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a comparison of vancomycin and metronidazole for the treatment of clostridium difficile-associated diarrhea, stratified by disease severity.the incidence and severity of clostridium difficile-associated diarrhea (cdad) has been increasing, and there have been recent reports of metronidazole treatment failure. metronidazole is still commonly used as first-line treatment for cdad but has never been compared with vancomycin in a prospective, randomized, double-blind, placebo-controlled trial. we conducted such a trial, stratifying patients according to disease severity, to investigate whether one agent was superior for treating either ...200717599306
value of repeat stool testing for clostridium difficile. 200717602913
use of probiotic lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial.to determine the efficacy of a probiotic drink containing lactobacillus for the prevention of any diarrhoea associated with antibiotic use and that caused by clostridium difficile.200717604300
hand hygiene and clostridium difficile. 200717606966
use of intravenous immunoglobulin for the treatment of severe clostridium difficile colitis.clostridium difficile is a gram-positive, anaerobic, spore-forming, rod-shaped bacterium responsible for most of the hospital-acquired diarrhea in developed countries. the organism received its name because it was difficult to isolate and grow in culture. infections in the elderly have been associated with significant morbidity and mortality as well as prolonged hospitalization.200717608247
clostridium difficile: changing epidemiology and new treatment options.the review summarizes changes in the epidemiology and treatment of clostridium difficile-associated disease.200717609596
association of interleukin-8 polymorphism and immunoglobulin g anti-toxin a in patients with clostridium difficile-associated diarrhea.previous studies have shown that failure to produce serum antibodies to c. difficile (cd) toxin a is associated with more severe and recurrent c. difficile-associated diarrhea (cdad); and that presence of aa genotype in the interleukin (il)-8 gene promoter -251 position is associated with increased susceptibility to cdad. this study examined the relationship between serum immunoglobulin g antibodies to cd toxin a and the presence of il-8 aa genotype in hospitalized patients with cdad.200717618838
salmonella pseudomembranous colitis.pseudomembranous colitis is most often associated with antibiotic use and caused most often by clostridium difficile. aclinical syndrome and pathology that is identical can be caused rarely by other organisms. we report a case of salmonella enterica pseudomembranous colitis and briefly review the literature regarding rare causes of this syndrome.200717619469
efficacy of hospital cleaning agents and germicides against epidemic clostridium difficile strains.to compare the effects of hospital cleaning agents and germicides on the survival of epidemic clostridium difficile strains.200717620238
onset of symptoms and time to diagnosis of clostridium difficile-associated disease following discharge from an acute care hospital.to identify patients with a diagnosis of clostridium difficile-associated disease (cdad) in the ambulatory care setting and determine the relationship of symptom onset and diagnosis to prior hospitalization and exposure to antimicrobials.200717620239
emergence and control of fluoroquinolone-resistant, toxin a-negative, toxin b-positive clostridium difficile.clostridium difficile is a major cause of infectious diarrhea in hospitalized patients. between august 2003 and january 2004, we experienced an increase in the incidence of c. difficile-associated disease. we describe the investigation into and management of the outbreak in this article.200717620240
longitudinal trends in antibiotic resistance in us nursing homes, 2000-2004.we evaluated antibiotic resistance trends in us nursing homes using the minimum data set. significant increases in the number and proportion of infections caused by antibiotic-resistant bacteria were documented over the 5-year study. further research on antibiotic resistance in nursing homes is urgently needed.200717620252
probiotics for preventing and treating nosocomial infections: review of current evidence and recommendations.objective: to review the available clinical data supporting the use of probiotics in preventing and treating serious nosocomial infections. data source: a medline database from 1996 to july 2006 and references from identified articles were used to perform a literature search relating to the clinical applications of probiotics in preventing and treating clostridium difficile-associated diarrhea (cdd) and prevention of hospital-associated pneumonia (hap). conclusion: nosocomial infections like hap ...200717625089
acute appendicitis in the setting of clostridium difficile colitis: case report and review of the literature.a 72-year-old man was hospitalized for exacerbation of chronic obstructive pulmonary disease and was treated with oral prednisone and 7 days of moxifloxacin. five days after completing the antibiotic course, he developed watery diarrhea and diffuse, crampy abdominal pain. on presentation he was afebrile, and abdominal examination revealed diffuse tenderness without peritoneal signs. stool tested positive for clostridium difficile toxin a by enzyme-linked immunosorbent assay. despite starting ora ...200717625978
diarrhoea associated with antibiotic use. 200717626915
comparative role of antibiotic and proton pump inhibitor in experimental clostridium difficile infection in mice.clostridium difficile inoculated balb/c mice were investigated to assess the comparative role of antibiotic and proton pump inhibitor. they were examined for colonization and toxin production by c. difficile as well as myeloperoxidase activity and histopathological changes in the intestinal tract. the c. difficile count, toxin a and b titres and myeloperoxidase activity were significantly higher (p>0.05) in ampicillin and lansoprazole receiving groups as compared to the control and the c. diffic ...200718094539
[laboratory-based evaluation of tox a/b quik chek "nissui" to detect toxins a and b of clostridium difficile].the tox a/b quik chek "nissui" which detects both toxin a (tcda) and toxin b (tcdb) of clostridium difficile in stool specimens through immunochromatography was first approved to be released in japan, and we evaluated its accuracy. in the evaluation, the tox a/b quik chek "nissui" could correctly detect tcda and tcdb in solution and in stool specimens spiked with culture broth of tcda and/or tcdb-producing isolates of c. difficile. the minimum detectable concentrations for tcda and tcdb were det ...200718154439
war on white coats. 200718156024
clostridium difficile. 200718087880
the addition of fiber and the use of continuous infusion decrease the incidence of diarrhea in elderly tube-fed patients in medical wards of a general regional hospital: a controlled clinical trial.to determine if feeds high in fiber continuously administered might minimize diarrhea.200718090158
efficacy of rifaximin and vancomycin combination therapy in a patient with refractory clostridium difficile-associated diarrhea. 200718090164
infection likely cause of 90 deaths. 200718161446
progress at outbreak trust but doctor hygiene rapped. 200718161470
effect of product temperature during primary drying on the long-term stability of lyophilized proteins.our objective was to investigate the effect of performing primary drying at product temperatures below and above tg' (glass transition temperature of the freeze-concentrated phase) on the long-term stability of lyophilized proteins. two protective media differing in the nature of the bulking agent used (amorphous or crystalline) were selected. several lyophilization cycles were performed by using various combinations of shelf temperature and chamber pressure to obtain different values of product ...200718161627
the distribution and density of clostridium difficile toxin receptors on the intestinal mucosa of neonatal pigs.clostridium difficile is an enteric pathogen affecting a variety of mammals, but it has only recently been diagnosed as a cause of neonatal typhlocolitis in pigs. the most important virulence factors of c. difficile are 2 large exotoxins, toxin a (tcda) and toxin b (tcdb). tcda is a potent enterotoxin with effects on host tissues that are dependent upon receptor-mediated endocytosis of the intact toxin. tcdb is an effective cytotoxin, but it apparently does not bind receptors on intact mucosal e ...200718039894
the changing face of clostridium difficile: what treatment options remain?in this issue of the journal, an article by pepin et al. documents the shifting sands of the modern-day clostridium difficile epidemic as seen in quebec. pepin and coauthors' observation that the superior activity of vancomycin over metronidazole has been lost since the emergence there of the hypervirulent strain nap1/027 in 2003 has implications for the future treatment of c. difficile-associated diarrhea (cdad). this editorial explores these, particularly in complicated cases and high-risk pop ...200718042108
clostridium difficile-associated disease with lethal outcome in a 77-year-old woman. a case report.clostridium difficile-associated disease (cdad) ranges in severity from mild diarrhoea to fulminant colitis and death. antimicrobial use is the primary risk factor for development of cdad. c. difficile typically affects older or severely ill patients, hospitalized or residents in long-term-care facilities. we report a case of cdad in a 77-year-old woman operated on for cholecystitis calculosa and treated with cephalosporins and aminoglycosides. symptoms and signs of cdad were watery diarrhoea, m ...200718043555
[acute and prolonged infectious diarrheas, of microbial and viral etiology: methods of clinical and microbiological diagnosis].the authors relate clinical-microbiological criteria for a rational diagnosis of acute and prolonged enteritis, distinguishing between home and imported diarrheas. during 2005, 381 subjects (192 children and 189 adults) with acute diarrhea and 110 subjects (16 children and 94 adults) with prolonged diarrhea were examined. in the first group salmonella prevailed in 11.1% of cases (10.9% among children and 11.1% among adults); campylobacter in 9.2% (respectively 8.9% and 9.5%); other bacteria were ...200718044404
acute trust boards still failing in bug battle, watchdog claims. 200718019262
clostridium difficile infection frequency in patients with nosocomial infections or using antibiotics.clostridium difficile is the most common cause of nosocomial infectious diarrhea. the frequency of colonization in hospitalized patients varies between 10 and 43%.200718019703
infection control. behind closed doors: is kent scandal a one-off. 200718020250
clostridium difficile.case study: george, a 55-year-old retired businessman with a diagnosis of myelofibrosis, underwent an allogeneic stem cell transplantation from his human leukocyte antigen-matched brother in june 2006. he was admitted to the hospital for a possible flare of graft-versus-host disease (gvhd) of the gut. his medications included tacrolimus, budesonide, and bechlamethasone for immunosuppression and pantoprazole. a stool sample was positive for clostridium difficile toxin a on october 31, 2006, and h ...200718063537
[pseudomembranous colitis].for some thirty years it has been known that pathologic proliferation oftoxigenic clostridium difficile may lead to inflammation of colonic mucosa which, in its fully developed form, manifests as pseudomembranous colitis. cdad (clostridium difficile - associated disease or diarrhoea) is the term which is generally and quite aptly used for the disease in literature on the subject. in most cases, the disease develops after the administration of broad-spectrum antibiotics, yet there are also other ...200718072436
lessons from the maidstone and tunbridge tragedy. 200718073641
[drug-induced pseudomembranous colitis]. 200718074594
screening for vancomycin-resistant enterococci using stools sent for clostridium difficile cytotoxin assay is effective: results of a survey of 300 patients in a large singapore teaching hospital.to assess the efficacy of screening stools sent for clostridium difficile cytotoxin assay (cdta) for surveillance of vancomycin-resistant enterococci (vre).200718071603
effects of a human milk-derived human milk fortifier on the antibacterial actions of human milk.to compare the effects of a human breastmilk-derived fortifier on the antibacterial activity of milk obtained from lactating mothers delivering prematurely with the effects of a powdered fortifier on the same milk.200718081457
[diarrhea associated to clostridium difficile in an elderly patient. global perspective]. 200718021658
detection of clostridium difficile in stool samples from patients in the early period after liver transplantation.we examined the frequency of detection of clostridium difficile (cd) toxins compared with the recovery of c. difficile in stool specimen cultures among orthotopic liver transplant (olt) patients with nosocomial diarrhea in the early period.200718021993
low risk of irritable bowel syndrome after clostridium difficile infection.the incidence of postinfectious irritable bowel syndrome (ibs) ranges between 4% and 32% of individuals after bacterial or parasitic infection. this study analyzed ibs symptoms in hospitalized patients three months after a symptomatic clostridium difficile infection.200718026576
probiotics in the management of colonic disorders.probiotics have been used in humans for almost a century and widely recommended for the treatment of a variety of ills assumed to be of colonic origin, including diarrhea, constipation, bloating, and flatulence. more recently, probiotics have been evaluated in the management of specific colonic disorders such as inflammatory bowel disease, irritable bowel syndrome, and clostridium difficile colitis. it is evident that no two probiotics are exactly alike; why then should we expect reproducible re ...200717991347
update of clostridium difficile-associated disease due to pcr ribotype 027 in europe.recent outbreaks of clostridium difficile-associated diarrhoea (cdad) with increased severity, high relapse rate and significant mortality have been related to the emergence of a new, hypervirulent c. difficile strain in north america, japan and europe. definitions have been proposed by the european centre of disease prevention and control (ecdc) to identify severe cases of cdad and to differentiate community-acquired cases from nosocomial cdad (http://www.ecdc.europa.eu/documents/pdf/cl_dif_v2. ...200717991399
annual incidence of mrsa falls in england, but c difficile continues to rise. 200717991958
long-term survival in a patient with acinar cell carcinoma of pancreas. a case report and review of literature.acinar cell carcinoma of the pancreas is a rare malignancy that may have acinar and endocrine differentiation. clinical practice guidelines exist for pancreatic ductal adenocarcinoma. however, treatment protocols for acinar cell carcinoma of the pancreas have not been standardized.200717993731
trans-cinnamaldehyde from cinnamomum zeylanicum bark essential oil reduces the clindamycin resistance of clostridium difficile in vitro.therapy with antimicrobial drugs, such as clindamycin, that perturb the intestinal flora but fail to inhibit growth of other microorganisms can permit the proliferation of clostridium difficile and the elaboration of exotoxin. therefore, there has been increasing interest in the use of inhibitors of antibiotic resistance for use in combination therapy. the essential oil of cinnamomum zeylanicum bark enhanced the bactericidal activity of clindamycin and decreased the minimum inhibitory concentrat ...200717995898
a case of clostridium difficile-associated disease due to the highly virulent clone of clostridium difficile pcr ribotype 027, march 2007 in germany. 200718005641
confirmed cases and report of clusters of severe infections due to clostridium difficile pcr ribotype 027 in germany. 200718005642
first isolation of clostridium difficile pcr ribotype 027 in finland. 200718005648
[interest of the disk diffusion method for screening clostridium difficile isolates with decreased susceptibility to antibiotics].in vitro determination of clostridium difficile susceptibility to antibiotics is not routinely performed. the aim of this study was to evaluate the performance of antibiotic susceptibility determination with the disk diffusion method for screening c. difficile isolates with decreased susceptibility to antibiotics.200717905536
[infectious aetiologies of travelers' diarrhoea].traveler's diarrhoea (td) occurs in 20 to 60% of european or north-american travelers in intertropical areas. following return from endemic zone, malaria must always be evocated in front of febrile diarrhoea. many causative infectious agents are involved in td and their frequency may vary according to destination and seasons. the main agents involved in td are escherichia coli pathovars (especially enterotoxigenic and enteroaggregative e. coli) followed by enteroinvasive bacteria (campylobacter ...200717942257
doctors need a "sea change" in their attitude to c difficile. 200717947757
refractory clostridium difficile-associated diarrhea. 200717955101
treatment strategies for c. difficile associated diarrhea.clostridium difficile-associated diarrhea usually occurs as a complication of antibiotic treatment. recent data shows an increase in incidence rate of cdad and higher rates of morbidity, colectomy and death. the management of cdad involves discontinuing the inciting antibiotic agent and treatment with metronidazole or vancomycin. the reduced response rates and higher recurrence rates with metronidazole treatment reported in recent studies raise the question of the effectiveness of metronidazole ...200717955730
amoxicillin-associated hemorrhagic colitis in the presence of klebsiella oxytoca.antibiotic-induced diarrhea can be a significant source of morbidity. pseudomembranous colitis, or clostridium difficile-associated diarrhea (cdad), is an increasingly reported adverse effect of therapy with broad-spectrum antibiotics and can prolong the hospital stay of affected patients. although sharing some of the same clinical symptoms as cdad, antibiotic-associated hemorrhagic colitis is a distinctly separate form of colitis that is characterized by the absence of toxin-producing c. diffic ...200717963468
rac2 gtpase activation by angiotensin ii is modulated by ca2+/calcineurin and mitogen-activated protein kinases in human neutrophils.angiotensin ii (ang ii) highly stimulates superoxide anion production by neutrophils. the g-protein rac2 modulates the activity of nadph oxidase in response to various stimuli. here, we describe that ang ii induced both rac2 translocation from the cytosol to the plasma membrane and rac2 gtp-binding activity. furthermore, clostridium difficile toxin a, an inhibitor of the rho-gtpases family rho, rac and cdc42, prevented ang ii-elicited o2-/ros production, phosphorylation of the mitogen-activated ...200717975262
outcome of metronidazole therapy for clostridium difficile disease and correlation with a scoring system.to determine the response rate of clostridium difficile disease (cdd) to treatment with metronidazole and assess a scoring system to predict response to treatment with metronidazole when applied at the time of cdd diagnosis.200717983659
epidemiology of clostridium difficile-associated diarrhea in a peruvian tertiary care hospital.the prevalence, incidence, and epidemiologic factors of clostridium difficile-associated diarrhea (cdad) in a peruvian hospital were studied. we conducted a cross-sectional study in patients > 14 years of age from medical/surgical wards of the cayetano heredia national hospital (lima, peru) from september 2005 to may 2006. cdad was defined in a case of nosocomial diarrhea when c. difficile toxin a and/or toxin b was detected by enzyme immune assay (eia) in stools. a total of 4,264 patients were ...200717984329
control of an outbreak of infection with the hypervirulent clostridium difficile bi strain in a university hospital using a comprehensive "bundle" approach.background: in june 2000, the hospital-acquired clostridium difficile (cd) infection rate in our hospital (university of pittsburgh medical center-presbyterian, pittsburgh, pa) increased to 10.4 infections per 1000 hospital discharges (hds); the annual rate increased from 2.7 infections per 1000 hds to 7.2 infections per 1000 hds and was accompanied by an increase in the frequency of severe outcomes. forty-seven (51%) of 92 ha cd isolates in 2001 were identified as the "epidemic bi strain." a co ...200717968819
confronting clostridium difficile in inpatient health care facilities. 200717968820
editorial commentary: vancomycin for your mother, metronidazole for your mother-in-law. 200717988743
association of proton-pump inhibitors with outcomes in clostridium difficile colitis.the role of concurrent use of proton-pump inhibitors (ppis) in the outcomes of treatment for clostridium difficile colitis was studied. methods. the records of inpatients at a large veterans affairs medical center in whom c. difficile colitis was diagnosed between june 2004 and july 2005 were retrospectively reviewed. data collected included patient characteristics at baseline, antibiotic therapy prescribed before and during therapy for c. difficile colitis, concurrent treatment with a ppi, resp ...200717989446
evaluation of three rapid assays for detection of clostridium difficile toxin a and toxin b in stool specimens.diagnosis of clostridium difficile-associated disease continues to be difficult for clinical microbiology laboratories. the aim of this study was to evaluate the performance of three enzyme immunoassays for detection of c. difficile toxins a and b: the recently marketed rapid enzyme immunoassay ridascreen clostridium difficile toxin a/b (r-biopharm, darmstadt, germany) and two established enzyme immunoassays, the c. difficile tox a/b ii assay (techlab, blacksburg, va, usa) and the prospect c. di ...200717211606
the clostron: a universal gene knock-out system for the genus clostridium.progress in exploiting clostridial genome information has been severely impeded by a general lack of effective methods for the directed inactivation of specific genes. those few mutants that have been generated have been almost exclusively derived by single crossover integration of a replication-deficient or defective plasmid by homologous recombination. the mutants created are therefore unstable. here we have adapted a mutagenesis system based on the mobile group ii intron from the ltrb gene of ...200717658189
a case of recurrent clostridium difficile diarrhea.clostridium difficile is an important and increasingly common cause of nosocomial diarrhea. recent epidemics of c. difficile-associated disease (cdad) reveal a pathogen that is becoming more virulent, leading to an increase in disease severity, treatment failures, and relapses. those of advanced age are at a particular risk of acquiring this debilitating and costly disease. this case describes cdad recurring in an 87-year-old resident of a long-term care facility, which caused hospitalization. a ...200717658971
acute colonic pseudo-obstruction.acute colonic pseudo-obstruction (acpo) is a syndrome of massive dilation of the colon without mechanical obstruction that develops in hospitalised patients with serious underlying medical and surgical conditions. acpo is associated with significant morbidity and mortality, and, therefore, requires urgent gastroenterologic evaluation. appropriate evaluation of the markedly distended colon involves excluding mechanical obstruction and other causes of toxic megacolon such as clostridium difficile ...200717643908
clostridium difficile: new therapeutic options.clostridium difficile disease is the major, known cause of nosocomial diarrhea and is an emerging cause of community-associated diarrhea. recent outbreaks due to a strain of apparent increased virulence, bi/nap1, and recognition of increasing metronidazole treatment failures as well as the morbidity associated with recurrent c. difficile disease have begun to spur studies to develop new therapies for c. difficile disease. nitazoxanide, tolevamer, ramoplanin, and rifaximin are key agents being ev ...200717644040
clostridium difficile-associated diarrhoea rates and global antibiotic consumption in five quebec institutions from 2001 to 2004.a massive outbreak of a new clostridium difficile clone affected the province of quebec between 2002 and 2004. there are several theories as to the exact cause of the emergence of this new clone, including the overuse of some classes of antibiotics. antibiotic prescription is associated with c. difficile-associated diarrhoea (cdad), but which class has the highest risk is still the subject of debate. we analysed the global antibiotic consumption patterns in five institutions in quebec, three in ...200717644347
molecular analysis of clostridium difficile at a university teaching hospital in japan: a shift in the predominant type over a five-year period.clostridium difficile isolates recovered from patients admitted to a teaching hospital in japan over a 5-year period were analyzed. two molecular typing systems, pcr ribotyping and pulsed-field gel electrophoresis (pfge) analysis, were used. twenty-six pcr ribotypes were found among the 148 isolates. the predominant type at our hospital appeared to shift during the study period, from pcr ribotype a in 2000 (15/33, 45%) to pcr ribotype f in 2004 (18/28, 64%). by using pfge with thiourea added to ...200717647032
detection of a genetic linkage between genes coding for resistance to tetracycline and erythromycin in clostridium difficile.elements carrying more than one antibiotic resistance gene have never been found in clostridium difficile, one of the major causes of nosocomial diarrheic diseases. in this study, c. difficile isolates were investigated for a possible genetic linkage between tet(m) and erm(b), the most frequent genes found in strains resistant to tetracycline and erythromycin. in the majority of c. difficile strains, tet(m) is carried by tn5397. however, tet(m) genes carried by tn916-like elements have been foun ...200717650959
probiotics and diarrhea: no high risk antibiotics? 200717656513
fucidic acid use in metronidazole nonresponders with clostridium difficile infection. 200717687186
cwp84, a surface-associated protein of clostridium difficile, is a cysteine protease with degrading activity on extracellular matrix proteins.clostridium difficile pathogenicity is mediated mainly by its a and b toxins, but the colonization process is thought to be a necessary preliminary step in the course of infection. the aim of this study was to characterize the cwp84 protease of c. difficile, which is highly immunogenic in patients with c. difficile-associated disease and is potentially involved in the pathogenic process. cwp84 was purified as a recombinant his-tagged protein, and specific antibodies were generated in rabbits. tr ...200717693508
binary toxin production in clostridium difficile is regulated by cdtr, a lyttr family response regulator.clostridium difficile binary toxin (cdt) is an actin-specific adp-ribosyltransferase that is produced by various c. difficile isolates, including the "hypervirulent" nap1/027 epidemic strains. in contrast to the two major toxins from c. difficile, toxin a and toxin b, little is known about the role of cdt in virulence or how c. difficile regulates its production. in this study we have shown that in addition to the cdta and cdtb toxin structural genes, a functional cdt locus contains a third gene ...200717693517
evidence for low risk of clostridium difficile infection associated with tigecycline.broad-spectrum antibiotics are often associated with a relatively high risk of clostridium difficile infection (cdi). however, exceptions to this rule, e.g., piperacillin-tazobactam, show that marked inhibition of gut flora is not synonymous with cdi risk. tigecycline has marked broad-spectrum activity that includes gram-positive and gram-negative facultative and obligate anaerobes. antibiotic susceptibility, gut model and clinical trial data suggest that tigecycline is associated with a relativ ...200717697004
c. difficile outbreaks in gatineau, sault ste. marie. 200717698816
effect of lactobacillus rhamnosus gg in persistent diarrhea in indian children: a randomized controlled trial.to evaluate the role of lactobacillus rhamnosus gg (lgg) as probiotic in persistent diarrhea (pd) in children of north bengal, india.200717700424
role of retinol in protecting epithelial cell damage induced by clostridium difficile toxin a.vitamin a (retinol), a fat-soluble vitamin, is an essential nutrient for the normal functioning of the visual system, epithelial cell integrity and growth, immunity, and reproduction. our group has investigated the effect of high doses of oral vitamin a on early childhood diarrhea in our prospective community-based studies from northeast brazil and found a beneficial role in reducing the mean duration but not incidence of diarrheal episodes. in this study, we explored the role of retinol supplem ...200717825865
prokinetic therapy for feed intolerance in critical illness: one drug or two?to compare the efficacy of combination therapy, with erythromycin and metoclopramide, to erythromycin alone in the treatment of feed intolerance in critically ill patients.200717828038
widespread environmental contamination associated with patients with diarrhea and methicillin-resistant staphylococcus aureus colonization of the gastrointestinal tract.patients colonized with methicillin-resistant staphylococcus aureus (mrsa) may contaminate their immediate environment with this organism. however, the extent to which gastrointestinal colonization with mrsa affects environmental contamination is not known. we investigated the frequency of environmental contamination in the rooms of patients with diarrheal stools and heavy gastrointestinal colonization with mrsa.200717828690
clostridium difficile-associated diarrhea in heart transplant recipients: is hypogammaglobulinemia the answer?information regarding clostridium difficile-associated diarrhea (cdad) after solid-organ transplantation (sot) is scarce, particularly after heart transplantation (ht). although host immune response to c. difficile plays a substantial role in the outcome of this infection, the responsibility of hypogammaglobulinemia (hgg) as a predisposing condition for cdad has not been studied in sot. we analyzed the incidence, clinical presentation, outcome and risk factors, including hgg, of cdad after ht.200717845929
intensive session: new approaches to medical issues in long-term care.this article, based on a series of presentations at the american medical directors association, briefly highlights new advances in medical areas of interest to long-term care physicians. the areas discussed are heart failure, vitamin d, falls, new treatments for diabetes mellitus, blood pressure measurement, anemia, clinical nutrition, pressure ulcers, clostridium difficile, insomnia, and antipsychotic therapy.200717845944
hse clears infection death managers. 200717847612
prospective study of clostridium difficile infections in europe with phenotypic and genotypic characterisation of the isolates.a 2-month prospective study of clostridium difficile infections was conducted in 38 hospitals from 14 different european countries in order to obtain an overview of the phenotypic and genotypic features of clinical isolates of c. difficile during 2005. of 411 isolates from diarrhoeagenic patients with suspected c. difficile-associated diarrhoea (cdad), 354 were toxigenic, of which 86 (24.3%) were toxin-variant strains. major toxinotypes included toxinotypes 0 (n = 268), v (n = 28), viii (n = 22) ...200717850341
cytomegalovirus and clostridium difficile ischemic colitis in a renal transplant recipient: a lethal complication of anti-rejection therapy?intestinal ischemia is reported to be the most common gastrointestinal complication of renal transplantation and a potential cause of morbidity and mortality. the recent use of more potent immunosuppressive drug regimens has reduced the incidence of acute rejection, increasing the incidence of potentially fatal infectious complications, such as clinically important cytomegalovirus (cmv) infection. a 42-year-old kidney transplant recipient experienced on postoperative day 10 a dehiscence of the u ...200717851290
clostridium difficile: dealing with a silent menace.clostridium difficile infection is a growing problem and infection is not confined to acute hospitals. people with c. difficile may be cared for in community hospitals or at home. some people with c. difficile suffer recurrent bouts of infection, others are left with ongoing bowel problems as a result of the infection. prevention, wherever possible, through prudent antibiotic prescribing and scrupulous infection control procedures can reduce infection risks. prompt diagnosis and treatment can re ...200717851307
early and late onset clostridium difficile-associated colitis following liver transplantation.clostridium difficile colitis (cdc) remains a serious and common complication after liver transplantation (lt). four hundred and sixty-seven consecutive lts in 402 individuals were performed between 1998 and 2001 at our center. standard immunosuppression consisted of tacrolimus, mycophenolate, and steroids. cd toxins a and b were detected by using a rapid immunoassay or enzyme immunoassay. cdc was diagnosed in 32 patients (5-1999 days post-lt), with 93.8% (30/32) of patients developing cdc durin ...200717854444
inflammation and apoptosis in clostridium difficile enteritis is mediated by pge2 up-regulation of fas ligand.clostridium difficile toxin a causes acute inflammation and fluid secretion in experimental animals and patients with c difficile infection. we previously reported that toxin a increased cyclooxygenase-2/prostaglandin e(2) (pge(2)) expression and apoptosis in human colonocytes. here, we assessed the role of secreted pge(2) in inflammation and enterocyte apoptosis in toxin a enteritis.200717854595
distribution of clostridium difficile pcr ribotype 027 in british hospitals. 200717868609
first isolation and report of clusters of clostridium difficile pcr 027 cases in ireland. 200717868610
asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic clostridium difficile strains among long-term care facility residents.asymptomatic fecal carriage of clostridium difficile is common in patients staying in health care facilities, but the importance of asymptomatic carriers with regard to disease transmission is unclear.200717879913
asymptomatic clostridium difficile colonization: is this the tip of another iceberg? 200717879914
diagnosis of clostridium difficile-associated diarrhea and odor. 200717879938
a case of norovirus and clostridium difficile infection: casual or causal relationship? 200717884245
reported clostridium difficile rates: accurate and targeting the problem? 200717884249
what is the true burden of clostridium difficile disease? 200717884251
clostridium difficile: emergence of hypervirulence and fluoroquinolone resistance.clostridium difficile is a well-known cause of sporadic and healthcare-associated diarrhea. multihospital outbreaks due to a single strain and outbreaks associated with antibiotic selective pressure, especially clindamycin, have been well documented. severe cases and fatalities from c. difficile are uncommon. the recent global emergence of a hypervirulent strain containing binary toxin (toxinotype iii ribotype 027), with or without deletion in a regulatory gene (tcdc gene), together with high-le ...200717885732
the potential impact of substitutive therapy with intravenous immunoglobulin on the outcome of heart transplant recipients with infections.hypogammaglobulinemia has been proposed to be a risk factor for infection after heart transplantation (oht). infection is a leading cause of morbility and mortality among these patients. in a retrospective study we analyzed the impact of substitutive therapy with nonspecific intravenous immunoglobulin (ivig) on the outcomes of heart transplant patients with infections. we analyzed the outcome of 123 consecutive heart transplant recipients in our center from june 1996 to november 2005. their mean ...200717889198
morphological and genetic diversity of temperate phages in clostridium difficile.eight temperate phages were characterized after mitomycin c induction of six clostridium difficile isolates corresponding to six distinct pcr ribotypes. the hypervirulent c. difficile strain responsible for a multi-institutional outbreak (nap1/027 or qcd-32g58) was among these prophage-containing strains. observation of the crude lysates by transmission electron microscopy (tem) revealed the presence of three phages with isometric capsids and long contractile tails (myoviridae family), as well a ...200717890338
prevalence of enterotoxin producing staphylococcus aureus in stools of patients with nosocomial diarrhea.nosocomial diarrhea causes prolonged hospital stay leading to additional diagnostic and therapeutic procedures resulting in higher costs. a total of 20%-25% of antibiotic-associated diarrhea (aad) cases are attributed to clostridium difficile. other microorganisms like clostridium perfringens and staphylococcus aureus are discussed to be associated with aad.200717721737
repression of clostridium difficile toxin gene expression by cody.cody, a global regulator of gene expression in low g + c gram-positive bacteria, was found to repress toxin gene expression in clostridium difficile. inactivation of the cody gene resulted in derepression of all five genes of the c. difficile pathogenicity locus during exponential growth and stationary phase. cody was found to bind with high affinity to a dna fragment containing the promoter region of the tcdr gene, which encodes a sigma factor that permits rna polymerase to recognize promoters ...200717725558
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