Publications

characterization of a nosocomial clostridium difficile outbreak by using plasmid profile typing and clindamycin susceptibility testing.	the mean number of cases of clostridium difficile diarrhea at the minneapolis veterans administration medical center increased to 17.3 per month in june-august 1985, compared with 7.1 per month in the previous 17 mo. plasmid profiles and clindamycin susceptibility were used as markers to evaluate the increase in cases. ninety clindamycin-resistant and 22 clindamycin-susceptible isolates of c. difficile from 1985 were examined for plasmids. a clindamycin-resistant organism contained a cryptic pla ...	1988	2844914
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
prevalence of enteric pathogens in homosexual men with and without acquired immunodeficiency syndrome.	we studied 388 homosexual or bisexual men from the baltimore-washington area to define the spectrum of enteric pathogen carriage in a population at high risk for "gay bowel syndrome" in association with human immunodeficiency virus infection. seventy-seven patients with acquired immunodeficiency syndrome, 68 gay men with symptoms of acute diarrhea or proctitis, and 243 gay men without gastrointestinal symptoms and participating in a natural history study of human immunodeficiency virus infection ...	1988	2831107
clostridium difficile as a nosocomial pathogen.	patients admitted to a 19-bed floor with intermediate nursing care were studied for the onset of clostridium difficile-associated diarrhoea during a six-month period (181 calendar days) in 1986-87. all admitted patients were reviewed weekly and followed after discharge from the study unit to other inpatient services. multiple items in the environment of five patients' rooms were sampled bacteriologically for the presence of c. difficile weekly during the study period. three of the rooms were sel ...	1988	2896737
acquisition of clostridium difficile from the hospital environment.	an outbreak of antibiotic-associated colitis that occurred on a ward of a michigan hospital during february-april, 1984, was studied by bacteriophage-bacteriocin typing. stools from the seven involved patients yielded clostridium difficile isolates of types b1537 or cld7;b1537. c. difficile was recovered from 31.4% of environmental cultures obtained on the ward, and the majority of isolates were types b1537 or cld7;b1537. when the ward was disinfected with unbuffered hypochlorite (500 parts per ...	1988	2835900
gastrointestinal carriage rate of clostridium difficile in elderly, chronic care hospital patients.	the carriage rate of clostridium difficile in patients at a chronic care hospital was determined by two point prevalence surveys at 6-monthly intervals. in the first survey c. difficile or its toxin was present in stool samples from five symptomless patients on three of the four wards studied. all of these colonized patients had been in hospital for at least 2 months, but there was no relationship between carriage of the organism and antibiotic use. when the survey was repeated 6 months later, n ...	1988	2899585
in vitro activities of daptomycin (ly146032) and paldimycin (u-70,138f) against anaerobic gram-positive bacteria.	the in vitro activities of daptomycin (ly146032), paldimycin (u-70,138f), vancomycin, and penicillin g against 344 clinical isolates of anaerobic gram-positive bacteria were determined by an agar dilution method in calcium-supplemented (50 micrograms/ml) wilkins-chalgren medium, using an inoculum of 10(5) cfu. daptomycin demonstrated excellent activity against a broad range of anaerobic gram-positive cocci and bacilli, including peptostreptococcus, eubacterium, bifidobacterium, actinomyces, prop ...	1988	2840019
immunochemical and structural similarities in toxin a and toxin b of clostridium difficile shown by binding to monoclonal antibodies.	clostridium difficile toxins a and b were shown to share immunochemical and structural features, including shared sequential epitopes. nineteen hybridomas generated after immunization of mice with a mixture of toxoids produced monoclonal antibodies, all igm(x), which bound to toxin a and toxin b in a solid-phase radioimmunoassay (ria). none of the antibodies neutralized the cytotoxicity of either toxin, alone or in pairs, nor did they neutralize mouse lethality. the antibodies did not inhibit he ...	1988	2459808
in vivo profiles of eicosanoids in ulcerative colitis, crohn's colitis, and clostridium difficile colitis.	to compare the local release of arachidonic acid metabolites in inflammatory diarrheal disease, in vivo equilibrium dialysis of the rectum was done in consecutive untreated patients with ulcerative colitis (n = 20), crohn's colitis (n = 10), and clostridium difficile colitis (n = 7). all patients had endoscopically proven rectal inflammation. eicosanoid profiles were determined in rectal dialysates by radioimmunoassay after preliminary purification. concentrations of prostaglandin e2, prostaglan ...	1988	2836256
clostridium difficile toxin a stimulates intracellular calcium release and chemotactic response in human granulocytes.	clostridium difficile, a common enteric pathogen, mediates tissue damage and intestinal fluid secretion by release of two protein exotoxins: toxin a, an enterotoxin, and toxin b, a cytotoxin. because toxin a elicits an intense inflammatory reaction in vivo, we studied the effects of highly purified c. difficile toxins on activation of human granulocytes. toxin a at concentrations of 10(-7) to 10(-6) m, but not toxin b, elicited a significant chemotactic and chemokinetic response by granulocytes ...	1988	2838520
identification and characterization of clostridium difficile promoter element that is functional in escherichia coli.	the promoter element involved in the expression of a previously characterized cloned clostridial antigen was isolated and characterized. a restriction fragment containing the promoter element of the clostridium difficile insert was cloned using the promoter probe vector, pga46. subclones of the clostridial dna insert in pga46 were then analyzed by nucleotide sequencing and by s1 nuclease experiments. the clostridial promoter element exhibits a high degree of homology with typical escherichia col ...	1988	2463955
oral fluoroquinolone therapy in clostridium difficile enterocolitis.		1988	3172400
purification and some properties of cytotoxin produced by clostridium difficile.	the cytotoxin produced by clostridium difficile was highly purified by using ammonium sulfate fractionation and successive column chromatographies of deae-sephadex a-25, hydroxyapatite, bio-gel a-0.5m, phenyl-sepharose cl-4b, and mono q. the purified cytotoxin gave a single band on conventional and sodium dodecyl sulfate-polyacrylamide gel electrophoresis in the presence of dithiothreitol. its molecular weight was estimated to be 260,000 and 50,000 by gel filtration and sodium dodecyl sulfate-po ...	1988	3173147
lack of association between clostridium difficile toxin and diarrhea in infants.		1988	3174309
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
clostridium difficile toxin b induces reorganization of actin, vinculin, and talin in cultured cells.	clostridium difficile toxin b is a powerful cytopathic agent which causes animal cells in culture to become rounded and arborized, an effect similar to that induced by the cytochalasins. in this study, we demonstrated that the morphological effects of the toxin are directed specifically against the actin and related components of the cytoskeleton. dramatic disruption and reorganization of the actin stress fibers were detectable prior to significant changes in cell shape and alterations in the mi ...	1988	3121372
[comparative characterization of the morphologic changes induced by the cytotoxic action of a filtrate of clostridium difficile strain b in cell cultures].	investigations carried out by the authors have demonstrated the possibility of the simultaneous evaluation of the results of the quantitative and qualitative characterization of the cytotoxic action of the filtrate of c. difficile strain b in the cultures of diploid human cells and cells fl. the action of the filtrate used in the same dilution (1:1,000) over equal incubation periods (15 minutes) has resulted in the appearance of different morphological changes in each of these cultures. the degr ...	1988	3188732
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
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
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
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
prospective study comparing imipenem-cilastatin with clindamycin and gentamicin for the treatment of serious surgical infections.	surgical infection remains a leading cause of hospital morbidity and mortality. we compared the efficacy and toxicity of imipenem-cilastatin sodium in 32 patients with that of clindamycin phosphate and gentamicin sulfate in 25 patients. in the imipenem-cilastatin group, 87.5% had a favorable outcome, with a 12.5% failure rate and 13 adverse reactions. in the clindamycin-gentamicin group, 80% had a favorable outcome, with a 20% failure rate and ten adverse reactions. two significant superinfectio ...	1988	3277587
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
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
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
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
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
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
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
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
infections after experimental cadaver bone marrow transplantation in beagle dogs. transplantations with and without selective gastrointestinal decontamination.	experimental transplantations of cadaver bone marrow (bmt) in beagle dogs were performed to evaluate the problems and potentials in a preclinical setting. the effectiveness of selective decontamination of the gut (sd) and gnotobiotic surveillance in preventing infections during longer aplastic periods was investigated. three groups of dogs were compared. group a: controls. group b: dogs with bmt, without sd and irregular gnotobiotic surveillance. group c: dogs with bmt, with sd and regular gnoto ...	1988	3283036
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
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
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
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
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
multiple relapses of clostridium difficile-associated diarrhea responding to an extended course of cholestyramine.		1989	2496393
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
diagnostic procedures for isolation and characterization of clostridium difficile associated with enterocolitis in foals.		1989	2488656
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
[laboratory methods of diagnosing pseudomembranous colitis and diarrhea caused by clostridium difficile (review of the literature)].		1989	2469839
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
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
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
bacteriotherapy for clostridium difficile diarrhoea.		1989	2570250
[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
clostridium difficle infection in health-care workers.		1989	2572809
bacteriotherapy for clostridium difficile colitis.		1989	2572812
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
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
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
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
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
polymicrobial septicaemia and clostridium difficile.		1989	2512153
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
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
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
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
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
[clostridium difficile enterocolitis in subjects treated with wide-spectrum antibiotics].	after a concise description the main aetiopathogenic features of clostridium difficile colitis, three clinical cases are reported. it is considered that this disease could be easily cured as long as high risk patients are determined.	1989	2622575
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
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
intravenous metronidazole and clostridium difficile-associated diarrhea or colitis.		1989	2584759
rapid method to detect shiga toxin and shiga-like toxin i based on binding to globotriosyl ceramide (gb3), their natural receptor.	shiga toxin and the closely related shiga-like toxins produced by escherichia coli represent a group of very similar cytotoxins that may play an important role in diarrheal disease and hemolytic uremic syndrome. these toxins have the same biologic activities and according to recent studies also share the same binding receptor, globotriosyl ceramide (gb3). they are currently detected, on the basis of their ability to damage several cell lines, by using expensive and tedious assays that require fa ...	1989	2666433
[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
intestinal infections: current aspects and new possibilities of prophylaxis and treatment.	intestinal infections of still high importance from the hygienic-epidemiological aspects and the recent results obtained in this field have been surveyed. recently recognized enteric pathogens (campylobacter, yersinia, rotavirus, clostridium difficile, etc.) as well as the newest data on the pathomechanism of intestinal infections have been discussed. these data not only have increased our knowledge of the pathology but also resulted in basic, favourable changes in therapy. detailed information ...	1989	2667192
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
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
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
interrelationships between digestive proteolytic activities and production and quantitation of toxins in pseudomembranous colitis induced by clostridium difficile in gnotobiotic mice.	clostridium difficile pathogenicity is related to in vivo production of toxins, and it is of great interest to detect toxins produced in biological samples. several reports have shown that proteases in stools interfere with immunological methods for quantitation of toxin a. the purpose of this work was to estimate the relationship between the proteases and the c. difficile toxins produced in a gnotobiotic mouse model of pseudomembranous cecitis. cecal proteolytic activities hydrolyzed toxin a, a ...	1989	2680988
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
clostridium difficile infection in health-care workers.		1989	2571792
nosocomial clostridium difficile infections.		1989	2747751
characterization and reassembly of a regular array in the cell wall of clostridium difficile gai 4131.	the cell wall of clostridium difficile gai 4131 was revealed by electron microscopy to have an outer layer composed of a nearly square array and contained the two major proteins with molecular weights of 38 kda and 42 kda. the properties and reassembly of the two major proteins into the regular array were investigated. when the isolated cell walls were treated with hydrophobic bond-disrupting agents or a chelating agent specific for ca2+, the two major proteins were effectively removed and the r ...	1989	2770560
fulminant idiopathic pseudomembranous colitis.	pseudomembranous colitis is characterized by inflammatory plaques and pseudomembranes on the colonic mucosa. the disorder most commonly occurs after the use of antibiotics, which allow overgrowth of clostridium difficile, a spore-forming, gram-positive rod that produces a toxin. overgrowth of staphylococcus aureus can also produce pseudomembranous colitis. in rare cases, pseudomembranous colitis is not associated with antibiotic use. when c. difficile is present, vancomycin or metronidazole usua ...	1989	2773757
purification and characterisation of clostridium difficile toxin a by bovine thyroglobulin affinity chromatography and dissociation in denaturing conditions with or without reduction.	highly purified toxin a of clostridium difficile was obtained by bovine thyroglobulin affinity chromatography followed by two sequential anion-exchange chromatography steps on q sepharose ff and mono q. after q sepharose ff chromatography of a thyroglobulin affinity-purified toxin a preparation, two major peaks of cytotoxicity representing toxins a and b were detected. the homogeneity of the final toxin a preparation obtained from mono q anion-exchange fast protein liquid chromatography was asce ...	1989	2778794
comparative in vitro activity of lomefloxacin, a difluoro-quinolone.	lomefloxacin is a new difluoro-quinolone. in this study, we have determined the in vitro activity of lomefloxacin against a wide range of clinical bacterial isolates and compared it with that of other fluoro-quinolones and some unrelated antimicrobials. lomefloxacin was very active against enterobacteriaceae (mic90, 0.5 micrograms/ml) with activity comparable to that of ofloxacin (mic90, 0.25 micrograms/ml). lomefloxacin was moderately active against isolates of pseudomonas aeruginosa (mic90, 4 ...	1989	2791500
clostridium difficile and its cytotoxin in diarrhoeic stools of hospitalized patients. toxigenic potential of the isolates.	cytotoxin assay and culture for clostridium difficile were performed on 303 diarrhoeic stools from 261 hospitalized patients. specimens from 42 patients were positive by at least one of the methods, and 40 of them had an antibiotic-associated diarrhoea. the cytotoxin assay was positive in 5 of 7 patients with pseudomembranous colitis. thirteen had an appropriate response to specific therapy and the remainder have resolved of diarrhoea without c. difficile directed chemotherapy. these findings sh ...	1989	2660635
in vitro and in vivo antibacterial activities of bmy 40062, a new fluoronaphthyridone.	the in vitro and in vivo activities of a new naphthyridone, bmy 40062, were compared with those of ciprofloxacin and ofloxacin. bmy 40062 showed about threefold more activity than ciprofloxacin showed and four- to eightfold more activity than ofloxacin showed against staphylococci, streptococci, and enterococci. bmy 40062 showed generally twofold less activity than ciprofloxacin showed against most species of the family enterobacteriaceae, pseudomonas aeruginosa, and acinetobacter spp. but twofo ...	1989	2764541
an outbreak of clostridium difficile associated diarrhoea in urological practice: a potential consequence of excessive antibiotic prophylaxis?	during an outbreak of clostridium difficile associated diarrhoea, 17 patients on a urological ward developed symptoms in a 17-day period. of these patients, 15 had received antibiotics during their admission. in order to eradicate the infection, it was necessary to close the unit for 1 month. antibiotic associated diarrhoea is a serious complication of the prophylactic and therapeutic use of such agents and, because of the common use of antimicrobials on urological units, there is potential for ...	1989	2810164
feacal carriage of cytotoxigenic strains of clostridium difficile by adult nigerians.	the isolation rate of clostridium difficile and the presence of its cytotoxin in stool were studied in adults with diarrhoea and healthy normal individuals over a period of one year. c. difficile was isolated from 23(56%) out of 41 patients with diarrhoea who gave history of antibiotic exposure prior to the development of the disease from 12(31.6%) of the 38 healthy controls with no history of antibiotic exposure. of the 23(31.6%) c. difficile isolated from the patients, 16(69.6%), and only 8(66 ...	1989	2791928
reactive oligoarthritis associated with clostridium difficile colitis.		1989	2784867
in vitro antimicrobial activity and susceptibility testing of ofloxacin. current status.	the fluoroquinolone, ofloxacin, exhibits a broad antibacterial spectrum. based on our data and a review of the literature, ofloxacin inhibited essentially 100 percent of staphylococci, including oxacillin-resistant strains, haemophilus influenzae, neisseria spp. and branhamella catarrhalis. ninety-five percent of enterobacteriaceae were susceptible to ofloxacin. pseudomonas aeruginosa and enterococci were less susceptible: 79 and 63 percent, respectively, were susceptible (minimal inhibitory con ...	1989	2690614
[preparation of diagnostic antitoxic serum to clostridium difficile].	the results of the studies on the preparation of diagnostic antitoxic sera to c. difficile, intended for use in biological assays with the aim of the laboratory diagnosis of clostridial enteric infections, are presented. the conditions for the detoxification of c. difficile native toxin have been established, the optimum schedules for the immunization of rabbits have been selected and specific antitoxic sera to c. difficile have been obtained. the neutralizing activity of these sera has been eva ...	1989	2735166
a randomized trial to compare amoxycillin/clavulanate with metronidazole plus gentamicin in prophylaxis in elective colorectal surgery.	a randomized controlled trial was designed to compare antibiotic prophylaxis with a standard combination of agents, metronidazole and gentamicin, with a single preparation, amoxycillin/clavulanate in 400 patients undergoing elective colorectal surgery. there were 41 patients who were excluded or withdrawn (wrong dose, inappropriate operation, established sepsis or concurrent disease). abdominal wound sepsis occurred in 14% of the assessable patients in the amoxycillin/clavulanate group and in 15 ...	1989	2691480
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
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