Publications

clostridium difficile infection in patients with haematological malignant disease. risk factors, faecal toxins and pathogenic strains.	two hundred and forty-eight patients from shared oncology and general medical wards were prospectively studied over a 6-month period for carriage of clostridium difficile during an outbreak of clinical disease with an epidemic strain of the organism. risk factors for infection were assessed. acute leukaemia and/or its treatment were identified as significantly increasing the risk of infection. the relationship between the type of c. difficile isolated (as defined by a typing system based on the ...	1988	3123260
clostridium difficile toxins a and b inhibit human immune response in vitro.	two clostridium difficile toxins isolated from strain vpi 10463 were tested for their effect on different human t-cell proliferation systems. in mitogen- and antigen-driven t-cell proliferation systems, toxins inhibited the proliferative response in a dose-dependent fashion. in interleukin-2-driven culture systems, no effect of toxins could be found on preactivated t cells. we suspected that monocytes were the influenced cells, since in antigen- and mitogen-driven systems monocytes were necessar ...	1988	3128476
purification and characterization of clostridium sordellii hemorrhagic toxin and cross-reactivity with clostridium difficile toxin a (enterotoxin).	hemorrhagic toxin (toxin ht) was purified from clostridium sordellii culture filtrate. the purification steps included ultrafiltration through an xm-100 membrane filter and immunoaffinity chromatography, using a monoclonal antibody to toxin a of clostridium difficile as the ligand. toxin ht migrated as a major band with a molecular weight of 525,000 and a minor band at 450,000 on nondenaturing gradient polyacrylamide gel electrophoresis. the molecular weight was estimated at 300,000 by sodium do ...	1988	3128481
characterization of cross-reactive proteins detected by culturette brand rapid latex test for clostridium difficile.	clostridium sporogenes, peptostreptococcus anaerobius, and bacteroides asaccharolyticus have been reported to react in the culturette brand rapid latex test (marion scientific, div. marion laboratories, inc., kansas city, mo.) for clostridium difficile. from the results of this study we showed that c. sporogenes and p. anaerobius produce a protein which is very similar biochemically and immunologically to the protein of c. difficile that is detected by the test. thus, the positive latex reaction ...	1988	3128574
purification and characterisation of two forms of toxin b produced by clostridium difficile.	toxin b from clostridium difficile was purified to homogeneity by gel filtration and high resolution ion exchange chromatography. two forms of toxin b were found. form 1 which seemed to consist of two identical subunits of 220-300 kda; femtogram amounts of this toxin induced rounding of fibroblast cells. form 2 contained subunits of 43 kda and 105 kda; the stoichiometric ratio probably being 4:1; picogram amounts were needed to induce rounding of fibroblast cells. immunological studies suggested ...	1988	3133248
incidence and significance of clostridium difficile in hospitalized cancer patients.	the aim of the study was to assess the incidence and clinical significance of clostridium difficile in patients in our cancer center. over a period of seven consecutive months, 557 stools samples obtained from 156 hospitalized cancer patients (37 leukemic patients receiving oral antimicrobial prophylaxis and 119 patients from whom a stool sample was sent to the laboratory) were analyzed for the presence of clostridium difficile. clostridium difficile and/or its toxin was recovered from 13 (35%) ...	1988	3134231
computer-aided densitometric analysis of protein patterns of clostridium difficile.	the applicability of whole-cell protein patterns obtained by sodium dodecylsulfate-polyacrylamide gel electrophoresis as a typing method for clostridium difficile was examined using a total of 227 strains isolated from 191 patients and their surroundings. computer-aided densitometric analysis was used to establish a reliable standardization technique with which a large number of protein patterns could be efficiently classified. the normalized tracks could be electronically superimposed and compa ...	1988	3134233
clostridium difficile plasmid isolation as an epidemiologic tool.	a large hospital outbreak of clostridium difficile diarrhea at the minneapolis veterans administration medical center (mvamc) was studied by plasmid profile typing. plasmids were obtained from 30 (37%) of 82 clinical isolates from mvamc patients and 10 (67%) of 15 non-mvamc isolates. while bacteriophage plus bacteriocin typing and polyacrylamide gel electrophoresis (page) plus bacterial agglutination typing proved more universally applicable, plasmid profiles may be useful for tracing isolated e ...	1988	3134239
actin-specific adp-ribosyltransferase produced by a clostridium difficile strain.	by screening possible adp-ribosyltransferase activities in culture supernatants from various clostridium species, we have found one clostridium difficile strain (cd196) (isolated in our laboratory) that is able to produce, in addition to toxins a and b, a new adp-ribosyltransferase that was shown to covalently modify cell actin as clostridium botulinum c2 or clostridium perfringens e iota toxins do. the molecular weight of the cd196 adp-ribosyltransferase (cdt) was determined to be 43 kilodalton ...	1988	3137166
[fundamental studies on the growth of clostridium difficile--the effect of medium ph on the germination & proliferation of spores].		1988	3138331
laboratory diagnosis of clostridium difficile-associated diarrhoea.	this paper reviews the various laboratory procedures available for the isolation and identification of clostridium difficile and the detection of toxins produced by this organism. laboratories should be selective in determining which patients require investigation for clostridium difficile-associated diarrhoea. transport and storage of stool specimens at 4 degrees c is recommended when delays in processing may occur. tissue culture techniques are still the best method for detection of cytotoxin ...	1988	3141153
pancreatic abscess caused by clostridium difficile.	the first known case of pancreatic abscess caused by clostridium difficile in a patient with no history of diarrhea or previous antibiotic therapy is presented. after surgical intervention and antibiotic therapy with metronidazole (500 mg every 8 h) and cefotaxime (1 g every 8 h) the patient recovered completely.	1988	3141163
clostridium difficile toxin a perturbs cytoskeletal structure and tight junction permeability of cultured human intestinal epithelial monolayers.	toxin a of clostridium difficile causes severe inflammatory enterocolitis in man and animals that appears to be mediated in part by acute inflammatory cells that migrate into the toxin a-exposed mucosa. to determine the direct effects of toxin a on intestinal epithelial permeability and structure in the absence of other modulating factors, we used cultured monolayers of a human intestinal epithelial cell line (t84). a toxin a concentration of 7 x 10(-1) micrograms/ml (3 x 10(-9) m) nearly abolis ...	1988	3141478
effect of toxins produced by various clostridium difficile strains on cecum size reduction in gnotobiotic mice.	inoculation of axenic mice with clostridium difficile strains induced a significant reduction in ceca weight (dry or wet), whereas a nontoxinogenic strain led to a partial reduction. a strain, which produces cytotoxin and no enterotoxin in vivo, caused a reduction similar to that observed with a nontoxinogenic strain. simultaneous cytotoxin and enterotoxin production by various c. difficile strains caused the cecum size to diminish to that observed for conventional control mice.	1988	3143476
clostridium difficile: its disease and toxins.	clostridium difficile is the etiologic agent of pseudomembranous colitis, a severe, sometimes fatal disease that occurs in adults undergoing antimicrobial therapy. the disease, ironically, has been most effectively treated with antibiotics, although some of the newer methods of treatment such as the replacement of the bowel flora may prove more beneficial for patients who continue to relapse with pseudomembranous colitis. the organism produces two potent exotoxins designated toxin a and toxin b. ...	1988	3144429
in vitro activity of azithromycin (cp-62,993), a novel macrolide, against enteric pathogens.	azithromycin (cp-62,993 [9-deoxy-9a-methyl-9a-aza-9a-homoerythromycin]) is a novel macrolide antimicrobial. in this study the in vitro activity of cp-62,993 has been determined against selected enteropathogens, including clostridium difficile, and compared with that of erythromycin. mics were determined using an agar incorporation technique in mueller-hinton medium, containing saponin-lysed horse blood at a final concentration of 10% v/v, with an inoculum of 10(4) cfu. cp-62,993 was considerably ...	1988	2854515
a comparison of teicoplanin and cefuroxime as prophylaxis for orthopaedic implant surgery: a preliminary report.	the relative merits of different antibiotic regimens for prophylaxis in orthopaedic implant surgery are difficult to evaluate because of the low frequency of infection. factors other than infection prevention may influence choice. we have compared 400 mg teicoplanin given intravenously on induction of anaesthesia with three perioperative injections of cefuroxime, in 146 patients undergoing total hip or total knee replacement. these interim results suggest that cefuroxime selects for increased ex ...	1988	2965126
in vitro antibacterial activity of trospectomycin (u-63366f), a novel spectinomycin analog.	trospectomycin (u-63366f) is a novel spectinomycin analog with broad-spectrum antibacterial activity. the in vitro activity of this analog was compared with that of spectinomycin and other reference antibiotics against 411 clinical isolates of aerobic and anaerobic bacteria. mics were determined by agar or broth dilution methods. the stability of trospectomycin in the presence of an enzyme extract derived from spectinomycin-resistant escherichia coli was determined. trospectomycin was more activ ...	1988	2966608
infectious complications in four long-term recipients of the jarvik-7 artificial heart.	this article describes the infectious complications that occurred among four of the longest-term recipients of the jarvik-7 artificial heart. infection arising from the drive lines, with spread to the mediastinal periprosthetic space, was the major limiting factor in long-term use of the device in these patients. periprosthetic infections were due to coagulase-negative staphylococci, staphylococcus aureus, pseudomonas aeruginosa, and other pseudomonas species. other infectious complications incu ...	1988	3336199
clostridium difficile in neonates: serogrouping and epidemiology.	a typing scheme for clostridium difficile based on serogrouping, toxigenicity and sorbitol fermentation was applied to 270 strains isolated in one neonatal ward during a 6-month prospective study. two hundred and twenty-three strains were isolated from 377 faecal samples of 114 neonates and 47 from 92 environmental specimens. the isolates were distributed among five different types; 87% of the faecal and 85% of the environmental isolates belonged to two of these types (toxigenic, sorbitol negati ...	1988	3338476
evaluation of a latex agglutination test for diagnosis of clostridium difficile-associated colitis.	current methods for diagnosis of clostridium difficile-associated colitis (cac) based on detection of cytotoxin b by a tissue culture assay (tca) require technical expertise and up to 48 hours incubation. recently, a latex agglutination (la) test (marion laboratories) for rapid diagnosis of cac has become available. although early evaluations have been favorable, new evidence suggests that the la reagent binds a soluble bacterial antigen that is not unique to toxigenic strains of c. difficile. t ...	1988	3341282
effects of clostridium difficile toxins a and b in rabbit small and large intestine in vivo and on cultured cells in vitro.	clostridium difficile is recognized as the major cause of antibiotic-associated colitis. c. difficile produces two toxins, a (enterotoxin) and b (cytotoxin), that are implicated in the pathogenesis of the colitis. we examined the dose responses, time course, and synergism of these two toxins in ligated rabbit intestinal loops and in tissue culture. in rabbit small intestinal loops, toxin a caused histologically demonstrable intestinal tissue damage as early as 2 h. the secretory response greater ...	1988	3343050
immunoblots and plasmid fingerprints compared with serotyping and polyacrylamide gel electrophoresis for typing clostridium difficile.	two new methods for typing clostridium difficile, immunoblotting and plasmid fingerprinting, were compared with serotyping and polyacrylamide gel electrophoresis (page). of these methods, immunoblotting was found to be the most valuable for use in a comprehensive typing system. more groups could be distinguished by immunoblotting than by serotyping or page. immunoblotting results were also more reproducible and distinctive than results by page. plasmid fingerprinting was an excellent marker for ...	1988	3343314
absence of diarrhea in toxic megacolon complicating clostridium difficile pseudomembranous colitis.	we describe a patient with clostridium difficile-associated pseudomembranous colitis who presented with toxic megacolon without diarrhea. the discussion includes a brief review of the literature, and suggests an important role for endoscopy in the diagnosis of pseudomembranous colitis and, possibly, as part of the therapy for toxic megacolon associated with clostridium difficile colitis. the unusual combination of toxic megacolon without antecedent diarrhea should be recognized as a possible man ...	1988	3344734
mucosal association by clostridium difficile in the hamster gastrointestinal tract.	for many organisms, mucosal association is an important virulence determinant. although studied in detail for other intestinal pathogens, this aspect of pathogenicity has not been studied for clostridium difficile. we compared the ability of an avirulent non-toxigenic strain (m-1), a highly virulent toxigenic strain (b-1), and a poorly virulent toxigenic strain (bat) of c. difficile to adhere to different regions of the gastrointestinal tract of hamsters pre-treated with clindamycin. strain b-1 ...	1988	3346902
stool caproic acid for screening of clostridium difficile.	clostridium difficile is the prime etiologic agent in the production of pseudomembranous colitis by its powerful cytotoxin. the most common test for the toxin is a tissue culture method with neutralization of cytopathic effect by a c. difficile antiserum. this method is expensive and requires a minimum of 72 hours before results can be obtained. attempts to create a rapid method, counterimmunoelectrophoresis, enzyme-linked immunosorbent, latex agglutination, and fluorescent antibody test are fra ...	1988	3354506
electrophoretic characterization of clostridium difficile strains isolated from antibiotic-associated colitis and other conditions.	clostridium difficile has been recognized as the cause of antibiotic-associated pseudomembranous colitis and of less severe diarrheal diseases associated with the use of antimicrobial agents. however, healthy carriers of this microorganism have been found, particularly healthy neonates and small children. various typing systems have been used to clarify the epidemiology of c. difficile. we used the electrophoretic patterns of edta-extracted proteins to characterize c. difficile strains from vari ...	1988	3356792
emergence in gnotobiotic mice of nontoxinogenic clones of clostridium difficile from a toxinogenic one.	in previous studies, we showed that diet composition or saccharomyces boulardii ingestion could protect gnotobiotic mice against lethal clostridium difficile infection. using an original method, we detected nontoxinogenic clones from feces of protected mice challenged with a toxinogenic clone of c. difficile. these clones became established at the same level as the toxinogenic one after about 30 days. in these protected mice bearing nontoxinogenic clones, no enterotoxin production could be detec ...	1988	3372017
in vitro activity of flomoxef in comparison to other cephalosporins.	flomoxef and cefazolin had nearly the same activity against staphylococci, which was stronger than that of other cephalosporins. against streptococcus pyogenes, streptococcus agalactiae and streptococcus pneumoniae, cefotaxime and cefazolin were more active than flomoxef, but the other cephamycins were less active than flomoxef. in comparison to the other cephalosporins, latamoxef and flomoxef had higher activity against branhamella catarrhalis, whereas cefotaxime, latamoxef and cefotetan were m ...	1988	3372024
studies on the resistance of clostridium difficile to antimicrobial agents.	the susceptibility of c. difficile isolated at the department of medical microbiology of the university of zurich to a wide selection of antibacterial, antimycobacterial and antifungal agents was tested in vitro. great differences in susceptibility were found against chloramphenicol, clindamycin, erythromycin, rifamycin, and tetracycline. resistance to clindamycin and erythromycin could always be transferred jointly to a susceptible c. difficile strain by mixed culture on filters at low frequenc ...	1988	3376619
in vitro activities of two oxazolidinone antimicrobial agents, dup 721 and dup 105.	the antibacterial activities of dup 105 and dup 721, new oxazolidinone antimicrobial agents, were compared with those of beta-lactams and glycopeptides. ninety percent of staphylococcus aureus and staphylococcus epidermidis isolates, including methicillin-resistant isolates, were inhibited by 4 micrograms of dup 105 and 1 microgram of dup 721 per ml. dup 721 inhibited hemolytic streptococcus groups a, b, c, f, and g at a concentration of less than or equal to 1 microgram/ml, and it inhibited vir ...	1988	3377467
vertebral osteomyelitis caused by clostridium difficile. a case report and review of the literature.		1988	3381119
purification and characterization of toxin b from clostridium difficile.	toxin b from clostridium difficile was purified to homogeneity and characterized. purification of toxin b was achieved by gel filtration, chromatography on two consecutive anion-exchange columns, and chromatography on a high-resolution anion-exchange column in the presence of 50 mm cacl2. the molecular weight of toxin b was estimated to be 250,000 by denaturing sodium dodecyl sulfate-polyacrylamide gel electrophoresis (sds-page) and 500,000 by gel filtration. no subunits were apparent when the t ...	1988	3384474
evidence for cross-infection in an outbreak of clostridium difficile-associated diarrhoea in a surgical unit.	environmental studies were performed in a hospital outbreak of clostridium difficile-associated diarrhoea. transmission was associated with the sluice room and the storage room where medical equipment was found to be contaminated with c.difficile. typing of isolates by antibiotic-susceptibility patterns and profiles of edta-extracted proteins showed the presence of an "epidemic" strain common to the majority of patients and environmental sites. control of the outbreak was achieved by improvement ...	1988	3385765
clostridium difficile and acute enterocolitis.	clostridium difficile belonging to groups not normally detected in infancy was the only potential pathogen detected in the stools of two infants with severe enterocolitis. further information regarding the virulence of this organism was obtained by use of a recently introduced typing scheme.	1988	3389873
effect of a single dose of cefotaxime or ceftriaxone on human faecal flora. a double-blind study.	the effect of cefotaxime and ceftriaxone on faecal flora was investigated in women undergoing routine vaginal or abdominal hysterectomy. three groups of 9 patients received, in a double-blind fashion and just before surgery, cefotaxime 2g intravenously, ceftriaxone 2g intravenously or no antibiotic (controls). stools were collected before prophylaxis (sample 1) and after surgery (samples 2 and 3). the only alteration after cefotaxime was a decrease of non-fastidious aerobic gram-negative flora i ...	1988	3396490
pathogenesis of postantibiotic diarrhoea caused by clostridium difficile: an in vitro study in the rabbit intestine.	to elucidate the pathophysiological changes leading to postantibiotic diarrhoea caused by clostridium difficile and its cytotoxin, oral ampicillin was given to rabbits, and jejunal, ileal, and caecal segments of those that developed diarrhoea were investigated in vitro. the rabbits that, in response to treatment, harboured clostridium difficile in their colonic lumen were studied, and the results expressed according to the presence or absence of clostridium difficile and/or its cytotoxin. thus, ...	1988	3396947
pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery.	we report 16 orthopaedic patients who had antibiotic-associated diarrhoea (pseudomembranous colitis) after operation. there was an association with the use of cephradine and with the prolongation of prophylaxis for more than three peri-operative doses. five cases occurred as a cluster, suggesting that the causative agent, clostridium difficile, may be infectious in some situations.	1988	3403605
epidemiology of clostridium difficile colonization in newborns: results using a bacteriophage and bacteriocin typing system.	we used a typing system based on bacteriophage and bacteriocin susceptibility to study the epidemiology of clostridium difficile colonization of newborn infants. c. difficile was found in the stools of 30 (16.0%) of 187 infants who were screened. increased length of stay in the nursery (p less than .001) and delivery by cesarian section (p less than .001) were associated with higher rates of colonization. the isolates initially detected from the environment and the infants were strain b1811-1700 ...	1988	3403992
acute diarrhoea in adults: aetiology, clinical appearance and therapeutic aspects.	a prospective study of acute diarrhoea was performed during 15 months 1981/1982 and included 731 patients and 240 controls. 43% had been infected abroad. a cluster of travellers with bacterial pathogens was diagnosed in july-august. the following pathogens were found: campylobacter (18%), enterotoxigenic e. coli (6%), salmonella spp. (5%), rotavirus (4%), yersinia enterocolitica (3%), giardia lamblia (3%), shigella spp. (2%), clostridium difficile (2%), enteroviruses (2%) and entamoeba histolyti ...	1988	3406670
clostridium difficile in an oncology unit.	in one year 21 new cases of clostridium difficile infection occurred on a paediatric oncology unit. eleven cases were in a two month period. this infection should be regarded as a communicable disease. investigations to detect c difficile should be carried out in children with malignant disease who have diarrhoea.	1988	3415338
role of competition for nutrients in suppression of clostridium difficile by the colonic microflora.	the cecal flora of mice is able to eliminate clostridium difficile from the mouse cecum even when c. difficile is the first organism established. we used a continuous-flow (cf) culture model of the cecal flora to investigate the possibility that competition for nutrients is one mechanism for this antagonism. the medium for the cf cultures consisted of homogenates of fecal pellets from germfree mice. carbohydrate analysis showed that mouse flora depleted 74 to 99.8% of the various carbohydrates f ...	1988	3417352
relapsing clostridium difficile toxin-associated colitis in ovarian cancer patients treated with chemotherapy.	symptomatic relapse of clostridium difficile toxin-associated colitis occurred in three patients with ovarian cancer. in two patients, c difficile toxin-positive diarrhea initially appeared in association with antibiotic therapy. the third patient developed diarrhea after chemotherapy, without recent antecedent antibiotic administration. patients were initially treated with oral metronidazole and became asymptomatic and toxin-negative. a symptomatic toxin-positive recurrence then developed after ...	1989	2761938
extended spectrum cephalosporins and clostridium difficile.	there is little information about how commonly the newer cephalosporins cause diarrhoea due to clostridium difficile. in this study of 111 patients with c. difficile-associated diarrhoea, 106 had received antimicrobial agents in the four weeks before detection of c. difficile. the relative risk for each antimicrobial agent was greatest with clindamycin, followed by cefotaxime, cephamandole and ceftriaxone. there was no statistically significant difference in risk between the cephalosporins evalu ...	1989	2759933
clostridium difficile in the intensive care unit: management problems and prevention issues.	several patients hospitalized in our 12-bed medical icu were found to have clostridium difficile associated colitis. stool cultures of all patients identified eight cases (three culture positive, and five culture and cytotoxin positive), seven of which were geographically and temporarily clustered within a 2-wk period. at least one patient appeared to contract the disease after hospitalization and in the absence of antibiotic therapy or other known major risk factors. the outbreak highlights the ...	1989	2752778
treatment of antibiotic-associated clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens.	high-dose (500 mg orally four times daily) vancomycin is considered by many investigators to be the most effective treatment for antibiotic-associated clostridium difficile colitis. however, a lower dosage of 125 or 150 mg given three or four times a day has become popular, has been shown to be effective, and is less expensive than the high-dose regimen. we therefore decided to compare two vancomycin dosage regimens in a randomized trial.	1989	2910090
clostridium difficile colitis secondary to intravenous vancomycin.	nearly every known antibiotic has been implicated as a cause of clostridium difficile colitis. we report the first case resulting from monotherapy with intravenous vancomycin. the patient was on chronic hemodialysis and was treated with intravenous vancomycin for presumed cervical osteomyelitis. after 29 days of therapy he developed abdominal pain and diarrhea and his stool was found to contain both c. difficile and cytotoxin. the patient responded with symptomatic and microbiological recovery t ...	1989	2910675
nosocomial acquisition of clostridium difficile infection.	we studied the acquisition and transmission of clostridium difficile infection prospectively on a general medical ward by serially culturing rectal-swab specimens from 428 patients admitted over an 11-month period. immunoblot typing was used to differentiate individual strains of c. difficile. seven percent of the patients (29) had positive cultures at admission. eighty-three (21 percent) of the 399 patients with negative cultures acquired c. difficile during their hospitalizations. of these pat ...	1989	2911306
recurrences of clostridium difficile diarrhea not caused by the original infecting organism.		1989	2915158
phenelfamycins, a novel complex of elfamycin-type antibiotics. iii. activity in vitro and in a hamster colitis model.	phenelfamycins a, b, c, e, f and unphenelfamycin make up a recently isolated group of elfamycin-type antibiotics. all of the phenelfamycins were active against gram-positive anaerobes, including clostridium difficile. phenelfamycin a was also active in vitro against neisseria gonorrhoeae and streptococci. phenelfamycin a was found to be effective in prolonging the survival of hamsters in an animal model of c. difficile enterocolitis. after oral administration of phenelfamycin a to hamsters, anti ...	1989	2921230
recovery of spores of clostridium difficile altered by heat or alkali.	the effect of heating or alkali-treatment on spore recovery in ordinary growth medium was examined for four strains of clostridium difficile. heating spores at 80 degrees c for 10 min produced 95.50-99.95% decreases in the recovery rates. treatment with 0.1 n naoh for 15 min produced 99.47 and 99.83% decreases in spore recovery rates for two of the four strains. the influence of either addition of lysozyme after treatment with sodium thioglycollate (thioglycollate-lysozyme method) or addition of ...	1989	2926793
oral fluoroquinolone therapy for clostridium difficile enterocolitis.		1989	2926941
evaluation of antibiotic-associated diarrhea with a latex agglutination test and cell culture cytotoxicity assay for clostridium difficile.	diagnosis of clostridium difficile (c. difficile) by its antigen or toxin has improved treatment for patients who have antibiotic-associated diarrhea and opportunistic colonization of the colon with c. difficile. unfortunately, results from the tissue culture cytotoxicity assay are not available for 48 h. we prospectively compared a latex agglutination test with the tissue culture cytotoxicity assay in 83 patients (15 with antibiotic-associated diarrhea, 23 with non-antibiotic-associated diarrhe ...	1989	2929558
effect of clindamycin on factor-vii activity in healthy cats.	four healthy cats were given clindamycin orally in daily doses of 25 or 50 mg/kg of body weight for 6 weeks. significant change in factor-vii activity was not found, compared with pretreatment values. in 2 cats tested, toxin produced by clostridium difficile was not detected in fecal samples obtained before treatment and at 6 weeks after treatment, suggesting that intestinal overgrowth by c difficile did not develop. results of the study seemed to indicate that orally administered clindamycin do ...	1989	2930027
[laboratory methods of diagnosing pseudomembranous colitis and diarrhea caused by clostridium difficile (review of the literature)].		1989	2469839
clostridium difficile toxin b: characterization and sequence of three peptides.	the cytotoxin, also named toxin b, was isolated from a toxigenic strain of clostridium difficile, purified to homogeneity and partially characterized. the purification procedure included ultrafiltration followed by anion-exchange chromatography. we noticed that a non-specific nucleic material eluted with the protein during the purification. the presence of these nucleic acids appeared to be important for the toxic activity of the protein. some characteristics of the cytotoxin were examined, espe ...	1989	2474559
diagnostic procedures for isolation and characterization of clostridium difficile associated with enterocolitis in foals.		1989	2488656
[enumeration and identification of clostridium from stools treated with the thioglycollate-lysozyme method].	we have used spore isolation by the sodium thioglycolate-lysozyme technique on collected stools. of the 51 stools studied, we found 41% of clostridium perfringens with an average ratio of 10(4) germs/gr. 15 strains were typical double hemolysis and trehalose positive-5 presented only one hemolysis and were trehalose negative. we only found a single strain of clostridium difficile with a rate of 10(4) germs/gr in the stools of a 10 months infant.	1989	2489405
[2 cases of arthralgia associated with infection by clostridium difficile].	the clostridium difficile is the etiologic agent most often isolated in patients with antibiotic-associated colitis. rarely this symptomatology is complicated by postinfection arthritis. the following describes 2 cases of acute colitis by clostridium difficile associated with acute polyarthritis.	1989	2491298
clostridium difficile settles in a nursing home.		1989	2493005
prevention of antibiotic-associated diarrhea by saccharomyces boulardii: a prospective study.	saccharomyces boulardii, a nonpathogenic yeast, has been widely used in europe to prevent antibiotic-associated diarrhea (aad). we performed a prospective double-blind controlled study to investigate aad in hospitalized patients and to evaluate the effect of s. boulardii, a living yeast, given in capsule form concurrently with antibiotics. over 23 mo, 180 patients completed the study. of the patients receiving placebo, 22% experienced diarrhea compared with 9.5% of patients receiving s. boulardi ...	1989	2494098
occurrence and significance of clostridium difficile in faecal specimens of hospitalized children.	stool specimens from 766 hospitalized children, 418 with diarrhoea and 348 controls, were investigated for c. difficile. in both groups the rate of isolation was highest (about 30%) during the first year of life, dropping to nearly 5% in older children. there was no significant difference in the frequency of c. difficile in children with diarrhoea and the controls nor was there a significant influence of previous antibiotic therapy on the rate of isolation. 111/135 strains (82.2%) produced toxin ...	1989	2494813
effect of purified clostridium difficile toxins on intestinal smooth muscle. i. toxin a.	in these studies we determined the effects of purified clostridium difficile toxin a, an enterotoxin, on the electrophysiological and contractile properties of rabbit intestinal circular smooth muscle and correlated these effects with changes of smooth muscle morphology. simultaneous measurements of intracellular membrane potential and contractility were determined in excised ileal muscle strips after administration of toxin a in vivo (60 micrograms/ml) into an isolated rabbit ileal loop or dire ...	1989	2495733
effect of purified clostridium difficile toxins on intestinal smooth muscle. ii. toxin b.	in the companion paper [am. j. physiol. 256 (gastrointest. liver physiol. 19): g759-g766, 1989] we showed that highly purified clostridium difficile toxin a had a profound effect on intestinal smooth muscle after in vivo but not in vitro exposure. in this study we assessed the effects of in vivo and in vitro exposure to c. difficile toxin b on simultaneous measurements of intracellular membrane potential and contractility in rabbit ileal smooth muscle. direct exposure of ileal smooth muscle to t ...	1989	2495734
focal ulcerative ileocolitis with terminal thrombocytopenic purpura in juvenile cotton top tamarins (saguinus oedipus).	a newly recognized syndrome characterized by an acute focal ulcerative ileocolitis, anemia and thrombocytopenic purpura in five juvenile cotton-top tamarins is described. the presentation and morphology of this syndrome is distinct from any other reported gastrointestinal disease reported in tamarins. traditional etiologies such as viruses, ingested toxins, campylobacter, salmonella and yersinia and clostridium difficile are not considered likely etiologic agents. nontraditional etiologies such ...	1989	2496272
multiple relapses of clostridium difficile-associated diarrhea responding to an extended course of cholestyramine.		1989	2496393
polymicrobial septicemia with clostridium difficile in acute diverticulitis.	a case is reported of a patient without previous gastrointestinal symptoms, who presented with polymicrobial septicemia caused by escherichia coli, enterococcus faecalis, clostridium difficile and bacteroides vulgatus. septicemia occurred during acute diverticulitis. a strain of clostridium difficile, which was of the same serogroup c as the blood culture isolate and also produced toxin, was recovered from the stools, but the pathogenic role of this organism in the gastrointestinal symptomatolog ...	1989	2497002
relationship between levels of clostridium difficile toxin a and toxin b and cecal lesions in gnotobiotic mice.	various clostridium difficile strains were studied with respect to their pathogenicity in monoassociated mice in relation to levels of toxin a and toxin b in vivo and in vitro. two strains which were the most potent toxin producers in vitro induced mortality (100%); mice monoassociated with these strains were found to have high levels of both toxins in their ceca and an intense cecal epithelial ulceration together with a severe inflammatory process. no mortality was observed with the other strai ...	1989	2499546
intestinal colonization with clostridium difficile in infants up to 18 months of age.	the faecal colonization with clostridium difficile was investigated among 343 infants during their first 18 months of life. rectal swabs were taken at the ages of 6 days, 6 weeks, 6 months, 11 months and 18 months. about 25% of the children were colonized with clostridium difficile between 6 days and 6 months of age. the colonization rate decreased to 3% at 18 months of age. the rate of strains producing cytotoxin was low in infants less than 6 months of age, but at that age about half of the st ...	1989	2502403
evolution of the caecal epithelial barrier during clostridium difficile infection in the mouse.	the most striking effect of clostridium difficile infection is its degrading of the intestinal barrier. the aim of this study is to establish whether the cellular or paracellular constituent of the barrier is the initial target of the toxins produced by c difficile. accordingly, the caecal epithelium of c3h/he mice was challenged under three experimental conditions with the c difficile strain vpi 10463: (1) by in vivo inoculation of axenic mice, (2) by adding the toxins to ligated caeca in vivo, ...	1989	2504650
cloning and characterization of overlapping dna fragments of the toxin a gene of clostridium difficile.	clostridium difficile, a human pathogen, produces two very large protein toxins, a and b (250-600 kda), which resist dissociation into subunits. to clone the toxin a gene, a genomic library of 3-8 kb chromosomal dna fragments of c. difficile strain vpi 10463 established in puc12 was screened with a rabbit polyclonal toxin a antiserum. thirty-five clones were isolated which carried 2.5-7.0 kb inserts representing a 10 kb region of the c. difficile genome. all the inserts were oriented in the same ...	1989	2506313
production, purification and characterization of clostridium difficile toxic proteins different from toxin a and from toxin b.	the purification and characterization of three new proteins called c1, c2, and c3 from clostridium difficile are described. their estimated molecular mass were about 350 (c1), 270 (c2) and 140 (c3) kda, consisting of subunits of 39 (c1), 43 (c2) and 41 (c3) kda, respectively. immunodiffusion revealed that the three proteins contained similar but not identical antigenic determinants to toxin a. each protein induced a cytotonic effect on hamster ovaric cells; the combined proteins, had a specific ...	1989	2506935
clostridium difficile toxin a. interactions with mucus and early sequential histopathologic effects in rabbit small intestine.	clostridium difficile produces two toxins, a (enterotoxic) and b (cytopathic), that are implicated in the pathogenesis of pseudomembranous colitis. however, the relationship of the secretory effect and the early histopathologic events is still unclear. we examined the early histopathologic effect of purified c. difficile toxin a in rabbit ileal loops and correlated the mucosal damage with the secretory response. as early as 2 hours after inoculation, toxin a at 1.0 micrograms caused cytolysis of ...	1989	2507823
comparative in vitro activity of the new oral penem alp-201 against aerobic and anaerobic bacteria.	the in vitro activity of the new penem derivative alp-201 against 226 aerobic and 350 anaerobic clinical bacterial isolates was determined using agar dilution techniques. for comparison amoxicillin, cefaclor, ceftazidime, doxycycline, erythromycin, imipenem and trimethoprim/sulfamethoxazole were also tested with aerobic bacteria, and cefoxitin, chloramphenicol, clindamycin, imipenem, metronidazole and piperacillin with anaerobic bacteria. alp-201 was found to be highly active against escherichia ...	1989	2512142
polymicrobial septicaemia and clostridium difficile.		1989	2512153
molecular studies on the epidemiology and pathogenicity of clostridium difficile.		1989	2514126
effects of clostridium difficile toxins a and b on cytoskeleton organization in hep-2 cells: a comparative morphological study.	a comparative study on the effects of toxin a and toxin b from clostridium difficile on hep-2 cells was carried out. both toxins caused cell retraction and rounding and seemed to exert their effect on cell morphology via a rearrangement of actin and alpha-actinin microfilaments. such a rearrangement occurred at an early stage, when no change in microtubular and cytokeratin systems was detectable. nevertheless, several structural modifications accompanying the cytopathological process induced by ...	1989	2515619
teicoplanin in the treatment of infections by staphylococci, clostridium difficile and other gram-positive bacteria.	eighty-three episodes of gram-positive infection in 82 patients were treated with teicoplanin in an open study. infectious episodes included endocarditis (6 cases), bacteraemia (7), osteomyelitis (8), pseudomembranous colitis (13), cellulitis (11), urinary tract infection (5), pneumonia (1), wound and post-surgical infections (9) and erysipelas (23). four patients affected by an overwhelming gram-positive infection as well as eight cases of gram-positive-gram-negative mixed infections received t ...	1989	2526109
clostridium difficile-associated typhlitis in specific pathogen free guineapigs in the absence of antimicrobial treatment.	clostridium difficile (toxin) associated typhlitis was diagnosed in untreated barrier-maintained specific pathogen free guineapigs. it resembled the pathological lesions of antibiotic induced enterocolitis. the possible role of limited colonization resistance to c. difficile provided by mouse enteric microflora in the pathogenesis of the disease is discussed.	1989	2527322
treatment of clostridium difficile-associated disease with teicoplanin.	forty-seven patients affected by clostridium difficile-associated disease were treated orally with either vancomycin (patients hospitalized from february 1984 to february 1987) or teicoplanin (from march 1987 to december 1988). all patients given teicoplanin remained asymptomatic after discontinuation of treatment, and all but one were also cleared of c. difficile. in the vancomycin group, clinical symptoms recurred in 3 of 23 evaluable patients, and follow-up cultures were positive in another a ...	1989	2528941
observations on phage-typing of clostridium difficile: preliminary evaluation of a phage panel.	of the various methods now employed to type clostridium difficile, the performance of the phage-typing, as proposed by sell et al., was investigated on a large collection of isolates from various local epidemiological settings. because those isolates appeared in preliminary trials mostly resistant to the reference phages, the panel was enlarged by including newly isolated phages. the new set was redundant but better suited to the purpose: out of 287 phage sensitivity patterns 8.4% only were resi ...	1989	2529136
mechanism of action of clostridium difficile toxin b: role of external medium and cytoskeletal organization in intoxicated cells.	toxin b, an exotoxin produced by clostridium difficile, induces the rounding-up and arborization of cultured mammalian cells, a typical effect which resembles that provoked by cytochalasins. in this study, the effect of toxin b was examined on astroglial cells grown in primary culture. a specific antiserum to toxin b was used to investigate its mechanisms of action. we found that the toxin exerts its effects on cell morphology after its incorporation into cells. the internalization of toxin b re ...	1989	2545447
presence of fructokinase in pancreatic islets.	homogenates of rat pancreatic islets that had been heated for 5 min at 70 degrees c to inactive hexokinases, catalyzed the atp-dependent phosphorylation of d-fructose. this reaction was dependent on the presence of k+ and was inhibited by d-tagatose although not by d-glucose or d-glucose 6-phosphate. the phosphorylation product was identified as fructose 1-phosphate through its conversion to a bisphosphate ester by clostridium difficile fructose 1-phosphate kinase. these findings allowed the con ...	1989	2551726
comparative study of clostridium difficile toxin a and cholera toxin in rabbit ileum.	the purpose of this study was to compare the effects of clostridium difficile toxin a and cholera toxin on fluid secretion, intestinal permeability, and arachidonate metabolites in rabbit ileum. injection of 25 micrograms of either purified toxin into 10-cm ileal loops caused significant increases in fluid secretion and intestinal permeability to mannitol as well as release of prostaglandin e2 into the lumen. toxin a, but not cholera toxin, caused a severe inflammatory reaction of the lamina pro ...	1989	2551764
cloning and hybridization analysis of ermp, a macrolide-lincosamide-streptogramin b resistance determinant from clostridium perfringens.	the erythromycin resistance determinant from clostridium perfringens cp592 was cloned and shown to be expressed in escherichia coli. the resultant plasmid, pjir122 (7.9 kilobase pairs [kb]), was unstable since in both reca+ and reca e. coli hosts spontaneous deletion of 2.7 kb, including the erythromycin resistance determinant, was observed. subcloning, as well as deletion analysis with bal 31, localized the erythromycin resistance gene (ermp) to within a 1.0-kb region of pjir122. a 0.5-kb fragm ...	1989	2552908
enterotoxin induced diarrhoea--an update.	the pathogenic personality or the criteria required to be a successful pathogen, of enteric bacteria includes, among others, the ability to produce potent proteins which by different intracellular mechanisms elicit what we overtly see as diarrhoea. enteropathogens belonging to several genera like vibrio, escherichia, shigella, salmonella, campylobacter, aeromonas and yersinia include species capable of elaborating strikingly similar exotoxins which seem to share common mechanisms of action invol ...	1989	2554547
hybridization analysis of three chloramphenicol resistance determinants from clostridium perfringens and clostridium difficile.	the chloramphenicol resistance determinant from a nonconjugative strain of clostridium perfringens was cloned and shown to be expressed in escherichia coli. subcloning and deletion analysis localized the resistance gene, catq, to within a 1.25-kilobase (kb) partial sau3a fragment. the catq gene contained internal hindii, haeiii, and drai restriction sites and was distinct from the catp gene, which was originally cloned (l. j. abraham, a. j. wales, and j. i. rood plasmid 14:37-46, 1985) from the ...	1989	2554801
bacteriotherapy for chronic relapsing clostridium difficile diarrhoea in six patients.	six patients with chronic relapsing diarrhoea caused by clostridium difficile were treated with rectal instillation of homologous faeces (one patient) or a mixture of ten different facultatively aerobic and anaerobic bacteria diluted in sterile saline (five patients). the mixture led to a prompt loss of cl difficile and its toxin from the stools and to bowel colonisation by bacteroides sp, which had not been present in pre-treatment stool samples. strains of escherichia coli, cl bifermentans, an ...	1989	2566734
protein-losing enteropathy associated with clostridium difficile infection.	a commercially available radial immunodiffusion assay was used to measure serum alpha-1-antitrypsin levels in stool samples from subjects aged over 60 years as a marker of protein-losing enteropathy. alpha 1-antitrypsin was found in all of 12 patients with colonoscopy-confirmed pseudomembranous colitis, 6 of 14 (43%) patients with clostridium difficile diarrhoea without pseudomembranes, 6 of 12 (50%) nursing-home patients culture-positive for cl difficile but negative for its cytotoxin, and none ...	1989	2567373
outbreak of clostridium difficile diarrhoea in an orthopaedic unit: evidence by phage-typing for cross-infection.	in a three-week period five patients had diarrhoea in an orthopaedic unit. the first case was clinically diagnosed as pseudomembranous colitis but the causative agent was not sought. of the remaining cases, two were clostridium difficile positive. the outbreak then apparently ceased, but during the following several days two of seven stool samples taken at random from asymptomatic patients yielded c. difficile. phage-typing of the isolates showed that all apparently belonged to the same strain.	1989	2567761
bacteriotherapy for clostridium difficile diarrhoea.		1989	2570250
clostridium difficile infection in health-care workers.		1989	2571792
clostridium difficle infection in health-care workers.		1989	2572809
bacteriotherapy for clostridium difficile colitis.		1989	2572812
intravenous metronidazole and clostridium difficile-associated diarrhea or colitis.		1989	2584759
intravenous/oral ciprofloxacin versus ceftazidime in the treatment of serious infections.	seventy-one adult patients with 72 infections were treated, by random selection, with intravenous/oral ciprofloxacin or intravenously administered ceftazidime. twenty-seven additional patients with 29 infections who were not appropriate for random assignment were treated in an open study with intravenously administered ciprofloxacin only; the latter infections were generally more serious or were caused by ceftazidime-resistant organisms. the most common doses were ciprofloxacin, 200 mg intraveno ...	1989	2589361
[hospital epidemic of clostridium difficile diarrhea: demonstration of cross-infection using a typing technic].	two hospital outbreaks of clostridium difficile diarrhoea in two general surgery units of different hospitals are described. moreover, the results of a study on the circulation of c. difficile in a neurosurgery unit following two cases of colitis are reported. c. difficile strains isolated from patients and environment have been typed using antimicrobial susceptibility testing and electrophoretic profiles of edta-extracted proteins. the majority of strains isolated in each hospital shared the sa ...	1989	2589733
high incidence of false positives by a latex agglutination test for the diagnosis of clostridium difficile associated colitis in compromised patients.	detection of clostridium difficile cytotoxin using cell culture assays for the diagnosis of antibiotic-associated colitis has been used for over a decade. because the methodology is time consuming and cumbersome, a recently introduced commercial latex agglutination (la) kit has attracted much attention. we compared the sensitivity and specificity of this method with the cytotoxic assay (cta) using diarrheal stools from 652 patients at a referral tertiary care center. specimens from 71 (10.9%) pa ...	1989	2591165
[the occurrence of clostridium difficile in fecal samples of dogs and cats].	fecal samples of 150 dogs and 175 cats originating from different veterinary practices were investigated for assessing the occurrence of clostridium (cl.) difficile by using a selective medium for cultural isolation. from dogs without enteric symptoms 7 (9.3%) of 75 samples were positive for cl. difficile, with 2 strains being cytotoxic for bovine embryonic lung fibroblast cells, which could be neutralized by cl. difficile-antitoxin. in samples of 75 dogs with enteric symptoms cl. difficile coul ...	1989	2596198
antibiotic exposure delays intestinal colonization by clostridium difficile in the newborn.	two antibiotic regimens commonly used in neonatal intensive care were compared for the rate at which clostridium difficile appeared in the faeces. over a nine month period neonates with suspected sepsis admitted to a special care baby unit (scbu) were randomly allocated to receive either cefotaxime or penicillin and netilmicin. a contemporaneous group also admitted to scbu but without sepsis served as non-treated controls. four hundred and sixteen stool specimens from 158 neonates without diarrh ...	1989	2600001