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quantifying transmission of clostridium difficile within and outside healthcare settings.to quantify the effect of hospital and community-based transmission and control measures on clostridium difficile infection (cdi), we constructed a transmission model within and between hospital, community, and long-term care-facility settings. by parameterizing the model from national databases and calibrating it to c. difficile prevalence and cdi incidence, we found that hospitalized patients with cdi transmit c. difficile at a rate 15 (95% ci 7.2-32) times that of asymptomatic patients. long- ...201626982504
fecal microbiota transplantation in children: a brief review.there has been a growing interest in fecal microbiota transplantation (fmt) over recent years, in part due to the increasing prevalence of clostridium difficile infection (cdi) and expanding association of intestinal dysbiosis with a wide range of human diseases. many adult studies have shown that fmt is an effective treatment for recurrent cdi and may possibly have applications in other illnesses such as inflammatory bowel disease (ibd); however, there is a paucity of data available in children ...201626982451
impact of a prospective audit and feedback antimicrobial stewardship program at a veterans affairs medical center: a six-point assessment.prospective audit and feedback is a core antimicrobial stewardship program (asp) strategy; however its impact is difficult to measure.201626978263
effect of surotomycin, a novel cyclic lipopeptide antibiotic, on intestinal colonization with vancomycin-resistant enterococci and klebsiella pneumoniae in mice.surotomycin (formerly called cb-183,315) is a novel, orally administered cyclic lipopeptide antibacterial in development for the treatment of clostridium difficile infection (cdi) that has potent activity against vancomycin-resistant enterococci (vre) but limited activity against gram-negative bacilli, including bacteroides spp. we used a mouse model to investigate the impact of surotomycin exposure on the microbiome, and to test the consequences of the disruption on colonization by vancomycin-r ...201626976870
bloom and bust: intestinal microbiota dynamics in response to hospital exposures and clostridium difficile colonization or infection.clostridium difficile infection (cdi) is the leading infectious cause of nosocomial diarrhea. hospitalized patients are at increased risk of developing cdi because they are exposed to c. difficile spores through contact with the hospital environment and often receive antibiotics and other medications that can disrupt the integrity of the indigenous intestinal microbiota and impair colonization resistance. using whole metagenome shotgun sequencing, we examined the diversity and composition of the ...201626975510
fecal microbiota transplantation: current applications, effectiveness, and future perspectives.fecal microbiota transplantation (fmt) is the infusion of liquid filtrate feces from a healthy donor into the gut of a recipient to cure a specific disease. a fecal suspension can be administered by nasogastric or nasoduodenal tube, colonoscope, enema, or capsule. the high success rate and safety in the short term reported for recurrent clostridium difficile infection has elevated fmt as an emerging treatment for a wide range of disorders, including parkinson's disease, fibromyalgia, chronic fat ...201626956193
clostridium difficile infection: epidemiology, diagnosis and understanding transmission.clostridium difficile infection (cdi) continues to affect patients in hospitals and communities worldwide. the spectrum of clinical disease ranges from mild diarrhoea to toxic megacolon, colonic perforation and death. however, this bacterium might also be carried asymptomatically in the gut, potentially leading to 'silent' onward transmission. modern technologies, such as whole-genome sequencing and multi-locus variable-number tandem-repeat analysis, are helping to track c. difficile transmissio ...201626956066
probiotics are effective at preventing clostridium difficile-associated diarrhea: a systematic review and meta-analysis.clostridium difficile infection (cdi) is the leading cause of antibiotic-associated diarrhea. cdi has increased in incidence and severity over the past decade, and is a growing worldwide health problem associated with substantial health care costs and significant morbidity and mortality. this meta-analysis examines the impact of probiotics on the incidence of clostridium difficile-associated diarrhea (cdad) among children and adults, in both hospital and outpatient settings.201626955289
host immune response to clostridium difficile infection in inflammatory bowel disease patients.clostridium difficile infection (cdi) affects patients with inflammatory bowel disease (ibd). the aim of this study was to compare humoral response to c. difficile toxins in ibd patients and control outpatients.201626954708
impact of evidence-based guidelines on outcomes of hospitalized patients with clostridium difficile infection.clostridium difficile infection (cdi) is the most common healthcare-associated infection in the united states. clinical practice guidelines for the treatment of cdi were updated in 2010 by the society for healthcare epidemiology of america and the infectious diseases society of america. an institutional guideline for the classification and management of cdi in accordance with the 2010 society for healthcare epidemiology of america/infectious diseases society of america guideline was developed an ...201626954650
toxin immunoassays and clostridium difficile infection-reply. 201626954051
toxin immunoassays and clostridium difficile infection. 201626954050
toxin immunoassays and clostridium difficile infection. 201626954049
toxin immunoassays and clostridium difficile infection. 201626954047
high variability in nosocomial clostridium difficile infection rates across hospitals after colorectal resection.hospital-acquired clostridium difficile infection is associated with adverse patient outcomes and high medical costs. the incidence and severity of c. difficile has been rising in both medical and surgical patients.201626953991
percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy.the length of antimicrobial therapy in complicated intra-abdominal infections (ciais) is controversial. a recent prospective, multicenter, randomized controlled trial found that 4 days of antimicrobial therapy after source control of ciai resulted in similar outcomes when compared with longer duration. we sought to examine whether outcomes remain similar in the subpopulation who received percutaneous drainage for source control of ciai.201626953758
recent advances in the understanding of antibiotic resistance in clostridium difficile infection.clostridium difficile epidemiology has changed in recent years, with the emergence of highly virulent types associated with severe infections, high rates of recurrences and mortality. antibiotic resistance plays an important role in driving these epidemiological changes and the emergence of new types. while clindamycin resistance was driving historical endemic types, new types are associated with resistance to fluoroquinolones. furthermore, resistance to multiple antibiotics is a common feature ...201626862400
opportunities for improvement in the care of patients hospitalized for inflammatory bowel disease-related colitis.algorithms for the diagnosis, management, and follow-up have been proposed for patients hospitalized for inflammatory bowel disease (ibd) colitis flare. the degree to which providers adhere to these algorithms is unknown. this study evaluated the quality of care in ibd patients hospitalized for disease-associated exacerbations and factors correlated with higher degrees of care.201626860508
the importance of matrix-assisted laser desorption ionization-time of flight mass spectrometry for correct identification of clostridium difficile isolated from chromid c. difficile chromogenic agar.the clinical workflow of using chromogenic agar and matrix-assisted laser desorption ionization time-of-fight mass spectrometry (maldi-tof ms) for clostridium difficile identification was evaluated. the addition of maldi-tof ms identification after the chromid c. difficile chromogenic agar culture could significantly improve the diagnostic accuracy of c. difficile.201626860352
a comparison of clostridium difficile diagnostic methods for identification of local strains in a south african centre.accurate diagnosis of clostridium difficile infection is essential for disease management. a clinical and molecular analysis of c. difficile isolated from symptomatic patients at groote schuur hospital, south africa, was conducted to establish the most suitable clinical test for the diagnosis and characterisation of locally prevalent strains. c. difficile was detected in stool samples using enzyme-based immunoassays (eia) and nucleic acid amplification methods, and their performance was compared ...201626860329
breakthroughs in the treatment and prevention of clostridium difficile infection.this review summarizes the latest advances in the treatment and prevention of clostridium difficile infection (cdi), which is now the most common health-care-associated infection in the usa. as traditional, standard cdi antibiotic therapies (metronidazole and vancomycin) are limited by their broad spectrum and further perturbation of the intestinal microbiota, which result in unacceptably high recurrence rates, novel therapeutic strategies for cdi are needed. emerging cdi therapies are focused o ...201626860266
identification of medicare recipients at highest risk for clostridium difficile infection in the us by population attributable risk analysis.population attributable risk percent (par%) is an epidemiological tool that provides an estimate of the percent reduction in total disease burden if that disease could be entirely eliminated among a subpopulation. as such, par% is used to efficiently target prevention interventions. due to significant limitations in current clostridium difficile infection (cdi) prevention practices and the development of new approaches to prevent cdi, such as vaccination, we determined the par% for cdi in variou ...201626859403
hospital clostridium difficile infection rates and prediction of length of stay in patients without c. difficile infection.background inpatient length of stay (los) has been used as a measure of hospital quality and efficiency. patients with clostridium difficile infections (cdi) have longer los. objective to describe the relationship between hospital cdi incidence and the los of patients without cdi. design retrospective cohort analysis. methods we predicted average los for patients without cdi at both the hospital and patient level using hospital cdi incidence. we also controlled for hospital characteristics (eg, ...201626858126
introduction to the special issue on clostridium difficile and the history of the international clostridium difficile symposium (icds). 201626856973
prevention of stress-related ulcer bleeding at the intensive care unit: risks and benefits of stress ulcer prophylaxis.stress-related mucosal disease is a typical complication of critically ill patients in the intensive care unit (icu). it poses a risk of clinically relevant upper gastrointestinal (gi) bleeding. therefore, stress ulcer prophylaxis (sup) is recommended in high-risk patients, especially those mechanically ventilated > 48 h and those with a manifest coagulopathy. proton pump inhibitors (ppi) and, less effectively, histamine 2 receptor antagonists (h2ra) prevent gi bleeding in critically ill patient ...201626855894
a response to the relationship between different types of sharps containers and clostridium difficile infection rates in acute care hospitals. 201626852081
reply to dikon in response to "a response to the relationship between different types of sharps containers and clostridium difficile infection rates in acute care hospitals". 201626851197
coexisting cytomegalovirus infection in immunocompetent patients with clostridium difficile colitis.cytomegalovirus (cmv) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents. however, cmv colitis is increasingly recognized in immunocompetent hosts. notably, cmv colitis coexisting with clostridium difficile infection (cdi) in apparently healthy individuals has been published in recent years, which could result in high morbidity and m ...201626850320
ultrastructural variability of the exosporium layer of clostridium difficile spores.the anaerobic sporeformer clostridium difficile is the leading cause of nosocomial antibiotic-associated diarrhea in developed and developing countries. the metabolically dormant spore form is considered the transmission, infectious, and persistent morphotype, and the outermost exosporium layer is likely to play a major role in spore-host interactions during the first contact of c. difficile spores with the host and for spore persistence during recurrent episodes of infection. although some stud ...201626850296
clostridium difficile associated risk of death score (cards): a novel severity score to predict mortality among hospitalised patients with c. difficile infection.clostridium difficile infection (cdi) is a public health threat and associated with significant mortality. however, there is a paucity of objectively derived cdi severity scoring systems to predict mortality.201626849527
telephone survey of infection-control and antibiotic stewardship practices in long-term care facilities in maryland.multidrug-resistant organisms are an emerging and serious threat to the care of patients. long-term care facilities are considered a reservoir of these organisms partly because of the over-prescribing of antibiotics. antibiotic use is common in long-term care facilities. antibiotic stewardship programs have been shown to reduce antibiotic consumption in acute-care facilities. the purpose of our study is to investigate existing infection-control practices and antibiotic stewardship programs in lo ...201626848066
beneficial effects of fecal microbiota transplantation on ulcerative colitis in mice.ulcerative colitis (uc) is a chronic condition and the most common form of inflammatory bowel disease. the goal of standard treatment is mainly to induce and maintain remission with anti-inflammatory, immunosuppressive agents, and/or colectomy. fecal microbiota transplantation (fmt) has been used successfully to treat relapsing or refractory clostridium difficile infection. the alteration of microbiota in mouse models of uc as well as in patients suggested the possibility of treating uc with fmt ...201626846120
predicting the risk of clostridium difficile infection upon admission: a score to identify patients for antimicrobial stewardship efforts.increasing morbidity and health care costs related to clostridium difficile infection (cdi) have heightened interest in methods to identify patients who would most benefit from interventions to mitigate the likelihood of cdi.201626845084
does alkaline colonic ph predispose to clostridium difficile infection?clostridium difficile caused nearly 500,000 infections and was associated with approximately 29,000 deaths in 2011, according to data from the centers for disease control and prevention. c. difficile is a bacterium that causes diarrhea and, often, severe illness in healthcare facilities, as well as the community. our objective was to determine whether alkaline colonic ph predisposes to colonization and infection with c. difficile.201626840963
immunogenicity and protective efficacy of recombinant clostridium difficile flagellar protein flic.clostridium difficile is a gram-positive bacillus and is the leading cause of toxin-mediated nosocomial diarrhea following antibiotic use. c. difficile flagella play a role in colonization, adherence, biofilm formation, and toxin production, which might contribute to the overall virulence of certain strains. human and animal studies indicate that anti-flagella immune responses may play a role in protection against colonization by c. difficile and subsequent disease outcome. here we report that r ...201626839147
clostridium difficile-associated diarrhoea in primary joint arthroplasty in aneurin bevan university health board south.the choice of perioperative antibiotics to reduce the prevalence of infection after joint arthroplasty should be considered carefully to minimise the risk of nosocomial infections. dramatic increases in the incidence and severity of healthcare-associated clostridium difficile infection with clostridium difficile-associated diarrhoea (cdad) have occurred since 2000.201626836055
bacterial probiotics as an aid in the control of clostridium difficile disease in neonatal pigs.although clostridium difficile infection (cdi) is a common disease in swine, there is a lack of prevention strategies. the objectives of this study were to evaluate: i) the effectiveness of lactobacillus spp. and ii) non-toxigenic c. difficile (ntcd) as prevention for the development of cdi in piglets. cesarean-derived piglets (n = 150) were randomly assigned to 6 groups: group 1 - negative control (n = 10); group 2 - ntcd only (n = 13); group 3 - lactobacillus spp. only (n = 14); group 4 - posi ...201626834271
antibacterials developed to target a single organism: mechanisms and frequencies of reduced susceptibility to the novel anti-clostridium difficile compounds fidaxomicin and lff571.clostridium difficile is the most common cause of antibacterial-associated diarrhea. clear clinical presentation and rapid diagnostics enable targeted therapy for c. difficile infection (cdi) to start quickly. cdi treatment includes metronidazole and vancomycin (van). despite decades of use for cdi, no clinically meaningful resistance to either agent has emerged. fidaxomicin (fdx), an rna polymerase inhibitor, is also approved to treat cdi. mutants with reduced susceptibility to fdx have been se ...201626834162
treatment of clostridium difficile infection using sq641, a capuramycin analogue, increases post-treatment survival and improves clinical measures of disease in a murine model.clostridium difficile infection (cdi) is a primary cause of antibiotic-associated diarrhoeal illness. current therapies are insufficient as relapse rates following antibiotic treatment range from 25% for initial treatment to 60% for treatment of recurrence. in this study, we looked at the efficacy of sq641 in a murine model of cdi. sq641 is an analogue of capuramycin, a naturally occurring nucleoside-based compound produced by streptomyces griseus.201626832756
host-microbiota interactions in the pathogenesis of antibiotic-associated diseases.improved understanding of the interplay between host and microbes stands to illuminate new avenues for disease diagnosis, treatment, and prevention. here, we provide a high-resolution view of the dynamics between host and gut microbiota during antibiotic-induced intestinal microbiota depletion, opportunistic salmonella typhimurium and clostridium difficile pathogenesis, and recovery from these perturbed states in a mouse model. host-centric proteome and microbial community profiles provide a nua ...201626832403
a multi-laboratory comparison of two molecular methods for the detection of toxigenic clostridium difficile.diarrheal disease due to toxigenic clostridium difficile (cd) accounts for an increased number of hospitalizations and deaths each year. published guidelines recommend reflex testing of cd antigen-positive samples to molecular testing or testing samples directly by a molecular assay. this multicenter study was designed to compare the accuracy of two different molecular methods targeting different cd genes: xpert c. difficile epi ruo rt-pcr assay (xpcr) which targets toxin b (cepheid, sunnyvale, ...201626829538
peripheral neuropathy after fecal microbiota transplantation for clostridium difficile infection: a case report.we present a case of a 71-year-old man with clostridium difficile infection who underwent fecal transplantation. the patient was found to have a predominantly demyelinating sensorimotor peripheral polyneuropathy upon electrodiagnostic testing. to our knowledge, only one case of peripheral neuropathy after fecal transplantation has previously been reported. although the exact cause of this patient's neuropathy cannot be confirmed, it has been speculated that the pathophysiology is an immune-media ...201626826616
genome sequence and analysis of peptoclostridium difficile strain zjcdc-s82.peptoclostridium difficile (clostridium difficile) is the major pathogen associated with infectious diarrhea in humans. concomitant with the increased incidence of c. difficile infection worldwide, there is an increasing concern regarding this infection type. this study reports a draft assembly and detailed sequence analysis of c. difficile strain zjcdc-s82. the de novo assembled genome was 4.19 mb in size, which includes 4,013 protein-coding genes, 41 rrna genes, and 84 trna genes. along with t ...201626823648
prevalence of probiotic use among inpatients: a descriptive study of 145 u.s. hospitals.to inform clinical guidance, public health efforts, and research directions, probiotic use in u.s. health care needs to be better understood. this work aimed to assess the prevalence of inpatient probiotic use in a sample of u.s. hospitals.201626822808
fecal transplantation for clostridium difficile-"all stool may not be created equal".clostridium difficile is a gram-positive bacterium that is recognized as a causative organism of pseudomembranous enterocolitis. this infection has become a major public health challenge and is a source of considerable morbidity and mortality in those infected. we present a 62-year-old african american female with a long history of hiv infection, who presented with abdominal pain and continuous diarrhea due to pseudomembranous colitis. after failing multiple episodes of conventional therapy, it ...201626821578
infection prevention in transplantation.the number of patients undergoing hematopoietic cell and solid organ transplantation are increasing every year, as are the number of centers both transplanting and caring for these patients. improvements in transplant procedures, immunosuppressive regimens, and prevention of transplant-associated complications have led to marked improvements in survival in both populations. infections remain one of the most important sources of excess morbidity and mortality in transplant, and therefore, infecti ...201626820654
difficult case of cronkhite-canada syndrome with small intestinal bacterial overgrowth, clostridium difficile infection and polymyalgia rheumatica.a 64-year-old woman presented with heavy diarrhoea, nausea and weight loss accompanied by alopecia and dystrophic fingernails and toenails. the preceding diagnosis of an inflammatory bowel disease, a common pitfall, was excluded by endoscopic work up. instead, cronkhite-canada syndrome (ccs), a rare polyposis condition, was identified as the reason for this almost pathognomonic combination of diagnostic findings including various polyps throughout the entire intestine and ectodermal abnormalitie ...201626818813
inappropriate antibiotic use and gastric acid suppression preceding clostridium difficile infection. 201626818749
decolonization in prevention of health care-associated infections.colonization with health care-associated pathogens such as staphylococcus aureus, enterococci, gram-negative organisms, and clostridium difficile is associated with increased risk of infection. decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (hais). this review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. alt ...201626817630
distribution and characterization of clostridium difficile isolated from dogs in japan.we collected 204 nondiarrhoeic canine fecal samples and isolated 68 clostridium difficile strains from 62 of these samples. strains were grouped into 29 pcr ribotypes. only 47% of the strains were toxigenic.201626456188
performance management of clostridium difficile infection in hospitals - the carrot or stick approach?public and political pressure for healthcare quality indicator monitoring, specifically healthcare-associated infection (hai) has intensified the debate regarding the merits of public reporting and target setting as policy approaches. this paper reviews the evidence for these approaches with a focus on hai, including clostridium difficile infection (cdi). healthcare key performance indicators (kpis) and associated targets have been used widely with little evaluation. while targets are associated ...201626456187
universal vs risk factor screening for methicillin-resistant staphylococcus aureus in a large multicenter tertiary care facility in canada.objective to assess the clinical effectiveness of a universal screening program compared with a risk factor-based program in reducing the rates of nosocomial methicillin-resistant staphylococcus aureus (mrsa) among admitted patients at the ottawa hospital. design quasi-experimental study. setting ottawa hospital, a multicenter tertiary care facility with 3 main campuses, approximately 47,000 admissions per year, and 1,200 beds. methods from january 1, 2006 through december 31, 2007 (24 months), ...201626470820
ursodeoxycholic acid inhibits clostridium difficile spore germination and vegetative growth, and prevents the recurrence of ileal pouchitis associated with the infection.to test whether ursodeoxycholic acid (udca) is inhibitory to clostridium difficile and can be used in the treatment of c. difficile-associated ileal pouchitis.201626485102
predominance of clostridium difficile ribotypes 012, 027 and 046 in a university hospital in chile, 2012.in a 1-year survey at a university hospital we found that 20·6% (81/392) of patients with antibiotic associated diarrohea where positive for c. difficile. the most common pcr ribotypes were 012 (14·8%), 027 (12·3%), 046 (12·3%) and 014/020 (9·9). the incidence rate was 2·6 cases of c. difficile infection for every 1000 outpatients.201626489717
evaluating the use of the case mix index for risk adjustment of healthcare-associated infection data: an illustration using clostridium difficile infection data from the national healthcare safety network.background case mix index (cmi) has been used as a facility-level indicator of patient disease severity. we sought to evaluate the potential for cmi to be used for risk adjustment of national healthcare safety network (nhsn) healthcare-associated infection (hai) data. methods nhsn facility-wide laboratory-identified clostridium difficile infection event data from 2012 were merged with the fiscal year 2012 inpatient prospective payment system (ipps) impact file by cms certification number (ccn) t ...201626486597
transmission of clostridium difficile during hospitalization for allogeneic stem cell transplant.objective to determine the role of unit-based transmission that accounts for cases of early clostridium difficile infection (cdi) during hospitalization for allogeneic stem cell transplant. setting stem cell transplant unit at a tertiary care cancer center. methods serially collected stool from patients admitted for transplant was screened for toxigenic c. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. in addition, isolates retrieved from cases of ...201626486102
clostridium difficile infection after subarachnoid hemorrhage: a nationwide analysis.clostridium difficile infection (cdi) is an important cause of hospital-acquired morbidity and mortality.201626485334
clinical significance of direct cytotoxicity and toxigenic culture in clostridium difficile infection.clostridium difficile infection (cdi) is the leading cause of hospital-acquired diarrhoea in developed countries. although an optimal diagnosis is crucial, laboratory diagnostics remain challenging. currently, the reference methods are direct cytotoxicity assay and toxigenic culture; however there is controversy in the interpretation of discordant results of these tests.201626505927
immunogenic properties of the surface layer precursor of clostridium difficile and vaccination assays in animal models.clostridium difficile is an opportunistic pathogen causing gut inflammation generally associated with an intestinal dysbiosis due to antibiotics. several virulence factors have been identified as playing a key role in gut colonization. the surface-layer proteins, comprised of two proteins, the high molecular weight slpa (hmw-slp) and the low molecular weight slpa (lmw-slp), are the most abundant proteins on the c. difficile surface. these two proteins are derived from the cwp84-mediated cleavage ...201626505926
defective mutations within the translocation domain of clostridium difficile toxin b impair disease pathogenesis.the clostridium difficile toxin b is one of the main virulence factors and plays an important role in the pathogenesis of c. difficile infection (cdi). we recently revealed crucial residues in the translocation domain of tcdb for the pore formation and toxin translocation. in this study, we investigated the effects of mutating a critical site involved in pore formation, leu-1106, to residues that differ in size and polarity (phe, ala, cys, asp). we observed a broad range of effects on tcdb funct ...201626507679
clinical utility of laboratory detection of clostridium difficile strain bi/nap1/027.clostridium difficile strain bi/nap1/027 is associated with increased c. difficile infection (cdi) rates and severity, and the efficacy of some cdi therapies may be strain dependent. although cultured c. difficile isolates can be reliably subtyped by various methods, the long turnaround times, high cost, and limited availability of strain typing preclude their routine use. nucleic acid amplification tests identify bi/nap1/027 rapidly from stool, but the emergence of closely related strains compr ...201626511742
an update on clostridium difficile toxinotyping.toxinotyping is a pcr-restriction fragment length polymorphism (rflp)-based method for differentiation of clostridium difficile strains according to the changes in the pathogenicity locus (paloc), a region coding for toxins a and b. toxinotypes are a heterogenous group of strains that are important in the development of molecular diagnostic tests and vaccines and are a good basis for c. difficile phylogenetic studies. here we describe an overview of the 34 currently known toxinotypes (i to xxxiv ...201626511734
a whole new ball game: stem cell-derived epithelia in the study of host-microbe interactions.recent advances in developmental and stem cell biology have resulted in techniques that enable the generation and maintenance of complex epithelium in vitro. while these models have been utilized to study host development and disease, a renewed appreciation of host-microbe interactions has sparked interest in employing these new techniques to study microbes at the epithelial interface. here we review the current advances in host-microbe interactions that have resulted from experiments using thes ...201626549696
clinical and microbiologic assessment of cases of pediatric community-associated clostridium difficile infection reveals opportunities for improved testing decisions.most children with clostridium difficile infection (cdi) experience community onset of cdi symptoms.201626517329
single fluorophore melting curve analysis for detection of hypervirulent clostridium difficile.this study demonstrates a novel detection assay able to identify and subtype strains of clostridium difficile. primers carefully designed for melting curve analysis amplify dna from three c. difficile genes, tcdb, tcdc and cdtb, during quantitative (q)pcr. the tcdb gene allows for confirmation of organism presence, whilst the tcdc and cdtb genes allow for differentiation of virulence status, as deletions in the tcdc gene and the concurrent presence of the cdtb gene, which produces binary toxin, ...201626516039
natural history of elderly-onset ulcerative colitis: results from a territory-wide inflammatory bowel disease registry.data on the natural history of elderly-onset ulcerative colitis [uc] are limited. we aimed to investigate clinical features and outcomes of patients with elderly-onset uc.201626512132
multidisciplinary performance improvement team for reducing health care-associated clostridium difficile infection.clostridium difficile is the most frequent cause of health care-associated diarrhea and is a significant cause of morbidity and mortality. it is also associated with a considerable financial burden. a concerted multidisciplinary approach is required for prevention.201626541068
outcomes of clostridium difficile infection in pediatric solid organ transplant recipients.the incidence of clostridium difficile infection (cdi) is increasing in the pediatric population. pediatric recipients of solid organ transplantation (sot) may be at a higher risk for cdi in part because of chemotherapy and prolonged hospitalization.201626538348
donor species richness determines faecal microbiota transplantation success in inflammatory bowel disease.faecal microbiota transplantation is a successful therapy for patients with refractory clostridium difficile infections. it has also been suggested as a treatment option for inflammatory bowel disease, given the role of the intestinal microbiota in this disease. we assessed the impact of faecal microbiota transplantation in patients with inflammatory bowel disease and studied predictors of clinical (non-)response in microbial profiles of donors and patients.201626519463
inactivation of clostridium difficile spores by microwave irradiation.spores are a potent agent for clostridium difficile transmission. therefore, factors inhibiting spores have been of continued interest. in the present study, we investigated the influence of microwave irradiation in addition to conductive heating for c. difficile spore inactivation in aqueous suspension. the spores of 15 c. difficile isolates from different host origins were exposed to conductive heating and microwave irradiation. the complete inhibition of spore viability at 10(7) cfu/ml was en ...201626546732
antibiotic prophylaxis and risk of clostridium difficile infection after coronary artery bypass graft surgery.antibiotic use, particularly type and duration, is a crucial modifiable risk factor for clostridium difficile. cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48 hours or less (vs ≤24 hours for noncardiac surgery), with increasing vancomycin use. we aimed to study associations between antibiotic prophylaxis (duration/vancomycin use) and c difficile among patients undergoing coronary artery bypass grafting.201626545971
diagnostic testing for clostridium difficile in italian microbiological laboratories.a laboratory diagnosis survey of clostridium difficile infection (cdi) was performed in italy in 2012-2013. questionnaires from 278 healthcare settings from 15 regions of italy were collected and analysed. eighty seven percent of the laboratories declared to routinely perform cdi diagnosis, 99% of them only after the clinician's request. among the 216 laboratories providing information on the size of the hospitals in which they were located, 65 had more than 500 beds (large hospitals), while 151 ...201626555737
nisin is an effective inhibitor of clostridium difficile vegetative cells and spore germination.clostridium difficile is the most frequently identified enteric pathogen in patients with nosocomial antibiotic-associated diarrhoea and pseudomembranous colitis. several clinically isolated c. difficile strains are resistant to antibiotics other than metronidazole and vancomycin. recently, bacteriocins of lactic acid bacteria have been proposed as an alternative or complementary treatment. the aim of this study was to investigate the inhibitory effect of nisin, a bacteriocin produced by several ...201626555543
defining appropriate use of proton-pump inhibitors among medical inpatients.proton-pump inhibitors (ppis) are commonly used among medical inpatients, both for prophylaxis against upper gastrointestinal bleeding (ugib) and continuation of outpatient use. while ppis reduce the risk of ugib, they also appear to increase the risk of hospital-acquired pneumonia (hap) and clostridium difficile infection (cdi). depending upon the underlying risks of these conditions and the changes in those risks with ppis, use of proton-pump inhibitors may lead to a net benefit or net harm am ...201626553337
a high rate of alternative diagnoses in patients referred for presumed clostridium difficile infection.we evaluated a cohort of patients referred to our center for presumed recurrent clostridium difficile infection (cdi) to determine final diagnoses and outcomes.201626565971
novel therapeutic strategies for clostridium difficile infections.in recent years, clostridium difficile has become the primary cause of antibiotic-associated diarrhea and pseudomembranous colitis, resulting in long and complicated hospital stays that represent a serious burden for patients as well as health care systems. currently, conservative treatment of c. difficile infection (cdi) relies on the antibiotics vancomycin, metronidazole or fidaxomicin, or in case of multiple recurrences, fecal microbiota transplantation (fmt).201626565670
safety and durability of rbx2660 (microbiota suspension) for recurrent clostridium difficile infection: results of the punch cd study.managing recurrent clostridium difficile infection (cdi) presents a significant challenge for clinicians and patients. fecal microbiota transplantation (fmt) is a highly effective therapy for recurrent cdi, yet availability of a standardized, safe, and effective product has been lacking. our aim in this study was to assess the safety and effectiveness of rbx2660 (microbiota suspension), a commercially prepared fmt drug manufactured using standardized processes and available in a ready-to-use for ...201626565008
inactivation of clostridium difficile in sewage sludge by anaerobic thermophilic digestion.there has been an increase in community-associated clostridium difficile infections with biosolids derived from wastewater treatment being identified as one potential source. the current study evaluated the efficacy of thermophilic digestion in decreasing levels of c. difficile ribotype 078 associated with sewage sludge. five isolates of c. difficile 078 were introduced (final density of 5 log cfu/g) into digested sludge and subjected to anaerobic digestion at mesophilic (36 or 42 °c) or thermop ...201626564276
the effect of broader, directed antimicrobial prophylaxis including fungal coverage on perioperative infectious complications after radical cystectomy.radical cystectomy (rc) with urinary diversion has a significant risk of infection. in an effort to decrease the rate of infectious complications, we instituted a broader, culture-based preoperative antimicrobial regimen, including fungal coverage, and studied its effect on infectious complications after rc.201626572724
establishing a fecal microbiota transplant service for the treatment of clostridium difficile infection.recurrent or refractory clostridium difficile infection (cdi) has become an increasing problem in the past decade. fecal microbiota transplant (fmt) is a highly efficacious treatment for recurrent cdi; however, a number of technical, logistical, and regulatory issues have hampered the development of an fmt capability at many hospitals. the development of a frozen stool bank of screened donor stool is an important step in the standardization of the procedure. this gives clinicians rapid access to ...201626628567
problems after restorative proctocolectomy: assessment and therapy.restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. although the surgical procedure significantly improves the patients' quality of life, complications are common. mechanical or structural complications related to surgical techniques as well as chronic pouchitis are common after the procedure.201626628102
clostridium difficile carriage in healthy pregnant women in china.infection with clostridium difficile has been shown to have particularly poor outcomes for pregnant women, including an increased risk of death. the purpose of this study was to investigate the prevalence, genotypic distribution, and characterization of c. difficile strains isolated from pregnant women without diarrhea in china. as part of this study, 3.7% (37 out of 1009) of samples acquired from pregnant females tested positive for c. difficile. of these positive samples, 27.0% (10) were toxig ...201626633756
metagenomic approach for identification of the pathogens associated with diarrhea in stool specimens.the potential to rapidly capture the entire microbial community structure and/or gene content makes metagenomic sequencing an attractive tool for pathogen identification and the detection of resistance/virulence genes in clinical settings. here, we assessed the consistency between pcr from a diagnostic laboratory, quantitative pcr (qpcr) from a research laboratory, 16s rrna gene sequencing, and metagenomic shotgun sequencing (mss) for clostridium difficile identification in diarrhea stool sample ...201626637379
novel approaches to treating clostridium difficile-associated colitis.clostridium difficile is being recognized as a growing threat to many health-care systems. epidemiology data shows that infection rates are soaring and the disease burden is increasing. despite the efficacy of standard treatments, it is becoming evident that novel therapeutics will be required to tackle this disease. these new treatments aim to enhance the intestinal microbial barrier, activate the immune system and neutralize the toxins that mediate this disease. many of these therapies are sti ...201626643655
bacteriophage combinations significantly reduce clostridium difficile growth in vitro and proliferation in vivo.the microbiome dysbiosis caused by antibiotic treatment has been associated with both susceptibility to and relapse of clostridium difficile infection (cdi). bacteriophage (phage) therapy offers target specificity and dose amplification in situ, but few studies have focused on its use in cdi treatment. this mainly reflects the lack of strictly virulent phages that target this pathogen. while it is widely accepted that temperate phages are unsuitable for therapeutic purposes due to their transduc ...201626643348
antimicrobial therapy of acute diarrhoea: a clinical review.diarrhoea is one of the most commonly occurring diseases. this article presents a review of the current state of the treatment of acute infectious diarrhoea, as well as of the most important pathogens. the general principles of the therapy of diarrhoea are exemplified, followed by a description of the targeted antimicrobial therapy of the most important bacterial gastrointestinal infections, including salmonellosis, shigellosis and campylobacter infections, as well as infections with pathogenic ...201626641310
colectomy in pediatric ulcerative colitis: a single center experience of indications, outcomes, and complications.there is a paucity of data on outcomes and complications of colectomy for pediatric ulcerative colitis (uc). this study reports the experience of a regional center for 18years.201626653944
clostridium difficile infection in texas hospitals, 2007-2011. 201626651237
clostridium difficile infection: a rarity in patients receiving chronic antibiotic treatment for crohn's disease.prolonged antibiotic use is limited by several adverse effects, one of which is clostridium difficile infection (cdi). the aim of this study was to determine the incidence of cdi in patients receiving chronic antibiotic treatment for crohn's disease (cd).201626650148
clinical significance of clostridium difficile in children less than 2 years old: a case-control study.the significance of clostridium difficile (cd) in the stools of children 2 years old or younger remains unclear. the aim of this study was to investigate risk factors and clinical evolution of diarrheic children ≤2 years old with or without cd in their stools.201626650114
proton pump inhibitors affect the gut microbiome.proton pump inhibitors (ppis) are among the top 10 most widely used drugs in the world. ppi use has been associated with an increased risk of enteric infections, most notably clostridium difficile. the gut microbiome plays an important role in enteric infections, by resisting or promoting colonisation by pathogens. in this study, we investigated the influence of ppi use on the gut microbiome.201626657899
subinhibitory concentrations of metronidazole increase biofilm formation in clostridium difficile strains.resistance mechanism to metronidazole is still poorly understood, even if the number of reports on clostridium difficile strains with reduced susceptibility to this antibiotic is increasing. in this study, we investigated the ability of the c. difficile strains 7032994, 7032985 and 7032989, showing different susceptibility profiles to metronidazole but all belonging to the pcr ribotype 010, to form biofilm in vitro in presence and absence of subinhibitory concentrations of metronidazole. the qua ...201626656887
clostridium difficile-diagnostic and clinical challenges. 201626656133
the insect peptide copa3 increases colonic epithelial cell proliferation and mucosal barrier function to prevent inflammatory responses in the gut.the epithelial cells of the gut form a physical barrier against the luminal contents. the collapse of this barrier causes inflammation, and its therapeutic restoration can protect the gut against inflammation. egf enhances mucosal barrier function and increases colonocyte proliferation, thereby ameliorating inflammatory responses in the gut. based on our previous finding that the insect peptide copa3 promotes neuronal growth, we herein tested whether copa3 could increase the cell proliferation o ...201626655716
prevention of infections in nursing homes: antibiotic prophylaxis versus infection control and antimicrobial stewardship measures.because of the lack of structural and human resources for implementing more effective and safe preventive procedures, antimicrobial prophylaxis is often used to prevent infections in nursing homes. however, if data on the efficacy of antibiotic prophylaxis in nursing homes are null, there is a plenty of evidence that the inappropriate use of antimicrobials in this setting is associated with a high rate of colonization and infection with multi-drug-resistant organisms (mdros), and of clostridium ...201626655286
discovery and development of surotomycin for the treatment of clostridium difficile.the primary challenge for treating clostridium difficile infections (cdi) is maintenance of clinical response after the end of treatment (sustained clinical response). disease recurrence following a positive clinical response occurs in approximately 6-25 % of patients after the first episode and in up to 65 % for subsequent recurrences. surotomycin, a novel cyclic lipopeptide antibiotic with a core derived by streptomyces roseosporus fermentation, disrupts c. difficile cellular membrane activity ...201626670919
systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for clostridium difficile infection.clostridium difficile infection is a major cause of nosocomial diarrhoea.201626662643
peri-transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant.clostridium difficile infections (cdi) remain the leading cause of infectious diarrhea among hospitalized patients in this country. patients with hematologic malignancies, especially those who undergo hematopoietic progenitor cell transplants are particularly at risk for developing cdi. one hundred and forty seven consecutive allogeneic hematopoietic progenitor cell transplants were analyzed for peri-transplant clostridium difficile infections (pt-cdi). sixteen patients (11%) developed pt-cdi (m ...201626661725
persistence of clostridium difficile in wastewater treatment-derived biosolids during land application or windrow composting.to determine the persistence of clostridium difficile spores in biosolids during composting or when amended into soil and held under natural environmental climatic conditions.201626661445
the impact of the introduction of fidaxomicin on the management of clostridium difficile infection in seven nhs secondary care hospitals in england: a series of local service evaluations.clostridium difficile infection (cdi) is associated with high mortality. reducing incidence is a priority for patients, clinicians, the national health service (nhs) and public health england alike. in june 2012, fidaxomicin (fdx) was launched for the treatment of adults with cdi. the objective of this evaluation was to collect robust real-world data to understand the effectiveness of fdx in routine practice. in seven hospitals introducing fdx between july 2012 and july 2013, data were collected ...201626661400
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