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processing of clostridium difficile toxins.the pathogenicity of clostridium difficile depends on the large clostridial glucosylating toxins a and b (tcda and tcdb). the proteins accomplish their own uptake by a modular structure comprising a catalytic and a binding/translocation domain. based on a proteolytic processing step solely the catalytic domain reaches the cytosol. within the cells, the glucosyltransferases inactivate small gtpases by mono-o-glucosylation. here, a short overview is given regarding latest insights into the intramo ...200818480324
multicentre study of the prevalence of toxigenic clostridium difficile in korea: results of a retrospective study 2000-2005.the prevalence of toxigenic clostridium difficile in korea has been reported to be approximately 60-80%. although the prevalence of the tcda(-)tcdb(+) c. difficile strain was less then 5% prior to the year 2000, it has become an emerging nosocomial pathogen in korea. therefore, we have attempted to determine the multicentre nationwide prevalence of tcda(+)tcdb(+) and tcda(-)tcdb(+) c. difficile for epidemiological purposes. c. difficile strains (n=724, 30 from 2000, 80 from 2001, 74 from 2002, 7 ...200818480325
characterization of clinical clostridium difficile isolates by pcr ribotyping and detection of toxin genes in austria, 2006-2007.in order to assess the lethality of clostridium difficile-associated disease (cdad) and the pcr ribotypes prevalent in austria, the austrian agency for health and food safety requested isolates of c. difficile from patients in a structured but arbitrary sampling scheme. in the allocated period from february 2006 to january 2007, local hospital laboratories within each of the nine provinces were asked to submit c. difficile isolates from at least ten cases of cdad. confirmation of species identif ...200818480326
antibiotic use and other risk factors at hospital level for outbreaks with clostridium difficile pcr ribotype 027.the first dutch outbreak due to clostridium difficile ribotype 027 was observed in mid-2005; by the end of that year, eight hospitals were affected. to study the relationship between hospital-wide antibiotic use and the incidence of 027-linked c. difficile-associated disease (cdad) three study groups were made: group a, all eight hospitals with an 027-associated epidemic; group b, five of a total of six hospitals with occasional 027 cases, without an increase in cdad; and group c, ten randomly s ...200818480327
systemic antibody response to clostridium difficile in colonized patients with and without symptoms and matched controls.it has been proposed that patients who develop clostridium difficile-associated disease (cdad) do so because they are unable to mount an adequate immune response. serum was collected from three groups of elderly in-patients: (i) cases (n=21) of cdad, being toxin a/b-positive; (ii) carriers (n=21) asymptomatic for cdad (no diarrhoea) but at least toxin or culture positive; and (iii) controls (n=26) asymptomatic for cdad and negative for both c. difficile toxin and culture. the age and gender of e ...200818480328
clostridium difficile txac314 and slp-36kda enhance the immune response toward a co-administered antigen.this study evaluated the in vivo adjuvant activity of two peptides derived from clostridium difficile: a fragment of the receptor-binding domain of toxin a (txa(c314)) and a fragment of the 36 kda surface-layer protein (slp-36kda) from strain c253. their ability to affect the magnitude, distribution and polarization of the immune response against fibronectin-binding protein a (fnbpa), a protective vaccine antigen against staphylococcus aureus, was evaluated using two different routes of immuniza ...200818480329
antibiotics involved in clostridium difficile-associated disease increase colonization factor gene expression.clostridium difficile is the most common cause of antibiotic-associated diarrhoea. antibiotics are presumed to disturb the normal intestinal microbiota, leading to depletion of the barrier effect and colonization by pathogenic bacteria. this first step of infection includes adherence to epithelial cells. we investigated the impact of various environmental conditions in vitro on the expression of genes encoding known, or putative, colonization factors: three adhesins, p47 (one of the two s-layer ...200818480330
enhancement of the cytotoxic activity of clostridium difficile toxin a by surface-associated antigens.cell-surface antigens of clostridium difficile and lps from escherichia coli were investigated for modulating effects on the activity of c. difficile toxin a on vero and caco2 cells. the antigens of c. difficile tested comprised: (i) an edta extract, which contained several major and minor cell-surface proteins and the membrane-associated lipocarbohydrate (lc); (ii) a guanidine hydrochloride extract, which mainly contained the surface-layer proteins; (iii) an aqueous phenol-extracted, protein-fr ...200818480331
assessing the role of p-cresol tolerance in clostridium difficile.clostridium difficile is an important nosocomial pathogen, resulting in antibiotic-associated disease ranging from mild diarrhoea to the life-threatening pseudomembranous colitis. upon antibiotic exposure, it is believed that the normal bowel microflora of patients is disrupted, allowing c. difficile to proliferate. significantly, c. difficile is among only a few bacteria able to ferment tyrosine to p-cresol, a phenolic compound that is toxic to other microbes via its ability to interfere with m ...200818480332
immunoreactive cell wall proteins of clostridium difficile identified by human sera.clostridium difficile is a leading cause of nosocomial infection in the developed world, causing antibiotic-associated disease in susceptible populations. the identity of immunogenic proteins is important in understanding the pathogenesis of disease and in the design of vaccines. this study analysed the sera of six patients infected during a hospital outbreak of a c. difficile ribotype 017 strain. using a proteomics-based approach, cell wall proteins were separated by two-dimensional page, and i ...200818480333
microarray analysis of the transcriptional responses of clostridium difficile to environmental and antibiotic stress.clostridium difficile is a spore-forming anaerobic bacterium that is an emerging nosocomial threat; incidence of infection in hospitals is increasing, both in frequency and severity, resulting in considerable morbidity and mortality. in order to adapt to the intestinal environment, c. difficile must react to the many stresses involved with colonization, including exposure to antibiotics, which represents the most frequent precipitating agent of c. difficile infection. the responses of c. diffici ...200818480334
glucosylation of rho gtpases by clostridium difficile toxin a triggers apoptosis in intestinal epithelial cells.the intestinal epithelial cell line ht-29 was used to study the apoptotic effect of clostridium difficile toxin a (tcda). tcda is a 300 kda single-chain protein, which glucosylates and thereby inactivates small gtpases of the rho family (rho, rac and cdc42). the effect of tcda-catalysed glucosylation of the rho gtpases is well known: reorganization of the actin cytoskeleton with accompanying morphological changes in cells, leading to complete rounding of cells and destruction of the intestinal b ...200818480335
comparative analysis of bi/nap1/027 hypervirulent strains reveals novel toxin b-encoding gene (tcdb) sequences.the reported incidence and mortality of clostridium difficile-associated disease has increased significantly, which in part is likely to be due to the emergence of a new, highly virulent strain in north america and europe. this epidemic strain, referred to as bi/nap1/027, has increased virulence, attributed to overexpression of the two toxin-encoding genes, tcda and tcdb, which may be due to truncation of the negative regulator (tcdc) by a 1 bp deletion. in a previous study of whole-genome compa ...200818480336
effect of sub-mic concentrations of metronidazole, vancomycin, clindamycin and linezolid on toxin gene transcription and production in clostridium difficile.clostridium difficile is the major cause of hospital-acquired infectious diarrhoea. several antimicrobials are known to induce and promote c. difficile-associated diarrhoea (cdad). the impact of metronidazole (mtr), vancomycin (van), clindamycin (cli) and linezolid (lzd) on growth, toxin gene transcription and toxin production in c. difficile was investigated. four c. difficile strains were grown with and without sub-mic concentrations of mtr, van, cli and lzd (0.5x mic) and growth was measured ...200818480337
fluoroquinolone resistance in clostridium difficile isolates from a prospective study of c. difficile infections in europe.the european study group on clostridium difficile (esgcd) conducted a prospective study in 2005 to monitor and characterize c. difficile strains circulating in european hospitals, collecting 411 isolates. eighty-three of these isolates, showing resistance or intermediate resistance to moxifloxacin (mx), were selected for this study to assess susceptibility to other fluoroquinolones (fqs) and to analyse the gyr genes, encoding the dna gyrase subunits gyra and gyrb. twenty mx-susceptible isolates ...200818480338
isolation of clostridium difficile from food animals in slovenia.a total of 313 faecal samples from three pig farms and two cattle farms was collected, and clostridium difficile was isolated from 133/257 piglet samples (51.8%) and from 1/56 calf samples (1.8%). toxins were tested only in calf samples and were positive in 44.6% (25/56). the only bovine isolate belonged to toxinotype xia (a(-)b(-)cdt(+)). porcine isolates belonged to toxinotype 0 (a(+)b(+)cdt(-)) and toxinotype v (a(+)b(+)cdt(+)). of the two ribotypes usually found in toxinotype v, the strains ...200818480339
designer probiotics: a potential therapeutic for clostridium difficile? 200818480340
[old dogmas and new perspectives in antibiotic-associated diarrhea].the introduction of antibiotics has been one of the most striking improvements in treatment and prophylaxis in medical history. at the same time, it is the antibacterial effect that is responsible for one of the most frequent complications associated with antibiotic treatment: antibiotic-associated diarrhea (aad). this iatrogenic complication causes a considerable proportion of additional morbidity but also costs. in the clinical praxis it is often difficult to predict the risk of aad associated ...200818484219
clostridium difficile and inflammatory bowel disease.clostridium difficile colitis has doubled in north america over the past 5 years and recent reports have demonstrated an increase in incidence and severity of these infections in patients with inflammatory bowel disease (ibd; crohn's disease, ulcerative colitis). studies from single institutions as well as trends identified in nationwide inpatient databases have shown that ibd patients with concomitant c. difficile infection experience increased morbidity and mortality. results from our center h ...200818484669
defensins versus bacteria: not just antibiotics anymore. 200818486618
[toxic megacolon secondary to clostridium difficile-associated pseudomembranous colitis].a 78-year-old male without pre-existing comorbidity who underwent revision of a hip arthroplasty developed abdominal pain and distension, diarrhoeas, pyrexia and leucocytosis after only 5 days' postoperative treatment with cefuroxime and gentamycine. abdominal computed tomography demonstrated severe colonic dilation, inflammation and oedema consistent with toxic megacolon. stool samples were positive for clostridium difficile. oral vancomycine treatment and colonic decompression were inefficient ...200818489880
community-onset clostridium difficile-associated diarrhoea not associated with antibiotic usage--two case reports with review of the changing epidemiology of clostridium difficile-associated diarrhoea.the emergence of hypervirulent strains of clostridium difficile causing outbreaks in hospitals and nursing homes may result in a greater than before spread of the bacterium in the community. by consequence, the incidence of community-onset cases of clostridium difficile-associated diarrhoea (cdad) may increase outside known risk groups that are currently characterised by prior hospitalisation, prior antibiotic usage, older age and significant comorbidity. here, we describe two case histories of ...200818490799
decreased effectiveness of metronidazole for the treatment of clostridium difficile infection? 200818491959
comparison of clinical and microbiological response to treatment of clostridium difficile-associated disease with metronidazole and vancomycin.there have been recent reports of frequent treatment failure associated with the use of metronidazole for treatment of clostridium difficile-associated disease. we tested the hypothesis that treatment failure with metronidazole is associated with a suboptimal microbiological response in comparison with that of vancomycin.200818491964
[diarrhoea caused by clostridium difficile in patients with postoperative subhepatic abscess].toxigenic strains of clostridium difficile in the majority of cases cause disease of the intestinal tract of hospitalized patients. for a long time, clostridium difficile was considered to produce both types of toxins (a+/b+ strain), however, the investigations conducted in the last ten years point to the existence of clinically significant isolates which produce only toxin b, i. e. toxin a negative/toxin b positive (a-/b+ strain) clostridium difficile.200818494275
an overview of harms associated with beta-lactam antimicrobials: where do the carbapenems fit in?the us institute of medicine's focus on patient safety has motivated hospital administrators to facilitate a culture of safety. as a result, subcommittees of the pharmacy and therapeutics committee have emerged in many hospitals to focus on adverse events and patient safety. antimicrobial harms have gained the attention of practicing clinicians and hospital formulary committees, because they top the list of drugs that are associated with adverse events and because of certain serious harms that h ...200818495060
rho-family gtpases modulate ca(2+) -dependent atp release from astrocytes.previously, we reported that activation of g protein-coupled receptors (gpcr) in 1321n1 human astrocytoma cells elicits a rapid release of atp that is partially dependent on a g(q)/phophospholipase c (plc)/ca(2+) mobilization signaling cascade. in this study we assessed the role of rho-family gtpase signaling as an additional pathway for the regulation of atp release in response to activation of protease-activated receptor-1 (par1), lysophosphatidic acid receptor (lpar), and m3-muscarinic (m3r) ...200818495810
open-label, dose escalation phase i study in healthy volunteers to evaluate the safety and pharmacokinetics of a human monoclonal antibody to clostridium difficile toxin a.recent data suggest that clostridium difficile-associated diarrhea is becoming more severe and difficult to treat. antibody responses to c. difficile toxin a are protective against symptomatic disease and recurrence. we examined the safety and pharmacokinetics (pk) of a novel neutralizing human monoclonal antibody against c. difficile toxin a (cda1) in healthy adults.200818502001
surveillance for community-associated clostridium difficile--connecticut, 2006.clostridium difficile is a well-known cause of hospital-acquired infectious diarrhea and is associated with increased health-care costs, prolonged hospitalizations, and increased patient morbidity. previous antimicrobial use, especially use of clindamycin or ciprofloxacin, is the primary risk factor for development of c. difficile-associated diarrhea (cdad) because it disrupts normal bowel flora and promotes c. difficile overgrowth. historically, cdad has been associated with elderly hospital in ...200818385641
a study of clostridium difficile-associated disease at king chulalongkorn memorial hospital, thailand.currently, in established antibiotic era, there is a widespread and increasing use of broad-spectrum antibiotics. clostridium difficile, one of the troublesome intruders, flourishes when normal gut flora is altered by antibiotics. c. difficile is recognized as a frequent and leading cause of antibiotic-associated diarrhea and colitis. it causes substantial morbidity and mortality in hospitalized patients.200818386542
current and future treatment modalities for clostridium difficile-associated disease.current and future treatment modalities for clostridium difficile-associated disease (cdad) are reviewed.200818387898
tolevamer, an anionic polymer, neutralizes toxins produced by the bi/027 strains of clostridium difficile.clostridium difficile-associated diarrhea (cdad) is caused by the toxins the organism produces when it overgrows in the colon as a consequence of antibiotic depletion of normal flora. conventional antibiotic treatment of cdad increases the likelihood of recurrent disease by again suppressing normal bacterial flora. tolevamer, a novel toxin-binding polymer, was developed to ameliorate the disease without adversely affecting normal flora. in the current study, tolevamer was tested for its ability ...200818391047
effect on diagnostic yield of repeated stool testing during outbreaks of clostridium difficile-associated disease.the effect on diagnostic yield of testing sequential stools was assessed during two hospital epidemics of clostridium difficile. using a rapid immunoassay, c. difficile-associated disease was diagnosed in 237 diarrhoeal patients, of whom 204 (86%) were diagnosed from the first faeces sample and 12 (5%) were diagnosed from follow-up samples obtained within 1 week. the remaining 21 (9%) patients yielded a positive test from stools obtained >1 week after the initial negative sample. it was conclude ...200818393996
clostridium difficile surveillance trends, saxony, germany. 200818394306
structure and mode of action of clostridial glucosylating toxins: the abcd model.toxins a and b, which are the major virulence factors of antibiotic-associated diarrhea and pseudomembranous colitis caused by clostridium difficile, are the prototypes of the family of clostridial glucosylating toxins. the toxins inactivate rho and ras proteins by glucosylation. recent findings on the autocatalytic processing of the toxins and analysis of the crystal structures of their domains have made a revision of the current model of their actions on the eukaryotic target cells necessary.200818394902
clostridium difficile-associated diarrhea: an emerging threat to pregnant women.to estimate if clostridium difficile-associated disease (cdad) is increasing in peripartum women.200818395693
heterogeneity of large clostridial toxins: importance of clostridium difficile toxinotypes.clostridium difficile toxinotypes are groups of strains defined by changes in the paloc region encoding two main virulence factors: toxins tcda and tcdb. currently, 24 variant toxinotypes (i-xxiv) are known, in addition to toxinotype 0 strains, which contain a paloc identical to the reference strain vpi 10463. variant toxinotypes can also differ from toxinotype 0 strains in their toxin production pattern. the most-studied variant strains are tcda-, tcdb+ (a-b+) strains and binary toxin cdt-produ ...200818397287
first cluster of clindamycin-resistant clostridium difficile pcr ribotype 027 in switzerland. 200818399816
efficacy of clostridium butyricum preparation concomitantly with helicobacter pylori eradication therapy in relation to changes in the intestinal microbiota.antibiotic associated diarrhea due to human intestinal microbiota abnormalities is a side effect of h. pylori eradication therapy. we examined intestinal microbiota changes during h. pylori eradication therapy and the preventive effect of cbm588 as a probiotic agent. nineteen patients with gastro-duodenal ulcer were randomly divided into three groups: group a (without probiotics), group b (with regular doses of cbm588) and group c (with double doses of cbm588). the incidence of diarrhea and soft ...200818402597
covert assessment of concurrent and construct validity of a chart to characterize fecal output and diarrhea in patients receiving enteral nutrition.an accurate and convenient method for characterizing fecal output and a consistent threshold for classifying diarrhea in patients receiving enteral nutrition are required. the aim of this study is to covertly assess the construct and concurrent validity of a chart for characterizing fecal output and classifying diarrhea in patients receiving enteral nutrition.200818407909
clinical trial: effectiveness of lactobacillus rhamnosus (strains e/n, oxy and pen) in the prevention of antibiotic-associated diarrhoea in children.convincing evidence that probiotic administration can lower the risk of antibiotic-associated diarrhoea is limited to certain micro-organisms.200818410562
treatment of clostridium difficile disease in patients not responding to metronidazole. 200818410968
overuse and inappropriate prescribing of proton pump inhibitors in patients with clostridium difficile-associated disease.clostridium difficile is the most common infectious cause of colitis and has been increasingly diagnosed in hospitalized patients. the number of prescriptions for proton pump inhibitors (ppis) has also increased significantly over time. few studies have reported an association between c. difficile-associated disease (cdad) and ppi use.200818411220
gp96 is a human colonocyte plasma membrane binding protein for clostridium difficile toxin a.clostridium difficile toxin a (txa), a key mediator of antibiotic-associated colitis, requires binding to a cell surface receptor prior to internalization. our aim was to identify novel plasma membrane txa binding proteins on human colonocytes. txa was coupled with biotin and cross-linked to the surface of ht29 human colonic epithelial cells. the main colonocyte binding protein for txa was identified as glycoprotein 96 (gp96) by coimmunoprecipitation and mass spectrum analysis. gp96 is a member ...200818411291
infection control measures to limit the spread of clostridium difficile. introduction. 200818412709
infection control measures to limit the spread of clostridium difficile.clostridium difficile-associated diarrhoea (cdad) presents mainly as a nosocomial infection, usually after antimicrobial therapy. many outbreaks have been attributed to c. difficile, some due to a new hyper-virulent strain that may cause more severe disease and a worse patient outcome. as a result of cdad, large numbers of c. difficile spores may be excreted by affected patients. spores then survive for months in the environment; they cannot be destroyed by standard alcohol-based hand disinfecti ...200818412710
successful treatment of fulminant clostridium difficile infection with fecal bacteriotherapy. 200818413636
sporicidal activity of two disinfectants against clostridium difficile spores.the sporicidal activity of an odour-free peracetic acid-based disinfectant (wofasteril) and a widely-used dichloroisocyanurate preparation (chlor-clean) was assessed against spores of the hyper-virulent strain of clostridium difficile (ribotype 027), in the presence and absence of organic matter. in environmentally clean conditions, dichloroisocyanurate achieved a >3 log10 reduction in 3 minutes, but a minimum contact time of 9 minutes was required to reduce the viable spore load to below detect ...200818414294
clostridium difficile toxinotype v, ribotype 078, in animals and humans. 200818417662
infection control experience in a cooperative care center for transplant patients.to characterize infection control experience during a 6.5-year period in a cooperative care center for transplant patients.200818419364
the case for vancomycin as the preferred drug for treatment of clostridium difficile infection. 200818419480
vancomycin for the treatment of clostridium difficile infection: for whom is this expensive bullet really magic?the epidemiology, clinical severity, and case-fatality ratio of clostridium difficile infection (cdi) changed dramatically with the emergence of a toxin hyperproducing strain (bi/nap1/027) in north america and europe in 2000. for the treatment of cdi, metronidazole and vancomycin remain the 2 most commonly used drugs. the 3 randomized controlled trials published thus far, as well as the upcoming tolevamer trial, use intermediate outcomes, rather than the outcomes that now preoccupy clinicians: t ...200818419481
treatment of metronidazole-refractory clostridium difficile enteritis with vancomycin.clostridium difficile infection of the colon is a common and well-described clinical entity. clostridium difficile enteritis of the small bowel is believed to be less common and has been described sparsely in the literature.200818426352
re-examination of risk factors for non-clostridium difficile-associated diarrhoea in hospitalized patients.this paper is a report of a study to determine the incidence of non-clostridium difficile-associated diarrhoea in hospitalized patients and to re-evaluate clinical characteristics and other risk factors related to non-c. difficile-associated diarrhoea.200818426460
rifamycin antibiotics for treatment of clostridium difficile-associated diarrhea.to review the existing data on use of the rifamycin class of antibiotics as therapy for clostridium difficile-associated diarrhea (cdad).200818430792
a case-control study of community-associated clostridium difficile infection.the aim of this study was to determine the incidence of and risk factors for community-associated clostridium difficile infection (cdi).200818434341
comparison of real-time pcr for detection of the tcdc gene with four toxin immunoassays and culture in diagnosis of clostridium difficile infection.we have developed a rapid real-time pcr method using fluorescence resonance energy transfer probes and the lightcycler (roche diagnostics), which will detect the presence of the tcdc gene of clostridium difficile in stool samples. our pcr method also will identify the presence of base pair deletions, one of which (18 bp) has been associated with the "epidemic" toxin-hyperproducing strains. we compared the results of this pcr with those of three c. difficile toxin-detecting enzyme immunoassays (e ...200818434563
human alpha-defensins inhibit clostridium difficile toxin b.clostridium difficile toxins a and b are major virulence factors implicated in pseudomembranous colitis and antibiotic-associated diarrhea. the toxins are glucosyltransferases, which inactivate rho proteins involved in cellular signaling. human alpha-defensins as part of the innate immune system inactivate various microbial pathogens as well as specific bacterial exotoxins. here, we studied the effects of alpha-defensins human neutrophil protein (hnp)-1, hnp-3, and enteric human defensin (hd)-5 ...200818435932
risk factors for the development of fulminant clostridium difficile colitis.the development of fulminant clostridium difficile colitis (fcdc) requires prompt operative intervention and is associated with a high mortality rate. the aim of this study was to use a case-control design to define the clinical and laboratory parameters that predict which patients with clostridium difficile infection are most likely to progress to fcdc.200818436010
diagnostic and treatment delays in recurrent clostridium difficile-associated disease.because clostridium difficile-associated disease (cdad) is primarily an inpatient issue, hospitalists are at the forefront of the timely diagnosis and treatment of patients with this disease.200818438792
both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of clostridium difficile-associated disease.for treatment of mild to moderate clostridium difficile-associated disease (cdad), oral metronidazole has been recommended as the preferred agent, in part due to concern that vancomycin may be more likely to promote colonization by vancomycin-resistant enterococci (vre). we performed a prospective observational study to examine the effects of oral metronidazole or vancomycin treatment of cdad on acquisition and concentration of vre stool colonization. before, during, and after 90 courses of cdad ...200818443120
reducing infection rates. 200818444375
clostridium difficile-associated diarrhea after antibiotic treatment for traveler's diarrhea.diarrhea commonly affects international travelers. episodes are usually short-lasting, but in some patients, symptoms may persist. clostridium difficile infection should be excluded in travelers with prolonged disease. we report what is, to our knowledge, the first reported study of patients with c. difficile-associated diarrhea after receipt of antibiotic treatment for traveler's diarrhea.200818444824
first confirmed cases of clostridium difficile pcr ribotype 027 in norway. 200818445386
nonbloody, red stools from coadministration of cefdinir and iron-supplemented infant formulas.cefdinir is an extended-spectrum, third-generation cephalosporin that may be used for treatment of acute otitis media in patients allergic to penicillin. when administered with iron-containing products, including infant formulas, cefdinir or one of its metabolites may bind to ferric ions, forming a nonabsorbable complex that imparts a reddish color to the stool. we describe a 9-month-old infant with failure to thrive and acute otitis media who developed an erythematous maculopapular rash during ...200818447664
clostridium difficile in broiler chickens sold at market places in zimbabwe and their antimicrobial susceptibility.clostridium difficile has been shown to be a nosocomial pathogen associated with diarrhoea and pseudomembranous colitis in hospitalised patients and the infection is believed to be acquired nosocomially. community-acquired c. difficile-associated diarrhoea has also been reported. recent studies have shown the occurrence of c. difficile in food animals which may act as a source of infection to humans. the aim of this study was to determine the occurrence of c. difficile in broiler chickens sold a ...200818448182
[detection of clostridia toxin markers in different types of the course of acute intestinal infections].the purpose of the investigation was to study the detection rates of markers and the level of c. diffcile a and b toxins and c. perfringens type a enterotoxin in patients with acute intestinal infections (aii). two hundred and seventy-three patients with aii of varying etiology were followed up. according to the clinical syndrome, the patients were divided into 3 groups: (1) patients with the gastroenteritic (ge) type; (2) those with the gastroenterocolitic (gec) type; (3) those with enterocolit ...200818450084
clostridium difficile infection. 200818456087
risk of clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain.perioperative antibacterial prophylaxis (pap) is an important component of surgical site infection prevention but may be associated with adverse effects, such as clostridium difficile infection (cdi). since the emergence of a hypervirulent strain of c. difficile, the risk of development of cdi after pap has not been evaluated. the purpose of this study was to determine the risk of pap-induced cdi after selected surgical procedures and to compare such risk before with such risk after the emergenc ...200818462108
nitazoxanide to treat persistent clostridium difficile colitis. 200818462579
rifaximin to treat recurrent clostridium difficile colitis. 200818462580
the molecular pathogenesis of clostridium difficile-associated disease.clostridium difficile-associated disease is a reemerging nosocomial disease of paramount importance not only in the united states, but most of the world as well. recently, c. difficile-associated disease appears to be on the rise, with a parallel increase noted in its severity and extent. although the main virulence factors, the large exotoxins known as toxin a and toxin b, have long been identified, only in the past few years has a near explosion of new information regarding the details of the ...200818462584
gum arabic establishes prebiotic functionality in healthy human volunteers in a dose-dependent manner.the present study was undertaken to determine the prebiotic efficacy of gum arabic upon consumption by man for up to 4 weeks and, if any, to establish the dose-effect relationship. human healthy volunteers consumed various daily doses (5, 10, 20, 40 g) of gum arabic (emulgold) in water for up to 4 weeks. daily consumption of water was taken as the negative control and that of 10 g inulin as the positive control. at 0, 1, 2 and 4 weeks quantification of bacterial numbers in stool samples was perf ...200818466655
clostridium difficile infection in patients with ileal pouch-anal anastomosis.there has been an increase in the incidence and severity of clostridium difficile-associated diarrhea in the u.s. the importance of c difficile infection in patients with ileal pouch-anal anastomosis (ipaa) is unknown. this study was designed to determine risk of acquiring c difficile infection in pouch disorders.200818467184
temporal effects of antibiotic use and hand rub consumption on the incidence of mrsa and clostridium difficile.the aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (abhrs) and the incidence of methicillin-resistant staphylococcus aureus (mrsa) and clostridium difficile.200818468995
c. difficile challenge. the es department's role in infection control. 200818472478
recent developments on the role of clostridium difficile in inflammatory bowel disease.clostridium difficile (cd), specifically its toxins, have been implicated as a risk factor for exacerbation of the inflammatory process in up to 5% of patients with ulcerative colitis or crohnos disease. typical evidence of colonic changes with cd infection, including pseudomembranous exudate, are often not present; however, a severe clinical course may result, including precipitation of toxic colitis and toxic megacolon. recently, hypervirulent cd strains have been reported raising concern for ...200818473400
uv-visible marker confirms that environmental persistence of clostridium difficile spores in toilets of patients with c. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol.e.an ultraviolet visible marker (uvm) was used to assess the cleaning compliance of housekeeping staff for toilets in a tertiary healthcare setting.200818474086
evaluation of two enzyme immunoassays for detection of clostridium difficile toxins a and b in swine.diagnosis of clostridium difficile-associated disease (cdad) in neonatal pigs is accomplished, in part, by detection of toxins a (tcda) and b (tcdb) in feces or colonic contents. samples (n=115) were tested simultaneously with two toxin assays (clostridium difficile tox a/b ii, techlab, blacksburg, va; gastro-tect clostridium difficile toxin a+b, medical chemical corporation). previous comparison of the tox a/b ii assay to the reference method (toxicity in cho cell monolayers) revealed an overal ...200818006252
laparoscopic parastomal hernia repair.management of the parastomal hernia represents a common clinical dilemma for both the surgeon and patient. once established, these defects are notoriously difficult to treat. although most parastomal hernias can be managed nonoperatively, approximately 30% will require intervention secondary to complications such as obstruction, pain, bleeding, poorly fitting appliances, or leakage. overall complication rates of up to 88%, combined with a growing body of literature citing decreased patient morbi ...200817999128
evaluation of two rapid immunochromatography tests for the detection of clostridium difficile toxins.the aim of the study was to evaluate the performance of two rapid immunochromatography tests, the tox a/b quick chek (techlab) and the immunocard toxins a&b test (meridian), in addition to the older tox a/b elisa, against pcr detection of the tcdb gene. two hundred patient-unique stool specimens were tested. in comparison to the polymerase chain reaction results, the sensitivity and specificity of the two rapid tests were 94.7% and 97.2%, respectively; corresponding values for the elisa were 93. ...200817990108
[update on clostridium difficile infections].purpose: clostridium difficile is an anaerobic gram positive, spore-forming bacterium which is responsible for 15-25% of antibiotic-associated diarrhea and for more than 95% of pseudomembranous colitis (pmc). this paper will review the main knowledge on c. difficile-associated infections and their recent evolution. current knowledge and key points: since 2003, outbreaks of severe c. difficile-associated diarrhea (cdad) have been increasingly reported in canada and the united states. this trend i ...200818023937
ileal smooth muscle motility depression on rabbit induced by toxin a from clostridium difficile.this study is aimed at elucidating with in vitro experiments the time course of alteration of ileal motility caused by in vivo exposure of ligated loops of ileum to toxin a (1 microg/ligated loop) of clostridium difficile. in the sham-operated animals no significant alteration of motility was observed. in ligated loops directly injected with toxin a and in loops neighboring those administered with this toxin, a biphasic time course of motility alterations was observed. there was initially (2 h a ...200817987387
importance of the environment in meticillin-resistant staphylococcus aureus acquisition: the case for hospital cleaning.in the uk, we continue to debate the importance of hospital cleaning in relation to increasing numbers of patients acquiring meticillin-resistant staphylococcus aureus (mrsa). however, there is little direct evidence for the effectiveness of cleaning because it has never been afforded scientific status. hospital hygiene is usually assessed visually, but this does not necessarily correlate with microbiological risk. a more robust case for hospital cleaning can be presented by considering the evid ...200817974481
small bowel evisceration: a rare complication of laparoscopic ileostomy. 200817944971
a possible role for clostridium difficile in the etiology of calf enteritis.clostridium difficile was investigated as a possible cause of enteritis in calves. the organism and its toxins (tcda and tcdb), respectively, were found in 25.3% and 22.9% of stool samples from diarrheic calves. culture positive samples were more likely than culture negative samples to be toxin positive. however, toxin positive stools were more common among nondiarrheic calves, but diarrheic calves were nearly twice as likely to be culture positive. ribotype 078 was dominant among isolates. salm ...200817964088
excess hospitalisation burden associated with clostridium difficile in patients with inflammatory bowel disease.clostridium difficile is an important cause of diarrhoea in hospitalised patients. an increasing number of cases of c difficile colitis occur in patients with inflammatory bowel disease (ibd)-crohn's disease (cd), ulcerative colitis (uc).200817905821
clostridium difficile, ethnicity and religion. 200818079020
aldosterone induces superoxide generation via rac1 activation in endothelial cells.currently, aldosterone is believed to be involved in the development of cardiovascular injury as a potential cardiovascular risk hormone. however, its exact cellular mechanisms remain obscure. this study was undertaken to examine the effect of aldosterone on superoxide production in cultured rat aortic endothelial cells with possible involvement of the small gtp-binding (g) protein rac1. the aldosterone levels showed a time-dependent (6-24 h) and dose-dependent (10(-8) to 10(-6) m) increase in s ...200818079208
catastrophic clostridium difficile enteritis in a pelvic pouch patient: report of a case.in recent years, clostridium difficile-associated infection has emerged as an increasingly problematic entity. more virulent strains have been isolated and new manifestations of the infection have been described.200818071831
do fluoroquinolones predispose patients to clostridium difficile associated disease? a review of the evidence.clostridium difficile associated diarrhea (cdad) is an important cause of hospital-acquired diarrhea, and increasingly of community-acquired diarrhea. the occurrence of cdad in the hospitalized patient is associated with increased length of stay, morbidity, mortality, and healthcare costs. exposure to antimicrobials is the single most important predisposing factor for acquiring cdad. the data suggesting that fluoroquinolones are an important risk factor for cdad is becoming stronger. also, diffe ...200818067688
tetracycline resistance gene tet(w) in the pathogenic bacterium clostridium difficile.in this study, the tet(w) gene region of a human clinical isolate of clostridium difficile resistant to tetracycline was characterized. this gene was a new allele showing 99% sequence identity to the gene found in the human strain bifidobacterium longum f8, and it is not transferable by "in vitro" mating experiments.200818070963
sphingosine-1-phosphate and endothelin-1 induce the expression of rgs16 protein in cardiac myocytes by transcriptional activation of the rgs16 gene.the expression of the negative regulator of g protein signaling 16 (rgs16) is rapidly induced in cardiomyocytes by various stimuli. to identify the promoter of the mouse rgs16 gene, a 1.8-kb deoxyribonucleic acid fragment 5' of the rgs16-coding region was subcloned into a firefly-luciferase reporter vector and four overlapping fragments were analyzed. the luciferase production was quantified in neonatal rat cardiac myocytes (nrcm). a 0.6-kb fragment that induced a tenfold increase in luciferase ...200818046543
a rare and unsuspected complication of clostridium difficile infection.to report the occurrence of abdominal compartment syndrome (acs) due to infection with clostridium difficile.200818026931
rapid and reliable diagnostic algorithm for detection of clostridium difficile.we evaluated a two-step algorithm for detection of clostridium difficile in 1,468 stool specimens. first, specimens were screened by an immunoassay for c. difficile glutamate dehydrogenase antigen (c.diff chek-60). second, screen-positive specimens underwent toxin testing by a rapid toxin a/b assay (tox a/b quik chek); toxin-negative specimens were subjected to stool culture. this algorithm allowed final results for 92% of specimens with a turnaround time of 4 h.200818032627
clostridium difficile-associated disease: update and focus on non-antibiotic strategies.clostridium difficile-associated disease (cdad) is a problem of especially the frail elderly. changes in virulence of prevalent strains in the early years of the new century saw mortality and morbidity increase from historical levels. this article explores non-antibiotic strategies including the use of probiotics. a number of avenues of ongoing research appear to have potential future clinical application. evidence exists linking acid-inhibiting drugs to an increased risk of cdad, and the adjunc ...200818033775
comparison of seven techniques for typing international epidemic strains of clostridium difficile: restriction endonuclease analysis, pulsed-field gel electrophoresis, pcr-ribotyping, multilocus sequence typing, multilocus variable-number tandem-repeat analysis, amplified fragment length polymorphism, and surface layer protein a gene sequence typing.using 42 isolates contributed by laboratories in canada, the netherlands, the united kingdom, and the united states, we compared the results of analyses done with seven clostridium difficile typing techniques: multilocus variable-number tandem-repeat analysis (mlva), amplified fragment length polymorphism (aflp), surface layer protein a gene sequence typing (slpast), pcr-ribotyping, restriction endonuclease analysis (rea), multilocus sequence typing (mlst), and pulsed-field gel electrophoresis ( ...200818039796
emerging toxin a-b+ variant strain of clostridium difficile responsible for pseudomembranous colitis at a tertiary care hospital in korea.sixty percent to 80% of clostridium difficile isolates in korea have been reported to be toxigenic. however, over 1 year, we encountered a high number of tcda-tcb+ strains associated with pseudomembranous colitis (pmc). c. difficile was isolated from 224 of 471 specimens (47.6%) from 371 patients. a subset of the culture-positive specimens (n = 106), containing no duplicate cases, was randomly selected for tcda and tcdb polymerase chain reaction (pcr) assays. pcr results showed that tcda+tcdb+ a ...200818082994
vancomycin-resistant enterococcal colonization appears associated with increased mortality among allogeneic hematopoietic stem cell transplant recipients.there are no cohort studies describing outcomes of patients colonized with vancomycin-resistant enterococci (vre) undergoing allogeneic hematopoietic stem cell transplantation (ahsct). we therefore conducted a retrospective cohort study of 217 consecutive adults undergoing ahsct at the mayo clinic (rochester, mn, usa) from 1998 to 2004. we analyzed the association between vre colonization prior to transplant and 100-day post transplant mortality and morbidity. we identified 22 pretransplant vre ...200818084341
randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia.to compare a strategy of combination therapy with a strategy of monotherapy with broad-spectrum antibiotics for suspected late ventilator-associated pneumonia.200818091545
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