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asymptomatic carriage of clostridium difficile in an irish continuing care institution for the elderly: prevalence and characteristics.clostridium difficile is an increasing cause of nosocomial diarrhoea and colitis. the aim of this study was to identify the prevalence and characteristics of asymptomatic c. difficile carriage in a continuing care institution for the elderly.201019495833
mortality and risk stratification in patients with clostridium difficile-associated diarrhoea.this study aimed to describe the mortality in hospital patients with a first documented episode of clostridium difficile-associated diarrhoea (cdad) and to identify prognostic risk factors.201019508548
clostridium difficile-associated small bowel enteritis after total proctocolectomy in a crohn's disease patient. 201019593163
clostridium difficile-associated diarrhea in crohn's disease patients with ostomy. 201019408324
characterization of the pccdc42 small g protein from pneumocystis carinii, which interacts with the pcste20 life cycle regulatory kinase.pneumocystis carinii (pc) causes severe pneumonia in immunocompromised hosts. the binding of pc trophic forms to alveolar epithelial cells is a central feature of infection, inducing the expression and activation of pcste20, a gene participating in mating, proliferation, and pseudohyphal growth. in related fungi, ste20 proteins are generally activated by immediate upstream small g proteins of the cdc42-like family. pccdc42 has not been previously described in pneumocystis. to address the potenti ...201019915161
development of a dna microarray to detect antimicrobial resistance genes identified in the national center for biotechnology information database.to understand the mechanisms and epidemiology of antimicrobial resistance (ar), the genetic elements responsible must be identified. due to the myriad of possible genes, a high-density genotyping technique is needed for initial screening. to achieve this, ar genes in the national center for biotechnology information genbank database were identified by their annotations and compiled into a nonredundant list of 775 genes. a dna microarray was constructed of 70mer oligonucelotide probes designed to ...201019916789
anti-clostridium difficile potential of tetramic acid derivatives from pseudomonas aeruginosa quorum-sensing autoinducers.we have examined the potential bactericidal activities of several tetramic acids derived from pseudomonas autoinducers against clostridium difficile, a cause of antibiotic-associated pseudomembranous colitis. clinical isolates of c. difficile (n=4) were incubated in broth with a chemically synthesized pseudomonas autoinducer and its tetramic acid derivatives. the structure-activity relationship and the mechanisms of action were examined by a time-killing assay and by determination of the morphol ...201019917748
evaluation of tcdb real-time pcr in a three-step diagnostic algorithm for detection of toxigenic clostridium difficile.clostridium difficile is the most common infectious cause of diarrhea in hospitalized patients. the optimal approach for the detection of toxigenic c. difficile remains controversial because no single test is sensitive, specific, and affordable. we have developed a real-time pcr method (direct stool pcr [dpcr]) to detect the tcdb gene encoding toxin b directly from stool specimens and have combined it with enzyme immunoassays (eias) in a three-step protocol. dpcr was performed on 699 specimens t ...201019923482
the clostron: mutagenesis in clostridium refined and streamlined.the recent development of the clostron group ii intron directed mutagenesis tool for clostridium has advanced genetics in this genus, and here we present several significant improvements. we have shown how marker re-cycling can be used to construct strains with multiple mutations, demonstrated using flp/frt in clostridium acetobutylicum; tested the capacity of the system for the delivery of transgenes to the chromosome of clostridium sporogenes, which proved feasible for 1.0kbp transgenes in add ...201019891996
[comparison of three clostridium difficile culture media: interest of enhancing spore germination media?].clostridium difficile is the most common agent of postantibiotic and nosocomial bacterial diarrhoea. since the emergence of the highly virulent and epidemic strain nap1/027 in europe, it appears necessary to isolate c. difficile strains to realize an epidemiologic follow-up by molecular typing. the aim of this work was to compare three selective culture conditions for the isolation of c. difficile.201019892495
activity of tigecycline against recent european clinical isolates of clostridium difficile. 201019892528
the potential value of faecal lactoferrin as a screening test in hospitalized patients with diarrhoea.nosocomial diarrhoea is common and its investigation carries a significant healthcare cost. this study aimed to determine the utility of faecal lactoferrin (fl), a readily measurable marker of intestinal inflammation, in hospitalized patients with diarrhoea.201019849752
tumor endothelial marker 5 expression in endothelial cells during capillary morphogenesis is induced by the small gtpase rac and mediates contact inhibition of cell proliferation.tumor endothelial marker (tem) 5 is an adhesion g-protein-coupled receptor upregulated in endothelial cells during tumor and physiologic angiogenesis. so far, the mechanisms leading to upregulation of tem5 and its function during angiogenesis have not been identified. here, we report that tem5 expression in endothelial cells is induced during capillary-like network formation on matrigel, during capillary morphogenesis in a three-dimensional collagen i matrix, and upon confluence on a two-dimensi ...201019853600
no-loaded zn(2+)-exchanged zeolite materials: a potential bifunctional anti-bacterial strategy.nitric oxide (no) is important for the regulation of a number of diverse biological processes, including vascular tone, neurotransmission, inflammatory cell responsiveness, defence against invading pathogens and wound healing. transition metal exchanged zeolites are nanoporous materials with high-capacity storage properties for gases such as no. the no stores are liberated upon contact with aqueous environments, thereby making them ideal candidates for use in biological and clinical settings. he ...201019861185
comparison of bd geneohm cdiff real-time pcr assay with a two-step algorithm and a toxin a/b enzyme-linked immunosorbent assay for diagnosis of toxigenic clostridium difficile infection.the bd geneohm cdiff assay, a real-time pcr assay for the detection of the clostridium difficile toxin b (tcdb) gene, was compared with the toxin a/b (tox a/b) ii enzyme-linked immunosorbent assay (elisa) and a two-step algorithm which includes a c. diff chek-60 glutamate dehydrogenase (gdh) antigen assay followed by cytotoxin neutralization. four hundred liquid or semisolid stool samples submitted for diagnostic c. difficile testing, 200 gdh antigen positive and 200 gdh antigen negative, were s ...201019864479
rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases.rifaximin is gaining attention for its potential activity in a multitude of gastrointestinal diseases. we review the unique pharmaceutical properties of this antibiotic and the published evidence in the literature regarding the use of rifaximin for different gastrointestinal disorders.201019881343
in vitro activity of tigecycline and comparators against a european compilation of anaerobes collected as part of the tigecycline evaluation and surveillance trial (test).the tigecycline evaluation and surveillance trial (test) is a global surveillance study designed to monitor the in vitro activity of the broad-spectrum antimicrobial tigecycline against nosocomial- and community-acquired pathogens. in this study the in vitro activity of tigecycline against 1256 anaerobic pathogens collected across europe has been compared to the activity of several comparator antibiotics. the pathogens examined in this study included bacteroides, prevotella, anaerococcus, clostr ...201019883155
antimicrobial prescribing in hospitals: be careful what you measure.measurement of prescribing is an important component of antimicrobial stewardship. the standard unit of measurement in hospitals is defined daily doses denominated by bed days (e.g. ddds per 1000 bed days) but alternatives have not been evaluated in depth.201019884120
rare extraintestinal infection caused by toxin-producing clostridium difficile.toxigenic clostridium difficile is a well known cause of antibiotic-associated diarrhea mainly among hospitalized patients, at the same time we have little information about extraintestinal infections caused by this bacterium. we report here on rare extraintestinal infection caused by toxigenic c. difficile: 31-year-old male, accident victim was admitted to the hospital because of polytrauma. microbiological examination of the pus revealed a toxin-producing c. difficile as an etiologic factor of ...201019835967
detection of gyra and gyrb mutations in clostridium difficile isolates by real-time pcr.fluoroquinolone (fq)-resistance in clostridium difficile has been associated with mutations in the quinolone-resistance determining region (qrdr) of gyr genes. in particular, the majority of resistant clinical isolates show mutations in codon 82 of gyra or in codon 426 of gyrb. a real-time pcr method was developed to identify these mutations in fq-resistant c. difficile strains. twenty-one clinical isolates, selected as representative of the different gyr alleles known up to date, and 20 clinica ...201019837154
clostridium difficile is associated with poor outcomes in patients with cirrhosis: a national and tertiary center perspective.clostridium difficile-associated disease (cdad) is associated with antibiotic use, acid suppression, and hospitalization, all of which occur frequently in cirrhosis. the aim was to define the effect of cdad on outcomes and identify risk factors for its development in cirrhosis.201019844204
a comprehensive surveillance, control and management programme for clostridium difficile infection. 201019765860
in vitro susceptibility to 17 antimicrobials of clinical clostridium difficile isolates collected in 1993-2007 in sweden.this study investigated the mics of 17 antimicrobials, for 606 toxigenic clinical isolates of clostridium difficile collected between 1993 and 2007 in sweden. low mic(90) values were found for metronidazole (0.5 mg/l), vancomycin (1.0 mg/l), teicoplanin (0.125 mg/l), fusidic acid (1.0 mg/l), linezolid (2.0 mg/l), daptomycin (2.0 mg/l) and tigecycline (0.064 mg/l). three isolates (0.5%) had elevated mics for vancomycin (4-8 mg/l); however, these isolates originated from the same patient, who was ...201019732094
clostridium difficile and inflammatory bowel disease: more questions than answers? 201019827137
laboratory markers as predictors of mortality in patients with clostridium difficile infection.previous studies have identified laboratory markers for severe clostridium difficile infection (cdi). the most consistent of these markers is the presence of marked leukocytosis. we examined the validity of these markers as predictors of mortality in patients with cdi. we excluded patients with preexisting hematologic conditions that would be expected to impair their ability to demonstrate leukocytosis. on univariate analysis, marked leukocytosis (p = 0.02), thrombocytopenia (p = 0.008), and inc ...201019794314
unusual manifestations of clostridium difficile infection.clostridium difficile infection (cdi) is an increasing nosocomial problem. new, more-virulent strains of c. difficile have spread across north america and europe. health care institutions now face a greater incidence of disease, often with greater severity. a need for surgical management for control of infection is on the increase. the clinical appearance of cdi is changed.201019795991
high prevalence of tcdc deletion-carrying clostridium difficile and lack of association with disease severity.we assessed the prevalence of tcdc deletion-carrying clostridium difficile using a stool polymerase chain reaction (pcr) assay that detects previously described 18- and 39-bp deletions (j. clin. microbiol. 2008;46:1996). we divided inpatients into 2 groups, those for whom the assay detected a deletion in tcdc and those for whom no deletion was detected. we compared risk factors (antibiotic use, hospitalization, nursing home stay, immunocompromise, age >65 years), complications (pseudomembranous ...201019775847
secondary pouchitis: those with identifiable etiopathogenetic or triggering factors.restorative proctocolectomy with ileal pouch-anal anastomosis (ipaa) is the surgical treatment of choice for the majority of patients with medically refractory ulcerative colitis (uc) or uc with dysplasia, or familial adenomatous polyposis. various forms of pouchitis frequently occur after surgery. in fact, pouchitis is the most frequent long-term complication of ipaa in patients with uc, with a cumulative prevalence of up to 50%. the etiology and pathogenesis of pouchitis are not entirely clear ...201019755972
preliminary molecular analysis of clostridium difficile isolates from healthy horses in northern italy.clostridium difficile, associated with a wide spectrum of diseases in humans, as well as in several animal species, is an important cause of colitis in adult horses and foals. the aim of this study was to investigate by toxin gene profile and pcr-ribotyping the molecular characteristics of 14 c. difficile strains isolated from 42 faeces of healthy horses. both toxin genes, tcda and tcdb, were present in only 1 isolate (7.1%). six isolates (42.9%) demonstrated tcda-/tcdb+ genotype, and seven isol ...201020004974
first report of hypervirulent strains polymerase chain reaction ribotypes 027 and 078 causing severe clostridium difficile infection in italy. 201020001530
clostridium difficile in food--innocent bystander or serious threat?clostridium difficile is a critically important cause of disease in humans, particularly in hospitalized individuals. three major factors have raised concern about the potential for this pathogen to be a cause of foodborne disease: the increasing recognition of community-associated c. difficile infection, recent studies identifying c. difficile in food animals and food, and similarities in c. difficile isolates from animals, food and humans. it is clear that c. difficile can be commonly found in ...201020002685
[clostridium difficile-associated infections. how dangerous are the new strains?].in recent years, a global increase of clostridium difficile-associated infections (cdi) and the emergence of new hypervirulent strains causing numerous outbreaks was noticed. the appearance of these strains was accompanied by increased morbidity and mortality, affecting patients previously unknown to be at risk for cdi. meanwhile, these hypervirulent strains occur in germany as well. so far, the changing epidemiology of cdi did neither change diagnosis nor therapy of cdi but necessitates a serie ...201019997894
hemolytic uremic syndrome in a preterm infant. 201019997939
evaluation of clostridium difficile in dogs and the household environment.clostridium difficile may be an emerging community-associated pathogen but little is known about its sources of exposure. this study evaluated c. difficile contamination in households and colonization of pets. c. difficile was isolated from 44/836 (5.3%) sites in 26/84 (31%) households. ribotype 027 was the most common (25%) environmental strain. c. difficile was isolated from 14/139 (10%) dogs. living with an immunocompromised individual was associated with c. difficile colonization in dogs. al ...201019951453
multilocus variable-number tandem-repeat analysis and multilocus sequence typing reveal genetic relationships among clostridium difficile isolates genotyped by restriction endonuclease analysis.numbers of clostridium difficile infections have increased worldwide in the past decade. while infection with c. difficile remains predominantly a health care-associated infection, there may also be an increased incidence of community-associated infections. c. difficile strains of public health significance continue to emerge, and reliable genotyping methods for epidemiological investigations and global surveillance of c. difficile are required. in this study, multilocus sequence typing (mlst) a ...201019955268
c. diff quik chek complete enzyme immunoassay provides a reliable first-line method for detection of clostridium difficile in stool specimens.we evaluated a single membrane device assay for simultaneously detecting both clostridium difficile glutamate dehydrogenase (gdh) and toxin a/b antigens against a standard that combines two pcr assays and cytotoxigenic culture. results showing dual gdh and toxin a/b antigen positives and negatives can be reported immediately as true positives and negatives, respectively. specimens with discrepant results for gdh and toxins a/b, which comprised 13.2% of the specimens, need to be retested.201019955275
serum anti-toxin b antibody correlates with protection from recurrent clostridium difficile infection (cdi).previous studies have demonstrated a correlation between clostridium difficile anti-toxin a serum antibodies and protection against symptomatic disease and recurrence.201019941990
changes in antibiotic susceptibility and ribotypes in clostridium difficile isolates from southern scotland, 1979-2004.an increase in the incidence of clinical cases of clostridium difficile infection has been reported in recent years, but few studies have examined changes in molecular epidemiology and antibiotic resistance over a long period of time. a collection of 179 isolates of c. difficile obtained from symptomatic adult patients in southern scotland between 1979 and 2004 was used to determine changes in the prevalence of epidemiological types and antibiotic susceptibilities to common antibiotics. pcr ribo ...201019942691
clostridium difficile and inflammatory bowel disease.the past decade has seen an alarming increase in the burden of disease associated with clostridium difficile. several studies have now demonstrated an increasing incidence of c difficile infection in patients with inflammatory bowel disease (ibd) with a more severe course of disease compared with the non-ibd population. this article summarizes the available literature on the impact of c difficile infection on ibd and discusses the various diagnostic testing and treatment options available. also ...201019944802
c. difficile colitis--predictors of fatal outcome.clostridium difficile colitis (cdc) has a clinical spectrum ranging from mild diarrhea to fulminant, potentially fatal colitis. the pathophysiology for this variation remains poorly understood. a total abdominal colectomy may be lifesaving if performed before the point of no return. identification of negative prognostic factors is desperately needed for optimization of the clinical and operative management.201019937192
emergence of clostridium difficile nap1 in latin america. 201019940046
impact of an intervention to control clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis.strategies to reduce rates of clostridium difficile infection (cdi) generally recommend isolation or cohorting of active cases and the reduced use of cephalosporin and quinolone antibiotics. data supporting these recommendations come predominantly from the setting of epidemic disease caused by ribotype 027 strains. we introduced an initiative involving a restrictive antibiotic policy and a cdi-cohort ward at an acute, 820-bed teaching hospital where ribotype 027 strains account for only one quar ...201019832710
slec is essential for germination of clostridium difficile spores in nutrient-rich medium supplemented with the bile salt taurocholate.clostridium difficile is the major cause of infectious diarrhea and a major burden to health care services. the ability of this organism to form endospores plays a pivotal role in infection and disease transmission. spores are highly resistant to many forms of disinfection and thus are able to persist on hospital surfaces and disseminate infection. in order to cause disease, the spores must germinate and the organism must grow vegetatively. spore germination in bacillus is well understood, and g ...201019933358
persistence of skin contamination and environmental shedding of clostridium difficile during and after treatment of c. difficile infection.current guidelines for control of clostridium difficile infection (cdi) suggest that contact precautions be discontinued after diarrhea resolves. however, limited information is available regarding the frequency of skin contamination and environmental shedding of c. difficile during and after treatment.201019929371
clostridium difficile infections in outpatient dialysis cohort.we examined the clostridium difficile infection rate and risk factors in an outpatient dialysis cohort. the cox proportional hazard for developing c. difficile infection was significantly higher with high comorbidity index and low serum albumin level. conversely, it was lower for patients who had frequent bloodstream and dialysis access-related infections.201019929691
clostridium difficile infection following chemotherapy.clostridium difficile infection (cdi) is a major concern for health care system and clinicians. interest in c. difficile infection has increased recently due to an ongoing c. difficile epidemic with a hypervirulent strain and mortality. disease due to c. difficile is responsible for substantial strain on the hospital system by increasing patients' length of stayand increasing costs. present studies have demonstrated chemotherapeutic agents as an independent risk factor for cdi potentially leadin ...201019929843
two-step glutamate dehydrogenase antigen real-time polymerase chain reaction assay for detection of toxigenic clostridium difficile.current diagnosis of clostridium difficile infection (cdi) relies upon detection of toxins a/b in stool by enzyme immunoassay [eia(a/b)]. this strategy is unsatisfactory because it has a low sensitivity resulting in significant false negatives. we investigated the performance of a two-step algorithm for diagnosis of cdi using detection of glutamate dehydrogenase (gdh). gdh-positive samples were tested for c. difficile toxin b gene (tcdb) by polymerase chain reaction (pcr). the performance of the ...201019900734
healthcare costs of staphylococcus aureus and clostridium difficile infections in veterans: role of vitamin d deficiency.clostridium difficile and staphylococcal infections are associated with increased morbidity, mortality and healthcare costs. vitamin d deficiency may also contribute to increased healthcare costs. there is increasing evidence that vitamin d may have an antimicrobial role. we examined the relationship of serum 25(oh)d levels to staphylococcal and c. difficile infections to determine if vitamin d deficiency was associated with adverse outcomes. in the outpatient setting, vitamin d deficiency in pa ...201020056018
emergency subtotal colectomy for fulminant clostridium difficile colitis--is a surgical solution considered for all patients?clostridium difficile has been an increasing problem in uk hospitals. at the time of this study, there was a high incidence of c. difficile within our trust and a number of patients developed acute fulminant colitis requiring subtotal colectomy. we review a series of colectomies for c. difficile, examining the associated morbidity and mortality and the factors that predispose to acute fulminant colitis.201020056063
clostridium difficile infection: more known than is realised. 201020056074
diagnosis of clostridium difficile infection is associated with a small increased risk of death in elderly inpatients. 201020061064
intravenous immunoglobulin for the treatment of severe clostridium difficile colitis: an observational study and review of the literature.clostridium difficile colitis (cdc) is the most common cause of hospital-acquired diarrhea. the increase in the incidence and fatality rate of cdc over the past decade has stimulated a search for new therapies, including intravenous immunoglobulin (ivig). we report our experience with ivig for the treatment of 21 patients with severe cdc.201020063275
tube feeding, the microbiota, and clostridium difficile infection.clostridium difficile (c. difficile) is now the leading cause of nosocomial diarrhea in the usa, accounting for 30% of patients with antibiotic-associated diarrhea, 70% of those with antibiotic-associated colitis, and most cases of pseudomembranous colitis. the organism has evolved over the last 8 years to become more virulent and resistant to antimicrobials (nap1/027 strain) causing a more severe form of the disease that has increased mortality and healthcare costs. while it is generally accept ...201020066732
chemical probes of surface layer biogenesis in clostridium difficile.clostridium difficile, a leading cause of hospital-acquired infection, possesses a dense surface layer (s-layer) that mediates host-pathogen interactions. the key structural components of the s-layer result from proteolytic cleavage of a precursor protein, slpa, into high- and low-molecular-weight components. here we report the discovery and optimization of the first inhibitors of this process in live bacteria and their application for probing s-layer processing. we also describe the design and ...201020067320
evaluation of the efficacy of electrochemically activated solutions against nosocomial pathogens and bacterial endospores.electrochemically activated solutions (ecas) are generated from halide salt solutions via specially designed electrolytic cells. the active solutions are known to possess high biocidal activity against a wide range of target microbial species, however, literature revealing the kill-kinetics of these solutions is limited. the aim of the study was to identify the kill-rate and extent of population kill for a range of target species (including endospores) using ecas generated at the anode (anolyte) ...201020070511
the effects of substituted cyclodextrins on the colloidal and conformational stability of selected proteins.the effects of various types of substituted and nonsubstituted cyclodextrins (cds) on the physical and colloidal stability of three different proteins were studied to further ascertain the mechanism by which cyclodextrins stabilize proteins. the three proteins examined in this study are the clostridium difficile toxoid a, yersinia pestis low-calcium-response v or v antigen (lcrv), and fibroblast growth factor 10 (fgf-10). these three pharmaceutically relevant proteins differ in molecular weight, ...201020049940
editorial: clostridium difficile infection: yet another predictor of poor outcome in cirrhosis.the development of clostridium difficile infection in cirrhosis is predictive of death, independent of severity of liver disease. the main risk factors are the use of antibiotics and proton-pump inhibitors (ppis). this is further evidence that supports the wise and cautious use of antibiotics in cirrhosis and suggests avoiding the use of ppis in these patients except for indications of proven benefit.201020054307
clostridium difficile infection in the intensive care unit.clostridium difficile infection (cdi) is an increasing nosocomial problem in north america and western europe, where outbreaks caused by a more virulent, toxin-hyperproducing strain have been recently reported. clostridium difficile infection is now characterized by a higher incidence, more frequent relapses, and a higher case-fatality ratio. as a consequence, fulminant cases requiring admission to the intensive care unit (icu) are much more common than previously. in recent years, metronidazole ...201020034951
piglet models of acute or chronic clostridium difficile illness.we examined the piglet model of clostridium difficile illness (cdi) in humans, because swine are naturally susceptible to c. difficile. the piglet is a reproducible model of acute or chronic cdi with characteristic pseudomembranous colitis. germ-free piglets were consistently and extensively colonized after oral challenge with the human strain 027/bi/nap1, establishing an infectious dose-age relationship. this allowed a demarcation between acute fatal and chronic models. the clinical manifestati ...201020039803
phenotypic characterisation of clostridium difficile reveals lack of extracellular virulence factor production and significant differences in antibiogram profiles. 201020031376
evaluation of diagnostic tests for clostridium difficile infection.we evaluated toxigenic clostridium difficile detection by a lateral flow assay for antigen and toxin, an enzyme immunoassay, and two commercial pcr methods. compared to the cell cytotoxicity neutralization assay and toxigenic culture, both toxin detection methods lacked sensitivity. pcr following combined antigen and toxin detection provided the most useful diagnostic information.201020032256
management of osteomyelitis of the foot in diabetes mellitus.although osteomyelitis occurs in approximately 10-20% of patients with diabetes-related foot ulcers, no widely accepted guideline is available for its treatment. in particular, little consensus exists on the place of surgery. a number of experts claim that early surgical excision of all infected or necrotic bone is essential. others suggest that surgery should not be performed routinely, but instead only in patients who do not respond to antibiotic treatment or in case of particular clinical ind ...201020010969
multilocus sequence typing of clostridium difficile.a robust high-throughput multilocus sequence typing (mlst) scheme for clostridium difficile was developed and validated using a diverse collection of 50 reference isolates representing 45 different pcr ribotypes and 102 isolates from recent clinical samples. a total of 49 pcr ribotypes were represented overall. all isolates were typed by mlst and yielded 40 sequence types (sts). a web-accessible database was set up (http://pubmlst.org/cdifficile/) to facilitate the dissemination and comparison o ...201020042623
bactericidal activity of telavancin, vancomycin and metronidazole against clostridium difficile.we compared the time-kill activities of telavancin, vancomycin and metronidazole at concentrations of 2 times, 4 times, and 8 times their respective mics against five clostridium difficile strains including rea type bi, using inocula that contained predominantly either vegetative cells or spores. telavancin mics (0.125-0.25 microg/ml) were 2-8-fold lower than those of vancomycin. telavancin was bacteriostatic, reducing the inoculum by 1-2.5 log(10) after 24 h. no major differences occurred with ...201020044011
purification, characterisation and identification of acidocin lchv, an antimicrobial peptide produced by lactobacillus acidophilus n.v. er 317/402 strain narine.in the last two decades, antimicrobial peptides (amps) have been gaining attention as antimicrobial alternatives to chemical food preservatives and commonly used antibiotics. lactobacillus acidophilus n.v. er 317/402 strain narine produces a small amp with a molecular weight of 1.1kda, designated acidocin lchv. in this study, the amp was extremely heat stable (90min at 130 degrees c), was active over a wide ph range and was found to be sensitive to proteolytic enzymes (trypsin, pepsin and protei ...201020045288
severe and refractory clostridium difficile infection successfully treated with tigecycline and metronidazole. 201020045292
antimicrobial-resistant pathogens in animals and man: prescribing, practices and policies.this meeting focused on infections in humans and animals due to methicillin-resistant staphylococcus aureus (mrsa), extended-spectrum beta-lactamase (esbl)-producing bacteria and clostridium difficile, and their corresponding treatments. mrsa is predominantly a human pathogen, and molecular typing has revealed that certain clones have spread widely both between humans and from humans to animals. esbl-producing bacteria, particularly those that express the ctx-m beta-lactamases, have been dissemi ...201020045808
proton pump inhibitors as a risk factor for paediatric clostridium difficile infection.proton pump inhibitors (ppis) and h(2) receptor antagonists (h(2)ras) may play an important role on the onset of clostridium difficile-associated disease (cdad) in adults. the impact of clostridium difficile on children treated with gastric acid-suppressing agents remains unknown.201020047577
isolation and characterization of bacteria resistant to metallic copper surfaces.metallic copper alloys have recently attracted attention as a new antimicrobial weapon for areas where surface hygiene is paramount. currently it is not understood on a molecular level how metallic copper kills microbes, but previous studies have demonstrated that a wide variety of bacteria, including escherichia coli, staphylococcus aureus, and clostridium difficile, are inactivated within minutes or a few hours of exposure. in this study, we show that bacteria isolated from copper alloy coins ...201020048058
changes in the composition of the human fecal microbiome after bacteriotherapy for recurrent clostridium difficile-associated diarrhea.clostridium difficile-associated disease (cdad) is the major known cause of antibiotic-induced diarrhea and colitis, and the disease is thought to result from persistent disruption of commensal gut microbiota. bacteriotherapy by way of fecal transplantation can be used to treat recurrent cdad, which is thought to reestablish the normal colonic microflora. however, limitations of conventional microbiologic techniques have, until recently, precluded testing of this idea. in this study, we used ter ...201020048681
exposure to hospital roommates as a risk factor for health care-associated infection.numerous patient- and hospital-level characteristics have been established as risk factors for the transmission of health care-associated infections (hais). few studies have quantitatively assessed the impact of exposure to hospital roommates on the acquisition of infections. this study evaluated the association between roommate exposures and the risk of hais.201020022405
a mariner-based transposon system for in vivo random mutagenesis of clostridium difficile.understanding the molecular basis of clostridium difficile infection is a prerequisite to the development of effective countermeasures. although there are methods for constructing gene-specific mutants of c. difficile, currently there is no effective method for generating libraries of random mutants. in this study, we developed a novel mariner-based transposon system for in vivo random mutagenesis of c. difficile r20291, the bi/nap1/027 epidemic strain at the center of the c. difficile outbreaks ...201020023081
comparison of two rapid assays for clostridium difficile common antigen and a c difficile toxin a/b assay with the cell culture neutralization assay.we compared 3 rapid assays for clostridium difficile with a cell culture cytotoxicity neutralization assay (ccna). of 600 stool samples, 46 were positive for toxigenic c difficile. both rapid common antigen assays were highly sensitive (91.3%-100%) and, therefore, were appropriate screening tests. the rapid toxin assay had poor sensitivity (61%) but excellent specificity (99.3%). testing stools for glutamate dehydrogenase (step 1) and those positive with a rapid toxin assay (step 2) would correc ...201020023265
total synthesis of le(a)-lacnac pentasaccharide as a ligand for clostridium difficile toxin a.the toxins tcda and tcdb produced by the human pathogen clostridium difficile gain entrance to host epithelial cells by recognizing cell-surface carbohydrate ligands. inhibiting the attachment of these toxins to host cells has been proposed to be a viable therapy to treat c. difficile infections. glycan array screening previously revealed that the le(a)-lacnac pentasaccharide binds strongly to tcda. here we report the efficient syntheses of the pentasaccharide and a structurally related tetrasac ...201020024143
health care-associated clostridium difficile infection in canada: patient age and infecting strain type are highly predictive of severe outcome and mortality.c. difficile infection (cdi) has become an important and frequent nosocomial infection, often resulting in severe morbidity or death. severe cdi is more frequently seen among individuals infected with the emerging nap1/027/bi (nap1) strain and in the elderly population, but the relative importance of these 2 factors remains unclear. we used a large canadian database of patients with cdi to explore the interaction between these 2 variables.201020025526
clostridium difficile infection and inflammatory bowel disease.the importance of clostridium difficile (c. difficile) infection amongst patients with inflammatory bowel disease (ibd) is increasingly being recognized. recent studies have demonstrated a concerning trend towards increased rates of infection, morbidity, mortality and health costs, and guidelines now promote testing for c. difficile in ibd patients experiencing a relapse. this critical review focuses on the epidemiology, risk factors, pathogenesis, treatment options and outcomes associated with ...201020025557
surveillance and trends of antimicrobial resistance among clinical isolates of anaerobes in kuwait hospitals from 2002 to 2007.the susceptibility trends for all anaerobes processed by the anaerobe reference laboratory against various antibiotics were determined by using data for 2557 isolates referred by all government hospitals in kuwait from 2002 to 2007. mic were determined for the following anti-anaerobic antibiotics: amoxicillin-clavulanic acid, clindamycin, imipenem, meropenem, metronidazole, penicillin, piperacillin, piperacillin-tazobactam and vancomycin (for gram-positive anaerobes only), using e-test method. t ...201019406247
[clostridium difficile associated reactive arthritis].extracolonic manifestations of clostridium difficile infections have rarely been reported as a reactive arthritis. we report a 43-year-old woman who presented with a polyarthritis following pseudomembranous colitis. she was admitted for fever and polyarthritis, 10 days after the onset of a c. difficile enterocolitis. samples obtained from urine and blood cultures remained sterile. corticosteroids were prescribed and clinical manifestations resolved within 3 weeks. ten months later, there was no ...201019457598
clinical outcomes of patients with ulcerative colitis and co-existing clostridium difficile infection.the incidence of clostridium difficile infection is increasing in the united states. the aim of our investigation is to compare short-term and long-term outcomes of patients admitted with an ulcerative colitis (uc) flare and co-existent c. difficile infection to those of non-infected patients.201019255850
susceptibility of clostridium difficile toward antimicrobial agents used as feed additives for food animals.a total of 65 toxigenic clostridium difficile strains isolated from patients with antibiotic-associated diarrhea were tested for susceptibility to avilamycin, flavomycin, monensin, and salinomycin. except for flavomycin the substances showed in vitro efficacy comparable to reports of the currently most commonly used drugs for treatment of c. difficile. this indicates that these old compounds may be useful for the treatment of c. difficile infections in man and perhaps for other bacterial causes ...201020950192
the diverse sporulation characteristics of clostridium difficile clinical isolates are not associated with type.clostridium difficile causes diarrhoeal diseases ranging from asymptomatic carriage to a fulminant, relapsing, and potentially fatal colitis. endospore production plays a vital role in transmission of infection, and in order to cause disease these spores must then germinate and return to vegetative cell growth. type bi/nap1/027 strains of c. difficile have recently become highly represented among clinical isolates and are associated with increased disease severity. it has also been suggested tha ...201020950700
outcomes of emergency colectomy for fulminant clostridium difficile colitis.clostridium difficile has become increasingly a common cause of nosocomial infection with increasing antibiotic usage. recently there has been an increase in the incidence of patients undergoing colectomy for fulminant c. difficile colitis (fcdc). early surgical consultation is necessary to avoid delay in diagnosis. we present a retrospective review of the outcomes of colectomies for fcdc at our large district general hospital.201020950772
the safety of drugs used in acid-related disorders and functional gastrointestinal disorders.medicines are frequently used in the management of acid-related disorders and functional gastrointestinal disorders. with the exception of complicated peptic ulcer disease, these disorders are not associated with appreciable mortality. drug treatments have consequently been held to the highest standards of safety. some medicines have been withdrawn or restricted based on assessments and perceptions of risk. however, the risk of serious toxicity is low for most of the agents discussed in this art ...201020951916
clostridium difficile infection and inflammatory bowel disease: understanding the evolving relationship.clostridium difficile (c. difficile) infection (cdi) is the leading identifiable cause of antibiotic-associated diarrhea. while there is an alarming trend of increasing incidence and severity of cdi in the united states and europe, superimposed cdi in patients with inflammatory bowel disease (ibd) has drawn considerable attention in the gastrointestinal community. the majority of ibd patients appear to contract cdi as outpatients. c. difficile affects disease course of ibd in several ways, inclu ...201020954275
recurrent haemophagocytic syndrome in an hiv-infected patient.we describe a case of recurrent haemophagocytic syndrome (hs) in an hiv-infected patient.the first episode was associated with active human herpesvirus 8 infection and progressive kaposi's sarcoma which was successfully treated with splenectomy, foscarnet and chemotherapy. the second episode was triggered by a clostridium difficile colitis and resolved completely after treatment with metronidazole only. recurrent hs has rarely been described in adult patients out of the setting of relapsing mali ...201020954469
clostridium difficile infection in cancer patients and hematopoietic stem cell transplant recipients.clostridium difficile has become the most common bacterial cause of nosocomial diarrhea. high rates of c. difficile infection (cdi) coupled with increasing morbidity and mortality attributed to cdi have sparked a renewed interest in this disease. emergence of hypervirulent strains, rising rates of severe and recurrent infection and associated infection control challenges, and diagnostic and therapeutic dilemmas are major issues in the non-oncology population. scant data on cdi exist in the cance ...201020954878
an update on clostridium difficile infection and its management. 201020955528
reducing the incidence of clostridium difficile infections: can we do it? 201020957908
comment: the relationship between inpatient fluoroquinolone use and clostridium difficile-associated disease. 201020959498
audit of the laboratory diagnosis of clostridium difficile infection in the uk.a uk-wide audit of the laboratory diagnosis of clostridium difficile infection (cdi) was undertaken by the association of clinical pathologists and the royal college of pathologists, in conjunction with keele university. a postal questionnaire was sent out to all consultant microbiologists, with eighty responses available for analysis. there was considerable variation in laboratory practices. in particular, only 56% of laboratories gave guidance on follow-up testing of toxin-negative samples, 68 ...201020965100
mapping interactions between germinants and clostridium difficile spores.germination of clostridium difficile spores is the first required step in establishing c. difficile-associated disease (cdad). taurocholate (a bile salt) and glycine (an amino acid) have been shown to be important germinants of c. difficile spores. in the present study, we tested a series of glycine and taurocholate analogs for the ability to induce or inhibit c. difficile spore germination. testing of glycine analogs revealed that both the carboxy and amino groups are important epitopes for rec ...201020971909
recent epidemiology of clostridium difficile infection during hematopoietic stem cell transplantation.given the limited information on clostridium difficile infection (cdi) during hematopoietic stem cell transplantation (hsct), we examined the recent epidemiology of cdi in hsct recipients at our institution. during the two-yr retrospective study period (2005-2006), 361 transplants were performed: 60% allogeneic and 40% autologous. among all hospitalized patients in a non-outbreak setting, cdi rates in hsct recipients were ninefold higher than those in general patients and 1.4-fold higher than th ...201020973823
identification of a genetic locus responsible for antimicrobial peptide resistance in clostridium difficile.clostridium difficile causes chronic intestinal disease, yet little is understood about how the bacterium interacts with and survives in the host. to colonize the intestine and cause persistent disease, the bacterium must circumvent killing by host innate immune factors, such as cationic antimicrobial peptides (camps). in this study, we investigated the effect of model camps on growth and found that c. difficile is not only sensitive to these compounds but also responds to low levels of camps by ...201020974818
murine model of clostridium difficile infection with aged gnotobiotic c57bl/6 mice and a bi/nap1 strain.the increased incidence and severity of clostridium difficile infection (cdi) in older adults (age, ≥65 years) corresponds with the emergence of the bi/nap1 strain, making elucidation of the host immune response extremely important. we therefore infected germ-free c57bl/6 mice aged 7-14 months with a bi/nap1 strain and monitored the mice for response. infected mice were moribund 48-72 h after infection and developed gross and histological cecitis and colitis and elevated concentrations of kerati ...201020977342
management of clostridium difficile infection: thinking inside and outside the box.treatment of clostridium difficile infection (cdi) has relied on 2 antimicrobial agents, metronidazole and vancomycin, since the recognition of this disease entity. while effective, these "inside the box" approaches to cdi management have the disadvantage of further microbial disruption of the host indigenous microflora. "outside the box" therapies use non-antimicrobial approaches to management and are theoretically less prone to causing recurrent cdi episodes. recent advances in understanding o ...201020979491
comparison of real-time pcr techniques to cytotoxigenic culture methods for diagnosing clostridium difficile infection.in the past decade, the incidence of clostridium difficile infections (cdi) with a more severe course has increased in europe and north america. assays that are capable of rapidly diagnosing cdi are essential. two real-time pcrs (lumc and lvi) targeting c. difficile toxin genes (tcdb, and tcda and tcdb, respectively) were compared with the bd geneohm pcr (targeting the tcdb gene), using cytotoxigenic culture as a gold standard. in addition, a real-time pcr targeting the tcdc frameshift mutation ...201020980562
what is the current role of algorithmic approaches for diagnosis of clostridium difficile infection?with the recognition of several serious outbreaks of clostridium difficile infection in the industrialized world coupled with the development of new testing technologies for detection of this organism, there has been renewed interest in the laboratory diagnosis of c. difficile infection. two factors seem to have driven much of this interest. first, the recognition that immunoassays for detection of c. difficile toxins a and b, for many years the most widely used tests for c. difficile infection ...201020980568
follicular fluid high-density lipoprotein-associated sphingosine 1-phosphate (s1p) promotes human granulosa lutein cell migration via s1p receptor type 3 and small g-protein rac1.coordinated migration and progesterone production by granulosa cells is critical to the development of the corpus luteum, but the underlying mechanisms remain obscure. sphingosine 1-phosphate (s1p), which is associated with follicular fluid high-density lipoprotein (ff-hdl), was previously shown to regulate ovarian angiogenesis. we herein examined the effects of s1p and ff-hdl on the function of granulosa lutein cells. both ff-hdl and s1p induced migration of primary human granulosa lutein cells ...201020980685
risk factors for treatment failure and recurrence after metronidazole treatment for clostridium difficile-associated diarrhea.the incidence of treatment failure or recurrence of clostridium difficile-associated diarrhea (cdad) following metronidazole treatment has increased recently. we studied the treatment failure, recurrence rate, and risk factors predictive of treatment failure and recurrence after metronidazole treatment for cdad.201020981209
statewide experience with clostridium difficile colitis in academic and nonacademic medical centers (*).abstract background: clostridium difficile colitis is a nosocomial infection that can present as minor, readily treated symptoms or as fulminant colitis leading to death. risk factors for c. difficile colitis have been defined, and certain populations of hospitalized patients appear to be particularly susceptible. however, most information on c. difficile colitis is from large tertiary-care medical centers. whether the community hospital experience is similar to that of large referral centers is ...201021028991
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