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new approach to the management of clostridium difficile infection: colonisation with non-toxigenic c. difficile during daily ampicillin or ceftriaxone administration.non-toxigenic strains of clostridium difficile are highly effective in preventing toxigenic c. difficile infection in hamsters when given following a single dose of an antimicrobial agent. the goal of this study was to determine the ability of non-toxigenic c. difficile to colonise hamsters during administration of an antibiotic to which the organisms are resistant - ceftriaxone - and an antibiotic to which they are susceptible - ampicillin - and to determine if non-toxigenic colonisation is pro ...200919303570
alternative strategies for clostridium difficile infection.although antibiotics are generally effective in achieving symptomatic recovery from clostridium difficile infection, the disease frequently relapses, partly because antibiotics not only kill c. difficile, but also disrupt colonisation resistance of the gut microflora. non-antibiotic strategies for the prevention and treatment of the infection include probiotics, deliberate colonisation by non-toxigenic c. difficile strains, toxin-binding agents, active immunisation, passive immunotherapy with in ...200919303571
what is the role of antimicrobial resistance in the new epidemic of clostridium difficile?the epidemiology of clostridium difficile infection (cdi) has changed in recent years, with the occurrence of large outbreaks of infection associated with the emergence of 'hypervirulent' strains, particularly pcr ribotype 027. there has been much speculation as to the nature of the factors responsible for driving the new epidemic of cdi, and various hypotheses have been proposed. these include increases in the size of the population at risk of cdi and/or their susceptibility to infection, incre ...200919303572
antibody-enhanced, fc gamma receptor-mediated endocytosis of clostridium difficile toxin a.toxin a (tcda) and toxin b (tcdb) are major virulence factors of clostridium difficile. these two toxins intoxicate cultured cells by similar mechanisms, and tcdb generally is more potent than tcda in cultured cells. the exact reason for this difference is unclear. here, we report that the cellular effects of tcda can be substantially enhanced via an opsonizing antibody through fc gamma receptor i (fcgammari)-mediated endocytosis. a tcda-specific monoclonal antibody, a1h3, was found to significa ...200919307220
cpdadh: a new peptidase family homologous to the cysteine protease domain in bacterial martx toxins.a cysteine protease domain (cpd) has been recently discovered in a group of multifunctional, autoprocessing rtx toxins (martx) and clostridium difficile toxins a and b. these cpds (referred to as cpdmartx) autocleave the toxins to release domains with toxic effects inside host cells. we report identification and computational analysis of cpdadh, a new cysteine peptidase family homologous to cpdmartx. cpdadh and cpdmartx share a rossmann-like structural core and conserved catalytic residues. in b ...200919309740
late endocytic dysfunction as a putative cause of amyloid fibril formation in alzheimer's disease.the assembly of amyloid beta-protein to amyloid fibrils is a critical event in alzheimer's disease. evidence exists that endocytic pathway abnormalities, including the enlargement of early endosomes, precede the extraneuronal amyloid fibril deposition in the brain. we determined whether endocytic dysfunction potently promotes the assembly of amyloid beta-protein on the surface of cultured cells. blocking the early endocytic pathway by clathrin suppression, inactivation of small gtpases, removal ...200919317854
the vexed relationship between clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission.comorbidity with clostridium difficile may cause diagnostic delay in newly presenting inflammatory bowel disease (ibd) patients, trigger relapse in established disease, confound therapies, and serve as an indicator of an underlying defect in innate immunity. retrospective analyses have suggested community acquisition; to address this we conducted a prospective analysis of c. difficile carriage in ibd patients using molecular methods specifically in an outpatient setting.200919319128
essential role of the glucosyltransferase activity in clostridium difficile toxin-induced secretion of tnf-alpha by macrophages.clostridium difficile causes serious and potentially fatal inflammatory diseases of the colon. two large protein toxins, tcda and tcdb, have been clearly implicated in pathogenesis. the goal of this study was to determine whether the glucosyltransferase activity of the toxins is critical for the induction of tumor necrosis factor-alpha (tnf-alpha), an important cytokine mediating both local and systematic inflammatory response. a dose-dependent tnf-alpha secretion was demonstrated in murine macr ...200919324080
presence of the epidemic north american pulsed field type 1 clostridium difficile strain in hospitalized children.a hypervirulent strain of clostridium difficile-labeled north american pulsed field type 1 causes severe disease in adults. to determine the prevalence of nap1 c. difficile in children, organisms from consecutive c. difficile toxin-positive stool samples at 2 children's hospitals microbiology laboratories were characterized. we found that 19.4% of these samples were nap1.200919324222
the mechanisms and efficacy of probiotics in the prevention of clostridium difficile-associated diarrhoea.the proportion and severity of clostridium difficile-associated diarrhoea (cdad) is increasing in health-care settings. antibiotics remain the most important risk factor for cdad, due to their limiting the ability of the gastrointestinal flora to inhibit c difficile colonisation. probiotics have therefore been investigated for primary and secondary prophylaxis against cdad, with varying success. this review looks at the current literature for in-vitro and clinical evidence for probiotic use in t ...200919324296
necessary but not sufficient: a comparison of surveillance definitions of clostridium difficile-associated diarrhea.in this article, we describe our comparison of the cleveland clinic surveillance definition of clostridium difficile-associated diarrhea and the definition mandated by the ohio department of health. we found the definitions to be concordant only 71% of the time; the ohio department of health definition identified 278 of the 391 cases identified by the cleveland clinic definition. surveillance definitions mandated by the ohio department of health overrepresented the number of cases attributable t ...200919228111
impact of clostridium difficile infection on pediatric inflammatory bowel disease.to determine the prevalence of and explore possible differences in the risk for and symptoms of clostridium difficile infection between patients with and without inflammatory bowel disease (ibd).200919230908
laboratory maintenance of clostridium difficile.clostridium difficile is a gram-positive, spore-forming, anaerobe and is the leading cause of antibiotic-associated diarrhea, pseudomembranous colitis, and toxic megacolon. essential to the lifestyle of c. difficile is the ability to form a metabolically dormant spore, germinate, and grow out upon appropriate signals and elicit disease with the secretion of two toxins. to aid in the study of this organism, this unit describes the growth and maintenance of c. difficile. included are methods to is ...200919235151
two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant staphylococcus aureus infection and clostridium difficile infection.to determine the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant staphylococcus aureus (mrsa) infection and clostridium difficile infection (cdi).200919236282
hospital-associated clostridium difficile infection: is it necessary to track community-onset disease?to compare clostridium difficile infection (cdi) rates determined with use of a traditional definition (ie, with healthcare-onset cdi defined as diagnosis of cdi more than 48 hours after hospital admission) with rates determined with use of expanded definitions, including both healthcare-onset cdi and community-onset cdi, diagnosed within 48 hours after hospital admission in patients who were hospitalized in the previous 30 or 60 days, and to determine whether differences exist between patients ...200919239377
management of clostridium difficile infection: survey of practices and compliance with national guidelines among primary care physicians. 200919239379
clinical risk factors for severe clostridium difficile-associated disease.identifying patients who are at high risk for severe clostridium difficile-associated disease (cdad) early in the course of their infection may help clinicians improve outcomes. therefore, we compared clinical features associated with severe versus nonsevere cdad by retrospectively reviewing records of hospitalized patients whose fecal assays were positive for c. difficile toxin. of 336 patients, 12.2% had severe disease and 10.1% died from all causes. regression modeling showed the following to ...200919239754
in vitro effect of metronidazole and vancomycin in combination on clostridium difficile. 200919240074
comparative in vitro activity of rep3123 against clostridium difficile and other anaerobic intestinal bacteria.the aim of this study was to determine the anaerobic spectrum of activity of rep3123, a novel diaryldiamine that inhibits bacterial methionyl-trna synthetases in gram-positive bacteria.200919240076
[collateral damage of cephalosporins and quinolones and possibilities for control].background: the occurrence of multidrug-resistant microorganisms is associated with an extended and long-term use of broad-spectrum antibiotics. indeed, this may lead to a colonization and even to an infection of the patient, which is called collateral damage. moreover, the risk for collateral damage can be assessed for different antibiotic classes. occurrence of multidrug-resistant microorganisms: the use of cephalosporins may induce a subsequent infection with vancomycin-resistant enterococci, ...200919242662
analysis of an outbreak of clostridium difficile infection controlled with enhanced infection control measures.in october 2004, our clostridium difficile infection (cdi) rate increased (relative risk, 3.51; 95% confidence interval: 2.96-4.16) from a baseline rate of 1.35 per 1000 patient-days. we describe the outbreak, the relationship between antibiotic use and cdi, and the effect of enhanced infection control measures (eicm) on cdi.200919243859
is there a future for probiotics in preventing clostridium difficile-associated disease and treatment of recurrent episodes?due to morbidity, mortality, and high costs associated with eradicating clostridium difficile once this organism causes colitis, this bacterium has been termed one of the most ecologically relevant microorganisms of the present day. symptoms associated with c. difficile diarrhea often first present during or shortly after a course of antibiotic therapy. during the past 5 years, the virulence of this organism has increased. c. difficile-associated disease (cdad) has reached epidemic proportions i ...200919244145
the use of probiotics in the prevention and treatment of antibiotic-associated diarrhea with special interest in clostridium difficile-associated diarrhea.antimicrobials are effective agents used to combat virulent bacterial, yeast, and fungal infections that may otherwise cause rampant disease leading to skyrocketing social/economic costs and possible epidemic morbidity and mortality rates. antibiotics are designed to attack specific bacterial pathogens but, in the process, indiscreetly reduce the number of beneficial human microbiota that is part of the gut-associated lymphatic tissue. broad-spectrum antibiotics can upset this uniquely balanced ...200919244146
rapid detection of toxigenic strains of clostridium difficile in diarrheal stools by real-time pcr. 200919244461
a nosocomial outbreak of norovirus infection masquerading as clostridium difficile infection.noroviruses (novs) are increasingly being recognized as important enteric pathogens. at a university-based hospital, we investigated a nosocomial outbreak of nov infection that was originally attributed to clostridium difficile. we describe here the unique challenges of the identification of novs as the true etiologic pathogen in an outbreak occurring in a health care setting, where c. difficile infection is endemic, as well as the important lessons learned.200919245344
early colectomy may be associated with improved survival in fulminant clostridium difficile colitis: an 8-year experience.we hypothesized that colectomy for fulminant clostridium difficile colitis (cdc) before organ failure would be associated with decreased mortality.200919245905
diagnosis of clostridium difficile infection by toxin detection kits. 200919246016
activity of a novel carbapenem, doripenem, against anaerobic pathogens.doripenem, a synthetic 1-beta-methyl carbapenem, has a broad-spectrum of activity against almost all species of anaerobic bacteria, including all bacteroides fragilis group species, most with mic(90) results at <or=1 microg/ml (with the exception of sutterella wadsworthensis). against clostridium difficile strains, it has a narrow range of inhibitory concentrations (1-4 microg/ml) that "may be achievable in the colon", potentially resulting in lower disease rates. it has been shown to be active ...200919249176
reining in recurrent clostridium difficile infection--who's at risk? 200919250653
inhibitory effect of rep3123 on toxin and spore formation in clostridium difficile, and in vivo efficacy in a hamster gastrointestinal infection model.rep3123 is a fully synthetic methionyl-trna synthetase inhibitor in pre-clinical development as a novel agent to treat clostridium difficile infection (cdi). this novel agent was investigated for its ability to block the production of toxins and spores, and was tested for efficacy in vivo in a hamster model.200919251726
pseudomembranes on colostomy. 200919252106
toxin b is essential for virulence of clostridium difficile.clostridium difficile is the leading cause of infectious diarrhoea in hospitals worldwide, because of its virulence, spore-forming ability and persistence. c. difficile-associated diseases are induced by antibiotic treatment or disruption of the normal gastrointestinal flora. recently, morbidity and mortality resulting from c. difficile-associated diseases have increased significantly due to changes in the virulence of the causative strains and antibiotic usage patterns. since 2002, epidemic tox ...200919252482
laboratory diagnosis of clostridium difficile-associated diarrhoea: microbiologists (should) do it with culture. 200919152191
characterization of clostridium difficile strains isolated from immunosuppressed inpatients in a hospital in rio de janeiro, brazil.the aim of this work was to identify and characterize clostridium difficile strains from fecal and hospital environmental samples. c. difficile toxins were detected by elisa in 28.5% of the analyzed samples. four strains were isolated from immunosuppressed inpatients presenting antibiotic-associated diarrhea. all strains possessed tcda and tcdb genes and did not present neither the cdta and cdtb genes nor any significant deletions in the tcdc gene. pfge and pcr-ribotyping analysis showed that tw ...200919154793
[a case of pseudomembranous colitis associated with rifampicin therapy in a patient with rectal cancer and gastrointestinal tuberculosis].pseudomembranous colitis (pmc) is known to be associated with the administration of antibiotics which alter normal gastrointestinal flora and allow overgrowth of clostridium difficile. most cases of rifampicin-induced pmc are seen in patients with pulmonary tuberculosis, but not with gastrointestinal tuberculosis. we report a case of pmc associated with rifampicin therapy in a patient with gastrointestinal tuberculosis. a 65-year-old female patient with rectal cancer and gastrointestinal tubercu ...200919158472
antimicrobial prophylaxis for colorectal surgery.research shows that administration of prophylactic antibiotics before colorectal surgery prevents postoperative surgical wound infection (swi). the best antibiotic choice, timing of administration and route of administration remain undetermined.200919160191
high frequency of rifampin resistance identified in an epidemic clostridium difficile clone from a large teaching hospital.rifampin is used as adjunctive therapy for clostridium difficile-associated disease, and the drug's derivative, rifaximin, has emerged as an attractive antimicrobial for treatment of c. difficile-associated disease. rifampin resistance in c. difficile strains has been reported to be uncommon.200919140738
pitfalls in the comparison of intercountry prevalence of healthcare-associated infection. 200919144447
etiology of acute gastroenteritis in three sentinel general practices, austria 2007.we studied the etiology of acute gastroenteritis in a village with a total population of approximately 6,000. this is the first study in austria that has investigated a broad range of pathogens recovered from an unselected population of patients who had consulted general practitioners because of gastroenteritis.200919148576
typing clostridium difficile strains based on tandem repeat sequences.genotyping of epidemic clostridium difficile strains is necessary to track their emergence and spread. portability of genotyping data is desirable to facilitate inter-laboratory comparisons and epidemiological studies.200919133124
nitazoxanide versus vancomycin in clostridium difficile infection: a randomized, double-blind study.vancomycin is the only us food and drug administration-approved drug for treatment of clostridium difficile infection (cdi). metronidazole has been widely used for this purpose but may be inferior to vancomycin, especially for hospitalized patients with severe disease. we report a prospective, double-blind, randomized controlled trial comparing nitazoxanide with vancomycin for treatment of cdi.200919133801
is rotavirus contributing to an increase of diarrhoea in a region of spain?diarrhoeal illnesses are the most frequent of notifiable diseases in aragon. physicians notify diarrhoea cases with presumed infectious origin on a weekly basis. following an increase in 2005-2006, we aimed to identify the responsible organism(s) in order to inform control measures. we described seasonality of diarrhoea notifications for 1998-2004 and 2005-2006. we calculated correlations between diarrhoea notifications and enteric pathogens diagnosed in two aragonese laboratories, and applied l ...200919134236
multipronged intervention strategy to control an outbreak of clostridium difficile infection (cdi) and its impact on the rates of cdi from 2002 to 2007.at the end of 2002, a new, more virulent strain of clostridium difficile, designated bi/nap1, was the cause of a massive outbreak of infection in the province of quebec. this particular strain was associated with a dramatic increase in morbidity and mortality among affected patients in 2003-2004. we tested and implemented a multipronged infection control approach to curtail the rate of c. difficile infection (cdi).200919125681
clostridium difficile infection and surgery. 200919109823
infliximab and other immunomodulating drugs in patients with inflammatory bowel disease and the risk of serious bacterial infections.there remain concerns about the safety of infliximab therapy in patients with inflammatory bowel disease (ibd).200919438424
application of multiple-locus variable-number tandem-repeat analysis to determine clonal spread of toxin a-negative clostridium difficile in a general hospital in buenos aires, argentina.isolates from patients with clostridium difficile infection (cdi) usually produce both toxin a (tcda) and toxin b (tcdb), but an increasing number of reports from europe and asia mention infections with tcda-negative, tcdb-positive (a-/b+) strains, usually characterized as pcr ribotype 017 (type 017). incidence rates of cdi per 10 000 admissions in a 200-bed argentinean general hospital were 37, 84, 67, 43, 48 and 42 for the years 2000 to 2005, respectively. the annual percentages of type 017 cd ...200919438624
prospective, observational, cross-sectional study of intestinal infections among acutely active inflammatory bowel disease patients.intestinal infections have been claimed to precipitate or aggravate flares of inflammatory bowel disease (ibd). the reported incidence of such infections among ibd patients varies between 9 and 13%, but only a few prospective studies have been conducted.200919439968
antibiotics and probiotics in inflammatory bowel disease: why, when, and how.to summarize recent evidence on the role of intestinal bacteria in inflammatory bowel diseases, and of antibiotics and probiotics in their treatment. the implications connected with the use of antibiotics are also examined.200919444096
[probiotics. a review].probiotics are defined viable microorganisms which in sufficient amount reach the intestine in an active state, to be able to exert positive health benefit on the host. thus far, they have shown particular promise on prevention or treatment of various pathologic conditions. our aim has been to report the most recent articles (until october 2008), resulting from randomized, double controlled trials, according to the conventional and molecular methods. in this review we have taken into considerati ...200919445282
enteral clostridium difficile, an emerging cause for high-output ileostomy.the loss of fluid and electrolytes from a high-output ileostomy (>1200 ml/day) can quickly result in dehydration and if not properly managed may cause acute renal failure. the management of a high-output ileostomy is based upon three principles: correction of electrolyte disturbance and fluid balance, pharmacological reduction of ileostomy output, and treatment of any underlying identifiable cause. there is an increasing body of evidence to suggest that clostridium difficile may behave pathologi ...200919447832
clostridium difficile in hip fracture patients: prevention, treatment and associated mortality.a series of infection control measures were introduced at the university hospitals of leicester nhs trust in 2006-2007 to reduce the incidence of clostridium difficile infection.200919450797
fulminant clostridium difficile colitis: patterns of care and predictors of mortality.there exist predictors of mortality and the need for colectomy among patients with fulminant clostridium difficile colitis.200919451485
inflammatory bowel disease potpourri: a vignette-based discussion. 200919452754
diagnosis and treatment of acute or persistent diarrhea.studies of microbial pathogens and the toxins they produce are important for determining the mechanisms by which they cause disease and spread throughout a population. some bacteria produce secretory enterotoxins (such as cholera toxin or the heat-labile or stable enterotoxins produced by escherichia coli) that invade cells directly. others invade cells or produce cytotoxins (such as those produced by shigella, enteroinvasive e coli, or clostridium difficile) that damage cells or trigger host re ...200919457416
treatment of clostridium difficile-associated disease.clostridium difficile infection is an increasing burden to the health care system, totaling more than $1 billion/year in the united states. treatment of patients with c difficile infection with metronidazole or vancomycin reduces morbidity and mortality, although the number of patients that do not respond to metronidazole is increasing. despite initial response rates of greater than 90%, 15%-30% of patients have a relapse in symptoms after successful initial therapy, usually in the first few wee ...200919457418
clostridium difficile infection caused by the epidemic bi/nap1/027 strain.rates and severity of clostridium difficile infection (cdi) in hospitals in north america and europe have increased since 2000 and correlate with dissemination of an epidemic strain characterized by higher than usual toxin a and b production, the presence of a third toxin, binary toxin, and high-level resistance to fluoroquinolone antibiotics. the strain, which is restriction endonuclease analysis group bi, pulse-field gel electrophoresis type nap1, and polymerase chain reaction ribotype 027, is ...200919457419
feasibility of routinely using hydrogen peroxide vapor to decontaminate rooms in a busy united states hospital.during a 22-month period at a 500-bed teaching hospital, 1,565 rooms that had housed patients infected with multidrug-resistant pathogens were decontaminated using hydrogen peroxide vapor. hydrogen peroxide vapor decontamination required a mean time of 2 hours and 20 minutes, compared with 32 minutes for conventional cleaning. despite the greater time required for decontamination, hydrogen peroxide vapor decontamination of selected patient rooms is feasible in a busy hospital with a mean occupan ...200919415969
successful combat of an outbreak due to clostridium difficile pcr ribotype 027 and recognition of specific risk factors.in the period april-september 2005, an outbreak of clostridium difficile infection (cdi) due to pcr ribotype 027 occurred among 50 patients in a 341-bed community hospital in harderwijk, the netherlands. a retrospective case-control study was performed to identify risk factors specific for cdi, using a group of patients with cdi (n = 45), a group of randomly selected control patients without diarrhoea (n = 90), and a group of patients with non-infectious diarrhoea (n = 109). risk factors for cdi ...200919416295
yeast, beef and pork extracts counteract clostridium difficile toxin a enterotoxicity.clostridium difficile is responsible for a large proportion of nosocomial cases of antibiotic-associated diarrhoea and pseudomembranous colitis. the present study provides evidence that yeast, beef and pork extracts, ingredients commonly used to grow bacteria, can counteract c. difficile toxin a enterotoxicity in vitro and in vivo. in model intestinal epithelial cells the individual extracts could prevent the toxin a-induced decrease in epithelial barrier function and partially prevented actin d ...200919416358
[nosocomial infections: mrsa und cdad as a challenge].inadequate antibiotic prescribing and poor adherence to infection control guidelines are the main reasons for the development and spread of methicillin-resistant staphylococcus aureus (mrsa) and clostridium difficile (cd), the most important cause of antibiotic-associated diarrhoea (ad) and colitis. both cdad and mrsa infection are associated with significant morbidity, excess mortality and substantial consumption of resources. increases in the incidence of both infections have been observed in ...200919418034
multicenter study of the impact of community-onset clostridium difficile infection on surveillance for c. difficile infection.to evaluate the impact of cases of community-onset, healthcare facility (hcf)-associated clostridium difficile infection (cdi) on the incidence and outbreak detection of cdi.200919419269
clostridium difficile infection in ohio hospitals and nursing homes during 2006.healthcare data suggest that the incidence and severity of clostridium difficile infection (cdi) in hospitals are increasing. however, the overall burden of disease and the mortality rate associated with cdi, including the contribution from cases of infection that occur in nursing homes, are poorly understood.200919419272
[a new virulent clone of clostridium difficile is a challenge for danish hospitals]. 200919419636
[first danish case of clostridium difficile ribotype 027].increasing rates of clostridium difficile-associated diarrhoea (cdad) with an unusual, severe course have been reported in canada, usa and several european countries since 2003. a new virulent strain, pcr ribotype 027 (cd027), is associated with this increase. we report the first danish case of cdad caused by cd027. a 85-year-old woman was admitted to hospital with pneumonia. following treatment initially with penicillin, secondly with moxifloxacin she developed bloody diarrhoea. a stool specime ...200919419637
the role of surgery in clostridium difficile colitis. 200919420031
outbreak of clostridium difficile 027 infection in vienna, austria 2008-2009.from november 2008 to 15 april 2009, 36 isolates of cd027 identified in austria, all originating from four hospitals in vienna. all isolates were positive for toxin a, toxin b and the binary toxin, and showed a characteristic 18 bp deletion in the tcdc gene. clostridium difficile is an anaerobic spore-forming bacterium. some strains may cause diarrhoea due to formation of toxins. symptomatic c. difficile infection (cdi) is primarily linked with hospital admission and antibiotic treatment, althou ...200919422768
control of antibiotic-resistant bacteria in the office and clinic. 200919433821
rehospitalizations: packaging discharge and transition services to prevent "bounce backs".there are many factors that can reduce the rates of rehospitalization, including transition or discharge coaches who work with the patient before, during, and after the discharge; better collaboration between hospitals and physicians to improve promptness and reliability of follow-up care; and earlier medical follow-up after surgical procedures.200919435389
intravenous tigecycline as adjunctive or alternative therapy for severe refractory clostridium difficile infection.clostridium difficile infection (cdi) has become more refractory to standard therapy. we describe 4 patients with severe refractory cdi who were successfully treated with tigecycline. symptoms improved within 1 week. no relapses were observed. this favorable outcome suggests that tigecycline might be a useful alternative for treating severe refractory cdi.200919435431
saccharomyces boulardii in a child with recurrent clostridium difficile. 200919371301
nation-wide prospective surveillance of clostridium difficile infections in hospitals in belgium, july 2007-june 2008.we report here baseline data from the first year of compulsory surveillance of clostridium difficile infections (cdi) in hospitals in belgium. between 1 july 2007 and 30 june 2008, 2,704 cdi were reported: 12% were recurrent and 66% were hospital-associated (half of which occurred 15 days or more after admission). cdi was considered the cause of death (direct or indirect) for 10% of the episodes. the median incidence of cdi was 1.5 per 1,000 admissions and 1.9 per 10,000 hospital-days for all ca ...200919371509
the emergence of clostridium difficile pcr ribotype 027 in denmark--a possible link with the increased consumption of fluoroquinolones and cephalosporins?increasing rates of clostridium difficile infection (cdi) with an unusual, severe course have been reported in several countries; this rise has partly been ascribed to the emergence of a virulent strain, c. difficile pcr ribotype 027 (cd027). an intriguing question is whether this could be related to increasing consumption of broadspectrum antibiotics. from 1997 to 2007, the number of hospital discharges in denmark with the diagnosis enterocolitis caused by c. difficile increased from eight to 2 ...200919371514
temporal effects of antibiotic use and clostridium difficile infections.we tested a previously published model for the analysis of the temporal relationship between antibiotic use and the incidence of clostridium difficile infection in a hospital with stable incidence of infection at >1 case per 1000 admissions per month.200919372170
are vasopressor use and mechanical ventilation the only predictors of worse outcome for fulminant clostridium difficile infection? 200919375066
a simple 3-step algorithm for improved laboratory detection of clostridium difficile toxin without the need for tissue culture cytotoxicity neutralization assays.this report describes a 3-step algorithm for the detection of clostridium difficile using an enzyme immunoassay for glutamate dehydrogenase (gdh) antigen, a lateral flow assay for c. difficile toxin, and anaerobic broth culture. this method was found to detect more toxin-containing stool samples than the use of a combination gdh antigen plus toxin a/b testing alone.200919376666
microarray identification of clostridium difficile core components and divergent regions associated with host origin.clostridium difficile is a gram-positive, spore-forming enteric anaerobe which can infect humans and a wide variety of animal species. recently, the incidence and severity of human c. difficile infection has markedly increased. in this study, we evaluated the genomic content of 73 c. difficile strains isolated from humans, horses, cattle, and pigs by comparative genomic hybridization with microarrays containing coding sequences from c. difficile strains 630 and qcd-32g58. the sequenced genome of ...200919376880
new approaches to decontamination of rooms after patients are discharged. 200919379097
comparison of the efficacy of a hydrogen peroxide dry-mist disinfection system and sodium hypochlorite solution for eradication of clostridium difficile spores.to compare a hydrogen peroxide dry-mist system and a 0.5% hypochlorite solution with respect to their ability to disinfect clostridium difficile-contaminated surfaces in vitro and in situ.200919379098
clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors.the present study investigates risk factors for onset of clostridium difficile-associated diarrhoea, specific ribotype and environmental spore contamination in a district general hospital in south east england. c. difficile isolates were ribotyped from 97 diarrhoeal cases, following detection of c. difficile toxin from faecal specimens by enzyme immunoassay (health protection agency, southampton). the isolates were tested for various antimicrobial susceptibilities by e-test. cases were assessed ...200919386381
[epidemic risk of disease associated with a new strain of clostridium difficile].the incidence of clostridium difficile infection in north america and europe has increased in the last years, generating concern among health professionals. a new strain of c. difficile has been identified in recent nosocomial outbreaks and community-acquired infections. this new strain, characterized as toxigenic type iii, pcr ribotype 027 (c. difficile 027), presents higher pathogenicity because of increased exotoxin production, and a characteristic antibiotic resistance profile. since 2003, s ...200919386385
outbreak of clostridium difficile 027 in north zealand, denmark, 2008-2009.we report an outbreak of clostridium difficile pcr ribotype 027 in denmark. the outbreak includes to date 73 cases from the area north of copenhagen, but there may be related cases elsewhere in zealand. most infections are healthcare-associated and in patients who previously received antibiotic treatment. the strain is resistant to moxifloxacin, erythromycin, and clindamycin, and carries genes for toxin a, toxin b, and for the binary toxin. the antimicrobial pattern differs from that of the stra ...200919389341
clostridium difficile infection in the "oldest" old: clinical outcomes in patients aged 80 and older.clostridium difficile infection (cdi) represents a cause of substantial morbidity, particularly for older adults. although older age is a risk factor for cdi, few studies have specifically focused on clinical outcomes in older adults, particularly the "oldest" old.200919392957
an ultrasensitive rapid immunocytotoxicity assay for detecting clostridium difficile toxins.we describe a novel ultrasensitive cell-based immunocytotoxicity assay for detecting clostridium difficile toxin a and b. the assay is simple to perform with a turnaround time of approximately 3 h . it is particularly sensitive in detecting tcda at a level less then 1 pg/ml. using this assay, we were able to detect the presence of c. difficile toxins in the fecal and serum specimens of experimentally infected piglets.200919393695
recurrent clostridium difficile infection: a review of risk factors, treatments, and outcomes.episodes of recurrent clostridium difficile infection (cdi) are difficult to treat for several reasons. foremost, data are lacking to support any particular treatment strategy. in addition, treatment of recurrent episodes is not always successful, and repeated, prolonged treatment is often necessary. identification of subgroups at risk for recurrent cdi may aid in diagnosing and treating these patients. two likely mechanistic factors increasing the risk of recurrent cdi are an inadequate immune ...200919394704
lactobacillus delbrueckii ssp. bulgaricus b-30892 can inhibit cytotoxic effects and adhesion of pathogenic clostridium difficile to caco-2 cells.probiotic microorganisms are receiving increasing interest for use in the prevention, treatment, or dietary management of certain diseases, including antibiotic-associated diarrhea (aad). clostridium difficile is the most common cause of aad and the resulting c. difficile - mediated infection (cdi), is potentially deadly. c. difficile associated diarrhea (cdad) is manifested by severe inflammation and colitis, mostly due to the release of two exotoxins by c. difficile causing destruction of epit ...200919397787
bacteremia due to clostridium difficile--review of the literature.extracolonic clostridium difficile infections have been infrequently reported. extracolonic manifestations of c. difficile include bacteremia, intra-abdominal abscess, osteomyelitis, visceral abscess, empyema, reactive arthritis, and small bowel disease with formation of pseudomembranes on ileal mucosa. most cases of extracolonic c. difficile have been preceded by gastrointestinal disease, either c. difficile colitis or surgical and anatomical disruption of the colon. bacteremia due to c. diffic ...200919398213
[clostridium difficile as a potential pathogen in preterm neonates].objective: to detect the presence of clostridium difficile toxins a and b in the stools of patients hospitalized in the university hospital olomouc who developed diarrhoea or other abdominal symptoms (abdominal pain, tympanites, indigestion, partial intestinal obstruction) related to antibiotic therapy. given occasional dyspepsia and necrotizing enterocolitis in preterm neonates, to consider the potential role of these toxins, in addition to that of the immature intestine, in the development of ...200919399727
mlst analysis reveals a highly conserved core genome among poultry isolates of clostridium septicum.clostridium septicum is a highly virulent, anaerobic bacterium capable of establishing necrotizing tissue infections and forming heat resistant endospores. disease is primarily facilitated by secretion of numerous toxic products including a lethal pore-forming cytolysin. spontaneously occurring clostridial myonecrosis involving c. septicum has recently reemerged as a concern for many poultry producers. however, despite its increasing prevalence, the epidemiology of infection and population struc ...200919402197
hospitalizations and deaths associated with clostridium difficile infection, finland, 1996-2004.to determine whether the rate of clostridium difficile-associated disease (cdad) and cdad-related deaths were increasing in finland, we analyzed registry data from 1996 through 2004. we determined the number of hospital discharges that had a diagnosis code specific for cdad from the international classification of diseases, 10th revision: "enterocolitis due to clostridium difficile" (a04.7) and "pseudomembranous enterocolitis associated with antimicrobial therapy" (k52.8), listed as any diagnosi ...200919402963
possible seasonality of clostridium difficile in retail meat, canada.we previously reported clostridium difficile in 20% of retail meat in canada, which raised concerns about potential foodborne transmissibility. here, we studied the genetic diversity of c. difficile in retail meats, using a broad canadian sampling infrastructure and 3 culture methods. we found 6.1% prevalence and indications of possible seasonality (highest prevalence in winter).200919402975
clostridium difficile in ready-to-eat salads, scotland.of 40 ready-to-eat salads, 3 (7.5%) were positive for clostridium difficile by pcr. two isolates were pcr ribotype 017 (toxin a-, b+), and 1 was pcr ribotype 001. isolates were susceptible to vancomycin and metronidazole but variably resistant to other antimicrobial drugs. ready-to-eat salads may be potential sources for virulent c. difficile.200919402979
clostridium difficile in retail meat products, usa, 2007.to determine the presence of clostridium difficile, we sampled cooked and uncooked meat products sold in tucson, arizona. forty-two percent contained toxigenic c. difficile strains (either ribotype 078/toxinotype v [73%] or 027/toxinotype iii [nap1 or nap1-related; 27%]). these findings indicate that food products may play a role in interspecies c. difficile transmission.200919402980
rapid molecular characterization of clostridium difficile and assessment of populations of c. difficile in stool specimens.our laboratory has developed testing methods that use real-time pcr and pyrosequencing analysis to enable the rapid identification of potential hypervirulent clostridium difficile strains. we describe a real-time pcr assay that detects four c. difficile genes encoding toxins a (tcda) and b (tcdb) and the binary toxin genes (cdta and cdtb), as well as a pyrosequencing assay that detects common deletions in the tcdc gene in less than 4 h. a subset of historical and recent c. difficile isolates (n ...200919403775
trans-10, cis-12 conjugated linoleic acid modulates phagocytic responses of canine peripheral blood polymorphonuclear neutrophilic leukocytes exposed to clostridium difficile toxin b.trans-10, cis-12 conjugated linoleic acid (t10c12-cla) has been reported to enhance phagocyte function. clostridium difficile toxin b (tcdb) has been known to inhibit ras-homologous (rho) guanosine triphosphatases (gtpases) which play essential roles in neutrophil immune functions. here, we examined whether in vitro treatment with t10c12-cla modulates the filamentous actin (f-actin) polymerization, phagocytic capacity, and oxidative burst activity (oba) of canine peripheral blood polymorphonucle ...200919269037
nosocomial diarrhea and clostridium difficile associated diarrhea in a turkish university hospital.clostridium difficile (c. difficile) is a well-established cause of nosocomial diarrhea. the aim of our study was to define the incidence of nosocomial diarrhea in our hospital and to determine the role of c. difficile. additionally, the risk factors for nosocomial diarrhea and clostridium difficile associated diarrhea (cdad) were investigated.200919269761
methods for surveillance of clostridium difficile. 200919272673
epidemiology of clostridium difficile colitis in hospitalized patients with inflammatory bowel diseases.a notable increase in-hospital admissions for clostridium difficile colitis has occurred in the united states. in this paper we evaluate changes in the epidemiology of clostridium difficile colitis in a subset of hospitalized patients with inflammatory bowel diseases.200919273954
analyses of fluoroquinolones and clostridium difficile-associated diarrhoea in tuberculosis patients.systematic studies of fluoroquinolones (fqs) and clostridium difficile-associated diarrhoea (cdad) are scarce among tuberculosis (tb) patients, in whom fluoroquinolones (fqs) are increasingly used.200919275794
emerging infections of the gastrointestinal tract.infections account for significant gi morbidity and mortality worldwide. new organisms are being identified, associated with diarrhoeal illness and some with other gastrointestinal illness as well. among gi viruses, sapovirus is now recognised to cause diarrhoea, especially in children. a hypervirulent strain of clostridium difficile has caused epidemics in many countries. newly identified bacterial species that may cause diarrhoea include campylobacter concisus, arcobacteria, edwardsiella tarda ...200919258189
spectrum of activity and mode of action of rep3123, a new antibiotic to treat clostridium difficile infections.the aim of this study was to characterize the antimicrobial profile of rep3123, a novel inhibitor of methionyl-trna synthetase (metrs) in development for the treatment of clostridium difficile infection.200919258353
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