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clostridium difficile infection is a frequent but well-controlled event after hematopoietic cell transplantation. 201726670398
a qualitative analysis of implementation of antimicrobial stewardship at 3 academic hospitals: understanding the key influences on success.inappropriate use of antimicrobials is linked to the development and spread of drug-resistant pathogens and is associated with increased morbidity, mortality, lengths of hospital stay, and health care costs. "antimicrobial stewardship" is the umbrella term for an evidence-based knowledge translation strategy involving comprehensive quality improvement activities to optimize the use of antimicrobials, improve patient outcomes, reduce the development of antimicrobial resistance and hospital-acquir ...201726478585
upper versus lower gastrointestinal delivery for transplantation of fecal microbiota in recurrent or refractory clostridium difficile infection: a collaborative analysis of individual patient data from 14 studies.the aim of this study was to compare upper gastrointestinal (ugi) versus lower gastrointestinal (lgi) delivery routes of fecal microbiota transplantation (fmt) for refractory or recurrent/relapsing clostridium difficile infection (cdi).201726974758
descriptive epidemiology of infectious gastrointestinal illnesses in sydney, australia, 2007-2010.there is a lack of information about the prevalence of gastrointestinal illnesses in australia. current disease surveillance systems capture only a few pathogens. the aim of this study is to describe the epidemiology of infectious gastrointestinal illnesses in sydney, australia.201726798556
fidaxomicin: a novel agent for the treatment of clostridium difficile infection.due to the limitations of existing treatment options for clostridium difficile infection (cdi), new therapies are needed.201726744587
severe refractory clostridium difficile infection with good response to fecal microbiota transplantation: a case report.a 49-year-old woman diagnosed with pseudomembranous enterocolitis was transferred to our hospital for medical treatment. she responded poorly to treatment with vancomycin hydrochloride and metronidazole, so she underwent fecal microbiota transplantation. treatment effects were observed the next day, and the diarrhea disappeared within 3 days. colonoscopy 4 days later revealed the resolution of pseudomembranes, and no recurrences were reported within the first year after discharge.201726743554
testing for clostridium difficile in patients with cancer. 201728339307
clostridium difficile infections in patients with inflammatory bowel disease.case report of a 23-year-old male presenting with a severe flare of crohn's disease, exacerbated by community-acquired infection with clostridium difficile. this case outlines the association between c. difficile infection and inflammatory bowel disease, as both a mimic and a precipitant of flares. the discussion concerns the latest literature consensus on assessment and management of clostridium difficile infection in patients with inflammatory bowel disease.201728337044
development of a bedside scoring system for predicting a first recurrence of clostridium difficile-associated diarrhea.a scoring system for identifying patients at high or low risk for recurrent clostridium difficile-associated diarrhea (cdad) is described.201728336757
surface layer proteins from virulent clostridium difficile ribotypes exhibit signatures of positive selection with consequences for innate immune response.clostridium difficile is a nosocomial pathogen prevalent in hospitals worldwide and increasingly common in the community. sequence differences have been shown to be present in the surface layer proteins (slps) from different c. difficile ribotypes (rt) however whether these differences influence severity of infection is still not clear.201728335725
morbidity in pregnant women associated with unverified penicillin allergies, antibiotic use, and group b streptococcus infections.the morbidity potentially associated with unverified penicillin allergy in pregnant women, with and without group b streptococcus (gbs) infections, is unknown. penicillin allergy testing is safe during pregnancy but is done infrequently.201728333608
outcomes of multisite antimicrobial stewardship programme implementation with a shared clinical decision support system.studies evaluating antimicrobial stewardship programmes (asps) supported by computerized clinical decision support systems (cdsss) have predominantly been conducted in single site metropolitan hospitals.201728333302
corrigendum: clostridium difficile infection worsen outcome of hospitalized patients with inflammatory bowel disease. 201728332614
molecular typing and antimicrobial susceptibility testing to six antimicrobials of clostridium difficile isolates from three czech hospitals in eastern bohemia in 2011-2012.in 2011-2012, a survey was performed in three regional hospitals in the czech republic to determine the incidence of clostridium difficile infections (cdis) and to characterize bacterial isolates. c. difficile isolates were characterized by pcr ribotyping, toxin genes detection, multiple-locus variable-number tandem-repeat analysis (mlva), and antimicrobial susceptibility testing to fidaxomicin, vancomycin, metronidazole, clindamycin, lff571, and moxifloxacin using agar dilution method. the inci ...201728332133
ivig - a cure to severe refractory nap-1 clostridium difficile colitis? a case of successful treatment of severe infection, which failed standard therapy including fecal microbiota transplants and fidaxomicin.the mainstay treatment of clostridium difficile infections (cdi) is antimicrobials with growing support for fecal microbiota transplants. we report the first case of an elderly man with severe refractory nap-1 pseudomembranous cdi who failed all medical therapy and two fecal transplants with response only seen after administration of intravenous immunoglobulin.201728331803
evaluating risk factors for clostridium difficile infection in stem cell transplant recipients: a national study.objective large-scale studies evaluating risk factors for clostridium difficile infection (cdi), a leading cause of infectious diarrhea among patients undergoing stem cell transplantation (sct), are lacking. we have evaluated risk factors for cdi among both autologous sct (auto-sct), and allogeneic sct (allo-sct) recipients using the national inpatient sample (nis) database provided by the healthcare cost and utilization project (hcup). methods we used patient data obtained from the nis database ...201728330512
practice patterns and outcomes associated with procalcitonin use in critically ill patients with sepsis.randomized trials support use of procalcitonin-based algorithms to decrease duration of antibiotics for critically ill patients with sepsis. however, current utilization of procalcitonin and associated outcomes in "real world" clinical settings is unclear. we sought to determine procalcitonin utilization in critically ill patients with sepsis in the united states and to examine associations between procalcitonin use and clinical outcomes.201728329238
protective factors in the intestinal microbiome against clostridium difficile infection in recipients of allogeneic hematopoietic stem cell transplantation.clostridium difficile infection (cdi) is a frequent complication in recipients of allogeneic hematopoietic stem cell transplantation (allo-hsct), who receive intensive treatments that significantly disrupt the intestinal microbiota. in this study, we examined the microbiota composition of allo-hsct recipients to identify bacterial colonizers that confer protection against cdi following engraftment.201728329030
a significant influence of metronidazole on busulfan pharmacokinetics: a case report of therapeutic drug monitoring.busulfan is a cytotoxic agent used in preconditioning for hematopoietic stem cell transplantation (hsct). therapeutic drug monitoring of busulfan is necessary owing to its narrow therapeutic range. patients undergoing preconditioning are susceptible to infection and might require co-administration of antibiotics. we present a case study of a three-year-old girl with precursor t-cell acute lymphoblastic leukemia who received intravenous busulfan before hsct. metronidazole was co-administered befo ...201728328762
quality of care and outcomes among hospitalized inflammatory bowel disease patients: a multicenter retrospective study.half of patients with inflammatory bowel disease (ibd) require hospitalization. we sought to characterize inpatient quality indicators of care and outcomes during ibd-related hospitalizations at 4 major ibd referral centers in canada.201728328622
bezlotoxumab (zinplava) for prevention of recurrent clostridium difficile infection. 201728323808
permanent bulbar urethral ligation: emerging treatment option for incontinent men with end-stage urethra.to report our experience with permanent urethral ligation for severe incontinence among men with end-stage urethra.201728322899
production of ramoplanin and ramoplanin analogs by actinomycetes.ramoplanin is a glycolipodepsipeptide antibiotic obtained from fermentation of actinoplanes sp. atcc 33076 that exhibits activity against clinically important multi-drug-resistant, gram-positive pathogens including vancomycin-resistant enterococcus (vre), methicillin-resistant staphylococcus aureus (mrsa), and vancomycin-intermediate resistant clostridium difficile. it disrupts bacterial cell wall through a unique mechanism of action by sequestering the peptidoglycan intermediate lipid ii and th ...201728321210
current knowledge on the laboratory diagnosis of clostridium difficile infection.clostridium difficile (c. difficile) is a spore-forming, toxin-producing, gram-positive anaerobic bacterium that is the principal etiologic agent of antibiotic-associated diarrhea. infection with c. difficile (cdi) is characterized by diarrhea in clinical syndromes that vary from self-limited to mild or severe. since its initial recognition as the causative agent of pseudomembranous colitis, c. difficile has spread around the world. cdi is one of the most common healthcare-associated infections ...201728321156
clostridium difficile: still costly, still difficult to treat, and still here. 201728320543
evaluation of fixed and variable hospital costs due to clostridium difficile infection: institutional incentives and directions for future research.economic analysis of clostridium difficile infection (cdi) should consider the incentives facing institutional decision-makers. to avoid overstating the financial benefits of infection prevention, fixed and variable costs should be distinguished.201728320542
patient mortality during unannounced accreditation surveys at us hospitals.in the united states, hospitals receive accreditation through unannounced on-site inspections (ie, surveys) by the joint commission (tjc), which are high-pressure periods to demonstrate compliance with best practices. no research has addressed whether the potential changes in behavior and heightened vigilance during a tjc survey are associated with changes in patient outcomes.201728319229
infection control implications of the laundering of ambulance staff uniforms and reusable mops.there is a lack of published studies on laundering in ambulance services. we performed bacterial culture on soiled and unsoiled uniforms and reusable mop heads artificially contaminated with escherichia coli, staphylococcus aureus, and clostridium difficile spores. current laundering processes used for routine cleans in the ambulances appears, from our simulations, to be effective at reducing vegetative pathogenic bacteria to undetectable levels, <3.398log10 colony-forming units (s. aureus and e ...201728318779
antibiotic-associated diarrhea: clinical characteristics and the presence of clostridium difficile.evidence in colombia and latin america has been insufficient for establishing the clinical characteristics of patients with antibiotic-associated diarrhea (aad). the present study attempts to describe the clinical characteristics of patients with aad and to determine the presence of clostridium difficile, utilizing the polymerase chain reaction (pcr) technique.201728318702
fecal microbiota transplantation in clostridium difficile infection: evidence and indications. 201728318210
snake in the grass: a case report of transfusion reactions due to contaminated donor arm disinfectant.bacterial contamination of blood components remains an on-going challenge. in the majority of cases, organisms contaminating the blood components are a part of normal skin flora. here, we report a case of bacterial contamination of blood units through contaminated donor arm disinfectant. there was a series of reactions due to random donor platelet (rdp) transfusion. the patients had features of septic transfusion reactions. on root cause analysis, spirit swabs used for disinfection of donors' ar ...201728316441
novel indications for fecal microbial transplantation: update and review of the literature.fecal microbial transplantation (fmt) is an established successful treatment modality for recurrent clostridium difficile infection (cdi). the safety profile and potential therapeutic advantages of fmt for diseases associated with dysbiosis and immune dysfunction have led to many publications, mainly case series, and while many studies and reviews have been published on the use of fmt for inflammatory bowel disease (ibd), its potential use for other disease conditions has not been thoroughly rev ...201728315032
assessment of risk factors for candidemia in non-neutropenic patients hospitalized in internal medicine wards: a multicenter study.an increasing prevalence of candidemia has been reported in internal medicine wards (imws). the aim of our study was to identify risk factors for candidemia among non-neutropenic patients hospitalized in imws.201728314653
epidemiology, risk factors and outcome of clostridium difficile infection in heart and heart-lung transplant recipients.clostridium difficile is a major cause of diarrhea in thoracic organ transplant recipients. we investigated the epidemiology, risk factors and outcome of clostridium difficile infection (cdi) in heart and heart-lung transplant (ht) recipients.201728314071
the attributable burden of clostridium difficile infection to long-term care facilities stay: a clinical study.advanced age, history of hospitalization, and antibiotic consumption are associated with the pathogenesis of clostridium difficile infection (cdi). long-term care facilities (ltcfs) represent a setting where cdi has been increasingly reported. we aimed to estimate the actual attributable burden of cdi to ltcf stay and determine the characteristics of the disease epidemiology in this setting.201728306141
the impact of antibiotic stewardship programs in combating quinolone resistance: a systematic review and recommendations for more efficient interventions.quinolones are among the most commonly prescribed antibiotics worldwide. a clear relationship has been demonstrated between excessive quinolone use and the steady increase in the incidence of quinolone-resistant bacterial pathogens, both in hospital and community sites. in addition, exposure to quinolones has been associated with colonization and infection with healthcare-associated pathogens such as methicillin-resistant staphylococcus aureus and clostridium difficile in hospitalized patients. ...201728303388
a qualitative study to identify reasons for clostridium difficile testing in pediatric inpatients receiving laxatives or stool softeners.to understand why clinicians send clostridium difficile tests from hospitalized children receiving laxatives or stool softeners, we performed a mixed-methods study. we prospectively identified tested patients and surveyed their clinicians by e-mail. reasons for testing included changes in stooling pattern on baseline bowel regimen, other changes in clinical status, and risk factors for c difficile infection. education targeting discontinuing bowel medications before c difficile testing could imp ...201728302431
clostridium difficile toxin a induces reactive oxygen species production and p38mapk activation to exert cellular toxicity in neuronal cells.clostridium difficile releases two exotoxins, toxin a and toxin b, which disrupt the epithelial cell barrier in the gut to increase mucosal permeability and trigger inflammation with severe diarrhea. many studies have suggested that enteric nerves are also directly involved in the progression of this toxin-mediated inflammation and diarrhea. c. difficile toxin a is known to enhance neurotransmitter secretion, increase gut motility, and suppress sympathetic neurotransmission in the guinea pig col ...201728301919
deprescribing versus continuation of chronic proton pump inhibitor use in adults.proton pump inhibitors (ppis) are a class of medications that reduce acid secretion and are used for treating many conditions such as gastroesophageal reflux disease (gerd), dyspepsia, reflux esophagitis, peptic ulcer disease, and hypersecretory conditions (e.g. zollinger-ellison syndrome), and as part of the eradication therapy for helicobacter pylori bacteria. however, approximately 25% to 70% of people are prescribed a ppi inappropriately. chronic ppi use without reassessment contributes to p ...201728301676
intracolonic vancomycin through laprascopic appendicostomy for treatment of severe clostridium difficile colitis does not get systemic absorption. 201728301334
clostridium difficile infection in acute care hospitals: systematic review and best practices for prevention.objective prevention of clostridium difficile infection (cdi) in acute-care hospitals is a priority for hospitals and clinicians. we performed a qualitative systematic review to update the evidence on interventions to prevent cdi published since 2009. design we searched ovid, medline, embase, the cochrane library, cinahl, the isi web of knowledge, and grey literature databases from january 1, 2009 to august 1, 2015. setting we included studies performed in acute-care hospitals. patients or parti ...201728300019
cost-effectiveness analysis on the use of fidaxomicin and vancomycin to treat clostridium difficile infection in france.fidaxomicin is a macrocyclic antibiotic with proven efficacy against clostridium difficile infection (cdi) in adults. it was licensed in france in 2012, but, due to higher acquisition costs compared with existing treatments, healthcare providers require information on its cost/benefit profile.201728299963
frequency and risk factors of clostridium difficile infection in hospitalized patients with pouchitis: a population-based study.clostridium difficile infection (cdi) in patients with the ileal pouch after proctocolectomy has been increasingly recognized. we sought to evaluate the frequency and risk factors of cdi in patients with the primary or secondary discharge diagnosis of pouchitis in the united states.201728296825
the epidemiology of clostridium difficile infection in a national kidney transplant centre.we aimed to describe the epidemiology and outcomes of cdi in a national kidney transplant centre from 2008-2015.201728295646
conventional and alternative treatment approaches for clostridium difficile infection.clostridium difficile-associated disease continues to be one of the leading health concerns worldwide. c. difficile is considered as a causative agent of nosocomial diarrhea that causes serious infection, which may result in death. the incidences of c. difficile infection (cdi) in developed countries have become increasingly high which may be attributed to the emergence of newer epidemic strains, extensive use of antibiotics, and limited alternative therapies. the available treatment options aga ...201728293151
detection of vancomycin-resistant enterococci (vre) in stool specimens submitted for clostridium difficile toxin testing.the aim of this study was to determine the association between clostridium difficile (c. difficile) and vancomycin-resistant enterococcus (vre) and efficacy of screening stools submitted for c. difficile toxin assay for prevalence of vre. between april 2012 and february 2014, 158 stool samples submitted for c. difficile toxin to the marmara university microbiology laboratory, were included in the study. stool samples were analyzed by enzyme immuno assay test; vidas (biomerieux, france) for toxin ...201728389190
oral teicoplanin as an alternative first-line regimen in clostridium difficile infection in elderly patients: a case series.elderly patients are more susceptible to clostridium difficile infections (cdis). despite existing guidelines, there is no specific treatment for cdi in geriatrics. vancomycin is commonly used in the treatment of cdi. teicoplanin is an alternative glycopeptide which recently received marketing authorization approval for cdi in europe.201728386820
genome sequence of a toxin-positive clostridium difficile strain isolated from murine feces.herein, we report the genome sequence of a clostridium difficile strain isolated from the feces of antibiotic-treated c57bl/6 mice. we have named this strain, which differs considerably from those of the previously sequenced c. difficile strains, lem1.201728385835
kick the bucket: one hospital system's journey to reduce clostridium difficile.albert einstein defines insanity as doing the same thing over again but expecting different results. although the united states claims to reduce antibiotic abuse, practice strict isolation, and clean meticulously, the burden of clostridium difficile outpaces goals. unless innovative approaches are tried, we risk culling elderly, immunosuppressed, and otherwise debilitated populations. emergency departments are a primary access point for patients who are unable to wait for primary care. as a resu ...201728385299
silver potentiates aminoglycoside toxicity by enhancing their uptake.the predicted shortage in new antibiotics has prompted research for chemicals that could act as adjuvant and enhance efficacy of available antibiotics. in this study, we tested the effects of combining metals with aminoglycosides on escherichia coli survival. the best synergising combination resulted from mixing aminoglycosides with silver. using genetic and aminoglycoside uptake assays, we showed that silver potentiates aminoglycoside action in by-passing the pmf-dependent step, but depended up ...201728383153
challenges and strategies for prevention of multidrug-resistant organism transmission in nursing homes.nursing home residents are at high risk for colonization and infection with bacterial pathogens that are multidrug-resistant organisms (mdros). we discuss challenges and potential solutions to support implementing effective infection prevention and control practices in nursing homes.201728382547
use of a perianal swab compared with a stool sample to detect symptomatic clostridium difficile infection.objective to evaluate the use of a perianal swab to detect cdi. methods a perianal swab was collected from each inpatient with a positive stool sample for c. difficile (by polymerase chain reaction [pcr] test) and was tested for c. difficile by pcr and by culture. the variables evaluated included demographics, cdi severity, bathing before perianal swab collection, hours between stool sample and perianal swab, cycle threshold (ct) to pcr positivity, and doses of cdi treatment before stool sample ...201728376944
the gut microbiome.more than a trillion, mostly good, microbes live within our gastrointestinal tract and are responsible for vital metabolic, immune and nutritional functions. dysbiosis, meaning a maladaptive imbalance of the microbiome, is associated with many common diseases and is a target for therapy.201728376573
microbiota.the human microbiota comprises all the microorganisms of our body, which can also be categorised as commensals, mutualists and pathogens according to their behaviour. our knowledge of the human microbiota has considerably increased since the introduction of 16s rrna next generation sequencing (16s rdna gene). this technological breakthrough has seen a revolution in the knowledge of the microbiota composition and its implications in human health. this article details the different human bacterial ...201728372875
does electronic stewardship work?faced with national requirements to promote antimicrobial stewardship and reduce drug-resistant infections, community hospitals are challenged to make the best use of existing resources. eighteen months after building antibiotic decision support into our electronic order platform, high-risk antibiotic use decreased by 83% (p < .001) at our community hospital. hospital-acquired clostridium difficile infections declined 24% (p = .07).201728371928
infection rates in tacrolimus versus cyclosporine-treated pediatric kidney transplant recipients on a rapid discontinuation of prednisone protocol: 1-year analysis.ar is lower in pktx recipients on tac vs csa. data comparing infection outcomes for children treated with these agents are limited. we retrospectively studied infection outcomes in 96 pktx recipients on a rdp. ps, dcgs, ar, and infection-free survival were assessed using kaplan-meier/log-rank tests and proportional hazards models. there were no differences in 1-year ps, dcgs, or ar between tac and csa recipients. after adjusting for ar, the hazard of cmv viremia was 4.0 times higher (95%ci: 1.04 ...201728371243
strongyloides stercoralis infection among human immunodeficiency virus (hiv)-infected patients in the united states of america: a case report and review of literature.background strongyloides stercoralis infection is endemic in subtropical and tropical regions but is reported rather sporadically in temperate countries. in the usa, the highest rates of infection are from the southeastern states, predominantly among immigrants. there is paucity of case reports on s. stercoralis infection among hiv-infected patients who were born and raised in the usa. case report a 61-year-old male with known hiv infection (cd4 count: 235 cells/ul, undetectable hiv rna, on anti ...201728366929
development of a dose assay for a clostridium difficile vaccine using a tandem ion exchange high performance liquid chromatography method.clostridium difficile is a gram-positive intestine bacterium that causes a severe diarrhea and could eventually be lethal. the main virulence factor is related to the release of two major exotoxins, toxin a (tcda) and toxin b (tcdb). recent c. difficile-associated disease (cdad) outbreaks have been caused by hypervirulent strains which secrete an additional binary toxin (cdta/cdtb). vaccination against these toxins is considered the best way to combat the cdad. recently, a novel tetravalent c. d ...201728366569
invasive listeriosis in a patient with several episodes of antibiotic associated colitis presumably due to clostridium difficile.a 62-year-old man developed a blood stream infection and meningitis due to listeria monocytogenes, 20 days after an episode of pseudo-membranous colitis. the patient, hospitalized for the first time for transurethral prostatectomy, was readmitted 20 days later with watery diarrhea. pseudo-membranous colitis was diagnosed and treated successfully, without testing for clostridium difficile infection (cdi). after 15 more days, the patient developed again diarrhea, fever and confusion. hospitalized ...201728365900
fluoroquinolone prophylaxis in autologous hematopoietic stem cell transplant recipients.although fluoroquinolone prophylaxis is frequently utilized in autologous hematopoietic stem cell transplant (ahsct) patients, its impact on morbidity and mortality is uncertain. this study investigates the role of quinolone prophylaxis after ahsct in recent years.201728365897
clinical and endoscopic features in patients with hospital-acquired diarrhea associated with clostridium difficile infection.clostridium difficile (cd) is the leading cause of hospital-acquired diarrhea. clinical and endoscopic findings are poorly described in our country. the aim of this study is to depict those findings.201728363494
gastrointestinal emergencies in critically ill cancer patients.to describe gastrointestinal emergencies in cancer patients.201728363097
inferring microbial interaction networks from metagenomic data using sglv-ekf algorithm.inferring the microbial interaction networks (mins) and modeling their dynamics are critical in understanding the mechanisms of the bacterial ecosystem and designing antibiotic and/or probiotic therapies. recently, several approaches were proposed to infer mins using the generalized lotka-volterra (glv) model. main drawbacks of these models include the fact that these models only consider the measurement noise without taking into consideration the uncertainties in the underlying dynamics. furthe ...201728361680
acid-suppressive therapy and risk of infections: pros and cons.this narrative review summarises the benefits, risks and appropriate use of acid-suppressing drugs (asds), proton pump inhibitors and histamine-2 receptor antagonists, advocating a rationale balanced and individualised approach aimed to minimise any serious adverse consequences. it focuses on current controversies on the potential of asds to contribute to infections-bacterial, parasitic, fungal, protozoan and viral, particularly in the elderly, comprehensively and critically discusses the growin ...201728361440
surgical prophylaxis with gentamicin and acute kidney injury: a systematic review and meta-analysis.gentamicin has been increasingly used instead of cephalosporins for surgical prophylaxis in an attempt to reduce the rate of "clostridium difficile" infection. there are limited data regarding nephrotoxicity related to gentamicin in these patients.201728361065
risk factors for clostridium difficile infection in surgical patients hospitalized in a tertiary hospital in belgrade, serbia: a case-control study.the objective of this study was to investigate independent risk factors (rfs) connected with healthcare-associated (ha) clostridium difficile infection (cdi) in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital.201728360993
old and new models for studying host-microbe interactions in health and disease: c. difficile as an example.there has been an explosion of interest in studying the indigenous microbiota, which plays an important role in human health and disease. traditionally, the study of microbes in relationship to human health involved consideration of individual microbial species that caused classical infectious diseases. with the interest in the human microbiome, an appreciation of the influence that complex communities of microbes can have on their environment has developed. when considering either individual pa ...201728360030
manual curation and reannotation of the genomes of clostridium difficile 630δerm and c. difficile 630.we resequenced the genome of clostridium difficile 630δerm (dsm 28645), a model strain commonly used for the generation of insertion mutants.201728357980
clostridium difficile infection in returning travellers.there is increasing recognition of the contribution of community-acquired cases to the global burden of clostridium difficile infection (cdi). the epidemiology of cdi among international travellers is poorly understood, and factors associated with international travel, such as antibiotic use and changes in gut microbiota, could potentially put travellers at higher risk.201728355613
molecular epidemiology and antimicrobial susceptibility of clostridium difficile isolates from two korean hospitals.clostridium difficile is one of the main etiological agents causing antibiotic-associated diarrhea. this study investigated the genetic diversity of 70 toxigenic c. difficile isolates from two korean hospitals by employing toxinotyping, ribotyping, multilocus sequence typing (mlst), and pulsed-field gel electrophoresis (pfge). toxin gene amplification resulted in 68 a⁺b⁺ and two a-b+ isolates. most isolates (95.7-100%) were susceptible to daptomycin, metronidazole, and vancomycin. seventy c. dif ...201728355266
predominance of clostridium difficile 027 during a five-year period in bolzano, northern italy.toxigenic clostridium difficile is responsible for antibiotic-associated diarrhoea and other diseases. the increasing frequency and severity is attributed to highly-virulent ribotypes such as 027. the aim of the study was to collect epidemiological and molecular data for c. difficile isolates during 2009-2013 in the central hospital of bolzano, northern italy. stool samples from inpatients of the bolzano central hospital were screened for toxins a and b, and c. difficile was cultured and tested ...201728353450
gram-positive bacterial infections: research priorities, accomplishments, and future directions of the antibacterial resistance leadership group.antimicrobial resistance in gram-positive bacteria remains a challenge in infectious diseases. the mission of the gram-positive committee of the antibacterial resistance leadership group (arlg) is to advance knowledge in the prevention, management, and treatment of these challenging infections to improve patient outcomes. our committee has prioritized projects involving methicillin-resistant staphylococcus aureus (mrsa) and vancomycin-resistant enterococci (vre) due to the scope of the medical t ...201728350900
enteric glial cells counteract clostridium difficile toxin b through a nadph oxidase/ros/jnk/caspase-3 axis, without involving mitochondrial pathways.enteric glial cells (egcs) are components of the intestinal epithelial barrier essential for regulating the enteric nervous system. clostridium difficile is the most common cause of antibiotic-associated colitis, toxin b (tcdb) being the major virulence factor, due to its ability to breach the intestinal epithelial barrier and to act on other cell types. here we investigated tcdb effects on egcs and the activated molecular mechanisms. already at 2 hours, tcdb triggered ros formation originating ...201728349972
milk fat globule membrane supplementation in formula modulates the neonatal gut microbiome and normalizes intestinal development.breast milk has many beneficial properties and unusual characteristics including a unique fat component, termed milk fat globule membrane (mfgm). while breast milk yields important developmental benefits, there are situations where it is unavailable resulting in a need for formula feeding. most formulas do not contain mfgm, but derive their lipids from vegetable sources, which differ greatly in size and composition. here we tested the effects of mfgm supplementation on intestinal development and ...201728349941
overexpression of the endosomal anion/proton exchanger clc-5 increases cell susceptibility toward clostridium difficile toxins tcda and tcdb.virulent c. difficile toxins tcda and tcdb invade host intestinal epithelia by endocytosis and use the acidic environment of intracellular vesicles for further processing and activation. we investigated the role of clc-5, a chloride/proton exchanger expressed in the endosomes of gastrointestinal epithelial cells, in the activation and processing of c. difficile toxins. enhanced intoxication by tcda and tcdb was observed in cells expressing clc-5 but not clc-4, another chloride/proton exchanger w ...201728348980
successful treatment of clostridium difficile bacteremia with aortic mycotic aneurysm in a patient with prior endovascular aortic aneurysm repair.the clinical spectrum of clostridium difficile infection can range from benign gastrointestinal colonization to mild diarrhea and life threatening conditions such as pseudomembranous colitis and toxic megacolon. extraintestinal manifestations of c. difficile are rare. here, we report a patient with a history of an endovascular aortic aneurysm repair (evar) presenting with an endovascular leak complicated by c. difficile bacteremia and a mycotic aneurysm. he was successfully treated with an expla ...201728348903
donor considerations in fecal microbiota transplantation.tremendous acceleration has been made in understanding the gut microbiota in the past decade and, with it, further understanding of the pathologic role of dysbiosis and the use of fecal microbiota transplantation (fmt) as therapy. fmt has been studied in many disease states including the most common indication of clostridium difficile infection (cdi), though many questions regarding stool donor selection remain.201728289858
determining clostridium difficile intra-taxa diversity by mining multilocus sequence typing databases.multilocus sequence typing (mlst) is a highly discriminatory typing strategy; it is reproducible and scalable. there is a mlst scheme for clostridium difficile (cd), a gram positive bacillus causing different pathologies of the gastrointestinal tract. this work was aimed at describing the frequency of sequence types (sts) and clades (c) reported and evalute the intra-taxa diversity in the cd mlst database (cd-mlst-db) using an mlsa approach.201728288567
cadazolid for the treatment of clostridium difficile.antibiotic development goals for cdi include potent antimicrobial effect against c. difficile, limited killing of host microbiota, potential effect on spores, and ability to interfere with toxin production. cadazolid, a novel, non-absorbable hybrid antibiotic has many of these criteria. in phase i and ii clinical trials, cadazolid was shown to be safe, well tolerated, and efficacious positioning itself as a potential future viable therapeutic option for cdi. areas covered: this review provides a ...201728286992
toxin production of clostridium difficile in sub-mic of vancomycin and clindamycin alone and in combination with ceftazidime.toxin production in clostridium difficile (c. difficile) is a key process for induction of diarrhea. several factors such as sub-mic of antibiotics impact on toxin production. the aim of this research is investigation of sub-minimum inhibitory concentration (sub-mic) of vancomycin (van), clindamycin (cli) separately and in combination with ceftazidime (caz) on toxin production in c. difficile. about ∼10(6) colony forming units (cfu) from 18-h culture of c. difficile atcc 9689 and clinical isolat ...201728286152
using clinical scenarios to understand preventability of clostridium difficile infections by inpatient antibiotic stewardship programs. 201728285605
clostridium difficile-derived membrane vesicles induce the expression of pro-inflammatory cytokine genes and cytotoxicity in colonic epithelial cells in vitro.clostridium difficile is the most common etiological agent of antibiotic-associated diarrhea in hospitalized and non-hospitalized patients. this study investigated the secretion of membrane vesicles (mvs) from c. difficile and determined the expression of pro-inflammatory cytokine genes and cytotoxicity of c. difficile mvs in epithelial cells in vitro. c. difficile atcc 43255 and two clinical isolates secreted spherical mvs during in vitro culture. proteomic analysis revealed that mvs of c. diff ...201728284851
community dynamics drive punctuated engraftment of the fecal microbiome following transplantation using freeze-dried, encapsulated fecal microbiota.fecal microbiota transplantation (fmt) is a highly effective treatment of recurrent and recalcitrant clostridium difficile infection (rcdi). in a recent study oral-delivery of encapsulated, freeze-dried donor material, resulted in comparable rates of cure to colonoscopic approaches. here we characterize shifts in the fecal bacterial community structure of patients treated for rcdi using encapsulated donor material. prior to fmt, patient fecal samples showed declines in diversity and abundance of ...201728282270
inhibition of spore germination, growth, and toxin activity of clinically relevant c. difficile strains by gut microbiota derived secondary bile acids.the changing epidemiology of clostridium difficile infection over the past decades presents a significant challenge in the management of c. difficile associated diseases. the gastrointestinal tract microbiota provides colonization resistance against c. difficile, and growing evidence suggests that gut microbial derived secondary bile acids (sbas) play a role. we hypothesized that the c. difficile life cycle; spore germination and outgrowth, growth, and toxin production, of strains that vary by a ...201728279860
factors associated with clostridium difficile infection: a nested case-control study in a three year prospective cohort.clostridium difficile infection (cdi) is a serious medical condition that is associated with substantial morbidity and mortality. identification of risk factors associated with cdi and prompt recognition of patients at risk is key to successfully preventing cdi.201728279859
epidemiology and risk factors for clostridium difficile infection in critically ill patients in spain: the procrid study.our objectives were to describe the incidence, clinical characteristics, and risk factors for clostridium difficile infection (cdi) in critically ill patients and to determine c. difficile pcr-ribotypes.201728279489
gastrointestinal organoids: understanding the molecular basis of the host-microbe interface.in recent years, increasing attention has been devoted to the concept that microorganisms play an integral role in human physiology and pathophysiology. despite this, the molecular basis of host-pathogen and host-symbiont interactions in the human intestine remains poorly understood owing to the limited availability of human tissue, and the biological complexity of host-microbe interactions. over the past decade, technological advances have enabled long-term culture of organotypic intestinal tis ...201728275681
strategies for optimizing the diagnostic predictive value of clostridium difficile molecular diagnostics.because nucleic acid amplification tests (naats) do not distinguish clostridium difficile infection (cdi) and asymptomatic c. difficile carriage, the diagnostic predictive value of naats is limited when used in patients with low probability of cdi. in this issue of the journal of clinical microbiology, truong et al. report significant reductions in hospital-onset cdi and oral vancomycin utilization at their institution following implementation of a novel intervention that leveraged their clinica ...201728275072
role of postgraduate year 2 pharmacy residents in providing weekend antimicrobial stewardship coverage in an academic medical center.the integration of pharmacy residents into an antimicrobial stewardship program (asp) is described, and data on the residents' asp interventions and outcomes are reported.201728274985
emerging monoclonal antibodies against clostridium difficile infection.clostridium difficile infections are characterized by a high recurrence rate despite antibiotic treatments and there is an urgent need to develop new treatments such as fecal transplantation and immonotherapy. besides active immunotherapy with vaccines, passive immunotherapy has shown promise, especially with monoclonal antibodies. areas covered: herein, the authors review the different assays performed with monoclonal antibodies against c. difficile toxins and surface proteins to treat or preve ...201728274145
[selection of laboratory procedures to detect toxigenic by the 2-step method].the 2-step method is an algorithm to detect toxigenic clostridium difficile. we herein compared the sensitivities and specificities of an enzyme immunoassay (toxin a/b-eia), toxigenic culture (tc-eia), loop-mediated isothermal amplification assay (lamp), and xpert c. difficile (xpert) with the detection of the toxin b gene by a polymerase chain reaction (pcr). the results obtained showed that the sensitivities and specificities of toxin a/b-eia, xpert, tc-eia, and lamp were 30 and 100%, 87.2 and ...201728274126
recurrent clostridium difficile infection among medicare patients in nursing homes: a population-based cohort study.we explored the epidemiology and outcomes of clostridium difficile infection (cdi) recurrence among medicare patients in a nursing home (nh) whose cdi originated in acute care hospitals.we conducted a retrospective, population-based matched cohort combining medicare claims with minimum data set 3.0, including all hospitalized patients age ≥65 years transferred to an nh after hospitalization with cdi 1/2011-11/2012. incident cdi was defined as icd-9-cm code 008.45 with no others in prior 60 days. ...201728272217
a rare case of raoultella planticola urinary tract infection in an immunocompromised patient with multiple myeloma.raoultella planticola is a gram-negative rod associated with soil and aquatic environments that has rarely been associated with human infections.201728271042
clostridium difficile disease: diagnosis, pathogenesis, and treatment update.clostridium difficile infections are the leading cause of health care-associated infectious diarrhea, posing a significant risk for both medical and surgical patients. because of the significant morbidity and mortality associated with c difficile infections, knowledge of the epidemiology of c difficile in combination with a high index of suspicion and susceptible patient populations (including surgical, postcolectomy, and inflammatory bowel disease patients) is warranted. c difficile infections ...201728267992
the challenge of detecting indels in bacterial genomes from short-read sequencing data.we tested the capabilities of four different software tools to detect insertions and deletions (indels) in a bacterial genome on the basis of short sequencing reads. we included tools applying the gapped-alignment (varscan, freebayes) or split-read (pindel) methods, respectively, and a combinatorial approach with local de-novo assembly (scanindel). tests were performed with 151-basepair, paired-end sequencing reads simulated from a bacterial (clostridioides difficile r20291) genome sequence with ...201728267569
microbiome: fecal transplant in clostridium difficile and ulcerative colitis. dr. paul moayyedi in an interview with dr. roman jaeschke: part 2. 201728267142
whole genome sequences of three clade 3 clostridium difficile strains carrying binary toxin genes in china.clostridium difficile consists of six clades but studies on clade 3 are limited. here, we report genome sequences of three clade 3 c. difficile strains carrying genes encoding toxin a and b and the binary toxin. isolates 103 and 133 (both of st5) and isolate 106 (st285) were recovered from three icu patients. whole genome sequencing using hiseq 2500 revealed 4.1-mb genomes with 28-29% gc content. there were ≥1,104 snp between the isolates, suggesting they were not of a single clone. the toxin a ...201728262711
inhibition of mrsa and of clostridium difficile by durancin 61a: synergy with bacteriocins and antibiotics.the aim of this study was to evaluate the efficacy of durancin 61a alone or in combination with nisin, pediocin pa-1, reuterin, microcin j25, vancomycin or tetracycline as an inhibitor of resistant clinical pathogens and to shed light on its mode of action.201728262046
hospital impact after a chemical spill that compromised the potable water supply: west virginia, january 2014.in january 2014, a chemical spill of 4-methylcyclohexanemethanol and propylene glycol phenyl ethers contaminated the potable water supply of approximately 300,000 west virginia residents. to understand the spill's impact on hospital operations, we surveyed representatives from 10 hospitals in the affected area during january 2014. we found that the spill-related loss of potable water affected many aspects of hospital patient care (eg, surgery, endoscopy, hemodialysis, and infection control of cl ...201728260560
impact of clostridium difficile infection in patients hospitalized with acute pancreatitis- a population based cohort study. 201728258934
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