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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
effect of an antimicrobial stewardship bundle for patients with clostridium difficile infection.the study objective was to determine whether there was an improvement in compliance with recommended clostridium difficile infection (cdi) treatment after introduction of an institutional cdi bundle with daily antimicrobial stewardship assessment.201626661392
ultrasensitive detection and quantification of toxins for optimized diagnosis of clostridium difficile infection.recently developed ultrasensitive and quantitative methods for detection of clostridium difficile toxins provide new tools for diagnosis and, potentially, for management of c. difficile infection (cdi). compared to methods that detect toxigenic organism, ultrasensitive toxin detection may allow diagnosis of cdi with increased clinical specificity, without sacrificing clinical sensitivity; measurement of toxin levels may also provide information relevant to disease prognosis. this minireview prov ...201626659205
clostridium difficile colonization in asymptomatic infants 1 to 12 months old, admitted to a community hospital. 201626581362
routine detection of clostridium difficile in western australia.despite increasing infection rates, clostridium difficile is not currently routinely tested for in all diarrhoeal faecal specimens in australia. in july 2014, all diarrhoeal specimens submitted to a diagnostic laboratory in western australia were surveyed to determine the true prevalence of c. difficile. in total, 1010 diarrhoeal non-duplicate faecal specimens were received during the month. testing for c. difficile was requested, or the criteria for a c. difficile investigation were met, for 67 ...201626592987
assessment of clostridium difficile burden in patients over time with first episode infection following fidaxomicin or vancomycin.in patients with first episode clostridium difficile infection treated with vancomycin or fidaxomicin, more patients receiving fidaxomicin achieved at least 2 log10 colony-forming units/g reduction in spores at the follow-up visit (p=.02). similar to published literature, a higher proportion of patients receiving fidaxomicin demonstrated sustained clinical response.201626592763
clinical and healthcare burden of multiple recurrences of clostridium difficile infection.clostridium difficile infection (cdi) is associated with a high risk of recurrence (rcdi). few studies have focused on multiple recurrences. to evaluate the potential of novel treatments targeting recurrence, we assessed the burden and severity of rcdi.201626582748
development and evaluation of double locus sequence typing for molecular epidemiological investigations of clostridium difficile.despite the development of novel typing methods based on whole genome sequencing, most laboratories still rely on classical molecular methods for outbreak investigation or surveillance. reference methods for clostridium difficile include ribotyping and pulsed-field gel electrophoresis, which are band-comparing methods often difficult to establish and which require reference strain collections. here, we present the double locus sequence typing (dlst) scheme as a tool to analyse c. difficile isola ...201626581425
virulence factors of clostridium difficile and their role during infection.clostridium difficile is the prominent etiological agent of healthcare-associated diarrhea. the disease symptoms range from mild diarrhea to life-threatening pseudomembranous colitis. the main risk factor for developing an infection after contamination by the resistant spores is the disruption of the gut microbiota, allowing the spores to germinate. the colonization of the gut is likely to be governed by the bacterial resistance to the host response and the bacterial adhesion to the mucosa. to d ...201626596863
the effectiveness of lactobacillus beverages in controlling infections among the residents of an aged care facility: a randomized placebo-controlled double-blind trial.to clarify the usefulness of lactobacillus casei strain shirota (lcs)-fermented milk in the normalization of bowel movements and improvement of infection control for the elderly residents and staff of facilities for the elderly.201626599038
analysis of morbidity and mortality outcomes in postoperative clostridium difficile infection in the veterans health administration.this study analyzes and reports clostridium difficile infection (cdi) rates, risk factors, and associations with postoperative outcomes in the veterans health administration (vha).201626606675
the high stakes of postoperative clostridium difficile infection. 201626606279
investigation of a cluster of clostridium difficile infections in a pediatric oncology setting.we investigated an increase in clostridium difficile infection (cdi) among pediatric oncology patients.201626601705
epidemiology and factors associated with candidaemia following clostridium difficile infection in adults within metropolitan atlanta, 2009-2013.we assessed prevalence of and risk factors for candidaemia following clostridium difficile infection (cdi) using longitudinal population-based surveillance. of 13 615 adults with cdi, 113 (0·8%) developed candidaemia in the 120 days following cdi. in a matched case-control analysis, severe cdi and cdi treatment with vancomycin + metronidazole were associated with development of candidaemia following cdi.201626608090
in the endemic setting, clostridium difficile ribotype 027 is virulent but not hypervirulent - erratum. 201626607744
use of the cobas 4800 system for the rapid detection of toxigenic clostridium difficile and methicillin-resistant staphylococcus aureus.the new cobas® cdiff and cobas® mrsa/sa tests were compared with conventional methods for the rapid detection of toxigenic clostridium difficile and methicillin-resistant staphylococcus aureus. the final concordance between cobas cdiff test and gdh/toxin gene screening was 97.62% and between cobas mrsa/sa test and chromogenic culture, 91.30%, respectively.201626611812
toxicity assessment of clostridium difficile toxins in rodent models and protection of vaccination.clostridium difficile is the leading cause of hospital-acquired diarrhea, also known as c. difficile associated diarrhea. the two major toxins, toxin a and toxin b are produced by most c. difficile bacteria, but some strains, such as bi/nap1/027 isolates, produce a third toxin called binary toxin. the precise biological role of binary toxin is not clear but it has been shown to be a cytotoxin for vero cells. we evaluated the toxicity of these toxins in mice and hamsters and found that binary tox ...201626614590
incidence of clostridium difficile infection in patients receiving high-risk antibiotics with or without a proton pump inhibitor.considering the incidence and severity of clostridium difficile infection (cdi), risk reduction strategies are crucial. prior studies suggest that proton pump inhibitor (ppi) use can increase the risk of cdi over antibiotics alone; however, data and guidelines have been conflicting.201626616410
clostridium difficile outbreak caused by nap1/bi/027 strain and non-027 strains in a mexican hospital.clostridium difficile infections caused by the nap1/b1/027 strain are more severe, difficult to treat, and frequently associated with relapses.201626620948
identification of key taxa that favor intestinal colonization of clostridium difficile in an adult chinese population.fecal microbial transplantation provides a high curative rate for recurrent clostridium difficile infection (cdi). however, limitations associated with fmt drive the need to identify key taxa for selective probiotic therapy for prevention, treatment and cure of human cdi. cdi-associated changes in gut microbiota were investigated in adult patients in the western countries and among infant population in china. however, there has been no such study involving adult patients in china. therefore, usi ...201626383014
fecal transplant is as effective and safe in immunocompromised as non-immunocompromised patients for clostridium difficile. 201626410257
pcr cycle threshold value predicts the course of clostridium difficile infection. 201626408277
striving for optimal care: updates in quality, value, and patient experience.hospitalists are playing a growing role in quality improvement efforts, and they are increasingly spearheading programs to improve patient experience and healthcare value. we aimed to summarize and critique recent research related to quality, value, and patient experience in the clinical practice of hospital medicine.201626417871
rising incidence of clostridium difficile related discharges among hospitalized children in the united states.using a national database, we report an increasing trend in clostridium difficile incidence among hospitalized children in the united states from 2003 to 2012. the incidence rate of cdi increased from 24.0 to 58.0 per 10,000 discharges per year (p<0.001) across all age groups, with the greatest increase in children 15 years and older. infect. control hosp. epidemiol. 2015;37(1):104-106.201626424193
localizing carbohydrate binding sites in proteins using hydrogen/deuterium exchange mass spectrometry.the application of hydrogen/deuterium exchange mass spectrometry (hdx-ms) to localize ligand binding sites in carbohydrate-binding proteins is described. proteins from three bacterial toxins, the b subunit homopentamers of cholera toxin and shiga toxin type 1 and a fragment of clostridium difficile toxin a, and their interactions with native carbohydrate receptors, gm1 pentasaccharides (β-gal-(1→3)-β-galnac-(1→4)[α-neu5ac-(2→3)]-β-gal-(1→4)-glc), pk trisaccharide (α-gal-(1→4)-β-gal-(1→4)-glc) an ...201626423923
susceptibility of clostridium difficile isolates from a phase 2 clinical trial of cadazolid and vancomycin in c. difficile infection.the aim of this study was to evaluate the susceptibilities of clostridium difficile isolates to cadazolid, a novel antibiotic for the treatment of c. difficile infection.201626433782
faecal microbiota transplantation in recurrent clostridium difficile infection: recommendations from the french group of faecal microbiota transplantation.faecal microbiota transplantation is effective for treating recurrent forms of clostridium difficile infection and its use in this indication is recommended in the most recent european and north american guidelines. in this context, faecal microbiota transplantation is beginning to be performed in france in clinical practice, while the rules governing this procedure have been defined in france only for clinical trials. to unify, secure, and evaluate practice in this field in france, the french g ...201626433619
recurrent clostridium difficile infection in intensive care unit patients.the purpose of this study was to assess the 12-week cumulative incidence of recurrent clostridium difficile infection (rcdi) and identify risk factors for rcdi in patients that acquired index c difficile infection (cdi) while in the intensive care unit (icu).201626432184
slow intestinal transit contributes to elevate urinary p-cresol level in italian autistic children.the uremic toxin p-cresol (4-methylphenol) is either of environmental origin or can be synthetized from tyrosine by cresol-producing bacteria present in the gut lumen. elevated p-cresol amounts have been previously found in the urines of italian and french autism spectrum disorder (asd) children up until 8 years of age, and may be associated with autism severity or with the intensity of abnormal behaviors. this study aims to investigate the mechanism producing elevated urinary p-cresol in asd. u ...201626437875
interleukin-23 (il-23), independent of il-17 and il-22, drives neutrophil recruitment and innate inflammation during clostridium difficile colitis in mice.our objective was to determine the role of the inflammatory cytokine interleukin-23 (il-23) in promoting neutrophil recruitment, inflammatory cytokine expression and intestinal histopathology in response to clostridium difficile infection. wild-type (wt) and p19(-/-) (il-23ko) mice were pre-treated with cefoperazone in their drinking water for 5 days, and after a 2-day recovery period were challenged with spores from c. difficile strain vpi 10463. interleukin-23 deficiency was associated with si ...201626455347
racial and ethnic disparities in health care-associated clostridium difficile infections in the united states: state of the science.among health care-associated infections (hais), clostridium difficile infections (cdis) are a major cause of morbidity and mortality in the united states. as national progress toward cdi prevention continues, it will be critical to ensure that the benefits from cdi prevention are realized across different patient demographic groups, including any targeted interventions.201626454749
increasing incidence of and increased mortality associated with clostridium difficile-associated megacolon. 201626445319
recommendations for probiotic use--2015 update: proceedings and consensus opinion.this paper describes the consensus opinion of the participants in the 4th triennial yale/harvard workshop on probiotic recommendations. the recommendations update those of the first 3 meetings that were published in 2006, 2008, and 2011. recommendations for the use of probiotics in necrotizing enterocolitis, childhood diarrhea, inflammatory bowel disease, irritable bowel syndrome and clostridium difficile diarrhea are reviewed. in addition, we have added recommendations for liver disease for the ...201626447969
factors predictive of severe clostridium difficile infection depend on the definition used.clostridium difficile infection (cdi) produces a variety of clinical presentations ranging from mild diarrhea to severe infection with fulminant colitis, septic shock, and death. over the past decade, the emergence of the bi/nap1/027 strain has been linked to higher prevalence and severity of cdi. the guidelines to treat patients with cdi are currently based on severity factors identified in the literature and on expert opinion and have not been systematically evaluated.201626335160
fecal microbiota transplantation for the treatment of clostridium difficile infection.clostridium difficile, a major cause of healthcare-associated diarrhea due to perturbation of the normal gastrointestinal microbiome, is responsible for significant morbidity, mortality, and healthcare expenditures. the incidence and severity of c difficile infection (cdi) is increasing, and recurrent disease is common. recurrent infection can be difficult to manage with conventional antibiotic therapy. fecal microbiota transplantation (fmt), which involves instillation of stool from a healthy d ...201626344412
comparison of whole-genome sequencing and molecular-epidemiological techniques for clostridium difficile strain typing.we analyzed in parallel 27 pediatric clostridium difficile isolates by repetitive sequence-based polymerase chain reaction (reppcr), pulsed-field gel electrophoresis (pfge), and whole-genome next-generation sequencing. next-generation sequencing distinguished 3 groups of isolates that were indistinguishable by reppcr and 1 isolate that clustered in the same pfge group as other isolates.201626407257
the diagnosis of clostridium difficile infection in outpatient pediatrics. 201626350428
trends in oral antibiotic, proton pump inhibitor, and histamine 2 receptor blocker prescription patterns for children compared with adults: implications for clostridium difficile infection in the community.the use of antibiotics, proton pump inhibitor (ppi), and histamine 2 receptor blocker (h2b) was compared between children and adults in the community from 2005 through 2011. antibiotic prescription rates remained stable for children, but increased significantly for adults, p = .03. ppi prescription rates increased for children, p = .02 and for adults, p = .009. h2b prescription rates increased for children, p = .03, but not for adults. antibiotic prescription rates were significantly higher in c ...201626350427
clostridium difficile colonization in hematopoietic stem cell transplant recipients: a prospective study of the epidemiology and outcomes involving toxigenic and nontoxigenic strains.clostridium difficile is a leading cause of infectious diarrhea in hematopoietic stem cell transplant (hsct) recipients. asymptomatic colonization of the gastrointestinal tract occurs before development of c. difficile infection (cdi). this prospective study examines the rates, risk factors, and outcomes of colonization with toxigenic and nontoxigenic strains of c. difficile in hsct patients. this 18-month study was conducted in the hsct unit at the karmanos cancer center and wayne state univers ...201626211988
regulation of clostridium difficile spore germination by the cspa pseudoprotease domain.clostridium difficile is a spore-forming obligate anaerobe that is a leading cause of healthcare-associated infections. c. difficile infections begin when its metabolically dormant spores germinate in the gut of susceptible individuals. binding of bile salt germinants to the csp family pseudoprotease cspc triggers a proteolytic signaling cascade consisting of the csp family protease cspb and the cortex hydrolase slec. conserved across many of the clostridia, csp proteases are subtilisin-like ser ...201626231446
incidence and clinical outcomes of clostridium difficile infection after treatment with tuberculosis medication.to determine the incidence and clinical characteristics of tuberculosis (tb) medication-associated clostridium difficile infection.201626260753
[ventriculo-gallbladder shunt: an alternative for the treatment of hydrocephalus].in the management of hydrocephalus, the ventriculo-gallbladder shunt is justified in situations where the ventriculo-peritoneal shunt is not useful due to peritoneal involvement and/or when the ventriculo-auricular and ventriculo-pleural shunts are contraindicated.201626259740
fecal microbiota transplant: treatment options for clostridium difficile infection in the intensive care unit.clostridium difficile infection (cdi) has steadily increased in incidence since the 1990s, with an associated increase in recurrence and severity, which has in turn lead to more intensive care unit (icu) admissions. the development of recurrent cdi, in particular, has been associated with increasing patient morbidity and mortality as well as an immense financial burden on the health care system. recently, fecal microbiota transplantation (fmt) has received much publicity as an effective means of ...201626141116
evaluation of incidence and risk factors for high-dose methotrexate-induced nephrotoxicity.high-dose methotrexate (doses ≥1 g/m(2)) is a key component of several chemotherapy regimens used to treat patients with leukemia or lymphoma. despite appropriate precautions with hydration, urine alkalinization, and leucovorin, nephrotoxicity remains a risk which can lead to significant morbidity and mortality. current reports of risk factors for nephrotoxicity focus on patients with nephrotoxicity with a lack of comparison to those without toxicity. this study aimed to describe the incidence o ...201626152702
asymptomatic and yet c. difficile-toxin positive? prevalence and risk factors of carriers of toxigenic clostridium difficile among geriatric in-patients.clostridium difficile infections (cdi) are the most frequent cause of diarrhoea in hospitals. geriatric patients are more often affected by the condition, by a relapse and complications. therefore, a crucial question is how often colonization with toxigenic clostridium difficile strains occurs in elderly patients without diarrhoea and whether there is a "risk pattern" of colonized patients that can be defined by geriatric assessment. furthermore, the probability for those asymptomatic carriers t ...201627846818
recurrent clostridium difficile infection and the microbiome.the diverse and densely populated gastrointestinal microbiota is essential for the regulation of host physiology and immune function. as our knowledge of the composition and function of the intestinal microbiota continues to expand, there is new interest in using these developments to tailor fecal microbiota transplantation (fmt) and microbial ecosystem therapeutics (met) for a variety of diseases. the potential role of fmt and met in the treatment of clostridium difficile infection (cdi)-curren ...201626153514
isolation and quantitation of clostridium difficile in aqueous and fecal matter using two types of selective media.we evaluated the isolation and quantitation of clostridium difficile from aqueous and fecal samples utilizing chromid cdif and cycloserine, cefoxitin, and fructose-containing agar with horse blood and taurocholate media. growth was similar between the two. chromid cdif provided enhanced isolation and required no ethanol pretreatment to inhibit normal flora. chromid cdif also improved turn-around time, requiring only 24 hours' incubation.201626198865
[fecal transplantation for the treatment of relapsing diarrhea associated with clostridium difficile infection in a liver transplantation patient]. 201626343156
clostridium difficile infection in inflammatory bowel disease: a nursing-based quality improvement strategy.patients with inflammatory bowel disease (ibd) have a higher prevalence of clostridium difficile infection (cdi) and worse outcomes. research has highlighted the inconsistent care that is provided to patients with ibd, and at our institution, the cdi testing rate was 41%. the present quality improvement intervention sought to increase cdi testing for inpatients with ibd with a flare.201626042744
clostridium difficile in crete, greece: epidemiology, microbiology and clinical disease.we studied the epidemiology and microbiology of clostridium difficile and the characteristics of patients with c. difficile infection (cdi) in crete in three groups of hospitalized patients with diarrhoea: group 1 [positive culture and positive toxin by enzyme immunoassay (eia)]; group 2 (positive culture, negative toxin); group 3 (negative culture, negative toxin). patients in group 1 were designated as those with definitive cdi (20 patients for whom data was available) and matched with cases i ...201625989816
a rare case of infectious colitis.methicillin-resistant staphylococcus aureus (mrsa) is responsible for numerous infectious processes. gastrointestinal tract involvement is rather rare and only a handful of cases of mrsa colitis have been reported in north america. we present a case of mrsa colitis in an adult without apparent risk factors. abdominal computed tomography (ct) showed thickening of the sigmoid colon, indicative of colitis, and empiric therapy with ciprofloxacin and metronidazole was started. initial work-up for inf ...201626014485
development of microbeads of chicken yolk antibodies against clostridium difficile toxin a for colonic-specific delivery.the incidence of clostridium difficile infection has increased in western world in the past 10 years, similar infection rates are also reported in developing countries such as china. current antibiotics treatments have recurrence rates between 15% and 30%. igy antibodies against toxin a of c. difficile could protect animal models from the challenge of lethal dose of c. difficile spores. however, igy is sensitive to the low ph environment of the stomach and proteinases in the intestine. the objec ...201625799315
clinical and demographic profile of patients reporting for clostridium difficile infection in a tertiary care hospital. 201625866002
clostridium difficile infection may loom behind ipilimumab-induced auto-immune colitis. 201625905620
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
the first clostridium difficile ribotype 027 strain isolated in taiwan. 201625791539
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
efficacy of perioperative synbiotics treatment for the prevention of surgical site infection after laparoscopic colorectal surgery: a randomized controlled trial.the aim of this study was to assess the effect of perioperative oral administration of synbiotics on the surgical outcome in patients undergoing laparoscopic colorectal resection.201625933911
[clostridium difficile, are all our patients diagnosed?].a close correlation between clinical and microbiological diagnosis in clostridium difficile infection (cdi) is very important to identify how severe is this health problem, and to approach its correct management of it, individually and as a population problem.201625743538
prolonged clostridium difficile infection may be associated with vitamin d deficiency.clostridium difficile infection (cdi) is one of the leading causes of hospital-acquired infections, creating a financial burden for the u.s. healthcare system. reports suggest that vitamin d-deficient cdi patients incur higher healthcare-associated expenses and longer lengths of stay compared to nondeficient counterparts. the objective here was to evaluate the relationship between vitamin d level and cdi recurrence.201625623479
luminal toxin-binding agents for clostridium difficile infection.to systematically search the literature for trials evaluating luminal toxin-binding agents (ltbas) for clostridium difficile infection (cdi).201625613056
targeted localized use of therapeutic antibodies: a review of non-systemic, topical and oral applications.therapeutic antibodies provide important tools in the "medicine chest" of today's clinician for the treatment of a range of disorders. typically monoclonal or polyclonal antibodies are administered in large doses, either directly or indirectly into the circulation, via a systemic route which is well suited for disseminated ailments. diseases confined within a specific localized tissue, however, may be treated more effectively and at reduced cost by a delivery system which targets directly the af ...201625600465
restrictive reporting of selected antimicrobial susceptibilities influences clinical prescribing.cascade and restrictive reporting are useful strategies to enhance antibiotic stewardship programs.201625466592
the evaluation of clostridium difficile infection (cdi) in a community hospital.clostridium difficile is a serious reemerging pathogen in europe and north america. c. difficile infection (cdi) has been of concern over the last decade in view of its significant morbidity and mortality, as well as the high health care costs involved with each case. although multiple risk factors are known to be associated with cdi, a number of patients develop severe infection even in the absence of known risk factors. cdi is diagnosed by the detection of the toxin a/b in stools by enzyme imm ...201625301221
which are the antibodies to watch in 2013?the start of the new year signals that it is time for mabs' annual review of the therapeutic monoclonal antibodies (mabs) in active phase 2/3 or phase 3 clinical studies. the entire clinical pipeline currently includes ~350 mabs, but most of these are in early development. as of the beginning of 2013, our "antibodies to watch" list includes 28 single mabs and one mab mixture that are undergoing evaluation in phase 3 studies for inflammatory or immunological disorders, cancers, high cholesterol, ...201623254906
high-throughput dna sequence analysis reveals stable engraftment of gut microbiota following transplantation of previously frozen fecal bacteria.fecal microbiota transplantation (fmt) is becoming a more widely used technology for treatment of recurrent clostridum difficile infection (cdi). while previous treatments used fresh fecal slurries as a source of microbiota for fmt, we recently reported the successful use of standardized, partially purified and frozen fecal microbiota to treat cdi. here we report that high-throughput 16s rrna gene sequencing showed stable engraftment of gut microbiota following fmt using frozen fecal bacteria fr ...201623333862
diverticular disease of the colon does not increase risk of repeat c. difficile infection.studies have suggested that colonic diverticulosis might increase the likelihood of repeat clostridium difficile infection (cdi). our study was designed to compare rates of repeat infection in patients with and without colon diverticula.201623442832
[antimicrobials : some practical considerations].antibiotics are frequently prescribed in hospitalized and in outpatients. we review four important aspects for their daily prescription. in elderly patients, the prescription should take into account changes in the volume of distribution and the usual decline in renal function even in the absence of chronic kidney disease. particular antibiotics can trigger infection with clostridium difficile. we discuss actual and novel strategies for its prevention. renal toxicity of antibiotics includes acut ...201628675267
clostridium difficile colitis: review of the therapeutic approach.clostridium difficile infection (cdi) is the leading cause of antibiotic-associated and nosocomial infectious diarrhea. presenting as clostridium difficile colitis, it is a significant cause of morbidity and mortality. metronidazole is regarded as the agent of choice for cdl therapy and also for the first recurrence in most patients with mild to moderate cdi. vancomycin is recommended as an initial therapy for patients with severe cdi. with recent food and drug administration-approval fidaxomici ...201622990077
complete genome sequence of peptoclostridium difficile strain z31.peptoclostridium (clostridium) difficile is a spore-forming bacterium responsible for nosocomial infections in humans. it is recognized as an important agent of diarrhea and colitis in several animal species and a possible zoonotic agent. despite the known importance of p. difficile infection in humans and animals, no vaccine or other effective measure to control the disease is commercially available. a possible alternative treatment for p. difficile infection is the use of a nontoxigenic strain ...201628828039
[fecal microbiota transplant in the treatment of recurrent clostridium difficile infection: a case report].clostridium difficile infection is a major cause of nosocomial diarrhea. its incidence has increased in the past 20 years and is associated with a significant morbidity and mortality. relapsing is frequent after treatment and the management of these recurrent clostridium difficile infections is challenging. several studies over the years have shown that fecal microbiota transplantion is associated with a high degree of success. fecal microbiota transplantion is now part of the european recommend ...201628525191
a sialic acid aldolase from peptoclostridium difficile nap08 with 4-hydroxy-2-oxo-pentanoate aldolase activity.sialic acid aldolases (e.c.4.1.3.3) catalyze the reversible aldol cleavage of n-acetyl-d-neuraminic acid (neu5ac) to from n-acetyl-d-mannosamine (mannac) and pyruvate. in this study, a sialic acid aldolase (pdnal) from peptoclostridium difficile nap08 was expressed in escherichia coli bl21 (de3). this homotetrameric enzyme was purified with a specific activity of 18.34u/mg for the cleavage of neu5ac. the optimal ph and temperature for aldol addition reaction were 7.4 and 65°c, respectively. pdna ...201627542750
exploiting a host-commensal interaction to promote intestinal barrier function and enteric pathogen tolerance.commensal intestinal bacteria can prevent pathogenic infection; however, limited knowledge of the mechanisms by which individual bacterial species contribute to pathogen resistance has restricted their potential for therapeutic application. here, we examined how colonization of mice with a human commensal enterococcus faecium protects against enteric infections. we show that e. faecium improves host intestinal epithelial defense programs to limit salmonella enterica serotype typhimurium pathogen ...201628580440
a retrospective comparison of fecal microbial transplantation methods for recurrent clostridium difficile infection.antibiotic treatment of clostridium difficile infection (cdi) has a high failure rate. fecal microbiota transplantation (fmt) has proven very effective in treating these recurrences.201628471618
clinical conundrums in management of sepsis in the elderly.in 2012, surviving sepsis campaign came out with updated international guidelines for management of severe sepsis and septic shock. paradoxically, there are no specific guidelines for management of sepsis in the elderly, although the elderly are more predisposed to sepsis, and morbidity and mortality related to sepsis. sepsis in the elderly is, more often than not, complicated by clinical conundrums such as congestive heart failure (chf), atrial fibrillation (af), chronic kidney disease (ckd), a ...201727847897
low awareness but positive attitudes toward fecal transplantation in ontario physicians.despite mounting evidence supporting fecal transplantation (ft) as a treatment for recurrent clostridium difficile infection (cdi), adoption into clinical practice has been slow.201725798151
effect of a probiotic on prevention of diarrhea and clostridium difficile and clostridium perfringens shedding in foals.up to 60% of foals develop diarrhea within 6 months after birth. preventive measures are limited but potentially probiotics could be used.201725903509
long-term follow-up of fecal microbiota transplantation for treatment of recurrent clostridium difficile infection in a dual solid organ transplant recipient.clostridium difficile infection is one of the most frequent causes of healthcare-associated infections, and its rates are also increasing in the community. mounting evidence suggests that fecal microbiota transplantation (fmt) may be effective; however, as there is paucity of data regarding the use of fmt in patients with solid organ transplants, we present a case of successful fmt in a patient with dual solid organ transplant.201726078735
antimicrobial resistance: thinking outside the box.the health care system is challenged by another serious issue: antimicrobial resistance. clostridium difficile is the most common infection in health care institutions and is becoming resistant to standard treatment. carbapenem-resistant enterobacteriaceae can be found in almost every state in the united states. confounding the antimicrobial resistance issue is the fact that few new antimicrobials are being developed by pharmaceutical companies. the situation is so critical that the white house ...201726200730
long-term follow-up study of fecal microbiota transplantation for severe and/or complicated clostridium difficile infection: a multicenter experience.our aim was to investigate fecal microbiota transplantation (fmt) efficacy in patients with severe and/or complicated clostridium difficile infection (cdi).201726125460
strategies for appropriate antibiotic use in intensive care unit.the comsumption of antibiotics is high, mainly in intensive care units. unfortunately, most are inappropriately used leading to increased multi-resistant bacteria. it is well known that initial empirical therapy with broad-spectrum antibiotics reduce mortality rates. however the prolonged and irrational use of antimicrobials may also increase the risk of toxicity, drug interactions and diarrhea due to clostridium difficile. some strategies to rational use of antimicrobial agents include avoiding ...201726132360
fecal microbiota transplant by push enteroscopy to treat diarrhea caused by clostridium difficile.clostridium difficile is the major etiological agent of pseudomembranous colitis and is found in up to 20% of adult inpatients. the recommended treatment is antibiotic therapy with metronidazole and/or vancomycin. however, the recurrence rate may reach up to 25% and it increases in each episode. the newest alternative to treat diarrhea due to recurrent clostridium difficile is fecal microbiota transplantation. the procedure was performed in 12 patients, with a 6-month follow-up on 10 of them. of ...201726154556
multifocal clinical performance improvement across 21 hospitals.improving quality and safety across an entire healthcare system in multiple clinical areas within a short time frame is challenging. we describe our experience with improving inpatient quality and safety at kaiser permanente northern california. the foundations of performance improvement are a “four-wheel drive” approach and a comprehensive driver diagram linking improvement goals to focal areas. by the end of 2011, substantial improvements occurred in hospital-acquired infections (central-line– ...201726247072
the impact of clostridum difficile on surgical rate among ulcerative colitis patients: a systemic review and meta-analysis.there is growing recognition of the impact of clostridum difficile infection (cdi) on patients with inflammatory bowel disease. clostridium difficile infection causes greater morbidity and mortality. this study aimed to evaluate the impact of c. difficile on surgical risk among ulcerative colitis (uc) patients. we searched the following databases: medline, embase, the cochrane central register of controlled trials, acp journal club, dare, cmr, and hta. studies were included if fulfilled the foll ...201726228363
the role of procalcitonin levels in assessing the severity of clostridium difficile infection. 201726392722
indication of acid suppression therapy and predictors for the prophylactic use of protonpump inhibitors vs. histamine-2 receptor antagonists in a malaysian tertiary hospital.proton-pump inhibitors (ppi) and histamine-2 receptor antagonists (h2ra) are common acid suppressants used in gastrointestinal disorders. the trend of usage in malaysia has changed from predominantly h2ra to ppi from 2007 to 2008, 3.46 versus 2.87 and 2.99 versus 3.24 ddd (defined daily dose)/1000 population/day respectively. this raises concerns as ppi overutilization amounts to higher cost expenditure and are associated with various untoward consequences such as clostridium difficile-associate ...201726445624
integration of erm(b)-containing elements through large chromosome fragment exchange in clostridium difficile.in clostridium difficile, erm(b) genes are located on mobile elements like tn5398 and tn6215. in previous studies, some of these elements were transferred by conjugation-like mechanisms, mobilized in trans by helper conjugative systems. in this study, we analyzed the genomes of several recipient strains that acquired either tn5398 or tn6215-like elements. we demonstrated that the integration of the transposons in the genome of the recipient cell was always due to homologous recombination events, ...201726442177
[acute respiratory distress syndrome due to clostridium difficile colitis: a case report and review of the literature].clostridium difficile is a major cause of antibiotic-associated diarrhea. we report a patient with complicated clostridium difficile infection (cdi) who developed rapidly progressive acute respiratory distress syndrome (ards), for which cdi was the only identifiable source. cdi should be considered in the differential diagnosis for anyone with diarrhea who presents especially in high-risk groups such as the elderly, hospitalized patients, or those who have had a history of cdi.201726397285
the long-term efficacy and safety of fecal microbiota transplant for recurrent, severe, and complicated clostridium difficile infection in 146 elderly individuals.clostridium difficile infection (cdi) in the elderly has a higher prevalence, greater morbidity and mortality, and lower response to conventional treatment than the general population. fecal microbiota transplant (fmt) is highly effective therapy for cdi but has not been studied specifically in the elderly. this study aims to determine the long-term efficacy and safety of fmt for recurrent (rcdi), severe (scdi), and complicated (ccdi) cdi in elderly patients.201726352106
[candidemia subsequent to clostridium difficile infection: direct relationship or coincidence?]. 201726364120
[recurrent disease due to ribotype 027 clostridium difficile]. 201726620602
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