Publications

cleaning the grey zones of hospitals: a prospective, crossover, interventional study.	environmental cleaning is a fundamental principle of infection prevention in hospitals, but its role in reducing transmission of health care-acquired pathogens has been difficult to prove experimentally. in this study we analyze the influence of cleaning previously uncleaned patient care items, grey zones (gz), on health care-acquired transmission rates.	2016	27397907
[oncologic aspects of clostridium difficile].	clostridium difficile infection is one of the most frequent among cancer patients. its diagnosis is complicated by the fact that the symptoms of the infection and the side effects of the anticancer treatments could be similar. chemotherapy itself might facilitate clostridium difficile infection. several risk factors are known but clostridium difficile infection can develop in the absence of these. neutreopenia is a risk factor for fatal clostridium difficile infection and also the side effect of ...	2016	27397423
infectious diarrhea: norovirus and clostridium difficile in older adults.	norovirus infection usually results in acute gastroenteritis, often with incapacitating nausea, vomiting, and diarrhea. it is highly contagious and resistant to eradication with alcohol-based hand sanitizer. appropriate preventative and infection control measures can mitigate the morbidity and mortality associated with norovirus infection. clostridium difficile infection is the leading cause of health care-associated diarrhea in the united states. antibiotic use is by far the most common risk fa ...	2016	27394020
binary toxin and its clinical importance in clostridium difficile infection, belgium.	binary toxin-producing clostridium difficile strains such as ribotypes 027 and 078 have been associated with increased clostridium difficile infection (cdi) severity. our objective was to investigate the association between presence of the binary toxin gene and cdi severity and recurrence. we performed a laboratory-based retrospective study including patients between january 2013 and march 2015 whose fecal samples were analyzed by polymerase chain reaction (pcr) for the presence of the genes for ...	2016	27393490
utility of prophylactic antibiotics in nonoperative facial fractures.	facial fractures are commonly managed nonoperatively. patients with facial fractures involving sinus cavities commonly receive 7 to 10 days of prophylactic antibiotics, yet no literature exists to support or refute this practice. the aim of this study was to compare the administration and duration of antibiotic prophylaxis on the incidence of soft tissue infection in nonoperative facial fractures. a total number of 289 patients who were admitted to our level i trauma center with nonoperative fac ...	2016	27391655
an exploratory study to evaluate clostridium difficile polymerase chain reaction ribotypes and infection outcomes.	clostridium difficile infection ranges from mild to severe prolonged diarrhea with systemic symptoms. previous studies have assessed the correlation of some disease severity parameters to c. difficile ribotypes. however, certain clinical parameters of interest have not yet been evaluated.	2016	27390531
the efficacy of intracolonic vancomycin for severe clostridium difficile colitis: a case series.	clostridium difficile infection (cdi) unresponsive to the standard treatments of metronidazole and oral vancomycin requires aggressive medical management and possible surgical intervention including colectomy. intracolonic vancomycin therapy has been reported to be particularly promising in the setting of severe cdi in the presence of ileus. this is a descriptive case series exploring the effect of adjunctive intracolonic vancomycin therapy on the morbidity and mortality in patients with moderat ...	2016	27388627
male veterans with complicated urinary tract infections: influence of a patient-centered antimicrobial stewardship program.	the influence of antimicrobial stewardship programs (asps) on outcomes in male veterans treated for complicated urinary tract infection has not been determined.	2016	27388268
management of inflammatory bowel disease in the elderly.	a substantial and growing proportion of patients with inflammatory bowel disease (ibd) are elderly, and these patients require tailored treatment strategies. however, significant challenges exist in the management of this population due to the paucity of data. establishing the initial diagnosis and assessing the etiology of future symptoms and flares can be challenging as several other prevalent diseases can masquerade as ibd, such as ischemic colitis, diverticular disease, and infectious coliti ...	2016	27387455
active caspase-1 induces plasma membrane pores that precede pyroptotic lysis and are blocked by lanthanides.	canonical inflammasome activation induces a caspase-1/gasdermin d (gsdmd)-dependent lytic cell death called pyroptosis that promotes antimicrobial host defense but may contribute to sepsis. the nature of the caspase-1-dependent change in plasma membrane (pm) permeability during pyroptotic progression remains incompletely defined. we assayed propidium(2+) (pro(2+)) influx kinetics during nlrp3 or pyrin inflammasome activation in murine bone marrow-derived macrophages (bmdms) as an indicator of th ...	2016	27385778
fecal transplant for clostridium difficile infection relapses using "pooled" frozen feces from non-related donors.		2016	27382953
rifamycin resistance in clostridium difficile is generally associated with a low fitness burden.	we characterized clinically occurring and novel mutations in the β subunit of rna polymerase in clostridium difficile (cdrpob), conferring rifamycin (including rifaximin) resistance. the arg505lys substitution did not impose an in vitro fitness cost, which may be one reason for its dominance among rifamycin-resistant clinical isolates. these observations were supported through the structural modeling of cdrpob. in general, most mutations lacked in vitro fitness costs, suggesting that rifamycin r ...	2016	27381389
non-slip socks: a potential reservoir for transmitting multidrug-resistant organisms in hospitals?	non-slip socks are increasingly used to prevent falls in hospitals. patients use them to walk to various parts of the hospital and also wear them in bed. fifty-four pairs of socks and 35 environmental floor samples were obtained from seven wards in a tertiary referral hospital. vancomycin-resistant enterococci (vre) were detected from 46 (85%) socks and meticillin-resistant staphylococcus aureus (mrsa) from five (9%). environmental sampling cultured vre from 24 (69%) floor samples and mrsa from ...	2016	27380919
receptors and binding structures for clostridium difficile toxins a and b.	two characteristics of toxins a and b from c. difficile (tcda, tcdb) are important for the understanding of the pathogenic effect of these homologous toxins. first, these toxins are huge single-chain but multidomain proteins that display their action intracellularly within the cytosol of host cells. and second, albeit various cell types highly differ in their sensitivity toward these toxins, no toxin-resistant cell type has been described yet. investigation of receptor-mediated uptake of these t ...	2016	27380268
the epidemiology and clinical features of clostridium difficile infection in liver transplant recipients.	clostridium difficile infection (cdi) is common after liver transplantation (lt); however, few studies have examined the risk factors, clinical manifestations, and outcomes of cdi in this population.	2016	27379554
cost-effectiveness analysis of the use of probiotics for the prevention of clostridium difficile-associated diarrhea in a provincial healthcare system.	objective to conduct a full economic evaluation assessing the costs and consequences related to probiotic use for the primary prevention of clostridium difficile-associated diarrhea (cdad). design cost-effectiveness analysis using decision analytic modeling. methods a cost-effectiveness analysis was used to evaluate the risk of cdad and the costs of receiving oral probiotics versus not over a time horizon of 30 days. the target population modeled was all adult inpatients receiving any therapeuti ...	2016	27377992
proton pump inhibitors should be used with caution in critically ill patients to prevent the risk of clostridium difficile infection.		2016	27377737
community-acquired clostridium difficile infections in emergency departments.	clostridium difficile infection (cdi) has become an emerging infectious disease, especially in community settings. little data is available on its frequency and characteristics in france. we aimed to describe cdi case patients consulting at the emergency department and to compare community-acquired and nosocomial cdis.	2016	27377443
subboiling moist heat favors the selection of enteric pathogen clostridium difficile pcr ribotype 078 spores in food.	emerging enteric pathogens could have not only more antibiotic resistance or virulence traits; they could also have increased resistance to heat. we quantified the effects of minimum recommended cooking and higher temperatures, individually on a collection of c. difficile isolates and on the survival probability of a mixture of emerging c. difficile strains. while minimum recommended cooking time/temperature combinations (63-71°c) allowed concurrently tested strains to survive, higher subboiling ...	2016	27375748
clostridium difficile-associated disease: a primary clinical evaluation of elderly patients in a geriatric hospital.	the purpose of this study was to screen all cases of clostridium difficile-associated disease during a 2-year period in a geriatric hospital to determine the incidence and clinical characteristics related to this risk. twenty percent of suspected cases were diagnosed as positive and analyzed. the c difficile disease-associated clinical factors were ischemic heart disease and chronic obstructive pulmonary disease. use of acetylsalicylic acid, other nonsteroidal anti-inflammatory drugs, and steroi ...	2016	27375063
targeting the ecology within: the role of the gut-brain axis and human microbiota in drug addiction.	despite major advances in our understanding of the brain using traditional neuroscience, reliable and efficacious treatments for drug addiction have remained elusive. hence, the time has come to utilize novel approaches, particularly those drawing upon contemporary advances in fields outside of established neuroscience and psychiatry. put another way, the time has come for a paradigm shift in the addiction sciences. apropos, a revolution in the area of human health is underway, which is occurrin ...	2016	27372861
reduction in clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection.	the clinical impact of implementing hydrogen peroxide vapour (hpv) disinfection of rooms vacated by patients with clostridium difficile infection (cdi) was evaluated. breakpoint time series analysis indicated a significant reduction (p<0.001) in the cdi rate at the time when hpv disinfection was implemented, resulting in a reduction in the cdi rate from 1.0 to 0.4 cases per 1000 patient-days in the 24 months before hpv usage compared with the first 24 months of hpv usage. hpv should be considere ...	2016	27372150
a diverse soil microbiome degrades more crude oil than specialized bacterial assemblages obtained in culture.	soil microbiome modification may alter system function, which may enhance processes like bioremediation. in this study, we filled microcosms with gamma-irradiated soil that was reinoculated with the initial soil or cultivated bacterial subsets obtained on regular media (reg-m) or media containing crude oil (co-m). we allowed 8 weeks for microbiome stabilization, added crude oil and monoammonium phosphate, incubated the microcosms for another 6 weeks, and then measured the biodegradation of crude ...	2016	27371586
epidemiology and risk factors for community-associated clostridium difficile infection: a narrative review.	clostridium difficile infection (cdi) was once considered a primarily nosocomial concern. emerging evidence from the last 20 years has highlighted a drastic shift in the known epidemiology of cdi, with disease outside of hospitals apparently occurring more frequently and causing severe disease in populations that were thought to be at low risk. this narrative review summarises potential pathways for infection outside of the hospital environment and highlights likely routes of transmission. furth ...	2016	27370914
reclassification of clostridium difficile as clostridioides difficile (hall and o'toole 1935) prévot 1938.	the recent proposal by lawson and rainey (2015) to restrict the genus clostridium to clostridium butyricum and related species has ramifications for the members of the genera that fall outside this clade that should not be considered as clostridium sensu stricto. one such organism of profound medical importance is clostridioides difficile that is a major cause of hospital-acquired diarrhea and mortality in individuals. based on 16s rrna gene sequence analysis, the closest relative of clostridium ...	2016	27370902
type iv pili promote early biofilm formation by clostridium difficile.	increasing morbidity and mortality from clostridium difficile infection (cdi) present an enormous challenge to healthcare systems. clostridium difficile express type iv pili (t4p), but their function remains unclear. many chronic and recurrent bacterial infections result from biofilms, surface-associated bacterial communities embedded in an extracellular matrix. cdi may be biofilm mediated; t4p are important for biofilm formation in a number of organisms. we evaluate the role of t4p in c. diffic ...	2016	27369898
characterization of clostridium difficile strains in british columbia, canada: a shift from nap1 majority (2008) to novel strain types (2013) in one region.	background. clostridium difficile is a major cause of gastrointestinal illness. epidemic nap1 strains contain toxins a and b, a deletion in repressor tcdc, and a binary toxin. objectives. to determine the molecular epidemiology of c. difficile in british columbia and compare between two time points in one region. methods. c. difficile isolates from hospital and community laboratories (2008) and one island health hospital laboratory (2013) were characterized by pulsed-field gel electrophoresis, p ...	2016	27366181
fidaxomicin versus vancomycin in the treatment of clostridium difficile infection: canadian outcomes.	background. this analysis examined the efficacy of fidaxomicin versus vancomycin in 406 canadian patients with clostridium difficile infection (cdi), based on data from 2 randomized, clinical trials. methods. patients received fidaxomicin or vancomycin 1. patients were assessed for clinical response recurrence of infection and sustained clinical response for 28 days after treatment completion. patients at increased risk of recurrence were subjected to subgroup analyses. results. clinical respons ...	2016	27366179
antibodies to toxin b are protective against clostridium difficile infection recurrence.	although newer studies have evaluated risk factors for recurrent clostridium difficile infection (cdi), the vast majority did not measure important biomarkers such as endogenous anti-toxin a and anti-toxin b antibody levels.	2016	27365387
editorial commentary: where to place the new treatments for clostridium difficile infection?		2016	27365386
[infection control from the viewpoint of medical safety by our clinical laboratory in tmdu hospital].	infection control based on appropriate bacteriological examinations and information is important for medical safety. i present the activities performed by our clinical laboratory in tokyo medical and dental university (tmdu) hospital. we detected and reported the first japanese case of kpc-2 carbapenemase-producing klebsiella pneumoniae, of which infection will be a serious problem in the near future in japan. we examine the antigen and toxins of clostridium difficile with an immunochromatograph ...	2016	27363226
[relationship between clostridium difficile its-pcr type and pathogenicity].	clostridium difficile (c. difficile) causes antibiotic-associated diarrhea and nosocomial infection. the pcr of internal transcribed spacer regions (its) is easily conductible in a relatively short time. the purpose of the current study is to classify c. difficile by pcr electrophoresis pattern of its (its-pcr type) and estimate the relationship of the its-pcr type of c. difficile with its pathogenicity. we examined 77 strains which were obtained in our hospital from march 2012 to august 2013. t ...	2016	27363217
editorial commentary: potential risks and rewards with prophylaxis for clostridium difficile infection.		2016	27358349
risk factors for clostridium difficile diarrhea in patients with solid organ transplantation.	there is limited knowledge about specific risk factors for clostridium difficile infection (cdi).	2016	27358344
laboratory identification of anaerobic bacteria isolated on clostridium difficile selective medium.	despite increasing interest in the bacterium, the methodology for clostridium difficile recovery has not yet been standardized. cycloserine-cefoxitin fructose taurocholate (ccft) has historically been the most used medium for c. difficile isolation from human, animal, environmental, and food samples, and presumptive identification is usually based on colony morphologies. however, ccft is not totally selective. this study describes the recovery of 24 bacteria species belonging to 10 different gen ...	2016	27352971
deciphering adaptation strategies of the epidemic clostridium difficile 027 strain during infection through in vivo transcriptional analysis.	clostridium difficile is responsible for a wide spectrum of infection from asymptomatic carriage to severe, relapsing colitis. since 2003, c. difficile infections have increased with a higher morbidity and mortality due to the emergence of epidemic and hypervirulent c. difficile strains such as those of the epidemic lineage 027/bi/nap1. to decipher the hypervirulence and epidemicity of 027 strains, we analyzed gene expression profiles of the r20291 027 strain using a monoxenic mouse model during ...	2016	27351947
(1)h(n), (13)c, and (15)n resonance assignments of the cdtb-interacting domain (cdtabid) from the clostridium difficile binary toxin catalytic component (cdta, residues 1-221).	once considered a relatively harmless bacterium, clostridium difficile has become a major concern for healthcare facilities, now the most commonly reported hospital-acquired pathogen. c. difficile infection (cdi) is usually contracted when the normal gut microbiome is compromised by antibiotic therapy, allowing the opportunistic pathogen to grow and produce its toxins. the severity of infection ranges from watery diarrhea and abdominal cramping to pseudomembranous colitis, sepsis, or death. the ...	2016	27351891
clostridium difficile in food and animals: a comprehensive review.	zoonoses are infections or diseases that can be transmitted between animals and humans through direct contact, close proximity or the environment. clostridium difficile is ubiquitous in the environment, and the bacterium is able to colonise the intestinal tract of both animals and humans. since domestic and food animals frequently test positive for toxigenic c. difficile, even without showing any signs of disease, it seems plausible that c. difficile could be zoonotic. therefore, animals could p ...	2016	27350639
impact of antimicrobial stewardship on outcomes in hospitalized veterans with pneumonia.	the purpose of this study was to evaluate the impact of an antimicrobial stewardship program (asp) on outcomes for inpatients with pneumonia, including length of stay, treatment duration, and 30-day readmission rates.	2016	27349712
vital signs: preventing antibiotic-resistant infections in hospitals - united states, 2014.	healthcare-associated antibiotic-resistant (ar) infections increase patient morbidity and mortality and might be impossible to successfully treat with any antibiotic. cdc assessed healthcare-associated infections (hai), including clostridium difficile infections (cdi), and the role of six ar bacteria of highest concern nationwide in several types of healthcare facilities.	2016	27348802
microbiota-regulated il-25 increases eosinophil number to provide protection during clostridium difficile infection.	clostridium difficile infection (cdi) is the most common cause of hospital-acquired infection in the united states. host susceptibility and the severity of infection are influenced by disruption of the microbiota and the immune response. however, how the microbiota regulate immune responses to mediate cdi outcome remains unclear. here, we have investigated the role of the microbiota-linked cytokine il-25 during infection. intestinal il-25 was suppressed during cdi in humans and mice. restoration ...	2016	27346351
clinical characterization of clostridium difficile infection in elderly patients.		2016	27340722
septins guide microtubule protrusions induced by actin-depolymerizing toxins like clostridium difficile transferase (cdt).	hypervirulent clostridium difficile strains, which are associated with increased morbidity and mortality, produce the actin-adp ribosylating toxin clostridium difficile transferase (cdt). cdt depolymerizes actin, causes formation of microtubule-based protrusions, and increases pathogen adherence. here, we show that septins (sept) are essential for cdt-induced protrusion formation. sept2, -6, -7, and -9 accumulate at predetermined protrusion sites and form collar-like structures at the base of pr ...	2016	27339141
clostridium difficile infection: an emerging cause of death in the twenty-first century.	enterocolitis due to clostridium difficile is major emerging cause of death in the u.s. between 1999 and 2012, c. diff. deaths rose by a staggering almost ten-fold amount, to 7,739 from 793. this article has three goals. first, we present a demographic description of c. diff. mortality in the u.s. since 1999. second, we test a hypothesis that the increase in c. diff. deaths is due to population aging. we find that the emergence of this cause of death follows a proportional hazard pattern above a ...	2016	27337554
clostridium difficile infection.	clostridium difficile is an anaerobic, gram-positive, spore-forming, toxin-secreting bacillus that has long been recognized to be the most common etiologic pathogen of antibiotic-associated diarrhea. c. difficile infection (cdi) is now the most common cause of health care-associated infections in the united states and accounts for 12% of these infections (magill ss et al., n engl j med370:1198-1208, 2014). among emerging pathogens of public health importance in the united states, cdi has the hig ...	2016	27337475
novel clostridium difficile anti-toxin (tcda and tcdb) humanized monoclonal antibodies demonstrate in vitro neutralization across a broad spectrum of clinical strains and in vivo potency in a hamster spore challenge model.	clostridium difficile (c. difficile) infection (cdi) is the main cause of nosocomial antibiotic-associated colitis and increased incidence of community-associated diarrhea in industrialized countries. at present, the primary treatment of cdi is antibiotic administration, which is effective but often associated with recurrence, especially in the elderly. pathogenic strains produce enterotoxin, toxin a (tcda), and cytotoxin, toxin b (tcdb), which are necessary for c. difficile induced diarrhea and ...	2016	27336843
correlation between fecal calprotectin levels, disease severity and the hypervirulent ribotype 027 strain in patients with clostridium difficile infection.	clostridium difficile is the most common infectious etiology of nosocomial diarrhea. fecal calprotectin (fc) is a sensitive marker of intestinal inflammation, found to be associated with enteric bacterial infections and inflammatory bowel disease.	2016	27334992
the signal sequence of the abundant extracellular metalloprotease ppep-1 can be used to secrete synthetic reporter proteins in clostridium difficile.	clostridium difficile is an opportunistic pathogen and the main cause of antibiotic-associated diarrhea. adherence of c. difficile to host cells is modulated by proteins present on the bacterial cell surface or secreted into the environment. cleavage of collagen-binding proteins is mediated by the zinc metalloprotease ppep-1, which was identified as one of the most abundant secreted proteins of c. difficile. here, we exploit the ppep-1 signal sequence to produce novel secreted enzymes. we have c ...	2016	27333161
understanding the mechanisms of faecal microbiota transplantation.	this review summarizes mechanistic investigations in faecal microbiota transplantation (fmt), which has increasingly been adapted into clinical practice as treatment for clostridium difficile infection (cdi) that cannot be eliminated with antibiotics alone. administration of healthy donor faecal microbiota in this clinical situation results in its engraftment and restoration of normal gut microbial community structure and functionality. in this review, we consider several main mechanisms for fmt ...	2016	27329806
using multiplex molecular testing to determine the etiology of acute gastroenteritis in children.	to detect the etiologic agents of acute gastroenteritis (age) in children using broad molecular-based techniques, and compare clinical presentations among etiologies.	2016	27329497
role of the microbiome, probiotics, and 'dysbiosis therapy' in critical illness.	loss of 'health-promoting' microbes and overgrowth of pathogenic bacteria (dysbiosis) in icu is believed to contribute to nosocomial infections, sepsis, and organ failure (multiple organ dysfunction syndrome). this review discusses new understanding of icu dysbiosis, new data for probiotics and fecal transplantation in icu, and new data characterizing the icu microbiome.	2016	27327243
erratum for marín et al., clostridium difficile isolates with high linezolid mics harbor the multiresistance gene cfr.		2016	27325817
antibiotic-associated diarrhoea in emergency department observation unit patients.	clostridium difficile diarrhoea is an urgent threat to patients, but little is known about the role of antibiotic administration that starts in emergency department observation units (edous). we studied risk factors for antibiotic-associated diarrhoea (aad) and c. difficile infection (cdi) in edou patients. this prospective cohort study enrolled adult patients discharged after edou antibiotic treatment between january 2013 and 2014. we obtained medical histories, edou treatment and occurrence of ...	2016	27324463
outcomes associated with observation stays versus inpatient admissions for pulmonary embolism.	changes in reimbursement policies have led to an increased use of observation stays in the united states (us). we sought to compare outcomes among pulmonary embolism (pe) patients managed through observation stays or inpatient admissions.the premier perspective comparative hospital database was used to identify patients with a primary international classification of diseases, ninth-edition diagnosis of pe (415.1×) from 11/2012-3/2015. patients were required to have claims for ≥1 diagnostic tests ...	2016	27324143
comparison of enzyme immunoassays and rapid diagnostic tests for clostridium difficile glutamate dehydrogenase and toxin a + b to toxinogenic culture on a highly selective chromogenic medium.	to compare clostridium. (c.) difficile toxin a/b and glutamate dehydrogenase (gdh) enzyme immunoassays or rapid diagnostic tests to toxinogenic culture on recently described highly selective agar plates. five hundred consecutive samples sent in for c. difficile diagnostics were tested by toxin a/b enzyme immunoassay (eia) and rapid diagnostic test (rdt), gdh eia and rdt, and culture on chromid c. difficile plates for 48 hrs, with toxin testing from culture if the toxin eia from feces was negativ ...	2016	27323765
vesicoileal fistula and clostridium difficile colitis in a child with acute lymphoblastic leukemia.		2016	27842209
pharmacologic stress gastropathy prophylaxis may not be necessary in at-risk surgical trauma icu patients tolerating enteral nutrition.	stress gastropathy is a rare complication of the intensive care unit stay with high morbidity and mortality. there are data that support the concept that patients tolerating enteral nutrition have sufficient gut blood flow to obviate the need for prophylaxis; however, no robust studies exist. this study assesses the incidence of clinically significant gastrointestinal bleeding in surgical trauma intensive care unit (sticu) patients at risk of stress gastropathy secondary to mechanical ventilatio ...	2016	27837045
national age group trends in clostridium difficile infection incidence and health outcomes in united states community hospitals.	prior studies have demonstrated an increase in clostridium difficile infection (cdi) incidence in the united states (u.s.) in recent years, but trends among different age groups have not been evaluated. this study describes national cdi incidence by age group over a 10-year period and mortality and hospital length of stay (los) among patients with cdi.	2016	27855653
characterization of the clostridium difficile volatile metabolome using comprehensive two-dimensional gas chromatography time-of-flight mass spectrometry.	clostridium difficile is a bacterial pathogen capable of causing life-threatening infections of the gastrointestinal tract characterized by severe diarrhea. exposure to certain classes of antibiotics, advanced age, and prolonged hospitalizations are known risk factors for infection by this organism. anecdotally, healthcare providers have reported that they can smell c. difficile infections in their patients, and several studies have suggested that there may indeed be an olfactory signal associat ...	2016	27855313
two novel myoviruses from the north of iraq reveal insights into clostridium difficile phage diversity and biology.	bacteriophages (phages) are increasingly being explored as therapeutic agents to combat bacterial diseases, including clostridium difficile infections. therapeutic phages need to be able to efficiently target and kill a wide range of clinically relevant strains. while many phage groups have yet to be investigated in detail, those with new and useful properties can potentially be identified when phages from newly studied geographies are characterised. here, we report the isolation of c. difficile ...	2016	27854339
chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis.	health care-associated infections (hai) have been shown to increase length of stay, the cost of care, and rates of hospital deaths (kaye and marchaim, j am geriatr soc 62(2):306-11, 2014; roberts and scott, med care 48(11):1026-35, 2010; warren and quadir, crit care med 34(8):2084-9, 2006; zimlichman and henderson, jama intern med 173(22):2039-46, 2013). importantly, infections acquired during a hospital stay have been shown to be preventable (loveday and wilson, j hosp infect 86:s1-70, 2014). i ...	2016	27876075
the role of single-shot metronidazole in the prevention of clostridium difficile infection following ileostomy reversal surgery.	symptomatic infection with clostridium difficile is strongly linked to antibiotic use and rates are higher for colorectal surgery. in february 2015, trust policy for antibiotic prophylaxis of ileostomy reversal surgery was changed from three doses of metronidazole plus cefuroxime to single-dose metronidazole, in a bid to reduce rates of clostridium difficile infection.	2016	27878620
draft genome sequence of robinsoniella peoriensis 6600698, a confounder of clostridium difficile diagnosis.	robinsoniella peoriensis is a gram-positive, strictly anaerobic, spore-forming, rod-shaped organism. here, we report the draft genome of r. peoriensis 6600698, initially classified as clostridium difficile due to growth on selective agar, a fecal gdh pcr-positive result, and clinical symptoms. r. peoriensis is a potential confounder of c. difficile diagnosis.	2016	27856584
burden of clostridium difficile-associated disease among patients residing in nursing homes: a population-based cohort study.	clostridium difficile (c. difficile) infection (cdi) is the leading cause of nosocomial diarrhea in the united states. this study aimed to examine the incidence of cdi and evaluate mortality and economic burden of cdi in an elderly population who reside in nursing homes (nhs).	2016	27884118
[adalimumab as induction therapy for crohn's disease - one center study].	adalimumab is a subcutaneously administered recombinant fully human monoclonal antibody targeting tumor necrosis factor alpha. it has been approved for use in poland to treat patients with crohn's disease under the program of polish national health found since 2010.	2016	27883347
highly divergent clostridium difficile strains isolated from the environment.	clostridium difficile is one of the most important human and animal pathogens. however, the bacterium is ubiquitous and can be isolated from various sources. here we report the prevalence and characterization of c. difficile in less studied environmental samples, puddle water (n = 104) and soil (n = 79). c. difficile was detected in 14.4% of puddle water and in 36.7% of soil samples. environmental strains displayed antimicrobial resistance patterns comparable to already published data of human a ...	2016	27880843
asymptomatic colitis induced by low-dose methotrexate.	a woman aged 77 years with a history of rheumatoid arthritis (ra) presented with inflammatory colitis confined to her rectum, which was incidentally found by a screening colonoscopy. histopathological examination of colonic biopsies showed non-specific inflammatory infiltrates of lymphocytes, the cause of which was unknown. she had been diagnosed with ra 5 years before, and she was receiving methotrexate 6 mg weekly, to which tocilizumab had been added 4 years earlier, which achieved stable cont ...	2016	27888222
antimicrobial stewardship programs that target only high-cost, broad-spectrum antimicrobials miss opportunities to reduce clostridium difficile infections.	antimicrobial stewardship programs are promoted as a strategy to reduce clostridium difficile infections. we implemented an antimicrobial stewardship program comprised of formulary restriction plus prospective audit with feedback for high-cost and broad-spectrum antimicrobials. subsequently, we reviewed all heath care facility-onset, health care facility-associated c difficile infections. we found that most of these infections were associated with the antecedent receipt of nonaudited, and often ...	2016	27908435
bezlotoxumab approved to prevent clostridium difficile recurrence.		2016	27864194
liver abscess and bacteremia caused by lactobacillus: role of probiotics? case report and review of the literature.	lactobacilli are non-spore forming, lactic acid producing, gram-positive rods. they are a part of the normal gastrointestinal and genitourinary microbiota and have rarely been reported to be the cause of infections. lactobacilli species are considered non-pathogenic organisms and have been used as probiotics to prevent antibiotic associated diarrhea. there are sporadic reported cases of infections related to lactobacilli containing probiotics.	2016	27863462
rethinking strategies to select antibiotic therapy in clostridium difficile infection.	in recent years, clostridium difficile infection (cdi) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective components not well delineated across treatment algorithms and clinical trials. furthermore, there is little evidence linking severity at onset to ou ...	2016	27862113
evidence for dual receptor-binding sites in clostridium difficile toxin a.	tcda (308 kda) and tcdb (270 kda) disrupt the integrity of the intestinal epithelial barrier and provide an environment favorable for clostridium difficile colonization. recent evidence suggests that entry of tcda into cells is mediated by at least two domains. here, we report the characterization of a second receptor-binding domain (rbd2) for tcda. while both the isolated combined repetitive oligopeptides (crops) and rbd2 fragments are rapidly internalized into cells under physiologic condition ...	2016	27861794
predominance of clostridium difficile ribotypes 017 and 078 among toxigenic clinical isolates in southern taiwan.	ribotypes and toxin genotypes of clinical c. difficile isolates in taiwan are rarely reported. a prospective surveillance study from january 2011 to january 2013 was conducted at the medical wards of a district hospital in southern taiwan. of the first toxigenic isolates from 120 patients, 68 (56.7%) of 120 isolates possessed both tcda and tcdb. of 52 (43.3%) with tcdb and truncated tcda (tcda-/tcdb+), all were ribotype 017 and none had binary toxin or tcdc deletion. eighteen (15%) toxigenic iso ...	2016	27861606
two clusters of fluoroquinolone and clindamycin-resistant clostridium difficile pcr ribotype 001 strain recognized by capillary electrophoresis ribotyping and multilocus variable tandem repeat analysis.	to perform a retrospective analysis of the high occurrence of clostridium difficile infection in the surgical department of a czech tertiary care hospital and to identify weaknesses in c. difficile infection (cdi) prevention and control policies.	2016	27860531
genome sequence of clostridium paraputrificum 373-a1 isolated in chile from a patient infected with clostridium difficile.	clostridium paraputrificum is a gut microbiota member reported in several cases of bacteremia and coinfections. so far, only one genome sequence of a c. paraputrificum (agr2156) isolate is available. here, we present the draft genome of c. paraputrificum strain 373-a1, isolated from stools from a patient with c. difficile infection.	2016	27811092
distribution of clostridium difficile pcr ribotypes and high proportion of 027 and 176 in some hospitals in four south eastern european countries.	while clostridium difficile epidemiology is well documented in many european countries, data are largely missing for south eastern european region. here we report the pcr ribotype distribution of 249 c. difficile isolates received for typing from six hospital settings from croatia, bosnia and herzegovina, republic of macedonia and serbia in time period from 2008 to 2015. twenty-four pcr ribotypes were detected. the majority of strains from bosnia and herzegovina and serbia belonged to pcr riboty ...	2016	27751937
characterization of clostridium difficile pcr-ribotype 018: a problematic emerging type.	recent surveys indicate that the majority of toxigenic clostridium difficile strains isolated in european hospitals belonged to pcr-ribotypes (rts) different from rt 027 or rt 078. among these types, rt 018 has been reported in italy and, more recently, in korea and japan. in italy, strains rt 018 have become predominant in the early 2000s, whereas the majority of strains isolated before were rt 126, a type belonging to the same lineage as the rt 078. in this study, we have found that italian st ...	2016	27725230
gut eradication of vim-1 producing st9 klebsiella oxytoca after fecal microbiota transplantation for diarrhea caused by a clostridium difficile hypervirulent r027 strain.	we report the fecal carriage eradication of a vim-1-producing st9 klebsiella oxytoca strain in a pluripathological 84-year-old woman after fecal microbiota transplantation to control relapsing r027 hypervirulent clostridium difficile infections. the donor was her son, in which the absence of fecal carbapenemase-producing bacteria was corroborated.	2016	27712927
clostridium difficile: a rare cause of pyogenic liver abscess.	extra-intestinal infections due to clostridium difficile have been reported rarely. herein we report a case of pyogenic liver abscess from toxigenic c. difficile in an 80-year-old non-hospitalized woman with diabetes mellitus, cerebrovascular and cardiovascular diseases. the patient was admitted to the emergency department with fever and abdominal pain. there was no history of diarrhea or use of antibiotics. laboratory parameters revealed signs of inflammation and elevated ast and alt levels. ab ...	2016	27693543
molecular types and antimicrobial susceptibility patterns of clostridium difficile isolates in different epidemiological settings in a tertiary care center in israel.	the aims of this prospective study were to examine the correlation between the molecular types and the antimicrobial susceptibility patterns of clostridium difficile isolates with the source of acquisition and the occurrence of c. difficile infections (cdi) in a tertiary center in israel. all available isolates from community-acquired (ca) cdi episodes (n=43) and matching numbers of isolates from community-onset, hospital acquired (co-ha, n=67) and ha-cdi (n=56) and 32 cases of recurrent cdi wer ...	2016	27638350
a genetic assay for gene essentiality in clostridium.	essential genes of pathogens are potential therapeutic targets, but are difficult to verify. here, gene essentiality was determined by targeted knockout following engineered gene duplication. null mutants of candidate essential genes of clostridium difficile were viable only in the presence of a stable second copy of the gene.	2016	27487328
predictors of clostridium difficile infection-related mortality among older adults.	over 90% of annual deaths caused by clostridium difficile infection (cdi) occur in persons aged ≥65 years. however, no large-scale studies have been conducted to investigate predictors of cdi-related mortality among older adults.	2016	27424303
teaching health care workers to adopt a systems perspective for improved control and prevention of health care-associated infections.		2016	27424302
a case of multiple recurrence of clostridium difficile infection with severe hematochezia in an immunocompromised host.	clostridium difficile infection (cdi) is increasing in incidence and severity. clinically, diarrhea frequently occurs, but severe hematochezia is rarely seen with cdi. we describe here a hematopoietic stem cell transplantation (hsct) recipient who experienced life-threatening gastrointestinal bleeding due to severe cdi. subsequent stool surveillance and molecular typing observed the patient who had two episodes of recurrence with a new strain of c. difficile distinct from the initial infection. ...	2016	27377777
clostridium difficile infection epidemiology and management: comparison of results of a prospective study with a retrospective one in a reference teaching and research hospital in northern italy.	clostridium difficile-associated disease (cdad) is the most common infectious antibiotic-associated diarrhea and is a growing health care problem. prevention of clostridium difficile infection focuses on clinical and epidemiologic infection control measures.	2016	27372227
hospitalized patients with heart failure and common bacterial infections: a nationwide analysis of concomitant clostridium difficile infection rates and in-hospital mortality.	patients with heart failure (hf) are frequently hospitalized with common bacterial infections. it is unknown whether they experience concomitant clostridium difficile infection (cdi) more frequently than patients without hf, and whether cdi affects their mortality.	2016	27317844
health care worker hand contamination at critical moments in outpatient care settings.	the delivery of health care in outpatient settings has steadily increased over the past 40 years. the risk of infection in these settings is considered to be low. however, the increasing severity of illness and complexity of care in outpatient settings creates a need to reexamine the transmission of pathogens in this setting.	2016	27287735
epidemiology of clostridium difficile infection in hospitalized oncology patients.	the epidemiology of clostridium difficile infection (cdi) among oncology inpatients is poorly understood. in multivariate analysis we identified age, history of cdi, and prior receipt of cephalosporins, β-lactam/β-lactamase inhibitors, metronidazole, and blood transfusion as risk factors associated with cdi. reducing broad-spectrum antibiotic use, particularly among older patients and those with a cdi history and recent blood transfusions, may decrease cdi risk in this population.	2016	27287733
a pilot study to assess the effectiveness and cost of routine universal use of peracetic acid sporicidal wipes in a real clinical environment.	peracetic acid sporicidal wipes have been shown to be an effective disinfectant, but in controlled test environments. their high cost may restrict use.	2016	27238941
rates of microbiologically diagnosed infection and pathogen detection in hematopoietic stem cell transplant patients.	infections remain a significant cause of mortality in hematopoietic stem cell transplant patients. evaluations of causes of infection are often unrevealing, and at some sites, increasing rates of antimicrobial resistance have been noticed. we performed a retrospective analysis of infection rates and microbiologic testing yield, or percent of tests ordered to diagnose an infection, in the first 100 days of 30 allogeneic and 56 autologous stem cell transplants performed at san antonio military med ...	2016	27849508
chemical and stress resistances of clostridium difficile spores and vegetative cells.	clostridium difficile is a gram-positive, sporogenic and anaerobic bacterium that causes a potentially fatal colitis. c. difficile enters the body as dormant spores that germinate in the colon to form vegetative cells that secrete toxins and cause the symptoms of infection. during transit through the intestine, some vegetative cells transform into spores, which are more resistant to killing by environmental insults than the vegetative cells. understanding the inherent resistance properties of th ...	2016	27833595
colon-targeted delivery of igy against clostridium difficile toxin a and b by encapsulation in chitosan-ca pectinate microbeads.	this study investigated the use of a newly developed chitosan-ca pectinate microbead formulation for the colon-targeted delivery of anti-a/b toxin immunoglobulin of egg yolk (igy) to inhibit toxin binding to colon mucosa cells. the effect of the three components (pectinate, calcium chloride, and chitosan) used for the microbead production was examined with the aim of identifying the optimal levels to improve drug encapsulation efficiency, swelling ratio, and cumulative igy release rate. the opti ...	2016	27826799
infection: modulation of clostridium difficile infection by dietary zinc.		2016	27826138
proton pump inhibitors do not increase risk for clostridium difficile infection in the intensive care unit.	patients in the intensive care unit (icu) frequently receive proton pump inhibitors (ppis) and have high rates of clostridium difficile infection (cdi). ppis have been associated with cdi in hospitalized patients, but icu patients differ fundamentally from non-icu patients and few studies have focused on ppi use exclusively in the critical care setting. we performed a retrospective cohort study to determine the associations between ppis and health-care facility-onset cdi in the icu.	2016	27575714
identification of factors impacting recurrent clostridium difficile infection and development of a risk evaluation tool.	recurrent clostridium difficile infection (rcdi) is a growing concern, yet limited data exists to clarify which patients are at highest risk. identification of these patients may better inform decisions of those who may benefit from prophylactic intervention. the purpose of this study was to determine which factors are associated with the recurrence of clostridium difficile infection (cdi) and to develop a risk stratification tool. methods. patients readmitted within 10 weeks of positive c. di ...	2016	27806252
costs and consequences associated with misdiagnosed lower extremity cellulitis.	inflammatory dermatoses of the lower extremity are often misdiagnosed as cellulitis (aka "pseudocellulitis") and treated with antibiotics and/or hospitalization. there is limited data on the cost and complications from misdiagnosed cellulitis.	2016	27806170
clostridium difficile infection: associations with chemotherapy, radiation therapy, and targeting therapy treatments.	although mucositis, diarrhea, and constipation as well as immunosuppression are well recognized side-effects of cancer treatment, the underlying mechanisms including changes in the composition of gut microbiota and clostridium difficile infection have not yet been thoroughly reviewed.	2016	27804875
hydralazine-induced anca vasculitis in the setting of acute clostridium difficile infection.	we report a rare case of hydralazine-induced anca associated glomerulonephritis with alveolar hemorrhage in the setting of acute clostridium difficile infection. a 71-year-old caucasian woman with hypertension, who was being treated with hydralazine 25 mg twice a day for six years, presented to the hospital with diarrhea, nausea, vomiting and anemia. she had acute kidney injury and urinalysis showed proteinuria, dysmorphic rbcs, and rare rbc cast. she was found to have clostridium difficile coli ...	2016	27801920
molecular epidemiology and antimicrobial susceptibility of clostridium difficile isolates from a university teaching hospital in china.	while the developed world has seen a significant increase in the number of scientific articles on clostridium difficile infection (cdi), the developing world still lags behind on this subject due to limited laboratory capacity, low awareness, and limited surveillance of this problem. as such, cdi is considered a neglected but potentially huge problem in developing countries. the major aim of this study was to systemically evaluate the utility of several molecular typing tools for cdi, including ...	2016	27799923
eosinophils, probiotics, and the microbiome.	there is currently substantial interest in the therapeutic properties of probiotic microorganisms as recent research suggests that oral administration of specific bacterial strains may reduce inflammation and alter the nature of endogenous microflora in the gastrointestinal tract. eosinophils are multifunctional tissue leukocytes, prominent among the resident cells of the gastrointestinal mucosa that promote local immunity. recent studies with genetically altered mice indicate that eosinophils n ...	2016	27549754