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use of a collagen membrane to enhance the survival of primary intestinal epithelial cells.intestinal epithelial cell culture is important for biological, functional and immunological studies. since enterocytes have a short in vivo life span due to anoikis, we aimed to establish a novel and reproducible method to prolong the survival of mouse and human cells. cells were isolated following a standard procedure, and cultured on ordered-cow's collagen membranes. a prolonged cell life span was achieved; cells covered the complete surface of bio-membranes and showed a classical enterocyte ...201627626762
screening of bifidobacteria and lactobacilli able to antagonize the cytotoxic effect of clostridium difficile upon intestinal epithelial ht29 monolayer.clostridium difficile is an opportunistic pathogen inhabiting the human gut, often being the aetiological agent of infections after a microbiota dysbiosis following, for example, an antibiotic treatment. c. difficile infections (cdi) constitute a growing health problem with increasing rates of morbidity and mortality at groups of risk, such as elderly and hospitalized patients, but also in populations traditionally considered low-risk. this could be related to the occurrence of virulent strains ...201627148250
periodontal-disease-associated biofilm: a reservoir for pathogens of medical importance.the ecological diversity of the periodontal microenvironment may provide suitable conditions for the colonization of species not usually considered members of the oral microbiota. in this investigation, we aimed to determine the prevalence and levels of pathogenic species of medical relevance in the microbiota of individuals with distinct periodontal clinical status. subgingival biofilm was obtained from patients with periodontal health (h, n = 81), gingivitis (g, n = 55), generalized aggressive ...201626416306
medical versus surgical patients with clostridium difficile infection: is there any difference?severity of clostridium difficile infection (cdi) varies from one patient to another. we aimed to test the hypothesis that surgical patients would suffer more severe cdis than medical patients. patients receiving in-hospital medical or surgical treatment for any underlying disease from 2007 to 2012, who developed cdi, were divided into two groups: "medical group" and "surgical group." demographics, disease characteristics, and outcomes including mortality and recurrence were compared. of 3231 pa ...201628234177
human clostridium difficile infection caused by a livestock-associated pcr ribotype 237 strain in western australia.clostridium difficile infection (cdi) is a significant gastrointestinal disease in the developed world and increasingly recognised as a zoonotic infection. in north america and europe, the pcr ribotype (rt) 078 strain of c. difficile is commonly found in production animals and as a cause of disease in humans although proof of transmission from animals is lacking. this strain is absent in australian livestock. we report a case of human cdi caused by a strain of c. difficile belonging to known aus ...201628348781
rhodococcus fascians infection after haematopoietic cell transplantation: not just a plant pathogen?rhodococcus spp. have been implicated in a variety of infections in immunocompromised and immunocompetent hosts. rhodococcus equi is responsible for the majority of reported cases, but rhodococcus erythropolis, rhodococcusgordoniae and rhodococcusruber infections have been described. there are no prior reports of human infection with rhodococcus fascians.201628348752
risk factors for clostridium difficile infection in hiv-infected patients.clostridium difficile infection is a healthcare-associated infection resulting in significant morbidity. although immunosuppression is associated with clostridium difficile infection acquisition and adverse outcomes, the epidemiology of clostridium difficile infection in hiv-infected patients has been little studied in the era of antiretroviral therapy. this study identifies the risk factors for acquisition of clostridium difficile infection in hiv-infected patients.201628348742
a cost-effective anaerobic culture method & its comparison with a standard method.twenty six anaerobes were recovered from 150 deep-seated abscess samples cultured by the proposed two-step combustion-modified candle-jar system and anoxomat. the degree of growth and colony size were similar in both systems, except for clostridium difficile. the modified candle-jar system was found to be a sensitive and cost-effective alternative that might be used in resource-limited settings.201628256472
molecular appraisal of intestinal parasitic infection in transplant recipients.diarrhoea is the main clinical manifestation caused by intestinal parasitic infections in patients, with special reference to transplant recipients who require careful consideration to reduce morbidity and mortality. further, molecular characterization of some important parasites is necessary to delineate the different modes of transmission to consider appropriate management strategies. we undertook this study to investigate the intestinal parasitic infections in transplant recipients with or wi ...201627934806
microbial ecosystem analysis in root canal infections refractory to endodontic treatment.the purpose of this study was to combine multiple displacement amplification and checkerboard dna-dna hybridization to qualitatively and quantitatively evaluate the microbiota present in infections refractory to endodontic treatment.201627377440
effect of united states buckwheat honey on antibiotic-resistant hospital acquired pathogens.due to an upsurge in antibiotic-resistant infections and lack of therapeutic options, new approaches are needed for treatment. honey may be one such potential therapeutic option. we investigated the susceptibility of hospital acquired pathogens to four honeys from wisconsin, united states, and then determined if the antibacterial effect of each honey against these pathogens is primarily due to the high sugar content.201628292167
molecular detection of clostridium difficile on inert surfaces from a costa rican hospital during and after an outbreak.hospital transmission of clostridium difficile is fostered by contamination of surfaces and medical equipment with spores highly resistant to disinfectants and regular cleaning procedures. despite the outbreaks and fatalities that c difficile causes, its epidemiology has not been studied in hospitals from middle- and low-income countries. to tackle this knowledge gap, the detection frequency of c difficile dna on inert surfaces of a major costa rican hospital during and after an outbreak was com ...201628340959
role of binary toxin in the outcome of clostridium difficile infection in a non-027 ribotype setting.binary toxin (bt) has been associated with strains causing more severe clostridium difficile infection (cdi), such as ribotype 027. data on the outcome of patients having bt present in ribotypes other than 027 are scarce. our objective was to investigate the association between bt isolates and outcome of cdi in a non-027 ribotype setting. we prospectively included cdi episodes (january-june 2013 and march-june 2014) from symptomatic patients aged >2 years. epidemiological and clinical data were ...201626119775
clostridium difficile infection: new insights into therapeutic options.clostridium difficile infection (cdi) is an important cause of mortality and morbidity in healthcare settings and represents a major social and economic burden. the major virulence determinants are large clostridial toxins, toxin a (tcda) and toxin b (tcdb), encoded within the pathogenicity locus. traditional therapies, such as metronidazole and vancomycin, frequently lead to a vicious circle of recurrences due to their action against normal human microbiome. new disease management strategies to ...201625955884
a novel, sporicidal formulation of ethanol for glove decontamination to prevent clostridium difficile hand contamination during glove removal.decontamination of gloves before removal could reduce the risk for contamination of hands of personnel caring for patients with clostridium difficile infection. we demonstrated that a novel sporicidal formulation of ethanol rapidly reduced c. difficile spores on gloved hands without adverse odor, respiratory irritation, or staining of clothing.201626679745
clostridium difficile infection incidence: impact of audit and feedback programme to improve room cleaning.audit and feedback programmes (afps) using fluorescent marking lead to improvements in room cleaning but have not been linked to reduced clostridium difficile infection (cdi) incidence.201626679727
persistence of clostridium difficile rt 237 infection in a western australian piggery.clostridium difficile is commonly associated with healthcare-related infections in humans, and is an emerging pathogen in food animal species. there is potential for transmission of c. difficile from animals or animal products to humans. this study aimed to determine if c. difficile rt 237 had persisted in a western australian piggery or if there had been a temporal change in c. difficile diversity. c. difficile carriage in litters with and without diarrhea was investigated, as was the acquisiti ...201626679487
biomedical applications of nisin.nisin is a bacteriocin produced by a group of gram-positive bacteria that belongs to lactococcus and streptococcus species. nisin is classified as a type a (i) lantibiotic that is synthesized from mrna and the translated peptide contains several unusual amino acids due to post-translational modifications. over the past few decades, nisin has been used widely as a food biopreservative. since then, many natural and genetically modified variants of nisin have been identified and studied for their u ...201626678028
impact of variations in test method parameters on in vitro activity of surotomycin against clostridium difficile and surotomycin quality control limits for broth microdilution and agar dilution susceptibility testing.test parameter variations were evaluated for their effects on surotomycin mics. calcium concentration was the only variable that influenced mics; therefore, 50 μg/ml (standard for lipopeptide testing) is recommended. quality control ranges for clostridium difficile (0.12 to 1 μg/ml) and eggerthella lenta (broth, 1 to 4 μg/ml; agar, 1 to 8 μg/ml) were approved by the clinical and laboratory standards institute based on these data.201626677246
clostridium difficile infection in pediatric inflammatory bowel disease.children with inflammatory bowel disease (ibd) are disproportionately susceptible to clostridium difficile infection (cdi) and the incidence is increasing. there has also been growing recognition of asymptomatic c. difficile colonization in pediatric ibd, which can sometimes be very difficult to distinguish from symptomatic c. difficile-associated disease in this population. in this study, we discuss the current knowledge of c. difficile infection in children with ibd, reviewing epidemiology, ri ...201626689599
immunogenicity and protective efficacy of clostridium difficile spore proteins.clostridium difficile is a spore-forming, anaerobic, gram-positive organism that is the leading cause of antibiotic-associated infectious diarrhea, commonly known as c. difficile infection (cdi). c. difficile spores play an important role in the pathogenesis of cdi. spore proteins, especially those that are surface-bound may play an essential role in the germination, colonization and persistence of c. difficile in the human gut. in our current study, we report the identification of two surface-b ...201626688279
clostridium difficile: the more we learn, the less we know. 201626687712
contamination of australian newborn calf carcasses at slaughter with clostridium difficile.in north america and europe, reports of a genetic overlap between toxigenic strains of clostridium difficile isolated from humans, livestock and retail meat suggest that food-borne transmission may be occurring. we investigated the prevalence, concentration and genetic diversity of c. difficile on the carcasses (n = 300) and in the faeces (n = 30) of neonatal veal calves at three abattoirs in australia in 2013. selective culture (both direct and enrichment) was performed, and all isolates were c ...201626686811
clostridium difficile infections in veterans health administration long-term care facilities.a nationwide initiative was implemented in february 2014 to decrease clostridium difficile infections (cdi) in veterans affairs (va) long-term care facilities. we report a baseline of national cdi data collected during the 2 years before the initiative.201626686361
impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital.the role of contaminated environments in the spread of hospital-associated infections has been well documented. this study reports the impact of a pulsed xenon ultraviolet no-touch disinfection system on infection rates in a community care facility.201626684369
postdischarge decontamination of mrsa, vre, and clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-c-emitting devices.two ultraviolet-c (uvc)-emitting devices were evaluated for effectiveness in reducing methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), and clostridium difficile (cd).201626684367
crystal structure of the ctp1l endolysin reveals how its activity is regulated by a secondary translation product.bacteriophages produce endolysins, which lyse the bacterial host cell to release newly produced virions. the timing of lysis is regulated and is thought to involve the activation of a molecular switch. we present a crystal structure of the activated endolysin ctp1l that targets clostridium tyrobutyricum, consisting of a complex between the full-length protein and an n-terminally truncated c-terminal cell wall binding domain (cbd). the truncated cbd is produced through an internal translation sta ...201626683375
genome-based infection tracking reveals dynamics of clostridium difficile transmission and disease recurrence.accurate tracking of clostridium difficile transmission within healthcare settings is key to its containment but is hindered by the lack of discriminatory power of standard genotyping methods. we describe a whole-genome phylogenetic-based method to track the transmission of individual clones in infected hospital patients from the epidemic c. difficile 027/st1 lineage, and to distinguish between the 2 causes of recurrent disease, relapse (same strain), or reinfection (different strain).201626683317
editorial commentary: whole-genome sequencing of clostridium difficile: exquisitely sensitive but not yet optimally applied. 201626683316
epidemiology, outcomes, and predictors of mortality in hospitalized adults with clostridium difficile infection.studies have demonstrated an increasing clostridium difficile infection (cdi) incidence in hospitals and the community, with increasing morbidity and mortality. in this study, we analyzed data from the national hospital discharge survey (nhds) to evaluate cdi epidemiology, outcomes, and predictors of mortality in hospitalized adults. we identified cases of cdi (and associated comorbid conditions) from nhds data from 2005 through 2009 using icd-9 codes. weighted univariate and multivariate analys ...201626694494
reducing overutilization of testing for clostridium difficile infection in a pediatric hospital system: a quality improvement initiative.study objectives included addressing overuse of clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing.201626692547
susceptibility of clostridium difficile to the food preservatives sodium nitrite, sodium nitrate and sodium metabisulphite.clostridium difficile is an important enteric pathogen of humans and food animals. recently it has been isolated from retail foods with prevalences up to 42%, prompting concern that contaminated foods may be one of the reasons for increased community-acquired c. difficile infection (ca-cdi). a number of studies have examined the prevalence of c. difficile in raw meats and fresh vegetables; however, fewer studies have examined the prevalence of c. difficile in ready-to-eat meat. the aim of this s ...201626700884
spectrum of clostridium difficile infections: particular clinical situations.incidence, pathogenesis, diagnostic techniques and therapeutic management of cdi have prompted abundant and adequate recent literature. however, report on clinical manifestations of cdi is frequently biased by the type of patients selected, the retrospective nature of many papers, the epidemic or endemic characteristics of the population reported. this article seeks to review some less discussed clinical and epidemiological aspects of cdi trying to include the clinical manifestations of this dis ...201626700883
nonclinical safety assessment of syn-004: an oral β-lactamase for the protection of the gut microbiome from disruption by biliary-excreted, intravenously administered antibiotics.syn-004 is a first in class, recombinant β-lactamase that degrades β-lactam antibiotics and has been formulated to be administered orally to patients receiving intravenous β-lactam antibiotics including cephalosporins. syn-004 is intended to degrade unmetabolized antibiotics excreted into the intestines and thus has the potential to protect the gut microbiome from disruption by these antibiotics. protection of the gut microbiome is expected to protect against opportunistic enteric infections suc ...201626700136
comparison of multilocus sequence typing and the xpert c. difficile/epi assay for identification of clostridium difficile 027/nap1/bi.clostridium difficile 027/nap1/bi is the most common c. difficile strain in the united states. the xpert c. difficile/epi assay allows rapid, presumptive identification of c. difficile nap1. we compared xpert c. difficile/epi to multilocus sequence typing for identification of c. difficile nap1 and found "very good" agreement at 97.9% (κ = 0.86; 95% confidence interval, 0.80 to 0.91).201626699700
the uncertain benefits of combination therapy for clostridium difficile infection. 201626703863
clostridium difficile associated reactive arthritis: case report and literature review.extra-gastro-intestinal tract manifestations associated with clostridium difficile infection (cdi), including reactive arthritis (rea), are uncommon.201626743187
the first two clostridium difficile ribotype 027/st1 isolates identified in beijing, china-an emerging problem or a neglected threat?clostridium difficile hyper-virulent ribotype 027 strain has become a significant concern globally, but has rarely been reported in asian countries including china. recently, a retrospective single-center study in beijing, china, detected two ribotype 027 c. difficile isolates from two patients coming for outpatient visits in 2012 and 2013. we performed a systematic investigation of the two isolates (and patients). both c. difficile isolates had the typical pcr ribotype 027 profile; were positiv ...201626740150
advanced chronic kidney disease: a strong risk factor for clostridium difficile infection.it has been suggested that chronic kidney disease (ckd) is a risk factor for clostridium difficile infection (cdi) and is associated with increased mortality among patients infected with c. difficile. however, recent studies of the clinical impact of ckd on cdi in asians are still insufficient. we sought to determine the relationship between ckd and cdi in a korean population.201626767866
effect of a clostridium difficile infection prevention initiative in veterans affairs acute care facilities.rates of clinically confirmed hospital-onset healthcare facility-associated clostridium difficile infections from july 1, 2012, through march 31, 2015, in 127 acute care veterans affairs facilities were evaluated. quarterly pooled national standardized infection ratios decreased 15% from baseline by the final quarter of the analysis period (p=.01, linear regression). infect control hosp epidemiol 2016;37:720-722.201626864803
the effect of statins on the outcome of clostridium difficile infection in hospitalized patients.several studies have shown an association between exposure to statins and favorable clinical outcomes for various types of infections. we aimed to assess the impact of statin use on mortality, disease severity and complications among hospitalized patients with clostridium difficile infection (cdi). data were analyzed from a retrospectively collected database of 499 patients diagnosed with cdi during 2009-2014. we compared infection outcomes between 178 statin (36 %) users and 321 (64 %) non-user ...201626864041
mutant generation by allelic exchange and genome resequencing of the biobutanol organism clostridium acetobutylicum atcc 824.clostridium acetobutylicum represents a paradigm chassis for the industrial production of the biofuel biobutanol and a focus for metabolic engineering. we have previously developed procedures for the creation of in-frame, marker-less deletion mutants in the pathogen clostridium difficile based on the use of pyre and coda genes as counter selection markers. in the current study we sought to test their suitability for use in c. acetobutylicum.201626732067
risk factors for recurrent clostridium difficile infection in allogeneic hematopoietic cell transplant recipients.clostridium difficile infection (cdi) is one of the leading causes of hospital-acquired infections in recent times. hematopoietic stem cell transplantation (hsct) confers increased risk for cdi because of prolonged hospital stay, immunosuppression, the need to use broad-spectrum antibiotics and a complex interplay of preparative regimen and gvhd-induced gut mucosal damage. our study evaluated risk factors (rf) for recurrent cdi in hsct recipients given the ubiquity of traditional rf for cdi in t ...201626726944
research in review: driving critical care practice change.during the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. this article summarizes some of this important work and considers it in the context of previous research and practice. examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma. care challenges addressed include eth ...201626724298
functional anatomy of the colonic bioreactor: impact of antibiotics and saccharomyces boulardii on bacterial composition in human fecal cylinders.sections of fecal cylinders were analyzed using fluorescence in situ hybridization targeting 180 bacterial groups. samples were collected from three groups of women (n=20 each) treated for bacterial vaginosis with ciprofloxacin+metronidazole. group a only received the combined antibiotic regimen, whereas the a/sb group received concomitant saccharomyces boulardii cncm i-745 treatment, and the a_sb group received s. boulardii prophylaxis following the 14-day antibiotic course. the number of stool ...201626723852
identification of oligosaccharides in human milk bound onto the toxin a carbohydrate binding site of clostridium difficile.the oligosaccharides in human milk constitute a major innate immunological mechanism by which breastfed infants gain protection against infectious diarrhea. clostridium difficile is the most important cause of nosocomial diarrhea, and the c-terminus of toxin a with its carbohydrate binding site, tcda-f2, demonstrates specific abolishment of cytotoxicity and receptor binding activity upon diethylpyrocarbonate modification of the histidine residues in tcda. tcda-f2 was cloned and expressed in e. c ...201626718473
evaluation of xpert c. difficile, bd max cdiff, imdx c. difficile for abbott m2000, and illumigene c. difficile assays for direct detection of toxigenic clostridium difficile in stool specimens.we evaluated the performance of four commercial nucleic acid amplification tests (naats: xpert c. difficile, bd max cdiff, imdx c. difficile for abbott m2000, and illumigene c. difficile) for direct and rapid detection of clostridium difficile toxin genes.201626709260
clostridium difficile-related hospitalizations in madrid (spain) between 2003 and 2014, a rising trend. 201626709248
[identifying gaps between guidelines and clinical practice in clostridium difficile infection].the first aim was to determine whether patients are being treated in accordance with the society for healthcare epidemiology of america and the infectious diseases society of america (idsa/shea) clostridium difficile guidelines and whether adherence impacts patient outcomes. the second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation.201626708998
clostridium difficile-mediated effects on human intestinal epithelia: modelling host-pathogen interactions in a vertical diffusion chamber.clostridium difficile infection is one of the leading causes of healthcare associated diarrhoea in the developed world. although the contribution of c. difficile toxins to disease pathogenesis is now well understood, many facets of host-pathogen interactions between the human intestinal epithelia and the c. difficile bacterium that may contribute to asymptomatic carriage and/or clinical disease remain less clear. herein, we tested the hypothesis that c. difficile strains mediate intestinal epith ...201626708704
synergistic efficacy of 405 nm light and chlorinated disinfectants for the enhanced decontamination of clostridium difficile spores.the ability of clostridium difficile to form highly resilient spores which can survive in the environment for prolonged periods causes major contamination problems. antimicrobial 405 nm light is being developed for environmental decontamination within hospitals, however further information relating to its sporicidal efficacy is required. this study aims to establish the efficacy of 405 nm light for inactivation of c. difficile vegetative cells and spores, and to establish whether spore susceptib ...201626708703
sentinel community clostridium difficile infection (cdi) surveillance in scotland, april 2013 to march 2014.surveillance of clostridium difficile infection (cdi) in scotland does not currently distinguish between cdi cases from hospitals and the community. therefore, the incidence of cdi in the community is unknown, and the burden of disease and the relationship with the hospital/healthcare setting is not well understood. a one-year sentinel community surveillance programme was initiated in collaboration with five scottish health boards in 2013 (representing 36% of all cdi cases reported in scotland). ...201626708405
shaping public health initiatives in kidney diseases: the peer kidney care initiative.while broad-based societal efforts to improve public health have targeted disorders such as cardiovascular disease and cancer for several decades, efforts devoted to kidney disease have developed only more recently. the peer kidney care initiative, a novel effort designed to address knowledge gaps in the care of patients with kidney disease, examines key disease processes, the roles of geography and seasonality on outcomes, and longitudinal trends in outcomes over time.201626765683
non-toxigenic clostridium difficile to prevent recurrent c. difficile infection. 201626763618
clostridium perfringens type a netf and nete positive and clostridium difficile co-infection in two adult dogs.the aim of this study was to report two cases of clostridium perfringens type a and clostridium difficile co-infection in adult dogs. both animals were positive for a/b toxin. toxigenic c. difficile and c. perfringens type a positive for nete and netf-encoding genes were isolated. this report reinforces the necessity of studying a possible synergism of c. difficile and c. perfringens in enteric disorders.201626762654
potential of lactoferrin to prevent antibiotic-induced clostridium difficile infection.clostridium difficile infection (cdi) is a global healthcare problem. recent evidence suggests that the availability of iron may be important for c. difficile growth. this study evaluated the comparative effects of iron-depleted (1% fe(3+) saturated) bovine apo-lactoferrin (apo-blf) and iron-saturated (85% fe(3+) saturated) bovine holo-lactoferrin (holo-blf) in a human in vitro gut model that simulates cdi.201626759363
frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent clostridium difficile infection: a randomized clinical trial.clostridium difficile infection (cdi) is a major burden in health care and community settings. cdi recurrence is of particular concern because of limited treatment options and associated clinical and infection control issues. fecal microbiota transplantation (fmt) is a promising, but not readily available, intervention.201626757463
expanded evidence for frozen fecal microbiota transplantation for clostridium difficile infection: a fresh take. 201626757461
probiotics for the prevention of antibiotic-associated diarrhea in children.this article provides recommendations, developed by the working group (wg) on probiotics of the european society for pediatric gastroenterology, hepatology, and nutrition, for the use of probiotics for the prevention of antibiotic-associated diarrhea (aad) in children based on a systematic review of previously completed systematic reviews and of randomized controlled trials published subsequently to these reviews. the use of probiotics for the treatment of aad is not covered. the recommendations ...201626756877
oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (jmto prev 07-01): a phase 3, multicenter, open-label, randomized trial.to confirm the efficacy of oral and parenteral antibiotic prophylaxis (abx) in the elective laparoscopic colorectal surgery.201626756752
analysis of tcdb proteins within the hypervirulent clade 2 reveals an impact of rhoa glucosylation on clostridium difficile proinflammatory activities.clostridium difficile strains within the hypervirulent clade 2 are responsible for nosocomial outbreaks worldwide. the increased pathogenic potential of these strains has been attributed to several factors but is still poorly understood. during a c. difficile outbreak, a strain from this clade was found to induce a variant cytopathic effect (cpe), different from the canonical arborizing cpe. this strain (nap1v) belongs to the nap1 genotype but to a ribotype different from the epidemic nap1/rt027 ...201626755157
first recurrence of clostridium difficile infection: clinical relevance, risk factors, and prognosis.therapy for recurrent clostridium difficile-associated diarrhea (cdad) is challenging. we evaluated the frequency, associated risk factors, and prognosis of first cdad recurrences. prospective cohort study of all consecutive cases of primary cdad diagnosed in a university hospital from january 2006 to june 2013. recurrent infection was defined as reappearance of symptoms within 8 weeks of the primary diagnosis, provided that cdad symptoms had previously resolved and a new toxin test was positive ...201626753991
antimicrobial stewardship in a long-term acute care hospital using offsite electronic medical record audit.objective to offer antimicrobial stewardship to a long-term acute care hospital using telemedicine. methods we conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired clostridium difficile infection (cdi) rates and antimicrobial use. simple linear regression was used to analyze changes in antimicrobial use; poisson regression was used to estimate the incidence rate ratio in cdi rates. the preimplementation period was april 1, 2010-m ...201626752662
discontinuation of systematic surveillance and contact precautions for vancomycin-resistant enterococcus (vre) and its impact on the incidence of vre faecium bacteremia in patients with hematologic malignancies.objective to study the effect of discontinuation of systematic surveillance for vancomycin-resistant enterococcus (vre) and contact isolation of colonized patients on the incidence of vre bacteremia setting a hematology-oncology unit with high prevalence of vre colonization characterized by predominantly sporadic molecular epidemiology participants inpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantation methods the incidence of vre bacteremia was measur ...201626750087
in vivo synthesis of cyclic-di-gmp using a recombinant adenovirus preferentially improves adaptive immune responses against extracellular antigens.there is a compelling need for more effective vaccine adjuvants to augment induction of ag-specific adaptive immune responses. recent reports suggested the bacterial second messenger bis-(3'-5')-cyclic-dimeric-guanosine monophosphate (c-di-gmp) acts as an innate immune system modulator. we recently incorporated a vibrio cholerae diguanylate cyclase into an adenovirus vaccine, fostering production of c-di-gmp as well as proinflammatory responses in mice. in this study, we recombined a more potent ...201626792800
association of healthcare exposure with acquisition of different clostridium difficile strain types in patients with recurrent infection or colonization after clinical resolution of initial infection.following the resolution of an episode of clostridium difficile infection (cdi), the factors associated with acquisition of different c. difficile strain types in patients with recurrent infection or persistent colonization have not been evaluated.201626792686
faecal microbiota transplantation for recurrent clostridium difficile infection and beyond: risks and regulation. 201626792682
clostridium difficile flagella predominantly activate tlr5-linked nf-κb pathway in epithelial cells.clostridium difficile has become the most common enteropathogen responsible for intestinal nosocomial post-antibiotic infections. this has coincided with the appearance of serious cases related to the emergence of hypervirulent strains. the toxins are the main virulence factors and elicit an inflammatory response during c. difficile infection. however, other bacterial components appear to be involved in the inflammatory process. in some pathogens, flagella play a role in pathogenesis through abn ...201626790921
changes in colonic bile acid composition following fecal microbiota transplantation are sufficient to control clostridium difficile germination and growth.fecal microbiota transplantation (fmt) is a highly effective therapy for recurrent clostridium difficile infection (r-cdi), but its mechanisms remain poorly understood. emerging evidence suggests that gut bile acids have significant influence on the physiology of c. difficile, and therefore on patient susceptibility to recurrent infection. we analyzed spore germination of 10 clinical c. difficile isolates exposed to combinations of bile acids present in patient feces before and after fmt. bile a ...201626789728
prevalence and clinical outcomes of clostridium difficile infection in the intensive care unit: a systematic review and meta-analysis.background.  intensive care unit (icu) patients are at higher risk for clostridium difficile infection (cdi).201626788544
the stealthy superbug: the role of asymptomatic enteric carriage in maintaining a long-term hospital outbreak of st228 methicillin-resistant staphylococcus aureus.whole-genome sequencing (wgs) of 228 isolates was used to elucidate the origin and dynamics of a long-term outbreak of methicillin-resistant staphylococcus aureus (mrsa) sequence type 228 (st228) sccmec i that involved 1,600 patients in a tertiary care hospital between 2008 and 2012. combining of the sequence data with detailed metadata on patient admission and movement confirmed that the outbreak was due to the transmission of a single clonal variant of st228, rather than repeated introductions ...201626787833
impact of surotomycin on the gut microbiota of healthy volunteers in a phase 1 clinical trial.clostridium difficile-associated diarrhea has been associated with disruption of the normal intestinal microbiota, particularly thebacteroides fragilisgroup andprevotellaspecies. surotomycin is a bactericidal cyclic lipopeptide in development for treatment ofclostridium difficile-associated diarrhea that has selective and potent activity againstc. difficileand other gram-positive bacteria and a minimal impact on intestinal gram-negative organisms. the impacts of ascending doses of surotomycin on ...201626787687
assessing the activity of microbicides against bacterial spores: knowledge and pitfalls.bacterial endospores (spores) have a higher intrinsic resistance to microbicides as compared to other microbial forms, most likely due to their impermeable outer layers and low water content. though structural differences between the spores of various bacterial species may account for observed variations in their resistance to microbicides, flaws in methods for testing the sporicidal activity of microbicides often exaggerate the differences. this has major implications when considering the selec ...201626784857
evaluation of a low-intensity ultraviolet-c radiation device for decontamination of computer keyboards.computer keyboards are a potential source for dissemination of pathogenic microorganisms. we demonstrated that a low-intensity ultraviolet-c (uv-c) radiation device was effective in reducing methicillin-resistant staphylococcus aureus, carbapenem-resistant escherichia coli, and clostridium difficile spores on steel carriers and significantly reduced bacterial counts on in-use keyboards.201626781219
a case of primary invasive aspergillus colitis masquerading as clostridium difficile infection. 201626780696
organism burden, toxin concentration, and lactoferrin concentration do not distinguish between clinically significant and nonsignificant diarrhea in patients with clostridium difficile.clostridium difficile infection is often overdiagnosed in patients with mild diarrhea. we evaluated 4 biomarkers as surrogates for clinically significant diarrhea (≥ 3 episodes in 24 hours) in 59 pcr-positive patients with and 59 pcr-positive patients without clinically significant diarrhea. organism burden (median tcdb cycle threshold value, 26.9 versus 27.1, p=0.25) and toxin a and b concentrations (toxin a, median, 0 versus 0 ng/ml, p=0.42; toxin b, median, 0 versus 0 ng/ml, p=0.25) were not ...201626778484
effects of a predictive preventive model for prevention of clostridium difficile infection in patients in intensive care units.health care-acquired clostridium difficile infection (hacdi) is associated with adverse outcomes at both the organization and patient level. factors that increase risk for development of hacdi have been identified. objectives of this study were to develop a predictive screening tool to identify patients at risk for hacdi and implement a bundle of mitigation interventions.201626775936
bile acid modifications at the microbe-host interface: potential for nutraceutical and pharmaceutical interventions in host health.bile acids have emerged as important signaling molecules in the host, as they interact either locally or systemically with specific cellular receptors, in particular the farnesoid x receptor (fxr) and tgr5. these signaling functions influence systemic lipid and cholesterol metabolism, energy metabolism, immune homeostasis, and intestinal electrolyte balance. through defined enzymatic activities, the gut microbiota can significantly modify the signaling properties of bile acids and therefore can ...201626772409
novel therapies for severe clostridium difficile colitis.clostridium difficile infection (cdi) is becoming a large healthcare burden with increasing incidence, high recurrence rates, and associated morbidity and mortality. disease severity varies from mild to severe and complicated presentations. current mainstays of therapy in severe cdi include: fluid resuscitation, support of organ dysfunction, discontinuation of inciting agents, and antibiotic treatment.201626771898
an integrated metabolomic and microbiome analysis identified specific gut microbiota associated with fecal cholesterol and coprostanol in clostridium difficile infection.clostridium difficile infection (cdi) is characterized by dysbiosis of the intestinal microbiota and a profound derangement in the fecal metabolome. however, the contribution of specific gut microbes to fecal metabolites in c. difficile-associated gut microbiome remains poorly understood. using gas-chromatography mass spectrometry (gc-ms) and 16s rrna deep sequencing, we analyzed the metabolome and microbiome of fecal samples obtained longitudinally from subjects with clostridium difficile infec ...201626871580
the challenge and potential of metagenomics in the clinic.the bacteria, fungi, and viruses that live on and in us have a tremendous impact on our day-to-day health and are often linked to many diseases, including autoimmune disorders and infections. diagnosing and treating these disorders relies on accurate identification and characterization of the microbial community. current sequencing technologies allow the sequencing of the entire nucleic acid complement of a sample providing an accurate snapshot of the community members present in addition to the ...201626870044
toxin b pcr cycle threshold as a predictor of poor outcome of clostridium difficile infection: a derivation and validation cohort study.prediction of patients with poor outcome is necessary in order to plan the proper management of clostridium difficile infection (cdi); however, clinical criteria are insufficient. in a previous study, we observed that high toxigenic c. difficile cfu stool counts at diagnosis were associated with a poor outcome. our objective was to investigate the role of the pcr toxin b amplification cycle threshold (ct) in the prediction of cdi poor outcome and to derive and validate a high-risk prediction rul ...201626869691
a prospective study of two isothermal amplification assays compared with real-time pcr, ccna and toxigenic culture for the diagnosis of clostridium difficile infection.new molecular methods of detecting clostridium difficile infection (cdi) provide the routine lab with a sensitive random access method to produce results that are available in a shorter time than traditional methods.201626868647
molecular characterization and antimicrobial susceptibility of tcda-negative clostridium difficile isolates from guangzhou, china.this study aimed to investigate the molecular characteristics and antimicrobial susceptibility of clostridium difficile clinical isolates in guangzhou, china. one hundred twenty isolates were collected from guangzhou general hospital at the guangzhou military command in china from march 2014 to april 2015, and 9 isolates were identified as tcda-negative/tcdb-positive (a(-)b(+)) strains. results showed that all of the strains were confirmed to be st37 and 0 single nucleotide variants (snvs) were ...201626867962
reactive oxygen species as additional determinants for cytotoxicity of clostridium difficile toxins a and b.clostridium difficile infections can induce mild to severe diarrhoea and the often associated characteristic pseudomembranous colitis. two protein toxins, the large glucosyltransferases tcda and tcdb, are the main pathogenicity factors that can induce all clinical symptoms in animal models. the classical molecular mode of action of these homologous toxins is the inhibition of rho gtpases by mono-glucosylation. rho-inhibition leads to breakdown of the actin cytoskeleton, induces stress-activated ...201626797634
asymptomatic rectal colonization with carbapenem-resistant enterobacteriaceae and clostridium difficile among residents of a long-term care facility in new york city.residents of long-term care facilities (ltcfs) are at increased risk for colonization and development of infections with multidrug-resistant organisms. this study was undertaken to determine prevalence of asymptomatic rectal colonization with clostridium difficile (and proportion of 027/nap1/bi ribotype) or carbapenem-resistant enterobacteriaceae (cre) in an ltcf population.201626796684
development and validation of a clostridium difficile health-related quality-of-life questionnaire.patients with clostridium difficile infection (cdi) can experience long-term symptoms and poor quality of life due to the disease. despite this, a health-related quality of life (hrqol) instrument specific for patients with cdi does not exist. the aim of this study was to develop and validate a disease-specific instrument to assess hrqol in patients with cdi.201626796081
acquisition of clostridium difficile on hands of healthcare personnel caring for patients with resolved c. difficile infection.in an observational study, we found that healthcare personnel frequently acquired clostridium difficile on their hands when caring for patients with recently resolved c. difficile infection (cdi) (<6 weeks after treatment) who were no longer under contact precautions. continuing contact precautions after diarrhea resolves may be useful to reduce transmission.201626795900
is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? a natural experiment with non-equivalent controls.a wide range of patient benefits have been attributed to single room hospital accommodation including a reduction in adverse patient safety events. however, studies have been limited to the us with limited evidence from elsewhere. the aim of this study was to assess the impact on safety outcomes of the move to a newly built all single room acute hospital.201626811373
tigecycline as last resort in severe refractory clostridium difficile infection: a case report. 201626810610
a detrimental role of immunosuppressive drug, dexamethasone, during clostridium difficile infection in association with a gastrointestinal microbial shift.we investigated the increased risk of clostridium difficile infection (cdi) caused by the combined use of antibiotics and an immunosuppressive drug in a mouse model. our data showed that an approximate return to pretreatment conditions of gut microbiota occurred within days after cessation of the antibiotic treatment, whereas the recovery of gut microbiota was delayed with the combined treatment of antibiotics and dexamethasone, leading to an increased severity of cdi. an alteration of gut micro ...201626809802
potassium acetate blocks clostridium difficile toxin a-induced microtubule disassembly by directly inhibiting histone deacetylase 6, thereby ameliorating inflammatory responses in the gut.clostridium difficile toxin a is known to cause deacetylation of tubulin proteins, which blocks microtubule formation and triggers barrier dysfunction in the gut. based on our previous finding that the clostridium difficile toxin a-dependent activation of histone deacetylase 6 (hdac-6) is responsible for tubulin deacetylation and subsequent microtubule disassembly, we herein examined the possible effect of potassium acetate (pa; whose acetyl group prevents the binding of tubulin to hdac-6) as a ...201626809801
effect of variation in test methods on performance of ultraviolet-c radiation room decontamination.to determine the effect of variation in test methods on performance of an ultraviolet-c (uv-c) room decontamination device.201626809607
older is not wiser, immunologically speaking: effect of aging on host response to clostridium difficile infections.clostridium difficile infection (cdi) is the most common cause of antibiotic-associated diarrhea and a significant burden on the health care system. aging has been identified in the literature as a risk factor for cdi as well as adverse outcome from cdi. although this effect of advanced age on cdi could be partially explained by clinical factors associated with aging, biologic factors are important. innate immune system, responsible for immediate response to acute infections, plays a major role ...201626809495
adverse events in faecal microbiota transplant: a review of the literature.faecal microbiota transplant (fmt) is the infusion of donor faeces into the gut with the aim of improving microbial diversity. the procedure has gained significant interest recently in the treatment of recurrent clostridium difficile infection (cdi). the literature is currently dominated by small case series and isolated case reports. there is no standardization of methods and recording of outcomes.201626803556
clostridium difficile recurrences in stockholm.sixty-eight hospital-admitted patients with a first episode of clostridium difficile infection (cdi) were included and followed up during 1 year. faeces samples were collected at 1, 2, 6 and 12 months after inclusion and analyzed for the presence of c. difficile toxin b, genes for toxin a, toxin b, binary toxin and tcdc deletion by pcr. all strains were also pcr-ribotyped and the mics of the isolates were determined against eight antimicrobial agents. in 68 patients initially included, antibioti ...201626802875
burden of nursing home-onset clostridium difficile infection in the united states: estimates of incidence and patient outcomes.background.  approximately 4 million americans receive nursing home (nh) care annually. nursing home residents commonly have risk factors for clostridium difficile infection (cdi), including advanced age and antibiotic exposures. we estimated national incidence of nh-onset (nho) cdi and patient outcomes. methods.  we identified nho-cdi cases from population-based surveillance of 10 geographic areas in the united states. cases were defined by c difficile-positive stool collected in an nh (or from ...201626798767
refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation.pseudomembranous colitis (pmc) is a nosocomial and opportunistic infection caused by clostridium difficile. pmc is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of c. difficile. metronidazole or vancomycin is considered to be the standard therapy for the management of pmc. however, pmc has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. here we describe a patient who experienced refractory pmc who ...201626884739
nicotine inhibits clostridium difficile toxin a-induced colitis but not ileitis in rats.nicotine is protective in ulcerative colitis but not crohn's disease of the small intestine, but little is known about the effects of nicotine on clostridium difficile toxin a-induced enteritis. isolated ileal or colonic segments in anesthetized rats were pretreated with nicotine bitartrate or other pharmacological agents before intraluminal injection of toxin a. after 3 hours, the treated segments were removed and inflammation was assessed. nicotine biphasically inhibited toxin a colitis but no ...201626881175
complications of hospital-onset healthcare facility-associated clostridium difficile infections among veterans.complications within 30 days of a clinically confirmed hospital-onset clostridium difficile infection diagnosis from july 1, 2012, through june 30, 2015, in 127 acute care veterans health administration facilities were evaluated. pooled rates for attributable intensive care unit admissions, colectomies, and deaths were 2.7%, 0.5%, and 0.4%, respectively. infect control hosp epidemiol 2016;37:717-719.201626880482
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