using next-generatio ...201728051919
fatal community-acquired ribotype 002 clostridium difficile bacteremia.extra-colonic infections, and especially bacteremia, are infrequent manifestations of clostridium difficile infection. c. difficile bacteremia is generally health-care associated and polymicrobial. we report the case of a patient on hunger strike that presented a c. difficile colitis and mono-microbial bacteremia on its admission to the hospital. multilocus variable number tandem repeat analysis of stool and blood isolates indicated clonality. the strain was characterized as a ribotype 002, an e ...201628043925
the potential impact of gut microbiota on your health:current status and future challenges.our health and probably also our behaviors and mood depend not only on what we eat or what we do (lifestyle behaviors), but also on what we host. it is well established for decades that all vertebrates including humans are colonized by a wide array of bacteria, fungi, eukaryotic parasites and viruses, and that, at steady state (homeostasis), this community of microbes establishes a friendly mutual relationship with the host. the term microbiota was originally meant to represent an ecological com ...201628042926
perceptions of fecal microbiota transplantation for clostridium difficile infection: factors that predict acceptance.despite the effectiveness of fecal microbiota transplantation (fmt) for treating recurrent clostridium difficile (c. difficile) infection, some patients are reluctant to accept this therapy. our study examined attitudes towards fmt and factors that contribute to patients' acceptance of this treatment.201728042242
probiotics for trauma patients: should we be taking a precautionary approach?the use of probiotics in the hospital setting is largely understudied and highly controversial. probiotics are living organisms that, when taken internally, can produce an immunomodulating effect and improve the gastrointestinal (gi) mucosal barrier. although used for centuries by healthy individuals for gi health, their use in the hospital setting is now gaining wide attention for the prevention of infectious complications such as antibiotic-associated diarrhea, clostridium difficile infections ...201628033143
comparative genome analysis and global phylogeny of the toxin variant clostridium difficile pcr ribotype 017 reveals the evolution of two independent sublineages.the diarrheal pathogen clostridium difficile consists of at least six distinct evolutionary lineages. the rt017 lineage is anomalous, as strains only express toxin b, compared to strains from other lineages that produce toxins a and b and, occasionally, binary toxin. historically, rt017 initially was reported in asia but now has been reported worldwide. we used whole-genome sequencing and phylogenetic analysis to investigate the patterns of global spread and population structure of 277 rt017 iso ...201728031436
treatment of clostridium difficile infection: a national survey of clinician recommendations and the use of faecal microbiota transplantation.adherence to clostridium difficile infection treatment guidelines is associated with lower recurrence rates and mortality as well as cost savings. this survey of irish clinicians indicates that patients are managed using a variety of approaches. faecal microbiota transplantation is potentially underused despite its recommendation in national and european guidelines.201728029471
clostridium difficile-associated clinical burden from lack of diagnostic testing in a chinese tertiary hospital.despite clostridium difficile infection (cdi) being a common cause of diarrhoea in hospitals worldwide, diagnostic testing or management guidelines are not available in most hospitals in china. in this prospective two-year study, the incidence of cdi among 276 patients with watery diarrhoea was 23.1%. lack of diagnostic testing for cdi was associated with improper management in 26.4% of patients, risk of nosocomial transmission from lack of isolation precautions, and risk of community transmissi ...201628029470
diagnostic testing methods for clostridium difficile infection: a statewide survey of ohio acute care hospitals.we surveyed ohio acute care hospitals on laboratory testing used for diagnosis of clostridium difficile infection (cdi). of 146 hospitals surveyed, 109 (84%) used nucleic acid amplification tests (naats) as stand-alone diagnostic assays. only 53 (42.4%) hospitals using naats had a mechanism in place to prevent repeat cdi testing.201728029400
infection prevention and control of clostridium difficile: a global review of guidelines, strategies, and recommendations.clostridium difficile is the leading cause of health care-associated infections. given the high incidence of c. difficile infection (cdi) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance.201628028434
can probiotics benefit children with autism spectrum disorders?children with autism are commonly affected by gastrointestinal problems such as abdominal pain, constipation and diarrhea. in recent years, there has been a growing interest in the use of probiotics in this population, as it hypothetically may help to improve bowel habits and the behavioral and social functioning of these individuals. the gut microbiome plays an important role in the pathophysiology of organic as well as functional gastrointestinal disorders. microbial modification with the use ...201628028357
successful treatment of severe clostridium difficile infection by administration of crushed fidaxomicin via a nasogastric tube in a critically ill patient.to report the successful use of crushed fidaxomicin via a nasogastric tube for treatment of a severe clostridium difficile infection in a critically ill patient.201728027991
the effects of the transforming care at the bedside program on perceived team effectiveness and patient outcomes.the objective of the study was to document the impact of transforming care at the bedside (tcab) program on health care team's effectiveness, patient safety, and patient experience. a pretest and posttest (team effectiveness) and a time-series study design (patient experience and safety) were used. the intervention (the tcab program) was implemented in 8 units in a multihospital academic health science center in montreal, quebec, canada. the impact of tcab interventions was measured using the te ...201728027197
role of p38alpha/beta map kinase in cell susceptibility to clostridium sordellii lethal toxin and clostridium difficile toxin b.lethal toxin from clostridium sordellii (tcsl), which is casually involved in the toxic shock syndrome and in gas gangrene, enters its target cells by receptor-mediated endocytosis. inside the cell, tcsl mono-o-glucosylates and thereby inactivates rac/cdc42 and ras subtype gtpases, resulting in actin reorganization and an activation of p38 map kinase. while a role of p38 map kinase in tcsl-induced cell death is well established, data on a role of p38 map kinase in tcsl-induced actin reorganizati ...201628025502
costs of clostridium difficile infection in pediatric operations: a propensity score-matching analysis.the purpose of this analysis was to assess the burden of clostridium difficile infection in the hospitalized pediatric surgical population and to characterize its influence on the costs of care.201628024858
lactobacillus probiotics in the prevention of diarrhea associated with clostridium difficile: a systematic review and bayesian hierarchical meta-analysis.recent meta-analyses of the efficacy of probiotics for preventing diarrhea associated with clostridium difficile have concluded there is a large effect favouring probiotics. we reexamined this evidence, which contradicts the results of a more recent large randomized controlled trial that found no benefit of lactobacillus probiotics for preventing c. difficile-associated diarrhea.201728018885
clostridium difficile infection: evolution, phylogeny and molecular epidemiology.over the recent decades, clostridium difficile infection (cdi) has emerged as a global public health threat. despite growing attention, c. difficile remains a poorly understood pathogen, however, the exquisite sensitivity offered by next generation sequencing (ngs) technology has enabled analysis of the genome of c. difficile, giving us access to massive genomic data on factors such as virulence, evolution, and genetic relatedness within c. difficile groups. ngs has also demonstrated excellence ...201728012982
oral vancomycin followed by fecal transplantation versus tapering oral vancomycin treatment for recurrent clostridium difficile infection: an open-label, randomized controlled trial.fecal transplantation (ft) is a promising treatment for recurrent clostridium difficile infection (cdi), but its true effectiveness remains unknown. we compared 14 days of oral vancomycin followed by a single ft by enema with oral vancomycin taper (standard of care) in adult patients experiencing acute recurrence of cdi.201728011612
fecal fixation: fecal microbiota transplantation for clostridium difficile infection. 201728011611
outcomes with fidaxomicin therapy in clostridium difficile infection.fidaxomicin is a new antibiotic used to treat clostridium difficile infection (cdi). given limited clinical experience with fidaxomicin, we assessed outcomes in a diverse cohort of patients with cdi treated with fidaxomicin.201628009682
[fecal microbiota transplantation: indications and perspectives].fecal transplantation demonstrated in a randomized trial its superiority compared to antibiotics in recurrent clostridium difficile (cd) infections. used in first-line treatment, it has reduced the mortality of patients suffering of cd infections caused by ribotype 027 and made it possible to cure patients with severe manifestations of cd infections caused by other ribotypes. the use of frozen microbiota, now validated, facilitates fecal microbiota transplantation. in addition, the frozen microb ...201628008840
a review of dose-responses of probiotics in human studies.the probiotic definition requires the administration of an 'adequate amount' in order to obtain a health benefit. what that amount should be is not indicated. here, an overview is given of studies that investigated the dose-response relation of probiotics in human interventions. studies were divided in; meta-analyses, meta-analyses on specific probiotic strains, and studies testing two or more doses of a probiotic (combination) in the same study. meta-analyses on the effect of probiotics on anti ...201628008787
therapeutic interventions for gut dysbiosis and related disorders in the elderly: antibiotics, probiotics or faecal microbiota transplantation?ageing and physiological functions of the human body are inversely proportional to each other. the gut microbiota and host immune system co-evolve from infants to the elderly. ageing is accompanied by a decline in gut microbial diversity, immunity and metabolism, which increases susceptibility to infections. any compositional change in the gut is directly linked to gastrointestinal disorders, obesity and metabolic diseases. increase in opportunistic pathogen invasion in the gut like clostridium ...201628008784
response to comment on "a small-molecule antivirulence agent for treating clostridium difficile infection".ebselen's antivirulence activity in clostridium difficile infection is likely due to multiple modes of action, but the contribution of each to its efficacy remains unclear.201628003551
comment on "a small-molecule antivirulence agent for treating clostridium difficile infection".new insights into the mechanism of action of ebselen, a small-molecule antivirulence agent that reduces disease pathology in a mouse model of clostridium difficile infection, suggest a different molecular target may be responsible for its efficacy.201628003550
primase is required for helicase activity and helicase alters the specificity of primase in the enteropathogen clostridium difficile.dna replication is an essential and conserved process in all domains of life and may serve as a target for the development of new antimicrobials. however, such developments are hindered by subtle mechanistic differences and limited understanding of dna replication in pathogenic microorganisms. clostridium difficile is the main cause of healthcare-associated diarrhoea and its dna replication machinery is virtually uncharacterized. we identify and characterize the mechanistic details of the putati ...201628003473
clinical characteristics and treatment outcomes of clostridium difficile infections by pcr ribotype 017 and 018 strains.the objective of this study was to identify the clinical characteristics of clostridium difficile infections (cdis) caused by toxin a-negative/toxin b-positive (a-b+) pcr ribotype 017 (r017) and a+b+ ribotype 018 (r018) strains, prevalent in asian countries. from february 2010 through january 2013, all cdi patients in our hospital were enrolled; their medical records were retrospectively reviewed, and the isolates were characterized by toxigenic culture and pcr ribotyping. based on the ribotypes ...201628002482
risk factors for hospital-acquired clostridium difficile infection among pediatric patients with cancer.hospital-acquired clostridium difficile infection (cdi) may cause life-threatening colitis for children with cancer, making identification of risk factors important. we described characteristics of pediatric cancer patients with primary and recurring cdi, and evaluated potential risk factors. among 189 cancer patients, 51 cases (27%) of cdi and 94 matched controls of cancer patients without cdi were analyzed. multivariable logistic regression was used to evaluate the association between cdi and ...201728002256
fecal microbiota transplant in severe and severe-complicated clostridium difficile: a promising treatment approach.severe and severe-complicated clostridium difficile infection (cdi) is associated with high morbidity and mortality. colectomy is standard of care; however, post-surgical mortality rates approach 50%. case reports suggest fecal microbiota transplant (fmt) is a promising treatment of severe and severe-complicated disease but there is a paucity of data. here, we present a single center experience with a novel sequential fmt protocol for patients refractory to maximal medical therapy. this approach ...201628001467
traditional chinese medicine qpyf as preventive treatment for clostridium difficile associated diarrhea in a mouse model.traditional chinese medicine qpyf has a good effect for treating antibiotic-associated diarrhea in clinical practice. the aim of this study is to test its efficacy to prevent clostridium difficile associated diarrhea (cdad) in a mouse model. c57bl/6 mice were infected with clostridium difficile vpi 10463 after exposure to antimicrobial mixture. qpyf was administered from 7 days prior to clostridium difficile infection to 20 days after infection, and its effect was compared with no treatment and ...201627999606
detection, ribotyping and antimicrobial resistance properties of clostridium difficile strains isolated from the cases of diarrhea.clostridium difficile is the most prevalent cause of antibiotic-associated infectious diarrhea al-around the world. prevalence of virulent and resistant strains of clostridium difficile is increasing now a day. the present investigation was carried out to study the prevalence, ribotyping and antibiotic resistance pattern of c. difficile isolated from diarrheic and non-diarrheic pediatrics.201627999477
complete microbiota engraftment is not essential for recovery from recurrent clostridium difficile infection following fecal microbiota transplantation.bacterial communities from subjects treated for recurrent clostridium difficile infection (rcdi) by fecal microbiota transplantation (fmt), using either heterologous donor stool samples or autologous stool samples, were characterized by illumina next-generation sequencing. as previously reported, the success of heterologous fmt (90%) was superior to that of autologous fmt (43%) (p = 0.019), and post-fmt intestinal bacterial communities differed significantly between treatment arms (p < 0.001). s ...201627999162
electronic prescribing system design priorities for antimicrobial stewardship: a cross-sectional survey of 142 uk infection specialists.the implementation of electronic prescribing and medication administration (epma) systems is a priority for hospitals and a potential component of antimicrobial stewardship (ams).201727999065
cumulative and temporal associations between antimicrobial prescribing and community-associated clostridium difficile infection: population-based case-control study using administrative data.community-associated clostridium difficile infection (ca-cdi; defined as cases without prior hospitalization in the previous 12 weeks who were either tested outside of hospital or tested within 2 days of admission to hospital) is a major public health problem. this study estimates the magnitude of the association between temporal and cumulative prescribing of antimicrobials in primary care and ca-cdi.201727999064
gut-sparing treatment of urinary tract infection in patients at high risk of clostridium difficile infection.recipients of faecal microbiota transplantation (fmt) in treatment of recurrent clostridium difficile infection (rcdi) remain at markedly increased risk of re-infection with c. difficile with new antibiotic provocations. urinary tract infections (utis) are common indications for antibiotics in these patients, often resulting in c. difficile re-infection.201727999027
the microbiome: what will the future hold?current research on the human microbiome has opened our eyes to the intimate relationship that we have with the bacteria that populate our gastrointestinal tract and its potential relationship to health and disease. to date, clinical research on the microbiome has identified intriguing associations between an altered microbiome and disease states, but proven therapeutic applications have been very limited. the ingestion of prebiotics, probiotics, and/or synbiotics is appealing to the general pub ...201627997976
the emerging metabolic view of clostridium difficile pathogenesis.it is widely accepted that clostridium difficile exploits dysbiosis and leverages inflammation to thrive in the gut environment, where it can asymptomatically colonize humans or cause a toxin-mediated disease ranging in severity from frequent watery diarrhea to pseudomembranous colitis or toxic megacolon. here, we synthesize recent findings from the gut microbiota and enteric pathogenesis fields to inform the next steps toward a better understanding of c. difficile infection (cdi). in this revie ...201627997854
role of interferon-γ and inflammatory monocytes in driving colonic inflammation during acute clostridium difficile infection in mice.the inflammatory response to the colonic pathogen clostridium difficile is characterized by the induction of inflammatory cytokines including interleukin-23 (il-23) and interferon-γ (ifn-γ) and the recruitment of myeloid cells including ly6c(h)(igh) monocytes. il-23 knockout mice showed reduced expression of the monocyte chemokines ccl4 and ccl7, but not ccl2, as well as reduced ly6c(h)(igh) ly6g(m)(id) monocyte recruitment to the colon in response to c. difficile colitis. clostridium difficile- ...201727995603
clostridium difficile infection: updates in management.clostridium difficile was first identified in 1978 as a diarrhea-causing bacterium in humans. in the last three decades, c. difficile infection (cdi) has reached an epidemic state, both in health care and community settings worldwide. there has been substantial progress in the field of cdi, including identification of novel risk factors, presence of cdi in individuals not considered at risk previously, and treatment options including new drugs, monoclonal antibodies, and fecal microbiota transpl ...201727995486
in vitro activities of mcb3681 and eight comparators against clostridium difficile isolates with known ribotypes and diverse geographical spread.treatments for clostridium difficile infection remain limited, despite the introduction of fidaxomicin, and development of new agents is necessary. we determined the in vitro susceptibilities of 199 prevalent or emerging clostridium difficile pcr ribotypes to mcb3681, a novel investigational quinolonyl-oxazolidinone, and 8 comparators (metronidazole, vancomycin, fidaxomicin, moxifloxacin, ciprofloxacin, clindamycin, tigecycline, and linezolid). mcb3681 showed good activity against c. difficile w ...201727993853
presence of clostridium difficile in pig faecal samples and wild animal species associated with pig farms.to determine the presence of clostridium difficile on fattening pig farms in north-eastern spain.201727990723
homogeneous and digital proximity ligation assays for the detection of clostridium difficile toxins a and b.the proximity ligation assay (pla) detects proteins via their interaction with pairs of proximity probes, which are antibodies coupled to noncomplementary dna oligonucleotides. the binding of both proximity probes to their epitopes on the target protein brings the oligonucleotides together, allowing them to be bridged by a third oligonucleotide with complementarity to the other two. this enables their ligation and the detection of the resulting amplicon by real-time quantitative pcr (qpcr), whic ...201627990343
novel portable platform for molecular detection of toxigenic clostridium difficile in faeces: a diagnostic accuracy study.a novel portable platform for nucleic acid amplification enables rapid detection of diarrhoea causing toxigenic clostridium difficile directly from faeces, even in resource-limited settings. we evaluated the accuracy and precision of the new commercial molecular test system.201627988815
probiotics and prevention of clostridium difficile infection.the role of probiotics as adjunctive measures in the prevention of clostridium difficile infection (cdi) has been controversial. however, a growing body of evidence has suggested that they have a role in primary prevention of cdi. elements of this controversy are reviewed and the proposed mechanisms of action, the value and cost effectiveness of probiotics are addressed with a focus on three agents, saccharomyces boulardii, lactobacillus rhamnosus gg and the combination of lactobacillus acidophi ...201627988389
predictors of severe outcomes in patients with clostridium difficile infection from a hispanic population.factors associated with complicated clostridium difficile infection (cdi) may vary among populations, and predictors of severe outcomes in cdi have not been studied in hispanic patients. the aim of this study was to identify factors associated with a higher risk of colectomy, all-cause mortality, and cdi-associated mortality in a hispanic population.201727987135
evaluation of the novel artus c. difficile qs-rgq, vanr qs-rgq and mrsa/sa qs-rgq assays for the laboratory diagnosis of clostridium difficile infection (cdi), and for vancomycin-resistant enterococci (vre) and methicillin-resistant staphylococcus aureus (mrsa) screening.clostridium difficile, methicillin-resistant staphylococcus aureus (mrsa) and vancomycin-resistant enterococci (vre) are worldwide prevalent healthcare-associated pathogens. we have evaluated three qiagen artus qs-rgq assays for the detection of these pathogens. we examined 200 stool samples previously tested for c. difficile infection (cdi), 94 rectal swabs previously screened for vre and 200 mrsa screening nasal swabs. with the routine diagnostic laboratory results being adopted as the gold st ...201627987047
clinical and microbiological characteristics of clostridium difficile infection among hospitalized children in the netherlands.little is known about pediatric clostridium difficile infection (cdi) epidemiology. we describe the clinical and microbiological characteristics of cdi among hospitalized children in the netherlands.201727986664
donor screening experience for fecal microbiota transplantation in patients with recurrent c. difficile infection.to evaluate our experience with stool donor recruitment, screening, retention, and donor perception for fecal microbiota transplantation (fmt).201627984397
dipicolinic acid release by germinating clostridium difficile spores occurs through a mechanosensing mechanism.classically, dormant endospores are defined by their resistance properties, particularly their resistance to heat. much of the heat resistance is due to the large amount of dipicolinic acid (dpa) stored within the spore core. during spore germination, dpa is released and allows for rehydration of the otherwise-dehydrated core. in bacillus subtilis, 7 proteins are encoded by the spova operon and are important for dpa release. these proteins receive a signal from the activated germinant receptor a ...201727981237
clostridium difficile colonization and antibiotics response in polyferms continuous model mimicking elderly intestinal fermentation.clostridium difficile (cd), a spore-forming and toxin-producing bacterium, is the main cause for antibiotic-associated diarrhea in the elderly. here we investigated cd colonization in novel in vitro fermentation models inoculated with immobilized elderly fecal microbiota and the effects of antibiotic treatments.201627980686
successful therapy of severe pseudomembranous clostridium difficile colitis using a combination of fecal microbiota therapy and fidaxomicin.the aim of this work was to describe the use of a combination of fidaxomicin and fecal microbiota therapy (fmt) in clostridium difficile infection (cdi).201727978522
recurrent clostridium difficile infection in children: patient risk factors and markers of intestinal inflammation.the management of clostridium difficile infection (cdi) in children is complicated by recurrence rates of 20%-30%. the identification of risk factors associated with recurrent disease might allow early recognition of those children at highest risk.201727977555
molecular epidemiology of clostridium difficile infection in hospitalized patients in eastern china.few studies on risk factors for and transmission of clostridium difficile infection (cdi) in china have been reported. a cross-sectional study was conducted for 3 years in eastern china. consecutive stool specimens from hospitalized patients with diarrhea were cultured for c. difficile. c. difficile isolates from these patients then were analyzed for toxin genes, genotypes, and antimicrobial resistance. a severity score for the cdi in each patient was determined by a blinded review of the medica ...201727974547
prospective randomized controlled study on the effects of saccharomyces boulardii cncm i-745 and amoxicillin-clavulanate or the combination on the gut microbiota of healthy volunteers.probiotics are believed to be beneficial in maintaining a healthy gut microbiota whereas antibiotics are known to induce dysbiosis. this study aimed to examine the effects of the probiotic saccharomyces boulardii cncm i-745 (sb), the antibiotic amoxicillin-clavulanate (ac) and the combination on the microbiota and symptoms of healthy humans. healthy subjects were randomized to one of 4 study groups: sb for 14 days, ac for 7 days, sb plus ac, control (no treatment). participants gave stool sample ...201727973989
[design of artificial foetor flatus based on bacterial volatile compounds].excessive flatulence can be a huge social problem. the purpose of this study was to design artificial flatus from bacterial volatile compounds to stimulate research into neutralizing measures.201627966414
antibiotic treatment of hospitalized patients with pneumonia complicated by clostridium difficile infection.clostridium difficile infection (cdi) is one of the most common gastrointestinal complication after antimicrobial treatment. it is estimated that cdi after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. the aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia cdi. we addressed the issue by examining retrospectively the records of 217 patients who met the diagno ...201627966110
probiotics: prevention of severe pneumonia and endotracheal colonization trial-prospect: protocol for a feasibility randomized pilot trial.probiotics are defined as live microorganisms that may confer health benefits when ingested. meta-analysis of probiotic trials suggests a 25 % lower ventilator-associated pneumonia (vap) and 18 % lower infection rates overall when administered to patients in the intensive care unit (icu). however, prior trials are small, largely single center, and at high risk of bias. before a large rigorous trial is launched, testing whether probiotics confer benefit, harm, or have no impact, a pilot trial is ...201527965798
isolation of clostridium difficile from dogs with digestive disorders, including stable metronidazole-resistant strains.the prevalence of clostridium difficile in 107 dogs with diverse digestive disorders attended in a spanish veterinary teaching hospital was assessed. the microorganism was isolated from 13 dogs (12.1%) of different disease groups. isolates belonged to pcr ribotypes 078, 106, 154 and 430 (all of them toxigenic) and 110 (non-toxigenic), and were resistant to several antimicrobial drugs. notably, seven isolates obtained from different dogs displayed stable resistance to metronidazole. the results o ...201727965048
an institutional comparison of total abdominal colectomy and diverting loop ileostomy and colonic lavage in the treatment of severe, complicated clostridium difficile infections.total abdominal colectomy (tac) is the standard surgical treatment of clostridium difficile infection (cdi). an alternative therapy, loop ileostomy and colonic lavage (il), was described in 2011, but the results have never been validated.201727964924
use of single molecule sequencing for comparative genomics of an environmental and a clinical isolate of clostridium difficile ribotype 078.how the pathogen clostridium difficile might survive, evolve and be transferred between reservoirs within the natural environment is poorly understood. some ribotypes are found both in clinical and environmental settings. whether these strains are distinct from each another and evolve in the specific environments is not established. the possession of a highly mobile genome has contributed to the genetic diversity and ongoing evolution of c. difficile. interpretations of genetic diversity have be ...201627964731
repeat clostridium difficile testing. 201627959982
clostridium difficile infection and fecal microbiota transplant.clostridium difficile infection (cdi) is a major source of morbidity and mortality for hospitalized patients. although most patients have a clinical response to existing antimicrobial therapies, recurrent infection develops in up to 30% of patients. fecal microbiota transplant is a novel approach to this complex problem, with an efficacy rate of nearly 90% in the setting of multiple recurrent cdi. this review covers the current epidemiology of cdi (including toxigenic and nontoxigenic strains, r ...201627959316
evaluation of the biofire filmarray® gastrointestinalpanel in a midwestern academic hospital.the biofire filmarray® gastrointestinal panel (gip) was implemented to replace traditional stool culture and enzyme immunoassay (eia) testing for stool pathogens. the purpose of this study was to evaluate the detection rate, incidence of coinfection, and culture recovery rate of gastrointestinal (gi) pathogens detected by the gip over a 1-year period. a total of 2257 stools collected from january to december 2015 were tested using the gip. clostridium difficile colonization was also evaluated by ...201727957599
risk factors and epidemiology of clostridium difficile infection in hematopoietic stem cell transplant recipients during the peritransplant period.hematopoietic stem cell transplant (hsct) recipients represent a high-risk group for developing clostridium difficile (cd) infection (cdi). we aimed to identify specific risk factors for cdi in an hsct patient population during the peritransplant period.201727943501
risk factors for the development of clostridium difficile infection in adult allogeneic hematopoietic stem cell transplant recipients: a single-center study in québec, canada.clostridium difficile infection (cdi) is a significant complication of allogeneic hematopoietic stem cell transplantation (allo-hsct). our primary objective was to determine risk factors for the development of cdi during the first year following allo-hsct.201727943498
efficacy of computed tomography for the prediction of colectomy and mortality in patients with clostridium difficile infection.to develop a ct predictor scale for the need for colectomy and to evaluate predictors of all-cause mortality within 30 days after diagnosis ofc. difficile infection (cdi).201627942384
fidaxomicin for the treatment of clostridium difficile infection in the pediatric population - not quite so soon yet.fidaxomicin is a new narrow spectrum macrocyclic antibiotic. it inhibits bacterial rna polymerase and eradicates c difficile with minimal effect on normal intestinal flora. the us fda granted orphan drug designation for all formulations of fidaxomicin for the treatment of c difficile infections in pediatric patients on january 10, 2011. fidaxomicin has bactericidal activity against c difficile with a prolonged post-antibiotic effect. even though this medication has an orphan designation for pedi ...201127942322
clostridium difficile toxin a undergoes clathrin-independent, pacsin2-dependent endocytosis.clostridium difficile infection affects a significant number of hospitalized patients in the united states. two homologous exotoxins, tcda and tcdb, are the major virulence factors in c. difficile pathogenesis. the toxins are glucosyltransferases that inactivate rho family-gtpases to disrupt host cellular function and cause fluid secretion, inflammation, and cell death. toxicity depends on receptor binding and subsequent endocytosis. tcdb has been shown to enter cells by clathrin-dependent endoc ...201627942025
reduction in hospital-associated methicillin-resistant staphylococcus aureus and vancomycin-resistant enterococcus with daily chlorhexidine gluconate bathing for medical inpatients.daily bathing with chlorhexidine gluconate (chg) is increasingly used in intensive care units to prevent hospital-associated infections, but limited evidence exists for noncritical care settings.201727938986
stable core virome despite variable microbiome after fecal transfer.we recently described the 4.5-year time course of the enteric bacterial microbiota and virome of a patient cured from recurrent clostridium difficile infection (rcdi) by fecal microbiota transplantation (fmt). here, we extended the virome analyses and found the patient's phage population to exhibit highly donor-similar characteristics following fmt, which remained stable for the whole period tested (up to 7 months). moreover, the detected viral populations of donor and patient exhibited comparab ...201627935413
molecular appraisal of intestinal parasitic infection in transplant recipients.diarrhoea is the main clinical manifestation caused by intestinal parasitic infections in patients, with special reference to transplant recipients who require careful consideration to reduce morbidity and mortality. further, molecular characterization of some important parasites is necessary to delineate the different modes of transmission to consider appropriate management strategies. we undertook this study to investigate the intestinal parasitic infections in transplant recipients with or wi ...201627934806
development and validation of a liquid chromatography tandem mass spectrometry assay for the measurement of faecal metronidazole.metronidazole is an oral antibiotic which is widely used in the treatment of patients with clostridium difficile associated disease.201627932283
acute bronchitis.cough is the most common illness-related reason for ambulatory care visits in the united states. acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia. pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted. pertussis should be suspected in patients with cough persisting for more than two weeks that is a ...201627929206
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