Publications

increasing hospitalization and death possibly due to clostridium difficile diarrheal disease.	this study calculated yearly estimated national hospital discharge (1985 to 1994) and age-adjusted death rates (1980 to 1992) due to bacterial, viral, protozoal, and ill-defined enteric pathogens. infant and young child hospitalization (but not death) rates in each category increased more than 50% during 1990 to 1994. age-adjusted death and hospitalization rates due to enteric bacterial infections and hospitalizations due to enteric viral infections have increased since 1988. the increases in ho ...	1998	9866738
acquisition of clostridium difficile and clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding.	clostridium difficile is the most common infectious cause of nosocomial diarrhea, but its role in diarrhea associated with tube feeding has not been rigorously investigated.	1998	9867755
clostridium difficile diarrhea after use of tacrolimus following renal transplantation.		1998	9868682
community-acquired pneumonia.		1998	9872273
regulation of phospholipase d activity in synaptosomes permeabilized with staphylococcus aureus alpha-toxin.	in order to investigate the regulation of presynaptic phospholipase d (pld) activity by calcium and g proteins, we established a permeabilization procedure for rat cortical synaptosomes using staphylococcus aureus alpha-toxin (30-100 microg/ml). in permeabilized synaptosomes, pld activity was significantly stimulated when the concentration of free calcium was increased from 0.1 microm to 1 microm. this activation was inhibited in the presence of kn-62 (1 microm), an inhibitor of calcium/calmodul ...	1998	9872388
clostridial pathogenicity in experimental necrotising enterocolitis in gnotobiotic quails and protective role of bifidobacteria.	the pathogenesis of neonatal necrotising enterocolitis (nec) remains unclear. gnotobiotic quails fed a lactose diet have been used to investigate the role of clostridial strains originating from faecal specimens of neonates through the intestinal lesions, the changes in microflora balance and the production of bacterial metabolites, i.e., short-chain fatty acids and hydrogen. bifidobacteria are thought to exert various beneficial effects on host health, including interaction with the colonic mic ...	1998	9879939
pcr-ribotyping and pyrolysis mass spectrometry fingerprinting of environmental and hospital isolates of clostridium difficile.	the relationships between environmental isolates of clostridium difficile were examined by two typing methods, pcr ribotyping and pyrolysis mass spectrometry (pyms). the 184 isolates were divided into 23 different pcr ribotypes, 13 of which were producers of toxins a and b; the remaining 10 types did not produce either toxin a or b. pyms analysis resolved 31 groups with 60 (32.5%) isolates in one group (group 9). in both methods most of the isolates showed similar clustering. pcr ribotypes of th ...	1998	9879953
prospective study of the risk of clostridium difficile diarrhoea in elderly patients following treatment with cefotaxime or piperacillin-tazobactam.	rates of clostridium difficile diarrhoea have recently been rising, with the elderly being at highest risk.	1998	9882029
silver sulfadiazine induced clostridium difficile toxic megacolon in a burn patient: case report.	a 53 yr old diabetic male presented with a 34% total body surface area (tbsa) deep partial- and full-thickness burns. on post burn days 4 and 9, all of his burns were excised and grafted. although he had only been treated with topical antibiotics, he developed clostridium difficile colitis after his second surgery that progressed to toxic megacolon and perforation. the incidence and treatment of toxic megacolon secondary to c. difficile is reviewed. early diagnosis and treatment with colonoscopi ...	1998	9882070
effectiveness of antibiotic prophylaxis in critically ill patients. antibiotic prophylaxis can lead to contamination with clostridium difficile.		1998	9882129
inhibition of small g proteins by clostridium sordellii lethal toxin activates cdc2 and map kinase in xenopus oocytes.	the lethal toxin (lt) from clostridium sordellii is a glucosyltransferase that modifies and inhibits small g proteins of the ras family, ras and rap, as well as rac proteins. lt induces cdc2 kinase activation and germinal vesicle breakdown (gvbd) when microinjected into full-grown xenopus oocytes. toxin b from clostridium difficile, that glucosylates and inactivates rac proteins, does not induce cdc2 activation, indicating that proteins of the ras family, ras and/or rap, negatively regulate cdc2 ...	1998	9882492
nosocomial infections in hand surgery.	the active and experienced hand surgeon should have enough knowledge to recognize both common and uncommon hand infections. control of hospital-acquired infections, including surgical site infections, requires a knowledge of potential personal risk factors and ongoing surveillance systems to aid in prevention and early detection. current national trends may soon require that surgical-site infections be diagnosed by specific criteria that will allow comparisons of data from various locations. alt ...	1998	9884892
comparative anti-anaerobic activity of men 10700, a penem antibiotic.	the in vitro activity of men 10700, a new penem, has been compared with that of metronidazole, clindamycin, ciprofloxacin, co-amoxiclav, imipenem and three third generation cephalosporins against 120 strains of anaerobes. the organisms tested comprised clostridium perfringens, clostridium difficile, bacteroides fragilis and speciated members of the genera fusobacterium, veillonella and peptostreptococcus. men 10700 showed activity similar to that of imipenem, and was more potent than metronidazo ...	1998	9916909
reactive oligoarthritis in a patient with clostridium difficile pseudomembranous colitis. review of the literature.	a 57-year-old man developed oligoarthritis of the right sacroiliac joint, knee and elbow in the wake of clostridium difficile pseudomembranous colitis. he was hla b27-positive and had a history of reiter's syndrome. his joint manifestations resolved after a course of nonsteroidal antiinflammatory drug therapy and injection of the right knee with triamcinolone acetonide. clostridium difficile should be recognized as a rare cause of reactive arthritis.	1998	9923050
multicentre evaluation of a commercial test for the rapid diagnosis of clostridium difficile-mediated antibiotic-associated diarrhoea.	an immunoassay for the detection of clostridium difficile toxin a in stool samples (clearview c. diff a; unipath, uk) was evaluated against the cell cytotoxicity assay using 407 stool samples from patients suspected to have, or considered at risk of, antibiotic-associated diarrhoea. of the samples tested, 98 were positive and 280 were negative by both tests (sensitivity 83.1%, specificity 96.9%). following resolution of the 29 discrepant results, the sensitivity and specificity of the immunoassa ...	1998	9923521
[resistance of respiratory and enteral bacteria to antibiotics].		1998	9927887
a double-blind, placebo-controlled, parallel group study of oral trovafloxacin on bowel microflora in healthy male volunteers.	treatment with oral antibiotic drugs generally influences normal fecal flora. these changes can be both beneficial (eg, elimination of aerobic, gram-negative bacilli) and detrimental (eg, the appearance of resistant pathogenic micro-organisms). trovafloxacin, a new fluoroquinolone with in vitro activity against anaerobes, and gram-negative, gram-positive, and atypical pathogens, is a potentially beneficial antimicrobial for bowel sterilization. this double-blind trial investigated the effect of ...	1998	9935254
the in-vitro activity of hmr 3647, a new ketolide antimicrobial agent.	the in-vitro activity of hmr 3647, a novel ketolide, was investigated in comparison with those of erythromycin a, roxithromycin, clarithromycin (14-membered ring macrolides), amoxycillin-clavulanate and ciprofloxacin against 719 recent clinical gram-positive, gram-negative and anaerobic isolates and type cultures. hmr 3647 generally demonstrated greater activity than the other compounds with mic90s of < or =0.5 mg/l, except for staphylococcus epidermidis (mic90 > 128 mg/l), haemophilus influenza ...	1998	10052892
prevalence of clostridium difficile toxin in kidney transplant recipients.		1998	10066067
toxins from anaerobic bacteria: specificity and molecular mechanisms of action.	major advances have been made in the past five years in the identification of cellular targets of toxins produced by anaerobic bacteria. these targets include the vesicular membrane docking and fusion apparatus, the actin cytoskeleton, the signal transduction machinery and the cell membrane. the recent discovery that large clostridial toxins (clostridium difficile a and b toxins, c. sordellii lethal and hemorrhagic toxins, and alpha c. novyi toxin) are monoglucosyltransferases, together with the ...	1998	10066460
clostridium difficile-associated diarrhoea.	at our hospital, the number of cases of clostridium difficile-associated diarrhoea increased from 29 in 1993 to 210 in 1995. the case notes of 110 patients with c difficile-associated diarrhoea during the first 6 months of 1995 were analysed retrospectively. the majority of the patients (106) had received antibiotics before the onset of diarrhoea; 46 had received three or more different antibiotics and 28 had received metronidazole. in 19 patients, the first stool sample after the onset of diarr ...	1998	10197216
clostridium difficile: a pathogen of the nineties.		1998	9665293
comparative in vitro activity of bay 12-8039 and five other antimicrobial agents against anaerobic bacteria.	the in vitro activity of bay 12-8039 against 360 anaerobic clinical isolates was determined by the agar dilution method and compared to that of five other antimicrobial agents. bay 12-8039 and imipenem were the most active agents tested. the following mic90 values were determined for bay 12-8039: peptostreptococcus spp. (50 isolates), 1 mg/l; propionibacterium acnes (30 isolates). 0.25 mg/l; clostridium perfringens (30 isolates), 0.5 mg/l; clostridium difficile (50 isolates), 2 mg/l; bacteroides ...	1998	9665302
identification of toxin a-negative, toxin b-positive clostridium difficile by pcr.	toxigenic strains of clostridium difficile have been reported to produce both toxins a and b nearly always, and nontoxigenic strains have been reported to produce neither of these toxins. recent studies indicate that it is not always true. we established a pcr assay to differentiate toxin a-negative, toxin b-positive (toxin a-, toxin b+) strains from both toxin-positive (toxin a+, toxin b+) strains and both toxin-negative (toxin a-, toxin b-) strains as an alternative to cell culture assay and e ...	1998	9665986
a novel toxinotyping scheme and correlation of toxinotypes with serogroups of clostridium difficile isolates.	two hundred nineteen clostridium difficile isolates from 22 serogroups were screened for changes in the genes coding for toxin b (tcdb) and toxin a (tcda). parts of the toxin genes were amplified, and the pcr fragments were checked for length polymorphisms and cut with several restriction enzymes to monitor restriction fragment length polymorphisms (rflps). for 47 strains (21%), differences in the toxin genes were found compared to the toxin genes of reference strain vpi 10,463. polymorphisms we ...	1998	9665999
clostridium difficile colitis associated with treatment of helicobacter pylori infection.	helicobacter pylori infection of the stomach is being detected and treated more often now than ever before. this is likely to result in an increase in complications such as antibiotic-associated diarrhea. however, there is no literature on the incidence of such diarrhea, particularly clostridium difficile colitis, in patients treated for helicobacter pylori infection. we report the case of a patient who developed clostridium difficile colitis after treatment for helicobacter pylori infection wit ...	1998	9672359
small gtp-binding proteins of the rho- and ras-subfamilies are not involved in the actin rearrangements induced by attaching and effacing escherichia coli.	attaching and effacing escherichia coli (aeec) are extracellular pathogens that induce the formation of actin-rich structures at their sites of attachment to eukaryotic host cells. we analysed whether small gtp-binding proteins of the rho- and ras-subfamilies, which control the cellular actin system, are essential for these bacterial-induced microfilament reorganizations. for this purpose we specifically inactivated them using the clostridium difficile toxins tcdb-10463 and tcdb-1470. such treat ...	1998	9673012
isolation of a clostridium exotoxin producer other than clostridium difficile from a patient with diarrhea.		1998	9675699
the role of surgery in pseudomembranous enterocolitis.	pseudomembranous enterocolitis is an inflammatory bowel disorder caused by clostridium difficile toxins. classical presentation includes abdominal pain, pyrexia, diarrhoea and leucocytes. the management is mainly conservative but in extreme cases surgery is necessary. resectional procedures (colectomy) carry a better prognosis than diversion procedures (colostomy). a careful history, a high index of suspicion, and early diagnosis and treatment would reduce the associated morbidity and mortality ...	1998	9683974
[clostridium difficile infections. current aspects].	clostridium difficile is a gram-positive anaerobe that forms subterminal spores. it is now one of major nosocomial pathogens, mainly in older patients, because of its ability to persist in the environment and to become established in the gastrointestinal tract once the natural microflora has been modified by antibiotic therapy. toxigenic strains of c. difficile produce toxin a (enterotoxin) or toxin b (cytotoxin) or both with cause the cytotoxic effect "rounding". c. difficile can spread from pa ...	1998	9691734
clostridium difficile and older adults: what primary care providers should know.	clostridium difficile poses particular risk for older adults, who are subject to more serious symptoms than younger patients. antibiotic exposure and other risk factors are associated with the pathogenesis of c. difficile-associated disease. treatment goals include prescribing anti-c. difficile activity agents (when indicated), attending to volume status and prescribing oral rehydration therapy as needed, avoiding the use of antiperistaltic drugs, discontinuing any offending antibiotics, avoidin ...	1998	9695082
incidence and impact of clostridium difficile infection in the uk, 1993-1996.	questionnaires were sent to 360 uk medical microbiologists to determine the incidence of clostridium difficile infection in the uk between 1993-1996, and to establish the current laboratory testing protocols. replies were received from 104 laboratories (29% response rate), 86, 7, 4 and 3% of which are in england, scotland, wales and northern ireland, respectively. the laboratories serve a total of approximately 90,000 hospital beds (median 750). c. difficile testing was performed by 83% of the l ...	1998	9699137
antimicrobial associations of an outbreak of diarrhoea due to clostridium difficile.	an increased incidence of diarrhoea due to clostridium difficile (cdd) at the northern general hospital, sheffield, prompted an investigation into antibiotic use on the renal, medical and geriatric wards, those mostly affected. for the first half of 1997 affected patients on these wards were identified and data collected as to which antimicrobials they had taken between admission and diagnosis. rates were then calculated of the number of affected patients on a drug over the quantity prescribed ( ...	1998	9699138
clostridium difficile in district general hospitals.		1998	9699145
a randomized crossover study of disposable thermometers for prevention of clostridium difficile and other nosocomial infections.	to test the hypothesis that use of disposable thermometers would result in lower rates of nosocomial clostridium difficile diarrhea and of total nosocomial infections, compared with electronic thermometers.	1998	9702571
prevalence of astroviruses in a children's hospital.	an enzyme immunoassay for astrovirus was used to screen 357 stool samples from 267 symptomatic inpatients at a tertiary-care children's hospital. thirty stool samples from 26 patients contained astrovirus antigen, while rotavirus was found in 34 samples and clostridium difficile toxin was found in 40. half of the astrovirus infections were nosocomial. additional pathogens were identified in six of the astrovirus antigen-positive stool samples. most (80%) of the astroviruses recovered were of ser ...	1998	9705394
clindamycin formulary restriction lowers costs, antimicrobial resistance.		1998	9706176
enterococci and vancomycin resistance.	the frequency of infections with multiply antibiotic-resistant gram-positive bacteria is increasing, and in some cases these organisms remain susceptible only to the glycopeptides vancomycin and teicoplanin. the appearance of transferable high-level glycopeptide resistance in enterococci--producing some strains that are now resistant to all available antibiotics--is thus a cause for concern. the enterococci readily colonize the bowel, spread rapidly among hospital patients, and transfer their an ...	1998	9710674
[pseudomembranous colitis].		1998	9711015
back to basics in management of clostridium difficile infections.		1998	9716052
in vitro activity of hmr 3647 against anaerobic bacteria.	the aim of the present investigation was to determine the in vitro activity of hmr 3647 compared with other antimicrobial agents against anaerobic bacteria. the activity of hmr 3647 was determined against 342 clinical isolates of anaerobic bacteria by the agar dilution method and was compared with azithromycin, clarithromycin, roxithromycin, erythromycin, cefoxitin, imipenem, clindamycin and metronidazole. among the macrolides hmr 3647 and among the beta-lactams imipenem were the most active age ...	1998	9720465
the complete dna sequence and analysis of the large virulence plasmid of escherichia coli o157:h7.	the complete dna sequence of po157, the large virulence plasmid of ehec strain o157:h7 edl 933, is presented. the 92 kb f-like plasmid is composed of segments of putative virulence genes in a framework of replication and maintenance regions, with seven insertion sequence elements, located mostly at the boundaries of the virulence segments. one hundred open reading frames (orfs) were identified, of which 19 were previously sequenced potential virulence genes. forty-two orfs were sufficiently simi ...	1998	9722640
prolonged depletion of guanosine triphosphate induces death of insulin-secreting cells by apoptosis.	inhibitors of imp dehydrogenase, such as mycophenolic acid (mpa) and mizoribine, which deplete cellular gtp, are used clinically as immunosuppressive drugs. the prolonged effect of such agents on insulin-secreting beta-cells (hit-t15 and ins-1) was investigated. both mpa and mizoribine inhibited mitogenesis, as reflected by [3h]thymidine incorporation. cell number, dna and protein contents, and cell (metabolic) viability were decreased by about 30%, 60%, and 80% after treatment of hit cells with ...	1998	9724027
in vitro evidence that rabbit distal colonic muscularis mucosae has a clostridium difficile toxin a receptor.	in the rabbit ileum clostridium difficile toxin a causes inflammation and mucosal damage via a specific glycoprotein receptor that contains alpha-d-galactose. in rabbit colon toxin a also causes inflammation, and this is associated with increased myoelectric activity and eicosanoid production. the present in vitro study was undertaken to determine if a toxin a receptor on one or more layers of colonic smooth muscle could mediate the motor effects of this agent. toxin a (20-100 microg/ml) was wit ...	1998	9724250
tyrosine-phosphorylation-dependent and rho-protein-mediated control of cellular phosphatidylinositol 4,5-bisphosphate levels.	the polyphosphoinositide ptdins(4,5)p2, best known as a substrate for phospholipase c isozymes, has recently been recognized to be involved in a variety of other cellular processes. the aim of this study was to examine whether the cellular levels of this versatile phospholipid are controlled by tyrosine phosphorylation. the studies were performed in human embryonic kidney (hek)-293 cells stably expressing the m3 muscarinic acetylcholine receptor. inhibition of tyrosine phosphatases by pervanadat ...	1998	9729471
chronic diarrhoea among hiv-infected adult patients in nairobi, kenya.	chronic diarrhoea and wasting are well recognized features of aids in africa. however, because of resource constraints few comprehensive aetiological studies have been conducted in sub-saharan africa which have included a broad range of microbiological investigations. we undertook a prospective cross-sectional study of adult patients admitted to a government hospital in nairobi, kenya, to determine possible bacterial, mycobacterial, parasitic and viral causes of diarrhoea; to consider which may ...	1998	9733379
symptomless colonisation by clostridium difficile and risk of diarrhoea.		1998	9734912
inhibition of enhanced toxin production by clostridium difficile in biotin-limited conditions.	production of toxins a and b by clostridium difficile is enhanced in a defined medium with biotin-limited conditions. in the present study compounds inhibitory to enhanced toxin production by a c. difficile strain were examined. increases in biotin concentration from 0.05 nm to 50 nm accelerated growth and inhibited enhanced toxin production. asparagine, glutamic acid and glutamine (10 mm) showed an effect on growth and toxin production similar to that of biotin. lysine (10 mm) suppressed growth ...	1998	9736158
gastrointestinal complications after aortic surgery.	a major gastrointestinal complication (gic) after aortic surgery may be disastrous, but these complications have received scant attention. this study was performed to determine the risk factors, associated events, and outcomes for patients with gic.	1998	9737449
comparison of restriction enzyme analysis, arbitrarily primed pcr, and protein profile analysis typing for epidemiologic investigation of an ongoing clostridium difficile outbreak.	during an outbreak of diarrhea in a general hospital in 1992, 166 clostridium difficile isolates from 102 patients were typed by restriction enzyme analysis (rea), arbitrarily primed pcr (ap-pcr), and protein profile analysis (pp) techniques. a total of 18 types and 5 subtypes were identified by rea, 32 types were identified by ap-pcr, and 9 types were identified by pp. analysis of the data indicated the presence of a predominant strain among 76, 75, and 84% of the isolates by rea, ap-pcr, and p ...	1998	9738050
intestinal secretory factor released by macrophages stimulated with clostridium difficile toxin a: role of interleukin 1beta.	clostridium difficile toxin a is associated with enterocolitis in animals and humans. however, the mechanisms of its secretory and damaging effects are not totally understood. in this work, we examined the intestinal secretion of electrolytes and water caused by supernatants from macrophages stimulated with toxin a in rabbit ileal mucosa mounted in ussing chambers. we also investigated the mechanism by which the intestinal secretory factor (isf) is released from stimulated macrophages. supernata ...	1998	9746596
[some aspects of the clostridium difficile infection].	clostridium difficile is now regarded as the most common nosocomial enteric pathogen. c. difficile infection has a wide spectrum of a clinical presentation ranging from asymptomatic carriage to the fulminant colitis. antibiotic therapy is the most important risk factor in pathogen contagion, however other factors are also involved. typical pathophysiology: 1. alteration of the indigenous colonic flora by antibodies, 2. ingestion of spores, 3. colonization by clostridium difficile, 4. production ...	1998	9748892
rho protein inhibition blocks protein kinase c translocation and activation.	small gtp-binding proteins of the ras and rho family participate in various important signalling pathways. large clostridial cytotoxins inactivate gtpases by udp-glucosylation. using clostridium difficile toxin b-10463 (tcdb) for inactivation of rho proteins (rhoa/rac/cdc42) and clostridium sordellii lethal toxin-1522 (tcsl) for inactivation of ras-proteins (ras/rac/ral, rap) the role of these gtpases in protein kinase c (pkc) stimulation was studied. phorbol-myristate-acetate (pma) induced a ra ...	1998	9588200
clostridium difficile toxin b induces apoptosis in intestinal cultured cells.	toxigenic strains of the anaerobic bacterium clostridium difficile produce at least two large, single-chain protein exotoxins involved in the pathogenesis of antibiotic-associated diarrhea and colitis. toxin a (cda) is a cytotoxic enterotoxin, while toxin b (cdb) is a more potent cytotoxin lacking enterotoxic activity. this study dealt with cdb, providing the first evidence that intestinal cells exposed to this toxin exhibit typical features of apoptosis in that a significant proportion of the t ...	1998	9596731
effects of toxin a from clostridium difficile on mast cell activation and survival.	toxins a and b from clostridium difficile are the main cause of antibiotic-associated diarrhea and pseudomembranous colitis. they cause fluid accumulation, necrosis, and a strong inflammatory response when inoculated in intestinal loops. since mast cells are a rich source of inflammatory mediators, abundant in the gut, and known to be involved in c. difficile-induced enteritis, we studied the in vitro effect of toxin a on isolated mast cells. normal rats sensitized by infection with nippostrongi ...	1998	9596744
clostridium difficile--associated diarrhea.		1998	9597221
clostridium difficile colitis: a possible cause of unexplained elevation of serum alkaline phosphatase levels in patients with aids.		1998	9597276
recent trends in diagnosis and treatment of clostridium difficile in a tertiary care facility.	with the prevalence of antibiotic use, the diagnosis and management of clostridium difficile disease requires assessment.	1998	9600288
determination and validation of a predictive model for clostridium difficile diarrhea in hospitalized oncology patients.	clostridium difficile colitis in the cancer patient receiving chemotherapy is a frequent cause of morbidity which may prolong hospitalization. techniques for identifying infection often delay the initiation of therapy.	1998	9602265
hospital-acquired infection in elderly patients.	increasing numbers of elderly people are being treated in hospitals and are at particular risk of acquiring infections. the incidence, risk factors and types of hospital-acquired infection (hai) in the elderly are reviewed. special reference is made to urinary tract infections, respiratory tract infections, gastrointestinal infections including clostridium difficile, bacteraemia, skin and soft tissue infections and infections with antibiotic-resistant organisms.	1998	9602974
inhibition of insulin-stimulated glucose transport in 3t3-l1 cells by clostridium difficile toxin b, clostridium sordellii lethal toxin, and clostridium botulinum c2 toxin.	the role of the actin cytoskeleton and/or gtpases of the rho/rac-family in glucose transport regulation was investigated in 3t3-l1 cells with clostridial toxins which depolymerize actin by inactivation of rho/rac (clostridium difficile toxin b and clostiridium sordellii lethal toxin (lt)) or by direct adp-ribosylation (clostridium botulinum c2 toxin). toxin b and c2 reduced insulin-stimulated, but not basal, 2-deoxyglucose (2-dog) uptake rates in 3t3-l1 fibroblasts. in parallel, the toxins produ ...	1998	9606023
in vitro activities of cefminox against anaerobic bacteria compared with those of nine other compounds.	the agar dilution mic method was used to test the activity of cefminox, a beta-lactamase-stable cephamycin, compared with those of cefoxitin, cefotetan, moxalactam, ceftizoxime, cefotiam, cefamandole, cefoperazone, clindamycin, and metronidazole against 357 anaerobes. overall, cefminox was the most active beta-lactam, with an mic at which 50% of isolates are inhibited (mic50) of 1.0 microg/ml and an mic90 of 16.0 microg/ml. other beta-lactams were less active, with respective mic50s and mic90s o ...	1998	9517922
recurrence of symptoms in clostridium difficile infection--relapse or reinfection?	we have fingerprinted clostridium difficile isolates from patients with symptomatic recurrences of infection, using random amplified polymorphic dna (rapd). the medical records of 55/79 patients were examined, from whom multiple c. difficile-positive faeces were received during hospitalization at least five days, but no more than two months, apart. in 20 of these cases symptoms either did not recur (i.e., absent for at least three days between episodes), or were explainable by other causes, such ...	1998	9522287
simultaneous outbreaks of two strains of toxigenic clostridium difficile in a general hospital.	we report an outbreak of clostridium difficile-associated disease (cdad) in a large dublin hospital. from january to june 1995, inclusive, 139 patients were affected; the mean age of cases was 68.8 +/- 19 years. clinical information is available for 73 cases identified during the first four months of the outbreak. the majority of patients presented with abrupt onset of watery diarrhoea; however, 19.2% presented with an unexplained pyrexia following a course of antimicrobial therapy and 5.5% pres ...	1998	9522288
typhlocolitis caused by clostridium difficile in suckling piglets.		1998	9526873
agents that inhibit rho, rac, and cdc42 do not block formation of actin pedestals in hela cells infected with enteropathogenic escherichia coli.	enteropathogenic escherichia coli (epec) induces formation of actin pedestals in infected host cells. agents that inhibit the activity of rho, rac, and cdc42, including clostridium difficile toxin b (toxb), compactin, and dominant negative rho, rac, and cdc42, did not inhibit formation of actin pedestals. in contrast, treatment of hela cells with toxb inhibited epec invasion. thus, rho, rac, and cdc42 are not required for assembly of actin pedestals; however, they may be involved in epec uptake ...	1998	9529109
clostridium difficile disease: diagnosis and treatment.	clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. disease is usually a consequence of antibiotic therapy, but sporadic cases do occur. cytotoxin assay for toxin b remains the gold standard for confirming diagnosis. several rapid enzyme immunoassay tests are available, but specificity and sensitivity vary; a negative test may not exclude disease. oral metronidazole 250 to 500 mg four times a day is the recommended first-line therapy; vancomycin (125 mg fo ...	1998	9531117
[clostridium difficile-associated diarrhea treated with homologous feces].	the incidence of clostridium difficile-associated diarrhoea has increased during the last few years. treatment with vankomycin or metronidazol is usually effective, but relapses are not uncommon. some good results have been reported with faecal enemas, but it is a controversal form of treatment. 18 patients with c. difficile-associated diarrhoea were given homologous faeces from one healthy donor. in 17 patients faeces was instillated via a coloscope and in one patient via a gastrostoma. c. diff ...	1998	9531822
[method of quantitative assessment of antimicrobial effects of iodine-containing preparations].	iodine-containing preparations were studied by uv spectral analysis. water-soluble composition of 1,3-diethylbenzimidasolium triiodide is inactivated in the presence of meat-peptone broth. dissolving of these preparations in a mixture of acetone and stearic acid does not change the physicochemical properties or impair the antibacterial effect. a high antibacterial effect of 12 iodine-containing compounds has been demonstrated: 15-min exposure suppressed the growth of bacteria at the minimal conc ...	1998	9532902
clostridium difficile toxin-induced colitis after use of clindamycin phosphate vaginal cream.	to report a case of toxin-positive clostridium difficile-induced colitis (cdic) after use of clindamycin phosphate vaginal cream.	1998	9533061
pseudomembraneous clostridium after autologous bone marrow transplantation.	clostridium difficile (c. difficile) pseudomembraneous colitis was diagnosed in a 13-year-old boy with hodgkin's disease 3 months after autologous bone marrow transplantation. hematopoiesis was fully reconstituted at the time. c. difficile infection occurred after gall bladder empyema had been treated conservatively with i.v. antibiotics and prophylactic 4-week administration of oral amoxicillin. c. difficile colitis was diagnosed early and intensive supportive therapy combined with administrati ...	1998	9535046
neurokinin-1 (nk-1) receptor is required in clostridium difficile- induced enteritis.	toxin a, a 308,000-mr enterotoxin from clostridium difficile, mediates antibiotic-associated diarrhea and colitis in humans. injection of toxin a into animal intestine triggers an acute inflammatory response characterized by activation of sensory neurons and immune cells of the intestinal lamina propria, including mast cells and macrophages, and migration of circulating neutrophils in the involved intestinal segment. in this study we show that mice genetically deficient in the neurokinin-1 recep ...	1998	9541482
clostridium difficile bacteremia in an immunocompetent child.		1998	9542965
protease activity of clostridium difficile strains.	the production of proteolytic enzymes by 10 clostridium difficile isolates of varying toxigenicity and clinical origin was studied to determine if all isolates secreted proteases. different protease substrates were studied: gelatin, collagen, phenylazobenzyloxycarbonyl-leucyl-glycyl-l-prolyl-d-arginine (pz-peptide), casein, azocasein, and azocoll. all isolates degraded gelatin, collagen, and azocoll. the supernatants of all isolates contained an enzyme capable of attacking gelatin incorporated i ...	1998	9543717
evaluation of four methods for detection of clostridium difficile or c. difficile toxin: cytotoxin assay, culture, latex agglutination, and a new rapid immunoassay (c. difficile toxin a test).	the performance of c. difficile toxin a test (oxoid, basingstoke, uk), an immunoassay for the detection of c. difficile toxin a in fecal samples, for the diagnosis of c. difficile-associated diarrhea was compared with those of cytotoxin assay, culture, and a latex agglutination assay (culturette brand cdt rapid clostridium difficile test; becton dickinson, cockeysville, md). a total of 105 stool specimens from 71 patients were tested. of the 105 specimens analyzed, 6 (5.7%) samples were positive ...	1998	9544497
glucosylation and adp ribosylation of rho proteins: effects on nucleotide binding, gtpase activity, and effector coupling.	we studied the effects of glucosylation of rhoa, rac1, and cdc42 at threonine-35 and -37 by clostridium difficile toxin b on nucleotide binding, gtpase activity, and effector coupling and compared these results with the adp ribosylation of rhoa at asparagine-41 catalyzed by clostridium botulinum c3 transferase. whereas glucosylation and adp ribosylation had no major effects on gdp release from rhoa, rac1, and cdc42, the rate of gtpgammas release from rho proteins was increased 3-6-fold by glucos ...	1998	9548761
[clostridium difficile toxin-associated diarrhea in geriatrics].	in the course of 1 year, clostridium difficile-associated diarrhea, which may lead to pseudomembranous colitis and therefore may be very harmful in frail elderly people, was diagnosed in six patients of a geriatric clinic. the disease is associated with antibiotic therapy, due to an overgrowth of the intestinal flora with clostridium difficile. symptoms varied from a state of asymptomatic carriage or benign diarrhea to acute stages of the disease with severe diarrhea, abdominal pain, fever and a ...	1998	9553219
clinical significance of alimentary tract microbes in bone marrow transplant recipients.	a prospective study on the microbes isolated from the alimentary tract in 120 bone marrow transplant (bmt) recipients (1991-1993) was undertaken to define the spectrum of organisms isolated under antimicrobial prophylaxis, their temporal sequence of emergence, and the associated morbidity and mortality. clostridium difficile (n = 20), isolated in the pre-engraftment and early post-engraftment periods (day 2-45 post-bmt), was the most common microbe recovered from stool of patients with diarrhea. ...	1998	9554172
[clostridium difficile outbreak in surgical wards].	to evaluate the clinical consequences of a hospital outbreak of clostridium difficile infections in the netherlands.	1998	9557041
direct evidence of mast cell involvement in clostridium difficile toxin a-induced enteritis in mice.	the pathogenesis of clostridium difficile toxin a-induced intestinal inflammation is not completely understood. the aim of this study was to define the contribution of mast cells to the fluid secretion and neutrophil infiltration associated with toxin a-induced enteritis.	1998	9558284
leukocyte-endothelial cell interactions: molecular mechanisms and implications in gastrointestinal disease.	leukocyte-endothelial cell adhesion is now recognized to represent an early and rate-limiting step in the leukocyte infiltration and accompanying tissue injury that is associated with acute and chronic inflammatory diseases of the gastrointestinal tract. adhesive interactions such as leukocyte rolling, adherence, and transendothelial migration are influenced by a variety of physical, chemical, and molecular factors that ultimately result in a net up-regulation or down-regulation of the inflammat ...	1998	9558298
metronidazole may inhibit intestinal colonization with clostridium difficile.	antibiotics suppress normal gut flora, allowing overgrowth of acquired or native clostridium difficile, with release of toxins that cause mucosal inflammation. oral metronidazole is used to treat antibiotic-associated colitis (pseudomembranous colitis). this study was designed to determine whether oral metronidazole, as part of preoperative bowel preparation, prevents or decreases incidence of antibiotic-associated colitis after elective colonic and rectal procedures.	1998	9559631
nosocomial diarrhea.	nosocomial diarrheas are an important problem in hospitals, and in critical care units in particular. hospital-acquired diarrhea may be on an infectious or noninfectious basis. common noninfectious causes of nosocomial diarrhea include medication-induced changes in the fecal flora or changes secondary to enteral hyperalimenation. infectious causes of nosocomial diarrhea are due to enteric pathogens in outbreak situations and virtually all of the causes are due to clostridium difficile. c. diffic ...	1998	9561820
risk factors for early recurrent clostridium difficile-associated diarrhea.	recurrence is a common sequela of clostridium difficile-associated diarrhea (cdd) and may increase morbidity, costs, and treatment-related antimicrobial resistance. because recurrent cdd (rcdd) frequently occurs very soon after an initial episode, our goal was to determine the risk factors for early rcdd (occurring < or = 45 days after the initial episode). we conducted a case-control study, comparing 13 patients with early rcdd (case patients) with 46 patients who had only one cdd episode (cont ...	1998	9564482
molecular analysis of the promoter region of the clostridium difficile toxin b gene that is functional in escherichia coli.	clostridium difficile is a human pathogen that produces two types of toxins, a and b, that cause a potentially lethal gastrointestinal syndrome termed pseudomembranous colitis. virtually nothing is known about the mechanism of regulation of toxin production in this organism, and cis-regulatory regions of neither toxin have yet been identified, thus prompting this investigation. a motif homologous with the shine-dalgarno sequence of escherichia coli occurs upstream from the putative initiation co ...	1998	9568996
the lack of therapeutic effect of saccharomyces boulardii in the prevention of antibiotic-related diarrhoea in elderly patients.	diarrhoea is a common side effect of antibiotic therapy, especially in the elderly. saccharomyces boulardii is a non-pathogenic yeast which has been demonstrated to reduce the frequency of diarrhoea in patients due to a variety of causes. we set out to assess its role in preventing antibiotic-related diarrhoea. consecutive patients over the age of 65 admitted to medical wards, and who were being prescribed antibiotics, were randomized to receive either s. boulardii 113 g twice daily or placebo f ...	1998	9570649
nonspecific binding of clostridium difficile toxin a to murine immunoglobulins occurs via the fab component.	clostridium difficile toxin a binds nonspecifically to a mouse monoclonal antibody (mab) immunoglobulin g3 lambda chain [igg3(lambda)], through the fab component. this binding, which is retained even after boiling the mab, is temperature dependent, with more toxin bound at 4 than 37 degrees c (p = 0.0024). the nonspecific binding was decreased by incubation of the igg3 lambda mab with alpha- or beta-galactosidase (p = 0.0001 and 0.029, respectively), indicating that toxin a binds to a carbohydra ...	1998	9573079
antibodies to recombinant clostridium difficile toxins a and b are an effective treatment and prevent relapse of c. difficile-associated disease in a hamster model of infection.	clostridium difficile causes antibiotic-associated diarrhea and colitis in humans through the actions of toxin a and toxin b on the colonic mucosa. at present, broad-spectrum antibiotic drugs are used to treat this disease, and patients suffer from high relapse rates after termination of treatment. this study examined the role of both toxins in pathogenesis and the ability of orally administered avian antibodies against recombinant epitopes of toxin a and toxin b to treat c. difficile-associated ...	1998	9573084
[diarrhea associated with clostridium difficile].		1998	9580506
gtpgammas-induced actin polymerisation in vitro: atp- and phosphoinositide-independent signalling via rho-family proteins and a plasma membrane-associated guanine nucleotide exchange factor.	in a cell-free system from neutrophil cytosol gtp(&ggr ;)s can induce an increase in the number of free filament barbed ends and massive actin polymerisation and cross-linking. gtp(&ggr ;)s stimulation was susceptible to an excess of gdp, but not bordetella pertussis toxin and could not be mimicked by aluminium fluoride, myristoylated gtpgammas.gialpha2 or gbeta1gamma2 subunits of trimeric g proteins. in contrast, rhogdi and clostridium difficile toxin b (inactivating rho family proteins) comple ...	1998	9580566
[outbreak of nosocomial diarrhea by clostridium difficile in a department of internal medicine].	clostridium difficile (dcd) is the main etiologic agent of nosocomial diarrhea of infectious origin. most of the cases of dcd have been detected in a hospital environment.	1998	9586362
clinical quiz. diffuse pseudomembranous colitis.		1998	9586762
a valid and reliable tool to quantify stool output in tube-fed patients.	a major problem in determining whether diarrhea exists in tube-fed patients is the quantification of stool output. on the basis of this need a stool output assessment tool was developed and tested for validity and reliability. interrater reliability and construct validity were determined by using staff nurses' and principal investigators' observations. observers blindly rated the bowel movement (bm) on size and consistency and on whether the bm was thought to represent "diarrhea." interrater rel ...	1998	9586792
multicenter evaluation of the clostridium difficile tox a/b test.	clostridium difficile, the primary cause of nosocomial diarrhea in the united states and many other industrialized countries, is recognized as a major health concern because of its ability to cause severe intestinal disease leading to complications such as relapses and infections due to vancomycin-resistant enterococci. the disease results from two toxins, toxins a and b, produced by this pathogen. in this study, we evaluated the tox a/b test, a new 1-h enzyme immunoassay (eia) that detects toxi ...	1998	9431944
primary symptomless colonisation by clostridium difficile and decreased risk of subsequent diarrhoea.	little is known about whether patients who develop clostridium-difficile-associated diarrhoea (cdad) are culture-positive or culture-negative before illness. the most important risk factor is antibiotic exposure. we aimed to find out whether patients identified as primary symptom-free c difficile carriers are at higher risk of developing cdad than patients who are culture-negative.	1998	9500319
timing of surgery for fulminating pseudomembranous colitis.	with increasing antibiotic usage clostridium difficile colitis is becoming more common. surgery for fulminating c. difficile colitis, however, is rare because of the effectiveness of specific anticlostridial chemotherapy. surgical outcome in five patients with fulminating c. difficile colitis involved in a recent outbreak of this disease is reported.	1998	9501823
isolation of a toxin b-deficient mutant strain of clostridium difficile in a case of recurrent c. difficile-associated diarrhea.	clostridium difficile-associated diarrhea (cdad) recurs in approximately 15%-20% of patients after discontinuation of metronidazole or vancomycin therapy. most recurrences are believed to be endogenous relapses due to the persistence of spores. however, there is evidence that reinfection with a different strain is a cause of recurrence. we report the case of a patient with a history of multiple episodes of c. difficile colitis. the patient, a 56-year-old female, has had 5 years of repeated recur ...	1998	9502463
laboratory surveillance method for nosocomial clostridium difficile diarrhea.	clostridium difficile is the most common infectious cause of endemic nosocomial diarrhea, but traditional surveillance methods for this infection can be time-consuming. the purpose of this article is to (1) describe a laboratory surveillance method for nosocomial diarrhea and nosocomial clostridium difficile diarrhea (cdd) that does not require chart review and (2) describe some of the epidemiology of these infections at a university-affiliated, public hospital by using this surveillance method.	1998	9503108
results of chapter project on statistical analysis.		1998	9503120
regulated transcription of clostridium difficile toxin genes.	the clostridium difficile toxa and toxb genes, encoding cytotoxic and enterotoxic proteins responsible for antibiotic-associated colitis and pseudomembranous colitis, were shown to be transcribed both from gene-specific promoters and from promoters of upstream genes. however, the gene-specific transcripts represented the majority of tox gene mrnas. the 5' ends of these mrnas were shown to correspond to dna sequences that had promoter activity when fused to the escherichia coli beta-glucuronidase ...	1998	9466260