Publications

overwhelming recurrent clostridium difficile infection after reversal of diverting loop ileostomy created for prior fulminant c. difficile colitis.		2016	27657564
advances in the microbiome: applications to clostridium difficile infection.	clostridium difficile is a major cause of morbidity and mortality worldwide, causing over 400,000 infections and approximately 29,000 deaths in the united states alone each year. c. difficile is the most common cause of nosocomial diarrhoea in the developed world, and, in recent years, the emergence of hyper-virulent (mainly ribotypes 027 and 078, sometimes characterised by increased toxin production), epidemic strains and an increase in the number of community-acquired infections has caused fur ...	2016	27657145
2016 update on medical overuse: a systematic review.	overuse of medical care is an increasingly recognized problem in clinical medicine.	2016	27654002
what's a snp between friends: the influence of single nucleotide polymorphisms on virulence and phenotypes of clostridium difficile strain 630 and derivatives.	clostridium difficile is a major cause of antibiotic induced diarrhea worldwide, responsible for significant annual mortalities and represents a considerable economic burden on healthcare systems. the two main c. difficile virulence factors are toxins a and b. isogenic toxin b mutants of 2 independently isolated erythromycin-sensitive derivatives (630e and 630δerm) of strain 630 were previously shown to exhibit substantively different phenotypes. compared to 630, strain 630e and its progeny grow ...	2016	27652799
tea and recurrent clostridium difficile infection.	background and aims. studies have shown effects of diet on gut microbiota. we aimed to identify foods associated with recurrent clostridium difficile infection (cdi). methods. in this cross-sectional survey, consecutive patients diagnosed with cdi were identified by electronic medical records. colitis symptoms and positive clostridium difficile assay were confirmed. health-care onset-health-care facility associated cdi was excluded. food surveys were mailed to 411 patients. survey responses serv ...	2016	27651790
clostridium difficile infection diagnostics - evaluation of the c. diff quik chek complete assay, a rapid enzyme immunoassay for detection of toxigenic c. difficile in clinical stool samples.	diagnostic testing for clostridium difficile infection (cdi) has, in recent years, seen the introduction of rapid dual-eia (enzyme immunoassay) tests combining species-specific glutamate dehydrogenase (gdh) with toxin a/b. in a prospective study, we compared the c. diff quik chek complete test to a combination of selective culture (sc) and loop-mediated isothermal amplification (lamp) of the toxin a gene. of 419 specimens, 68 were positive in sc including 62 positive in lamp (14.7%). the combine ...	2016	27651167
a comparison of histamine receptor antagonists versus proton pump inhibitor gastrointestinal ulcer prophylaxis in kidney transplant recipients.	there are several different agents that can be used for gastrointestinal (gi) ulcer prophylaxis in posttransplant recipients, such as histamine-2 receptor antagonists (h2ra) or proton pump inhibitors (ppis).	2016	27650918
community- and healthcare-associated clostridium difficile infections, finland, 2008-2013(1).	we evaluated incidence, case-fatality rate, and trends of community-associated (ca) and healthcare-associated (ha) clostridium difficile infections (cdis) in finland during 2008-2013. cdis were identified in the national infectious disease register, deaths in the national population information system, hospitalizations to classify infections as ca or ha in the national hospital discharge register, and genotypes in a reference laboratory. a total of 32,991 cdis were identified: 10,643 (32.3%) wer ...	2016	27648884
fecal microbiota transplant in patients with clostridium difficile infection: a systematic review.	fecal microbiota transplantation (fmt) restores a diverse bacterial profile to the gastrointestinal tract and may effectively treat patients with clostridium difficile infection (cdi). the objective of this systematic review was to evaluate the effectiveness of fmt in the treatment of cdi.	2016	27648772
the phosphotransfer protein cd1492 represses sporulation initiation in clostridium difficile.	the formation of spores is critical for the survival of clostridium difficile outside the host gastrointestinal tract. persistence of c. difficile spores greatly contributes to the spread of c. difficile infection (cdi), and the resistance of spores to antimicrobials facilitates the relapse of infection. despite the importance of sporulation to c. difficile pathogenesis, the molecular mechanisms controlling spore formation are not well understood. the initiation of sporulation is known to be reg ...	2016	27647869
risk factors for short- and long-term mortality in very old patients with clostridium difficile infection: a retrospective study.	most cases of clostridium difficile infections (cdi) occur in patients aged 65 years and older. older age is associated with increased mortality. risk factors for mortality in patients aged 80 years and older are not well recognized.	2016	27647625
taking advantage of public reporting: an infection composite score to assist evaluating hospital performance for infection prevention efforts.	the standardized infection ratio (sir) evaluates individual publicly reported health care-associated infections, but it may not assess overall performance.	2016	27645403
proton pump inhibitors and risk of clostridium difficile infection: a multi-country study using sequence symmetry analysis.	to determine the association between incident proton pump inhibitor (ppi) use and clostridium difficile infections across multiple countries method: national data covering the total population in australia and korea, the canadian population over 65 years and a 3 million person random sample data set from taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in japan. sequence symmetry analysis was used to assess the association with ...	2016	27645304
non-invasive fecal microbiota transplantation for recurrent clostridium difficile infection in a patient presenting with hypertensive disorder post interventionem.	fecal microbiota transplantation has gathered much attention due to its high efficacy in resolving recurrent clostridium difficile infection. until today, it is recognized as a safe procedure without any severe side effects. patients with impaired conscious states suffering from recurrent episodes of aspiration are at increased risk by endoscopic interventions needed during standard approaches for fecal microbiota transplantation application.here, we illustrate the case of a tetraplegic patient ...	2016	27644000
[fecal microbiota transplantation, a novel therapy for recurrent clostridium difficile infection].	clostridium difficile infection is caused by a disturbance of the gut microbiota, often resulting from the use of antibiotics. among a sub group of patients with this disorder, treatment with antibiotics is not effective. they develop a chronic, recurrent infection. such patients can be treated with a fecal microbiota transplantation (fmt), or fecal transplantation. the crucial steps for safe application of fecal transplantation are central donor selection and screening. to optimise safety and t ...	2016	27643493
pantoprazole or placebo for stress ulcer prophylaxis (pop-up): randomized double-blind exploratory study.	pantoprazole is frequently administered to critically ill patients for prophylaxis against gastrointestinal bleeding. however, comparison to placebo has been inadequately evaluated, and pantoprazole has the potential to cause harm. our objective was to evaluate benefit or harm associated with pantoprazole administration.	2016	27635481
endoscopic delivery of fecal biotherapy in inflammatory bowel disease.	the intestinal microbiome plays an important role in the pathogenesis of inflammatory bowel disease (ibd). we are able to use the microbiome as a therapeutic target with use of fecal microbiota transplantation (fmt) for cure of recurrent clostridium difficile infection. given our ability to target the dysbiotic state with fmt, its use as therapy in ibd has tremendous potential. this overview discusses the practical considerations of fmt therapy with respect to our current understanding of safety ...	2016	27633598
reprofiled anthelmintics abate hypervirulent stationary-phase clostridium difficile.	prolonged use of broad-spectrum antibiotics disrupts the indigenous gut microbiota, which consequently enables toxigenic clostridium difficile species to proliferate and cause infection. the burden of c. difficile infections was exacerbated with the outbreak of hypervirulent strains that produce copious amounts of enterotoxins and spores. in recent past, membrane-active agents have generated a surge of interest due to their bactericidal property with a low propensity for resistance. in this stud ...	2016	27633064
hypersensitivity reaction following administration of low-dose oral vancomycin for the treatment of clostridium difficile in a patient with normal renal function.	systemic absorption of oral vancomycin for the treatment of clostridium difficile is thought to be trivial in patients without risk factors for increased systemic absorption and is often overlooked in clinical practice. a 51-year-old male elicits a suspected immunoglobulin e-mediated hypersensitivity following administration of low-dose oral vancomycin for the treatment of severe c difficile the patient had normal renal function and was administered low doses of the medication, however, had a me ...	2016	27630210
modulation of the surface-layer protein of clostridium difficile through cwp84 inhibition.	cysteine protease cwp84 is responsible for surface-layer processing in clostridium difficile and was also shown to cleave several human extracellular matrix components in vitro. to enable the facile identification and characterization of cwp84 inhibitors, we developed a fluorogenic 10-mer peptide based on the enzyme's natural substrate slpa that is amenable for use in fret-based high-throughput screening. the design of substrate-mimetic inhibitors led to epoxysuccinate 8c, which displayed an ina ...	2016	27626098
henoch schonlein purpura and clostridium difficile infection: a hematologist's point of view.		2016	27689213
serendipity in refractory celiac disease: full recovery of duodenal villi and clinical symptoms after fecal microbiota transfer.	treatment of refractory celiac disease type ii (rcd ii) and preventing the development of an enteropathy associated t-cell lymphoma in these patients is still difficult. in this case report, we describe a patient with rcd ii who received fecal microbiota transfer as treatment for a recurrent clostridium difficile infection, and remarkably showed a full recovery of duodenal villi and disappearance of celiac symptoms. this case suggests that altering the gut microbiota may hold promise in improvin ...	2016	27689204
chemokine cxcl13 expression was up-regulated in clostridium difficile infection.	clostridium difficile infection (cdi) is the leading cause of antibiotic- and healthcare-associated diarrhea. cxcl13 is a well-known cxc chemokine involved in inflammation, but its role in cdi remains unknown. in this study, serum and fecal samplings were collected from 51 cdi patients, 50 diarrhea patients without cdi and 50 healthy control subjects to determine the cxcl13 levels by enzyme-linked immunosorbent assay (elisa). besides, a mouse model of c. difficile infection was established, and ...	2016	27685937
measuring appropriate antimicrobial use: attempts at opening the black box.	indiscriminate antimicrobial use has plagued medicine since antibiotics were first introduced into clinical practice >70 years ago. infectious diseases physicians and public health officials have advocated for preservation of these life-saving drugs for many years. with rising burden of antimicrobial-resistant organisms and clostridium difficile infections, halting unnecessary antimicrobial use has become one of the largest public health concerns of our time. inappropriate antimicrobial use has ...	2016	27682070
eccmid 2016: addressing the burden of recurrent clostridium difficile infections.	26th european congress of clinical microbiology and infectious diseases (eccmid), 9-12th april 2016, amsterdam, the netherlands the european congress of clinical microbiology and infectious diseases (eccmid) is the annual scientific meeting of the european society of clinical microbiology. eccmid 2016, held in amsterdam, the netherlands, was attended by over 11,600 clinical microbiologists and infectious disease physicians from more than 120 countries. the congress offered an essential opportuni ...	2016	27679929
assessing the risk of hospital-acquired clostridium difficile infection with proton pump inhibitor use: a meta-analysis.	background clostridium difficile is the principal infectious cause of antibiotic-associated diarrhea and accounts for 12% of hospital-acquired infections. recent literature has shown an increased risk of c. difficile infection (cdi) with proton pump inhibitor (ppi) use. objective to conduct a systematic assessment of the risk of hospital-acquired cdi following exposure to ppi. methods we searched multiple databases for studies examining the relationship between ppi and hospital-acquired cdi. poo ...	2016	27677811
the housefly musca domestica as a mechanical vector of clostridium difficile.	clostridium difficile is a bacterial healthcare-associated infection that may be transferred by houseflies (musca domestica) due to their close ecological association with humans and cosmopolitan nature.	2016	27671221
patients with risk factors for complications do not require longer antimicrobial therapy for complicated intra-abdominal infection.	a prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. we hypothesized that patients with specific risk factors for complications also had similar outcomes. short-course patients with obesity, diabetes, or acute physiology and chronic health evaluation ii ≥15 from the stop-it trial were compared with longer duration patients. outcomes ...	2016	27670577
inappropriate clostridium difficile testing and consequent overtreatment and inaccurate publicly reported metrics.	background the nationally reported metric for clostridium difficile infection (cdi) relies solely on laboratory testing, which can result in overreporting due to asymptomatic c. difficile colonization. objective to review the clinical scenarios of cases of healthcare facility-onset cdi (ho-cdi) and to determine the appropriateness of c. difficile testing on the basis of presence of symptomatic diarrhea in order to identify areas for improvement. design retrospective cohort study. setting northwe ...	2016	27666285
faecal microbiota transplantation for recurring clostridium difficile infection in a patient with crohn's disease and ileorectal anastomosis.	faecal microbiota transplantation (fmt) is increasingly being used to treat refractory and recurring clostridium difficile infection (cdi). although fmt appears to be safe and highly effective in patients with a preserved colon and immunocompetence, its use in patients with inflammatory bowel disease (ibd) who are on immunomodulating therapies is controversial. in particular, patients who have undergone colectomy may have different treatment responses to fmt. in this case report, we describe the ...	2016	27664230
vaccinology gets help from chemistry.	a recent report on the immunological activity of protein conjugates of synthetic lipoteicoic fragments from clostridium difficile underpins the use of these molecules for the development of a vaccine. in a recent issue of cell chemical biology, broecker et al. (2016) illustrate the utility of glycoarray-based selection of bacterial carbohydrates with the potential to become vaccine candidates.	2016	27662251
prevention of infection due to clostridium difficile.	clostridium difficile is one of the foremost nosocomial pathogens. preventing infection is particularly challenging. effective prevention efforts typically require a multifaceted bundled approach. a variety of infection control procedures may be advantageous, including strict hand decontamination with soap and water, contact precautions, and using chlorine-containing decontamination agents. additionally, risk factor reduction can help reduce the burden of disease. the risk factor modification is ...	2016	27660089
clearance of vancomycin-resistant enterococcus concomitant with administration of a microbiota-based drug targeted at recurrent clostridium difficile infection.	background. vancomycin-resistant enterococcus (vre) is a major healthcare-associated pathogen and a well known complication among transplant and immunocompromised patients. we report on stool vre clearance in a post hoc analysis of the phase 2 punch cd study assessing a microbiota-based drug for recurrent clostridium difficile infection (cdi). methods. a total of 34 patients enrolled in the punch cd study received 1 or 2 doses of rbx2660 (microbiota suspension). patients were requested to volu ...	2016	27703995
nodular colitis: endoscopic image an unusual finding.	an 82-year-old male with a history of high blood pressure, copd, chronic myeloid leukemia, and stage-4 chronic renal failure. admitted to hospital for lower-limb cellulitis and severe copd exacerbation, he received antibiotic therapy and bronchodilators. during his hospital stay he developed severe anemia and had an hematochezia event with no diarrhea. a complete colonoscopy found small (4-7 mm) nacreous elevated lesions, circumferential in shape, in the cecum and ascending colon with some bleed ...	2016	27701886
norovirus infection in solid organ transplant recipients: a single-center retrospective study.	norovirus (nov) is gaining recognition as an important cause of diarrhea among solid organ transplant (sot) recipients, but existing studies have been limited by a small sample size.	2016	27699965
quantitative structure activity relationship (qsar) studies on nitazoxanide-based analogues against clostridium difficile in vitro.	quantitative structure activity relationship (qsar) has been established between the various physiochemical parameters of a series of nitazoxanide-based analogues and its antibacterial activity against clostridium difficile. genetic function approximation (gfa) and comparative molecular field analysis (comfa) techniques were used to identify the descriptors that have influence on biological activity. the most influencing molecular descriptors identified in 2d-qsar include spatial, topological, a ...	2016	27731829
disparate prevalence of toxigenic and nontoxigenic clostridium difficile among distinct adult patient populations in a single institution.	clostridium difficile (cd) disease remains a costly and important hospital-associated infection. although nontoxigenic cd is detected by some cd testing methods, can interfere with some detection algorithms and has been suggested as a treatment for cd disease, little is known about the relative occurrence of toxigenic and nontoxigenic cd in a single institution.we used both chromogenic and selective agar media to recover cd isolates and a molecular method to detect the toxin b gene from over 240 ...	2016	27624898
compared lethality rates of clostridium difficile infections at the local, regional and national levels in france.		2016	27621820
modulation of microbiota as treatment for intestinal inflammatory disorders: an uptodate.	alterations of intestinal microflora may significantly contribute to the pathogenesis of different inflammatory and autoimmune disorders. there is emerging interest on the role of selective modulation of microflora in inducing benefits in inflammatory intestinal disorders, by as probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (fmt). to summarize recent evidences on microflora modulation in main intestinal inflammatory disorders, pubmed was searched using ter ...	2016	27621567
epidemiology and outcome of clostridium difficile infections in patients hospitalized in internal medicine: findings from the nationwide fadoi-practice study.	clostridium difficile (cd) is a leading cause of diarrhoea among hospitalized patients. the objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of cd infections (cdi) in internal medicine (im) wards in italy.	2016	27825317
clostridium difficile associated diarrhoea: an increased problem.	clostridium difficile associated diarrhoea is a major health problem that seems to be on the increase. in our study, we analyse the changes in the incidence of this infection over the last 11 years.	2016	27823794
[clostridium difficile infection : what is currently available for treatment?]	clostridium difficile (c. difficile) is an anaerobic, gram-positive, spore-forming, toxin-secreting bacillus. it is transmitted via a fecal-oral route and can be found in 1-3 % of the healthy population. symptoms caused by c. difficile range from uncomplicated diarrhea to a toxic megacolon. the incidence, frequency of recurrence, and mortality rate of c. difficile infections (cdis) have increased significantly over the past few decades. the most important risk factor is antibiotic treatment in e ...	2016	27796474
dietary zinc alters the microbiota and decreases resistance to clostridium difficile infection.	clostridium difficile is the most commonly reported nosocomial pathogen in the united states and is an urgent public health concern worldwide. over the past decade, incidence, severity and costs associated with c. difficile infection (cdi) have increased dramatically. cdi is most commonly initiated by antibiotic-mediated disruption of the gut microbiota; however, non-antibiotic-associated cdi cases are well documented and on the rise. this suggests that unexplored environmental, nutrient and hos ...	2016	27668938
effect of fecal microbiota transplantation on recurrence in multiply recurrent clostridium difficile infection: a randomized trial.	to date, evidence for the efficacy of fecal microbiota transplantation (fmt) in recurrent clostridium difficile infection (cdi) has been limited to case series and open-label clinical trials.	2016	27547925
toxin profiles, pcr ribotypes and resistance patterns of clostridium difficile: a multicentre study in china, 2012-2013.	a total of 178 clinical isolates of clostridium difficile were collected from five major teaching hospitals representing northern, eastern and southern china from august 2012 to july 2013. among the 178 isolates, 162 (91.0%) were toxigenic, including 66 (40.7%) toxin a-negative, toxin b-positive, 95 (58.6%) toxin a-positive, toxin b-positive and only 1 (0.6%) toxin a-, toxin b- and binary toxin-positive. twenty-nine different pcr ribotypes were identified, of which 017 (21.0%), 012 (17.3%) and n ...	2016	27793509
snp-ing out the differences: investigating differences between clostridium difficile lab strains.		2016	27791481
molecular characteristics of clostridium difficile isolates from human and animals in the north eastern region of india.	a total of 1034 samples were collected from different sources and c. difficile was isolated from 18 (9.04%) of 199 human, 9 (4.89%) of 184 cattle, 29 (12.44%) of 233 pig, and from 23 (13.94%) of 165 poultry samples. variations were observed on the rate of isolation according to age and clinical conditions (diarrhoea). none of the samples from cow, sheep, goat, local chicken, and wild animals yielded any c. difficile. out of those isolates, 8, 2, 19 and 6 isolates from human, cattle, pig and poul ...	2016	27569848
efficacy of oral vancomycin in preventing recurrent clostridium difficile infection in patients treated with systemic antimicrobial agents.		2016	27567123
molecular characterisation of czech clostridium difficile isolates collected in 2013-2015.	clostridium difficile is a leading nosocomial pathogen and molecular typing is a crucial part of monitoring its occurrence and spread. over a three-year period (2013-2015), clinical c. difficile isolates from 32 czech hospitals were collected for molecular characterisation. of 2201 c. difficile isolates, 177 (8%) were non-toxigenic, 2024 (92%) were toxigenic (tcda and tcdb) and of these, 677 (33.5%) carried genes for binary toxin production (cdta, cdtb). capillary-electrophoresis (ce) ribotyping ...	2016	27519407
[clostridium difficile infections in geriatric patients].	clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in europe and north america. infections with c. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. other risk factors are proton pump inhibitors, which are taken by many elderly patients. the main virulence factors are toxins a and b. the clinical spectrum ranges from asymptomatic colonization to severe disease with abdominal complications and sepsis. the cur ...	2016	27785569
antibiotic treatment of hospitalized patients with pneumonia complicated by clostridium difficile infection.	clostridium difficile infection (cdi) is one of the most common gastrointestinal complication after antimicrobial treatment. it is estimated that cdi after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. the aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia cdi. we addressed the issue by examining retrospectively the records of 217 patients who met the diagno ...	2016	27620311
clostridium difficile presence in spanish and belgian hospitals.	clostridium difficile is recognised worldwide as the main cause of infectious bacterial antibiotic-associated diarrhoea in hospitals and other healthcare settings. the aim of this study was to first survey c. difficile prevalence during the summer of 2014 at the central university hospital of asturias (spain). by typing the isolates obtained, it was then possible to compare the ribotype distribution at the spanish hospital with results from the st luc university hospital in belgium over the same ...	2016	27616443
newly identified bacteriolytic enzymes that target a wide range of clinical isolates of clostridium difficile.	clostridium difficile has emerged as a major cause of infectious diarrhea in hospitalized patients, with increasing mortality rate and annual healthcare costs exceeding $3 billion. since c. difficile infections are associated with the use of antibiotics, there is an urgent need to develop treatments that can inactivate the bacterium selectively without affecting commensal microflora. lytic enzymes from bacteria and bacteriophages show promise as highly selective and effective antimicrobial agent ...	2016	27260850
drug utilization review of cephalosporins in a secondary care hospital in united arab emirates.	background cephalosporins are one of the most commonly used antibiotics in united arab emirates (uae). few studies have been carried out to evaluate the antibiotic utilization pattern in uae in spite of the obvious increase in cephalosporins resistance during the past decade. objective to assess the prescriptions pattern of cephalosporins among physicians at a secondary care hospital in ras al khaimah, uae. method this observational prospective study was carried out during october 2013 to april ...	2016	27817172
identification of risk factors associated with clostridium difficile infection in liver transplantation recipients: a single-center analysis.	clostridium difficile remains the leading cause of health care-associated infectious diarrhea, and its incidence and severity are increasing in liver transplant recipients. several known risk factors for c difficile infection (cdi) are inherently associated with liver transplantation, such as severe underlying illness, immunosuppression, abdominal surgery, and broad-spectrum antibiotic use. we conducted a single-center retrospective case control study to characterize risk factors for cdi among p ...	2016	27788814
assessing methanobrevibacter smithii and clostridium difficile as not conventional faecal indicators in effluents of a wastewater treatment plant integrated with sludge anaerobic digestion.	wastewater treatment plants (wwtp) are an important source of surface water contamination by enteric pathogens, affecting the role of environmental water as a microbial reservoir. we describe the release to the environment of certain anaerobes of human and environmental concern. the work was focused on emerging microbial targets. they are tracing, by rt-qpcr, on wwtp effluents, both liquid and solid, when an anaerobic digestion step is included. the focus is placed on clostridium spp. with the s ...	2016	27697372
new and emerging therapies for clostridium difficile infection.	clostridium difficile infection has attained high prominence given its prevalence and impacts on patients and healthcare institutions. multiple new approaches to the prevention and treatment of c. difficile infection (cdi) are undergoing clinical trials.	2016	27753689
crystal structures of two nitroreductases from hypervirulent clostridium difficile and functionally related interactions with the antibiotic metronidazole.	nitroreductases (nrs) are flavin mononucleotide (fmn)-dependent enzymes that catalyze the biotransformation of organic nitro compounds (rno2; r = alkyl, aryl) to the nitroso rn=o, hydroxylamino rnhoh, or amine rnh2 derivatives. metronidazole (mtz) is a nitro-containing antibiotic that is commonly prescribed for lower-gut infections caused by the anaerobic bacterium clostridium difficile. c. difficile infections rank number one among hospital acquired infections, and can result in diarrhea, sever ...	2016	27623089
a dna vaccine targeting tcda and tcdb induces protective immunity against clostridium difficile.	clostridium difficile-associated disease (cdad) constitutes a great majority of hospital diarrhea cases in industrialized countries and is induced by two types of large toxin molecules: toxin a (tcda) and toxin b (tcdb). development of immunotherapeutic approaches, either active or passive, has seen a resurgence in recent years. studies have described vaccine plasmids that express either tcda and/or tcdb receptor binding domain (rbd). however, the effectiveness of one vector encoding both toxin ...	2016	27770789
the projected effectiveness of clostridium difficile vaccination as part of an integrated infection control strategy.	early clinical trials of a clostridium difficile toxoid vaccine show efficacy in preventing c. difficile infection (cdi). the optimal patient group to target for vaccination programmes remains unexplored. this study performed a model-based evaluation of the effectiveness of different cdi vaccination strategies, within the context of existing infection prevention and control strategies such as antimicrobial stewardship.	2016	27727031
endoscopic peroral jejunal fecal microbiota transplantation.	fecal microbiota transplantation (fmt) is a valuable treatment modality for recurrent clostridium difficile (c. difficile) colitis. multiple questions including the best delivery route and volume remain unanswered. here, we report a case series of high-volume fmt using endoscopic jejunal application route.	2016	27575658
positive predictive value of the immunoassay for clostridium difficile toxin a and b detection at a private hospital.	clostridium difficile (c. difficile) is a gram-positive bacillus that is a common cause of diarrhea in the hospital environment, with a documented incidence of up to 10%. there are different methods to detect it, but a widely used test in our environment is the immunoassay for toxins a and b.	2016	27316592
[laboratory diagnosis of clostridium difficile infection].	clostridium difficile is the leading cause of nosocomial diarrhoea in developed countries, and is one of the main aetiologic agents of community diarrhea. the eruption of the hypervirulent strain bi/nap1/027 has given rise to an increase in the morbidity and mortality of c.difficile infection (cdi). this document aims to review the main clinical pictures of cdi and the laboratory diagnosis, including sampling, transport and storage of specimens, specimen processing, diagnostic procedures, antimi ...	2016	26493356
rapid identification of the etiological factors causing diarrheal diseases.	the main objective of this investigation was to develop and pilot a real-time polymerase chain reaction (rt-pcr) diagnostic system for rapid and simultaneous identification of pathogens with a particular emphasis on diarrheal disease diagnostics. the diarrheal diseases were selected as a target for the pilot because they constitute a primary public health priority in georgia and worldwide. the product developed by our research team "neo_pcr_diagnostics" represents an original system for the iden ...	2016	27770538
epidemiology and recurrence rates of clostridium difficile infections in germany: a secondary data analysis.	clostridium difficile infection (cdi) is the most common cause of health-care-associated infectious diarrhea. recurrence rates are as high as 20-30% after standard treatment with metronidazole or vancomycin, and appear to be reduced for patients treated with fidaxomicin. according to the literature, the risk of cdi recurrence increases after the second relapse to 30-65%. accurate data for germany are not yet available.	2016	27770261
therapeutic manipulation of the microbiota: past, present, and considerations for the future.	the growing appreciation of the potential role of indigenous microbiota in disease has resulted in a concomitant interest in manipulating the microbiome for therapeutic effect. the most successful example of microbiota manipulation for treatment of a disease is in recurrent infection with the bacterial pathogen clostridium difficile.	2016	27619640
correction: importance of glutamate dehydrogenase (gdh) in clostridium difficile colonization in vivo.	[this corrects the article doi: 10.1371/journal.pone.0160107.].	2016	27768767
household transmission of clostridium difficile to family members and domestic pets.	objective to determine the risk of clostridium difficile transmission from index cases with c. difficile infection (cdi) to their household contacts and domestic pets. design a prospective study from april 2011 to june 2013. setting patients with cdi from canadian tertiary care centers. participants patients with cdi, their household human contacts, and pets. methods epidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. ...	2016	27767004
wall teichoic acids are involved in the medium-induced loss of function of the autolysin cd11 against clostridium difficile.	bacterial lysins are potent antibacterial enzymes with potential applications in the treatment of bacterial infections. some lysins lose activity in the growth media of target bacteria, and the underlying mechanism remains unclear. here we use cd11, an autolysin of clostridium difficile, as a model lysin to demonstrate that the inability of this enzyme to kill c. difficile in growth medium is not associated with inhibition of the enzyme activity by medium, or the modification of the cell wall pe ...	2016	27759081
the monoclonal antitoxin antibodies (actoxumab-bezlotoxumab) treatment facilitates normalization of the gut microbiota of mice with clostridium difficile infection.	antibiotics have significant and long-lasting impacts on the intestinal microbiota and consequently reduce colonization resistance against clostridium difficile infection (cdi). standard therapy using antibiotics is associated with a high rate of disease recurrence, highlighting the need for novel treatment strategies that target toxins, the major virulence factors, rather than the organism itself. human monoclonal antibodies mk-3415a (actoxumab-bezlotoxumab) to c. difficile toxin a and toxin b, ...	2016	27757389
frizzled proteins are colonic epithelial receptors for c. difficile toxin b.	clostridium difficile toxin b (tcdb) is a critical virulence factor that causes diseases associated with c. difficile infection. here we carried out crispr-cas9-mediated genome-wide screens and identified the members of the wnt receptor frizzled family (fzds) as tcdb receptors. tcdb binds to the conserved wnt-binding site known as the cysteine-rich domain (crd), with the highest affinity towards fzd1, 2 and 7. tcdb competes with wnt for binding to fzds, and its binding blocks wnt signalling. fzd ...	2016	27680706
shoe soles as a potential vector for pathogen transmission: a systematic review.	shoe soles are possible vectors for infectious diseases. although studies have been performed to assess the prevalence of infectious pathogens on shoe soles and decontamination techniques, no systematic review has ever occurred. the aim of this study was to perform a systematic review of the literature to determine the prevalence of infectious agents on shoe bottoms and possible decontamination strategies. three electronic bibliographic databases were searched using a predefined search strategy ...	2016	27495010
nosocomial clostridium difficile-associated diarrhoea in assiut university children's hospital, egypt.	there are no large epidemiological studies of clostridium difficile-associated disease (cdad) in hospitalised children.	2016	25496416
burden of six healthcare-associated infections on european population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study.	estimating the burden of healthcare-associated infections (hais) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. based on the methodology of the burden of communicable diseases in europe (bcode) project and 2011-2012 data from the european centre for disease prevention and control (ecdc) point prevalence survey (pps) of hais and antimicrobial use in european acute care hospit ...	2016	27755545
the use and efficacy of fecal microbiota transplantation for refractory clostridium difficile in patients with inflammatory bowel disease.	clostridium difficile (cd) is an anaerobic, spore-forming bacillus that is responsible for a spectrum of gastrointestinal illness ranging from asymptomatic carriage to toxic megacolon and death. the prevalence of cd infection is increasing in both hospitalized and community-based inflammatory bowel disease populations. standard antibiotic therapy fails to cure or prevent recurrence in more than 50% of patients, thus increasing the need for alternative therapies. recently, fecal microbiota transp ...	2016	27755271
increased rates of clostridium difficile infection and poor outcomes in patients with ibd with cytomegalovirus.	clostridium difficile infection (cdi) and cytomegalovirus (cmv) reactivation are associated with disease exacerbations and poor outcomes in inflammatory bowel disease (ibd). therefore, we assessed the association between these organisms in patients with ibd and the impact on colectomy.	2016	27755270
emergence and spread of moxifloxacin-resistant clostridium difficile ribotype 231 in sweden between 2006 and 2015.	an aggregation of moxifloxacin-resistant clostridium difficile ribotype 231 (rt231) isolates was first identified in the county of stockholm in 2008, and by the end of 2015 isolates of rt231 had spread to 13 of 21 swedish counties. we investigated the epidemiology of c. difficile rt231 in sweden between 2006 and 2015 using whole genome sequencing (wgs) and evaluated whether its emergence could be associated with extended moxifloxacin use. we performed wgs and phylogenetic analysis of 51 c. diffi ...	2016	27752322
thermal contrast amplification reader yielding 8-fold analytical improvement for disease detection with lateral flow assays.	there is an increasing need for highly sensitive and quantitative diagnostics at the point-of-care. the lateral flow immunoassay (lfa) is one of the most widely used point-of-care diagnostic tests; however, lfas generally suffer from low sensitivity and lack of quantification. to overcome these limitations, thermal contrast amplification (tca) is a new method that is based on the laser excitation of gold nanoparticles (gnps), the most commonly used visual signature, to evoke a thermal signature. ...	2016	27750420
successful colonoscopic fecal microbiota transplantation for active ulcerative colitis: first report from india.	forty-four-year-old male with ulcerative colitis (uc) for 11 years reported frequent relapse despite daily sulfasalazine 4 g, azathioprine 125 mg, and rectal 5-aminosalicylic acid. repeated use of corticosteroids led to cataract. at enrollment, he was passing eight stools a day with blood with a mayo score of 9 (3+1+3+2). stool was negative for ova/cysts/acid fast bacilli and clostridium difficile toxin assay. rectal biopsy showed cryptitis, crypt abscess, and crypt distortion with no inclusion ...	2016	27718119
[recurrences in clostridium difficile infections in cancer patients].		2016	27293195
the cost-efficiency and care effectiveness of probiotic administration with antibiotics to prevent hospital-acquired clostridium difficile infection.	health care facility-acquired clostridium difficile infections (hcfa-cdi) have increased over the last several decades despite facilities developing protocols for prescribing probiotics with antibiotics to prevent hcfa-cdi. the literature does not consistently support this. a retrospective medical record review evaluated the care effectiveness of this practice. care effectiveness was not found; patients receiving probiotics with antibiotics were twice as likely to develop hcfa-cdi (p = .004). ex ...	2016	27749722
laboratory experience with the liaison analyzer in the diagnosis of clostridium difficile-associated diarrhea.	chemiluminescent or enzyme-linked fluorescent immunoassays are commonly used to diagnose clostridium difficile-associated diarrhea.	2016	27766170
healthcare personnel attire and devices as fomites: a systematic review.	background transmission of pathogens within the hospital environment remains a hazard for hospitalized patients. healthcare personnel clothing and devices carried by them may harbor pathogens and contribute to the risk of pathogen transmission. objective to examine bacterial contamination of healthcare personnel attire and commonly used devices. methods systematic review. results of 1,175 studies screened, 72 individual studies assessed contamination of a variety of items, including white coats, ...	2016	27609491
mortality and costs in clostridium difficile infection among the elderly in the united states.	objective to examine attributable mortality and costs of clostridium difficile infection (cdi) in the medicare population. design a population-based cohort study among us adults aged at least 65 years in the 2008-2010 medicare 5% sample, with follow-up of 12 months. patients incident cdi episode was defined by the international classification of diseases, ninth revision, clinical modification code of 008.45 and no other occurrences within the preceding 12 months. to quantify the adjusted mortali ...	2016	27572289
a regional outbreak of clostridium difficile pcr-ribotype 027 infections in southeastern france from a single long-term care facility.	objective to describe and analyze a large outbreak of clostridium difficile 027 (cd-027) infections. methods confirmed cd-027 cases were defined as cd infection plus real-time polymerase chain reaction assay (pcr) positive for cd-027. clinical and microbiological data on patients with cd-027 infection were collected from january 2013 to december 2015 in the provence-alpes-côte-d'azur region (southeastern france). results in total, 19 healthcare facilities reported 144 cd-027 infections (112 conf ...	2016	27484769
gut microbiota differences in children from distinct socioeconomic levels living in the same urban area in brazil.	to compare gut microbiota in impoverished children versus children of high socioeconomic status living in the same urban area in brazil.	2016	26982745
clostridium difficile environmental contamination within a clinical laundry facility in the usa.	clostridium difficile is both a hospital and community acquired pathogen. the current study determined if c. difficile could be cultured from clinical laundry facility surfaces. a total of 240 surface samples were collected from dirty areas (n = 120), which handle soiled clinical linens, and from clean areas (n = 120), which process and fold the clean linens, within the university of washington consolidated laundry facility in 2015. sampling was done four times over the course of one year. the d ...	2016	27744367
the tipping point: patients predisposed to clostridium difficile infection and a hospital antimicrobial stewardship programme.	the incidence and severity of clostridium difficile infection (cdi) have increased in recent years. predictive models may help to identify at-risk patients before the onset of infection. early identification of high-risk patients could help antimicrobial stewardship (ams) programmes and other initiatives to better prevent c. difficile in these patients.	2016	27742079
a clostridium difficile cell wall glycopolymer locus influences bacterial shape, polysaccharide production and virulence.	clostridium difficile is a diarrheagenic pathogen associated with significant mortality and morbidity. while its glucosylating toxins are primary virulence determinants, there is increasing appreciation of important roles for non-toxin factors in c. difficile pathogenesis. cell wall glycopolymers (cwgs) influence the virulence of various pathogens. five c. difficile cwgs, including psii, have been structurally characterized, but their biosynthesis and significance in c. difficile infection is un ...	2016	27741317
probiotics and liver disease: where are we now and where are we going?	probiotics are live, nonpathogenic bacteria capable of colonizing the colonic mucosa. the most common probiotics include strains of lactobacillus or bifidobacteria, which are part of the normal gastrointestinal microbiota. initial studies of selected probiotic species have suggested potential efficacy in several gastrointestinal diseases including inflammatory bowel diseases (particularly pouchitis), antibiotic-related diarrhea, clostridium difficile toxin-induced colitis, infectious diarrhea, i ...	2016	27741172
probiotics history.	gut microbiota promotes healthy effects on the host and prevents diseases. probiotic (probios, for life) are defined as "live microorganisms which when administered in adequate amounts confer a health benefit on the host." at the beginning of 1900s louis pasteur identified the microorganisms responsible for the process of fermentation, whereas e. metchnikoff associated the enhanced longevity of bulgarian rural people to the regular consumption of fermented dairy products such as yogurt. he sugge ...	2016	27741152
selected topics in anaerobic bacteriology.	alteration in the host microbiome at skin and mucosal surfaces plays a role in the function of the immune system, and may predispose immunocompromised patients to infection. because obligate anaerobes are the predominant type of bacteria present in humans at skin and mucosal surfaces, immunocompromised patients are at increased risk for serious invasive infection due to anaerobes. laboratory approaches to the diagnosis of anaerobe infections that occur due to pyogenic, polymicrobial, or toxin-pr ...	2016	27726792
receipt of antibiotics in hospitalized patients and risk for clostridium difficile infection in subsequent patients who occupy the same bed.	to assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for cdi in subsequent patients who occupy the same bed.	2016	27723860
more than 50% of clostridium difficile isolates from pet dogs in flagstaff, usa, carry toxigenic genotypes.	nosocomial acquisition of clostridium difficile is well documented, yet recent studies have highlighted the importance of community acquired infections and identified community associated reservoirs for this pathogen. multiple studies have implicated companion pets and farm animals as possible sources of community acquired c. difficile infections in humans. to explore the potential role of pet dogs in human c. difficile infections we systematically collected canine fecal samples (n = 197) in fla ...	2016	27723795
fecal microbiota-based therapeutics for recurrent clostridium difficile infection, ulcerative colitis and obesity.	the human gut microbiome is a complex ecosystem of fundamental importance to human health. our increased understanding of gut microbial composition and functional interactions in health and disease states has spurred research efforts examining the gut microbiome as a valuable target for therapeutic intervention. this review provides updated insight into the state of the gut microbiome in recurrent clostridium difficile infection (cdi), ulcerative colitis (uc), and obesity while addressing the ra ...	2016	27720396
rapid change of fecal microbiome and disappearance of clostridium difficile in a colonized infant after transition from breast milk to cow milk.	clostridium difficile is the most common known cause of antibiotic-associated diarrhea. upon the disturbance of gut microbiota by antibiotics, c. difficile establishes growth and releases toxins a and b, which cause tissue damage in the host. the symptoms of c. difficile infection disease range from mild diarrhea to pseudomembranous colitis and toxic megacolon. interestingly, 10-50 % of infants are asymptomatic carriers of c. difficile. this longitudinal study of the c. difficile colonization in ...	2016	27717398
longitudinal survey of clostridium difficile presence and gut microbiota composition in a belgian nursing home.	increasing age, several co-morbidities, environmental contamination, antibiotic exposure and other intestinal perturbations appear to be the greatest risk factors for c. difficile infection (cdi). therefore, elderly care home residents are considered particularly vulnerable to the infection. the main objective of this study was to evaluate and follow the prevalence of c. difficile in 23 elderly care home residents weekly during a 4-month period. a c. difficile microbiological detection scheme wa ...	2016	27716140
crystal structure and dna binding activity of a padr family transcription regulator from hypervirulent clostridium difficile r20291.	clostridium difficile is a spore-forming obligate anaerobe that can remain viable for extended periods, even in the presence of antibiotics, which contributes to the persistence of this bacterium as a human pathogen during host-to-host transmission and in hospital environments. we examined the structure and function of a gene product with the locus tag cdr20291_0991 (cdpadr1) as part of our broader goal aimed at elucidating transcription regulatory mechanisms involved in virulence and antibiotic ...	2016	27716049
characterization of the adherence of clostridium difficile spores: the integrity of the outermost layer affects adherence properties of spores of the epidemic strain r20291 to components of the intestinal mucosa.	clostridium difficile is the causative agent of the most frequently reported nosocomial diarrhea worldwide. the high incidence of recurrent infection is the main clinical challenge of c. difficile infections (cdi). formation of c. difficile spores of the epidemic strain r20291 has been shown to be essential for recurrent infection and transmission of the disease in a mouse model. however, the underlying mechanisms of how these spores persist in the colonic environment remains unclear. in this wo ...	2016	27713865
effect of detecting and isolating asymptomatic clostridium difficile carriers-reply.		2016	27695841