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efficacy of oral vancomycin in preventing recurrent clostridium difficile infection in patients treated with systemic antimicrobial agents.we compared rates of recurrent clostridium difficile infection in patients receiving or not receiving oral vancomycin prophylaxis with systemic antimicrobial therapy. the incidence of c. difficile infection was significantly lower in patients receiving prophylaxis (4.2% vs 26.6% in those without prophylaxis; odds ratio, 0.12; 95% confidence interval, .04-.4; p < .001).201627318333
reduction of antibiotic resistance genes in intestinal microbiota of patients with recurrent clostridium difficile infection after fecal microbiota transplantation. 201627317794
the cellular lipids of romboutsia.we have examined the lipids of three isolates, romboutsia lituseburensis, romboutsia ilealis, and romboutsia sp. strain frifi, of the newly described genus romboutsia by two-dimensional thin-layer chromatography (2d-tlc) and by liquid chromatography/mass spectrometry (lc/ms). we have found three phospholipids, phosphatidylglycerol (pg), cardiolipin and phosphatidic acid in all three species. a fourth phospholipid, lysyl-pg, was found in r. lituseburensis and strain frifi. polyprenyl-phosphates w ...201627317428
effects of high-pressure treatment on spores of clostridium species.this work analyzes the high-pressure (hp) germination of spores of the food-borne pathogen clostridium perfringens (with inner membrane [im] germinant receptors [grs]) and the opportunistic pathogen clostridium difficile (with no im grs), which has growing implications as an emerging food safety threat. in contrast to those of spores of bacillus species, mechanisms of hp germination of clostridial spores have not been well studied. hp treatments trigger bacillus spore germination through spores' ...201627316969
epidemiological and economic burden of clostridium difficile in the united states: estimates from a modeling approach.despite a large increase in clostridium difficile infection (cdi) severity, morbidity and mortality in the us since the early 2000s, cdi burden estimates have had limited generalizability and comparability due to widely varying clinical settings, populations, or study designs.201627316794
fecal microbiota transplantation via fluoroscopy-guided nasojejunal catheter placement: indications, technique, and the role of radiology.clostridium difficile is a well-established cause of nosocomial gastrointestinal disease. although antibiotics remain an effective first-line treatment for c. difficile colitis (cdc), relapse and recurrence are common. fmt has emerged as one of the safest and most effective known therapies available for recurrent or refractory cdc, which is likely due to restoration of the protective microbiotic barrier of the gastrointestinal tract. fmt varies greatly across institutions by route of delivery, d ...201627315076
clostridium difficile infections amongst patients with haematological malignancies: a data linkage study.identify risk factors for clostridium difficile infection (cdi) and assess cdi outcomes among australian patients with a haematological malignancy.201627314498
diagnosing clostridium difficile-associated diarrhea using enzyme immunoassay: the clinical significance of toxin negativity in glutamate dehydrogenase-positive patients.the enzyme immunoassay (eia) has lower sensitivity for clostridium difficile toxins a and b than the polymerase chain reaction in the diagnosis of c. difficile-associated diarrhea (cdad). furthermore, toxin positivity with eia performed on c. difficile isolates from stool cultures may be observed even in patients with eia glutamate dehydrogenase (gdh)-positive and toxin-negative stool specimens. it is unclear whether such patients should be treated as having cdad.201627313472
evolution of an audit and monitoring tool into an infection prevention and control process.in 2010, an infection prevention and control team in an acute hospital trust integrated an audit and monitoring tool (amt) into the management regime for patients with clostridium difficile infection (cdi).201627313140
role of binary toxin in the outcome of clostridium difficile infection in a non-027 ribotype setting - corrigendum. 201627312805
comparison of the vidas c. difficile and quik chek-60 glutamate dehydrogenase assays for the detection of clostridium difficile in faecal samples. 201627311869
a mlst clade 2 clostridium difficile strain with a variant tcdb induces severe inflammatory and oxidative response associated with mucosal disruption.the epidemiology of clostridium difficile infections is highly dynamic as new strains continue to emerge worldwide. here we present a detailed analysis of a new c. difficile strain (icc-45) recovered from a cancer patient in brazil that died from severe diarrhea. a polyphasic approach assigned a new pcr-ribotype and pfge macrorestriction pattern to strain icc-45, which is toxigenic (tcda(+), tcdb(+) and ctdb(+)) and classified as st41 from mlst clade 2 and toxinotype ixb. strain icc-45 encodes f ...201627311833
fecal microbiota therapy as rescue therapy for life-threatening clostridium difficile infection in the critically ill: a small case series. 201627452730
candidemia in patients with body temperature below 37°c and admitted to internal medicine wards: assessment of risk factors.an increasing number of candidemia episodes has been reported in patients cared for in internal medicine wards. these usually older and frail patients may not be suspected as having candidemia because they lack fever at the onset of the episode. to identify the risk factors associated with the lack of fever at the onset of candidemia (ie, the collection of the first positive blood culture for candida spp.) in patients cared for in internal medicine wards, we compared 2 group of patients with or ...201627452680
longitudinal investigation of carriage rates, counts, and genotypes of toxigenic clostridium difficile in early infancy.asymptomatic infant carriers of toxigenic clostridium difficile are suggested to play a role in the transmission of c. difficile infection (cdi) in adults. however, the mode of c. difficile carriage in infants remains to be fully elucidated. we investigated longitudinal changes in carriage rates, counts, and strain types of toxigenic c. difficile in infants. stools collected from 111 healthy infants in belgium periodically from birth until the age of 6 months were examined by quantitative pcr ta ...201627451451
using expert process to combat clostridium difficile infections.in 2008, clostridium difficile rates were increasing in ontario, canada, and in response, hospitals were mandated by the ontario ministry of health to publicly report their c difficile infection (cdi) rates. in order to assist hospitals which had ongoing cdi outbreaks, a process of an external infection control resource team (icrt) was introduced. this article describes the function and process of the icrt, managed by public health ontario, and reviews the lessons learned over the first 5 years ...201627451312
formicin - a novel broad-spectrum two-component lantibiotic produced by bacillus paralicheniformis apc 1576.bacteriocins represent a rather underutilized class of antimicrobials despite often displaying activity against many drug-resistant pathogens. lantibiotics are a post-translationally modified class of bacteriocins, characterized by the presence of lanthionine and methyllanthionine bridges. in this study, a novel two-peptide lantibiotic was isolated and characterized. formicin was isolated from bacillus paralicheniformis apc 1576, an antimicrobial-producing strain originally isolated from the int ...201627450592
reducing co-administration of proton pump inhibitors and antibiotics using a computerized order entry alert and prospective audit and feedback.antibiotics and proton pump inhibitors (ppis) are associated with clostridium difficile infection (cdi). both a computer order entry alert to highlight this association as well as antimicrobial stewardship directed prospective audit and feedback represent novel interventions to reduce the co-administration of antibiotics and ppis among hospitalized patients.201627449956
progress in our understanding of the gut microbiome: implications for the clinician.the investigation of the role of the microbial communities of our gastrointestinal tract (microbiota) has accelerated dramatically in recent years thanks to rapid developments in the technologies that allow us to fully enumerate and evaluate the full complement of bacterial species and strains that normally inhabit the gut. laboratory studies in a range of inventive animal models continue to provide insights into the role of the microbiota in health and to generate plausible hypotheses relating ...201627448618
fecal microbiota transplantation for recurrent clostridium difficile infection in the elderly: long-term outcomes and microbiota changes.fecal microbiota transplantation (fmt) has become the cornerstone in management of recurrent clostridium difficile infection (rcdi) in adults. however, data on efficacy, safety, long-term outcomes, and microbiota alterations are limited in elderly patients (>65 years).201627447476
association between nsaids and clostridium difficile-associated diarrhea: a systematic review and meta-analysis.objective. clostridium difficile infection is a leading cause of nosocomial diarrhea in developed countries. studies evaluating the associations of increased risk of community-acquired cdad and the use of nonsteroidal anti-inflammatory drugs (nsaids) have yielded inconclusive results. we conducted a systematic review and meta-analysis to compare the odds of nsaid exposure in patients with cdad versus patients without cdad in both community-based and healthcare-associated settings. methods. relev ...201627446866
draft genome sequence of clostridium difficile strain it1118, an epidemic isolate belonging to the emerging pcr ribotype 018.clostridium difficile pcr ribotype 018 has emerged in italy, south korea, and japan, causing severe infections and outbreaks. in this study, we sequenced the genome of it1118, an italian clinical isolate, to clarify the molecular features contributing to the success of this epidemic type.201627445391
high risk of post-infectious irritable bowel syndrome in patients with clostridium difficile infection.infectious enteritis is a commonly identified risk factor for irritable bowel syndrome (ibs). the incidence of clostridium difficile infection (cdi) is on the rise. however, there is limited information on post-infectious ibs (pi-ibs) development following cdi and the host- and infection-related risk factors are not known.201627444134
community-associated clostridium difficile diarrhoea. 201627439642
hospital acquired clostridium difficile infection in pediatric wards: a retrospective case-control study.clostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections. the aim of this study was to determine the incidence and potential risk factors for c. difficile infection (cdi) in hospitalized children who developed diarrhea. a retrospective study was performed at a university hospital in istanbul over a three-year period (2012-2014).201627563524
clostridium difficile pcr ribotypes 001 and 176 - the common denominator of c. difficile infection epidemiology in the czech republic, 2014.in 2014, 18 hospitals in the czech republic participated in a survey of the incidence of clostridium difficile infections (cdi) in the country. the mean cdi incidence was 6.1 (standard deviation (sd):7.2) cases per 10,000 patient bed-days and 37.8 cases (sd: 41.4) per 10,000 admissions. the mean cdi testing frequency was 39.5 tests (sd: 25.4) per 10,000 patient bed-days and 255.8 tests (sd: 164.0) per 10,000 admissions. a total of 774 c. difficile isolates were investigated, of which 225 (29%) b ...201627484171
evaluating the effectiveness of an antimicrobial stewardship program on reducing the incidence rate of healthcare-associated clostridium difficile infection: a non-randomized, stepped wedge, single-site, observational study.the incidence rate of healthcare-associated clostridium difficile infection (ha-cdi) is estimated at 1 in 100 patients. antibiotic exposure is the most consistently reported risk factor for ha-cdi. strategies to reduce the risk of ha-cdi have focused on reducing antibiotic utilization. prospective audit and feedback is a commonly used antimicrobial stewardship intervention (asi). the impact of this asi on risk of ha-cdi is equivocal. this study examines the effectiveness of a prospective audit a ...201627309536
immunoglobulin a vasculitis complicated with clostridium difficile infection: a rare case report and brief review of the literature.immunoglobulin a (iga) vasculitis, formerly called henoch-schönlein purpura, is a leukocytoclastic type of vasculitis affecting small vessels with a deposition of immune iga complexes, clinically characterized by the classic tetrad of nonthrombocytopenic palpable purpura, arthralgia (or arthritis), and gastrointestinal and renal involvement. although the cause of the disease remains unknown, immune complexes of iga and unidentified antigens seem to play a central pathogenic role. the diagnosis i ...201627308656
[infection control and safety culture in german hospitals].healthcare-associated infections (hai) are the most frequent adverse events in the healthcare setting and their prevention is an important contribution to patient safety in hospitals.201627306879
evaluation of the vidas glutamate dehydrogenase assay for the detection of clostridium difficile.we evaluated the performance of the vidas gdh assay for the detection of clostridium difficile. in total, 350 fecal specimens collected from patients clinically suspected of having cdi were analyzed by c. difficile culture and enzyme-linked fluorescent immunoassay (vidas gdh); the results were compared with those of toxigenic c. difficile culture (tc), pcr (xpert c. difficile assay), and toxin ab eia (vidas cdab). the numbers of culture-positive and culture-negative samples were 108 and 242, res ...201627282799
clostridium difficile infection in a french university hospital: eight years of prospective surveillance study.the epidemiology of clostridium difficile infection (cdi) has changed with an increase in incidence and severity. prospective surveillance was therefore implemented in a french university hospital to monitor the characteristics of patients at risk and to recognize local trends. between 2007 and 2014, all hospitalized patients (≥18 years) with cdi were included. during the survey, the mean incidence rate of cdi was 2.9 per 10,000 hospital-days. in all, 590 patients were included. most of the epis ...201627281101
amelioration of clostridium difficile infection in mice by dietary supplementation with indole-3-carbinol.to determine the therapeutic effects of dietary supplementation on clostridium difficile infection (cdi).201627280500
low frequency of asymptomatic carriage of toxigenic clostridium difficile in an acute care geriatric hospital: prospective cohort study in switzerland.the role of asymptomatic carriers of toxigenic clostridium difficile (tcd) in nosocomial cross-transmission remains debatable. moreover, its relevance in the elderly has been sparsely studied.201627280019
universality of human microbial dynamics.human-associated microbial communities have a crucial role in determining our health and well-being, and this has led to the continuing development of microbiome-based therapies such as faecal microbiota transplantation. these microbial communities are very complex, dynamic and highly personalized ecosystems, exhibiting a high degree of inter-individual variability in both species assemblages and abundance profiles. it is not known whether the underlying ecological dynamics of these communities, ...201627279224
lectin binding studies on a glycopolymer brush flow-through biosensor by localized surface plasmon resonance.a localized surface plasmon resonance biosensor in a flow-through configuration was applied for investigating kinetics of lectin binding to surface-grafted glycopolymer brushes. polycarbonate filter membranes with pore sizes of 400 nm were coated with a 114-nm thick gold layer and used as substrate for surface-initiated atom-transfer radical polymerization of a glycomonomer. these grafted from glycopolymer brushes were further modified with two subsequent enzymatic reactions on the surface to yi ...201627277814
crispr/cas9-based efficient genome editing in clostridium ljungdahlii, an autotrophic gas-fermenting bacterium.acetogenic bacteria have the potential to convert single carbon gases (co and co2) into a range of bulk chemicals and fuels. realization of their full potential is being impeded by the absence of effective genetic tools for high throughput genome modification. here we report the development of a highly efficient crispr/cas9 system for rapid genome editing of clostridium ljungdahlii, a paradigm for the commercial production of ethanol from synthesis gas. following the experimental selection of tw ...201627276212
glucosylation drives the innate inflammatory response to clostridium difficile toxin a.clostridium difficile is a major, life-threatening hospital-acquired pathogen that causes mild to severe colitis in infected individuals. the tissue destruction and inflammation which characterize c. difficile infection (cdi) are primarily due to the rho-glucosylating toxins a and b. these toxins cause epithelial cell death and induce robust inflammatory signaling by activating the transcription factor nf-κb, leading to chemokine and cytokine secretion. the toxins also activate the inflammasome ...201627271747
[prevention of catheter-associated urinary tract infections].with a share of 22.4%, nosocomial urinary tract infections (nutis) are among the most frequent infections acquired in hospitals, along with surgical site infections (24.7%), pneumonia (21.5%), clostridium difficile infections (6.6%) and primary sepsis (6%) 1. 80% of all nutis are associated with indwelling urinary catheters, with 12-16% of all hospitalised patients and up to 81.8% of all intensive care patients receiving an indwelling urinary catheter during their hospital stay 2 3. therefore, p ...201627271450
differences in the molecular epidemiology and antibiotic susceptibility of clostridium difficile isolates in pediatric and adult patients.the rising incidence of clostridium difficile infections (cdis) in adults is partly related to the global spread of fluoroquinolone-resistant strains, namely, bi/nap1/027. although cdis are also increasingly diagnosed in children, bi/nap1/027 is relatively uncommon in children. little is known about the antibiotic susceptibility of pediatric cdi isolates. c. difficile was cultured from tcdb-positive stools collected from children diagnosed with cdi between december 2012 and december 2013 at an a ...201627270275
prevention of clostridium difficile infection: a systematic survey of clinical practice guidelines.background clostridium difficile infection (cdi) is the most common cause of hospital-acquired infectious diarrhea. objective to analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (cpgs) on cdi prevention. design and setting we searched medical databases and gray literature for cpgs on cdi prevention published january 2004-january 2015. three reviewers independently screened articles and rated cpg quality using the appraisal of guidelines for ...201627267201
characteristics and demographic distributions of toxigenic clostridium difficile strains in rajavithi hospital, 2009-2015.in recent years, toxigenic clostridium difficile infection (cdi) has been the cause of c. difficile-associated diseases (cdad), resulting in increasing hospitalization, community infection outbreak and mortality all over the world.201627266236
clostridium difficile infections in children: impact of the diagnostic method on infection rates.background polymerase chain reaction (pcr) assays based on the detection of the toxin b gene are replacing enzyme-linked immunosorbent assay (elisa)-based toxin production detection or cell cytotoxicity assay in most laboratories. objective to determine the proportion of pediatric patients diagnosed with clostridium difficile infection by pcr who would have also been diagnosed by elisa and to compare the clinical characteristics of pcr+/elisa+ vs pcr+/elisa- patients. methods using the microbiol ...201627263967
mdsine: microbial dynamical systems inference engine for microbiome time-series analyses.predicting dynamics of host-microbial ecosystems is crucial for the rational design of bacteriotherapies. we present mdsine, a suite of algorithms for inferring dynamical systems models from microbiome time-series data and predicting temporal behaviors. using simulated data, we demonstrate that mdsine significantly outperforms the existing inference method. we then show mdsine's utility on two new gnotobiotic mice datasets, investigating infection with clostridium difficile and an immune-modulat ...201627259475
isolation of c. difficile carriers alone and as part of a bundle approach for the prevention of clostridium difficile infection (cdi): a mathematical model based on clinical study data.clostridium difficile infection is the most common hospital-acquired infection. besides infected patients, carriers have emerged as a key player in c. difficile epidemiology. in this study, we evaluated the impact of identifying and isolating carriers upon hospital admission on the incidence of cdi incidence and hospital-acquired c. difficile colonization, as a single policy and as part of bundle approaches. we simulated c. difficile transmission using a stochastic mathematical approach, conside ...201627258068
faecal microbiota transplantation: applications and limitations in treating gastrointestinal disorders.the process of stool transfer from healthy donors to the sick, known as faecal microbiota transplantation (fmt), has an ancient history. however, only recently researchers started investigating its applications in an evidence-based manner. current knowledge of the microbiome, the concept of dysbiosis and results of preliminary research suggest that there is an association between gastrointestinal bacterial disruption and certain disorders. researchers have studied the effects of fmt on various g ...201627239328
clostridium difficile infection: early history, diagnosis and molecular strain typing methods.recognised as the leading cause of nosocomial antibiotic-associated diarrhoea, the incidence of clostridium difficile infection (cdi) remains high despite efforts to improve prevention and reduce the spread of the bacterium in healthcare settings. in the last decade, many studies have focused on the epidemiology and rapid diagnosis of cdi. in addition, different typing methods have been developed for epidemiological studies. this review explores the history of c. difficile and the current scope ...201627238460
nitroimidazole carboxamides as antiparasitic agents targeting giardia lamblia, entamoeba histolytica and trichomonas vaginalis.diarrhoeal diseases caused by the intestinal parasites giardia lamblia and entamoeba histolytica constitute a major global health burden. nitroimidazoles are first-line drugs for the treatment of giardiasis and amebiasis, with metronidazole 1 being the most commonly used drug worldwide. however, treatment failures in giardiasis occur in up to 20% of cases and development of resistance to metronidazole is of concern. we have re-examined 'old' nitroimidazoles as a foundation for the systematic dev ...201627236016
high fecal iga is associated with reduced clostridium difficile colonization in infants.colonization of infants with clostridium difficile is on the rise. although better tolerated by infants than adults, it is a risk factor for future allergic disease. the present study describes associations between infant fecal immunoglobulin a (iga) and colonization with c. difficile in 47 infants enrolled in the canadian healthy infant longitudinal development (child) study. c. difficile colonization was observed in over half (53%) of the infants. median iga was lower in infants colonized with ...201627235197
effect of prolonged diarrhea in renal transplant recipients at a single center in taiwan.post-renal transplantation diarrhea is a common complication; however, it is easily ignored. this study aimed to determine the factors influencing graft function for renal transplant recipients with diarrhea.201627234755
misuse of antibiotics reserved for hospital settings in outpatients: a prospective clinical audit in a university hospital in southern france.some antibiotics are reserved essentially for hospital settings owing to cost effectiveness and in order to fight the emerging antibiotic resistance crisis. in some cases, antibiotics reserved exclusively for use in hospitals may be prescribed in outpatients for serious infections or in the absence of a therapeutic alternative. a 30-day prospective audit of outpatient prescriptions of antibiotics reserved exclusively for use in hospitals was performed. the objective of this study was to evaluate ...201627234677
a roadmap for gene system development in clostridium.clostridium species are both heroes and villains. some cause serious human and animal diseases, those present in the gut microbiota generally contribute to health and wellbeing, while others represent useful industrial chassis for the production of chemicals and fuels. to understand, counter or exploit, there is a fundamental requirement for effective systems that may be used for directed or random genome modifications. we have formulated a simple roadmap whereby the necessary gene systems maybe ...201627234263
fecal microbiota transplantation for severe clostridium difficile infection after left ventricular assist device implantation: a case control study and concise review on the local and regional therapies.we report herein a case of fecal microbiota transplantation (fmt) used for severe clostridium difficile infection for a 65-year-old lebanese man who underwent left ventricular assist device implantation. to the best of our knowledge this is the first case report from lebanon and the region presenting such technique.201627233894
production and characterization of chemically inactivated genetically engineered clostridium difficile toxoids.a recombinant clostridium difficile expression system was used to produce genetically engineered toxoids a and b as immunogens for a prophylactic vaccine against c. difficile-associated disease. although all known enzymatic activities responsible for cytotoxicity were genetically abrogated, the toxoids exhibited residual cytotoxic activity as measured in an in vitro cell-based cytotoxicity assay. the residual cytotoxicity was eliminated by treating the toxoids with 1-ethyl-3-(3-dimethylaminoprop ...201627233688
reduction in post-operative acute kidney injury following a change in antibiotic prophylaxis policy for orthopaedic surgery: an observational study.evidence has shown that a prophylactic antibiotic regimen of flucloxacillin and gentamicin for orthopaedic surgery was associated with increased rates of post-operative acute kidney injury (aki). this resulted in changes in the national antibiotic policy recommendation for orthopaedic surgical prophylaxis. this study aimed to assess whether this change from flucloxacillin and gentamicin to co-amoxiclav was associated with changes in the rates of aki and clostridium difficile infection (cdi).201627231276
[a novel approach to genotyping of hospital isolates of clostridium difficile].development of a novel approach in genotyping of clostridium difficile and its testing on the example of 140 hospital isolates.201627228665
clostridium difficile infection. 201627227752
[fecal microbiota transplantation in relapsing clostridium difficile colitis].since the turn of the millennium there has been an alarming increase in the incidence and severity of clostridium difficile infections. stopping medication with the triggering antibiotic and switching to a recommended antibiotic leads to healing up in 80%. however, patients who relapse have a 40% risk of an additional relapse and those with 2 or more episodes face a 60% risk. fecal microbiota transplantation (fmt) is a new therapeutic option. up to now there only exist two randomized studies (un ...201627221557
chinese physicians' perceptions of fecal microbiota transplantation.to explore chinese physicians' perceptions towards fecal microbiota transplantation (fmt) and to provide information and an assessment of fmt development in china.201627217707
clostridium difficile infection following systemic antibiotic administration in randomised controlled trials: a systematic review and meta-analysis.antibiotics have been the most important risk factor for clostridium difficile infection (cdi). however, only data from non-randomised studies have been reviewed. we sought to evaluate the risk for development of cdi associated with the major antibiotic classes by analysing data from randomised controlled trials (rcts). the pubmed, cochrane and scopus databases were searched and the references of selected rcts were also hand-searched. eligible studies should have compared only one antibiotic ver ...201627216385
recurrence of clostridium difficile infection in patients with inflammatory bowel disease: the recidivism study.recurrent clostridium difficile infection (rcdi) contributes to a significant burden of disease in patients with inflammatory bowel disease (ibd). in this study, we seek to identify risk factors for rcdi in a population of ibd patients at the mount sinai hospital ibd centre.201627215924
fecal microbiota transplantation for recurrent clostridium difficile infection in hematopoietic stem cell transplant recipients.recurrent clostridium difficile infection (cdi) is a consequence of intestinal dysbiosis and is particularly common following hematopoietic stem cell transplantation (hsct). fecal microbiota transplantation (fmt) is an effective method of treating cdi by correcting intestinal dysbiosis by passive transfer of healthy donor microflora. fmt has not been widely used in immunocompromised patients, including hsct recipients, owing to concern for donor-derived infection. here, we describe initial resul ...201627214585
assessing the magnitude and trends in hospital acquired infections in canadian hospitals through sequential point prevalence surveys.healthcare acquired infections (hai) are an important public health problem in developed countries, but comprehensive data on trends over time are lacking. prevalence surveys have been used as a surrogate for incidence studies and can be readily repeated.201627213039
the microbiota and immune response during clostridium difficile infection.clostridium difficile is a gram-positive, spore forming anaerobe that infects the gut when the normal microbiota has been disrupted. c. difficile infection (cdi) is the most common cause of hospital acquired infection in the united states, and the leading cause of death due to gastroenteritis. patients suffering from cdi have varying symptoms which range from mild diarrhea to pseudomembranous colitis and death. the involvement of the immune response to influence disease severity is just beginnin ...201627212111
[role of care surgery in the treatment of pseudomembranous colitis].pseudomembranous colitis, caused by clostridium difficile, has an increased incidence in recent years, driven mainly by the indiscriminate use of antibiotics. although initial treatment is medical, the role of emergency surgery has gained ground due to high mortality and the emergence of increasingly virulent strains. in our country the prevalence is still low so sometimes our experience in handling is limited.201627209466
economic burden of primary compared with recurrent clostridium difficile infection in hospitalized patients: a prospective cohort study.few studies have investigated the additional healthcare costs of recurrent c. difficile infection (cdi).201627209056
risk factors associated with interfacility transfers among patients with clostridium difficile infection.preventing the transmission of clostridium difficile infection (cdi) over the continuum of care presents an important challenge for infection control.201627207161
elevated fecal calprotectin associates with adverse outcomes from clostridium difficile infection in older adults.clostridium difficile infection (cdi) causes a mild to moderate colitis in most patients, but some, especially older adults, develop severe, adverse outcomes. biomarkers predicting outcomes are needed to optimize treatments. this study tested whether fecal calprotectin associated with a composite primary outcome of complicated cdi (intensive care unit admission, colectomy, or death due to cdi within 30 days of diagnosis) and/or 8-week recurrence.201627206404
the surgical management of complicated clostridium difficile infection: alternatives to colectomy.clostridium difficile is the most common nosocomial infection in the united states. there is a subset of patients for whom medical therapy fails or who progress rapidly to the development of complicated disease, often marked by critical systemic illness. patients with complicated clostridium difficile infection (cdi) who progress or fail to improve benefit from surgery.201627206241
antibiotic stewardship programs in u.s. acute care hospitals: findings from the 2014 national healthcare safety network annual hospital survey.the national action plan to combat antibiotic resistant bacteria calls for all us hospitals to improve antibiotic prescribing as a key prevention strategy for resistance and clostridium difficile antibiotic stewardship programs (asps) will be important in this effort but implementation is not well understood.201627199462
fecal microbiota transplantation for the intestinal decolonization of extensively antimicrobial-resistant opportunistic pathogens: a review.treatment options for multidrug-resistant (mdr) bacterial infections are limited and often less effective. non-pharmacologic approaches to preventing or treating mdr infections are currently restricted to improved antimicrobial stewardship and infection control practices. fecal microbiota transplantation (fmt), a highly effective treatment for recurrent clostridium difficile infection, has emerged as a promising therapy for intestinal mdr bacterial decolonization. a total of eight case reports h ...201627194400
new approaches to infection prevention and control: implementing a risk-based model regionally.infectious disease outbreaks result in substantial inconvenience to patients and disruption of clinical activity.201627194074
increasing incidence of clostridium difficile infections: results from a 5-year retrospective study in a large teaching hospital in the italian region with the oldest population.limited information is available on the incidence of clostridium difficile infections (cdis) in italian hospitals. in this study, we assessed the changes in the incidence of cdi over a 5-year period in a teaching hospital in liguria, the italian region with the oldest population. secondary endpoints were the development of severe cdi and 30-day mortality. the annual incidence of cdi/10000 patient-days significantly increased from 0·54 in 2010 to 3·04 in 2014 (χ 2 for trend, p < 0·001). the media ...201627193828
the burden of clostridium difficile after cervical spine surgery.study design retrospective database analysis. objective the purpose of this study is to investigate incidence, comorbidities, and impact on health care resources of clostridium difficile infection after cervical spine surgery. methods a total of 1,602,130 cervical spine surgeries from the nationwide inpatient sample database from 2002 to 2011 were included. patients were included for study based on international classification of diseases ninth revision, clinical modification procedural codes fo ...201627190732
atypical presentation of c. difficile infection: report of a case with literature review.clostridium difficile (c. difficile) is a gram-positive, obligate, anaerobic spore-forming bacillus first reported by hall and o'toole in 1935. it occurs mostly after antibiotic use and invariably presents with watery diarrhea. we describe an atypical presentation of c. difficile in a 64-year-old caucasian female who presented to the our emergency department with abdominal pain, nausea, and vomiting for one day. a complete blood count revealed leukocytosis 30 x 10(9)/l and a subsequent computed ...201627190728
impact of a healthcare provider educational intervention on frequency of clostridium difficile polymerase chain reaction testing in children: a segmented regression analysis.although clostridium difficile infections (cdis) are increasingly diagnosed in children, many children diagnosed with cdi lack classic risk factors. frequent use of highly sensitive tcdb polymerase chain reaction (pcr) testing in low-risk patients leads to cdi misdiagnosis and unnecessary cdi antibiotic use in children with c difficile carriage.201627190172
hiv infection results in metabolic alterations in the gut microbiota different from those induced by other diseases.imbalances in gut bacteria have been associated with multiple diseases. however, whether there are disease-specific changes in gut microbial metabolism remains unknown. here, we demonstrate that human immunodeficiency virus (hiv) infection (n = 33) changes, at quantifiable levels, the metabolism of gut bacteria. these changes are different than those observed in patients with the auto-immune disease systemic lupus erythaematosus (n = 18), and clostridium difficile-associated diarrhoea (n = 6). u ...201627189771
preclinical development of ramizol, an antibiotic belonging to a new class, for the treatment of clostridium difficile colitis.antibiotic-resistant bacteria is a major threat to human health and is predicted to become the leading cause of death from disease by 2050. despite the recent resurgence of research and development in the area, few antibiotics have reached the market, with most of the recently approved antibiotics corresponding to new uses for old antibiotics, or structurally similar derivatives thereof. we have recently reported an in silico approach that led to the design of an entirely new class of antibiotic ...201627189122
adverse event reporting for proton pump inhibitor therapy: an overview of systematic reviews.to assist clinicians in counseling patients regarding the risk of adverse events from proton pump inhibitors (ppis), by synthesizing evidence from published systematic reviews of antireflux therapy.201627188706
predictors of early failure after fecal microbiota transplantation for the therapy of clostridium difficile infection: a multicenter study.fecal microbiota transplant (fmt) is a highly efficacious treatment for recurrent or refractory clostridium difficile infection (cdi); however, 10-20% of patients fail to achieve cure after a single fmt. the aim of this study was to identify risk factors associated with fmt failure and to develop and validate a prediction model for fmt failure.201627185076
impact of sink location on hand hygiene compliance after care of patients with clostridium difficile infection: a cross-sectional study.the impact of sink location on hand washing compliance after contact with patients with clostridium difficile infection (cdi) is poorly understood. the aim of this study is to determine the location of hand wash sinks available to healthcare workers (hcws) after caring for patients with cdi and to assess the impact on hand washing compliance.201627184488
epidemiology of clostridium difficile infection-associated reactive arthritis in children: an underdiagnosed, potentially morbid condition.the incidence of clostridium difficile infection has increased among children. the epidemiology of pediatric c difficile infection-associated reactive arthritis is poorly understood.201627182697
clostridium difficile infection in children: a review.clostridium difficile is a sporogenic, anaerobic, gram-positive, emerging enteric pathogen. it represents the most common cause of health care-associated diarrhoea in the united states, with significantly associated morbidity, mortality, and health care costs. historically regarded as a little more than an innocent coloniser bystander of the gastrointestinal tract of children, c difficile has increasingly demonstrated its behaviour as a true pathogen in the paediatric age groups. this organism m ...201627182626
analysis of clostridium difficile infections in patients hospitalized at the nephrological ward in poland.few studies have evaluated the incidence and risk factors of clostridium difficile infection (cdi) in the adult polish population, in particular in solid organ recipients hospitalized at the nephrological ward.201627180967
probiotics as adjunctive therapy for preventing clostridium difficile infection - what are we waiting for?with the end of the golden era of antibiotic discovery, the emergence of a new post-antibiotic age threatens to thrust global health and modern medicine back to the pre-antibiotic era. antibiotic overuse has resulted in the natural evolution and selection of multi-drug resistant bacteria. one major public health threat, clostridium difficile, is now the single leading cause of hospital-acquired bacterial infections and is by far the most deadly enteric pathogen for the u.s.201627180657
administration of probiotic kefir to mice with clostridium difficile infection exacerbates disease.lifeway(®) kefir, a fermented milk product containing 12 probiotic organisms, is reported to show promise as an alternative to fecal microbiota transplantation for recurrent clostridium difficile infection (cdi). we employed a murine cdi model to study the probiotic protective mechanisms and unexpectedly determined that kefir drastically increased disease severity. our results emphasize the need for further independent clinical testing of kefir as alternative therapy in recurrent cdi.201627180007
structural and functional changes within the gut microbiota and susceptibility to clostridium difficile infection.alteration of the gut microbial community structure and function through antibiotic use increases susceptibility to colonization by clostridium difficile and other enteric pathogens. however, the mechanisms that mediate colonization resistance remain elusive. as the leading definable cause of infectious diarrhea, toxigenic c. difficile represents a burden for patients and health care systems, underscoring the need for better diagnostics and treatment strategies. next-generation sequence data has ...201627180006
n-3 and n-6 fatty acid changes in the erythrocyte membranes of patients with 658240251 clostridium difficile infection.the implications of circulating essential fatty acids (fa) on the inflammatory risk profile and clinical outcome are still unclear. in order to gain a deeper understanding of the role of polyunsaturated fatty acids (pufa) in the pathogenesis of acute infection, we analyzed the fa content in red blood cell (rbc) membranes of patients with clostridium difficile infection (cdi) and controls. we prospectively studied 60 patients including 30 patients with cdi and 30 controls to assess lipid concentr ...201627172707
[fecal microbiota transplantation].fecal microbiota transplantation (fmt) is a therapeutic method, in which the fecal microflora from healthy donors is transmitted to the patient to restore the healthy microbial composition of the gut. in the recent years, there is a growing interest in the therapeutic potential of fmt in various diseases. the standard fmt protocols do not exist. procedures of fmt vary in several aspects such as donor selection, preparation of fecal material, preparation of the recipient and administration way. f ...201627172442
pseudomembranous colitis: not always clostridium difficile.although clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for c difficile or if presumed c difficile infection does not respond to treatment. histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause.201627168512
endogenous il-17 as a factor determining the severity of clostridium difficile infection in mice.clostridium difficile infection (cdi) is a toxin-mediated intestinal disease. toxin a, toxin b and binary toxin are believed to be responsible for the pathogenesis of cdi, which is characterized by massive infiltration of neutrophils at the infected intestinal mucosa. il-17 is one of the cytokines that play critical roles in several inflammatory and immunological diseases through various actions, including promoting neutrophil recruitment. the aim of this study was to examine the role of this cy ...201627166143
gut microbiota composition and clostridium difficile infection in hospitalized elderly individuals: a metagenomic study.the gut microbiota composition of elderly hospitalized patients with clostridium difficile infection (cdi) exposed to previous antibiotic treatment is still poorly investigated. the aim of this study was to compare the microbiota composition by means of 16s rrna microbial profiling among three groups of hospitalized elderly patients (age ≥ 65) under standard diet including 25 cdi-positive (cdi group), 29 cdi-negative exposed to antibiotic treatment (ab+ group) and 30 cdi-negative subjects not on ...201627166072
pseudomembranous colitis secondary to methicillin-resistant staphylococcus aureus (mrsa).a 37-year-old woman with a history of type ii diabetes and crohn's disease, status postcholecystectomy, presented with a >2-week history of cramping abdominal pain, nausea, non-bloody/non-bilious emesis and, later, diarrhoea. a flexible sigmoidoscopy was performed, revealing that 'a segmental pseudomembrane was found from rectum to sigmoid colon'. clostridium difficile pcr on the stool was repeated twice and resulted negative both times. a food history prior to onset of symptoms was consistent w ...201627165998
predominance and high antibiotic resistance of the emerging clostridium difficile genotypes napcr1 and nap9 in a costa rican hospital over a 2-year period without outbreaks.clostridium difficile is the major causative agent of nosocomial antibiotic-associated diarrhea. in a 2009 outbreak of c. difficile-associated diarrhea that was recorded in a major costa rican hospital, the hypervirulent nap1 strain (45%) predominated together with a local genotype variant (napcr1, 31%). both strains were fluoroquinolone-resistant and the napcr1 genotype, in addition, was resistant to clindamycin and rifampicin. we now report on the genotypes and antibiotic susceptibilities of 6 ...201627165560
infection: targeting asymptomatic carriers of clostridium difficile infection. 201627165512
impact of microbial derived secondary bile acids on colonization resistance against clostridium difficile in the gastrointestinal tract.clostridium difficile is an anaerobic, gram positive, spore-forming bacillus that is the leading cause of nosocomial gastroenteritis. clostridium difficile infection (cdi) is associated with increasing morbidity and mortality, consequently posing an urgent threat to public health. recurrence of cdi after successful treatment with antibiotics is high, thus necessitating discovery of novel therapeutics against this pathogen. susceptibility to cdi is associated with alterations in the gut microbiot ...201627163871
how to manipulate the microbiota: fecal microbiota transplantation.fecal microbiota transplantation (fmt) is a rather straightforward therapy that manipulates the human gastrointestinal (gi) microbiota, by which a healthy donor microbiota is transferred into an existing but disturbed microbial ecosystem. this is a natural process that occurs already at birth; infants are rapidly colonized by a specific microbial community, the composition of which strongly depends on the mode of delivery and which therefore most likely originates from the mother (palmer et al. ...201627161356
clostridium difficile infection.infection of the colon with the gram-positive bacterium clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. c. difficile is the leading cause of health-care-associated infective diarrhoea. the life cycle of c. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. the primary mediators of inflamma ...201627158839
clostridium difficile associated diarrhea.clostridium difficile associated diarrhea (cdad) is increasingly important in primary care, and associated with high cost, significant morbidity and mortality. as the preferred treatment for different groups of patients varies considerably, it is important to stratify cdad patients into mild versus severe and uncomplicated versus complicated. while treatment with either metronidazole or oral vancomycin cures a majority of patients, and despite improvement in early diagnosis and therapy, recurren ...201627156262
clostridium difficile ribotype 176 - a predictor for high mortality and risk of nosocomial spread?the objective of this survey was to determine the incidence of clostridium difficile infections (cdi) at the department of infectious diseases, bulovka hospital, and to evaluate clinical and epidemiological data on cdi patients together with a detailed molecular characterisation of c. difficile isolates. the patient outcomes were correlated to causative c. difficile pcr-ribotype.201627155489
the challenge of clostridium difficile infection.clostridium difficile infection is a major problem in the united states, resulting in significant morbidity, mortality, and financial costs to the health care system. this commentary provides an update regarding the epidemiology, diagnosis, current recommended management, and challenges surrounding c. difficile infection.201627154892
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