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tackling c difficile with environmental cleaning.chlorine-based cleaning products are often used in acute settings for high-level disinfection of the environment to help control c difficile. however, these products must be used at high concentrations, making them irritant, toxic and corrosive. this means they are inappropriate for the near-patient environment, and can lead to user resistance and non-compliance. more recently, products using peracetic acid and hydrogen peroxide have become available, which are highly effective even under condit ...201121998939
role of rho gtpases in human trophoblast migration induced by igfbp1.insulin like growth factor binding protein-1 (igfbp1), the main secretory product of the decidualized endometrium of a pregnant woman has previously been shown to interact with the alpha5beta1 integrin of evt cell surface to stimulate its migration in an igf-independent manner. this migration stimulation has also been shown to require activation of extracellular signal regulated kinases 1 and 2 (mapk3/1) and focal adhesion kinase (fak, official symbol ptk). the present study examined the roles o ...201121940708
assessment of severity of clostridium difficile infection. 201121876855
aerial dissemination of clostridium difficile on a pig farm and its environment.clostridium difficile is increasingly recognized as an important enteropathogen in both humans and animals. the finding of c. difficile in air samples in hospitals suggests a role for aerial dissemination in the transmission of human c. difficile infection. the present study was designed to investigate the occurrence of airborne c. difficile in, and nearby a pig farm with a high prevalence of c. difficile. airborne colony counts in the farrowing pens peaked on the moments shortly after or during ...201122014605
predictors of fatal outcome after colectomy for fulminant clostridium difficile colitis: a 10-year experience. dr.markelov@gmail.com.surgical treatment of fulminant clostridium difficile colitis has high mortality rates. identification of a set of preoperative characteristics that could predict outcome after surgery is necessary to optimize clinical management and guide surgical timing. data were retrospectively collected on patients operated on for c. difficile colitis between 2000 and 2010 at our institution. statistical analysis was performed to identify predictors of mortality. we reviewed the records of 13 inpatients di ...201121944509
clostridium difficile carriage in elderly subjects and associated changes in the intestinal microbiota.clostridium difficile is an important nosocomial pathogen associated particularly with diarrhoeal disease in elderly individuals in hospitals and long-term care facilities. we examined the carriage rate of clostridium difficile by culture as a function of faecal microbiota composition in elderly subjects recruited from the community, outpatient and short term respite and long term hospital stay. the carriage rate ranged from 1.6% (n=123) for subjects in the community, 9.5% (n=43) in outpatient s ...201122162545
Malignant neuroleptic syndrome and Clostridium difficile: Causal association or mere coincidence? 201122154227
Risk Factors and Outcomes Associated With Severe Clostridium difficile Infection in Children.BACKGROUND:: The incidence and severity of Clostridium difficile infection (CDI) is increasing among adults; however, little is known about the epidemiology of CDI among children. METHODS:: We conducted a nested case-control study to identify the risk factors for and a prospective cohort study to determine the outcomes associated with severe CDI at 2 children's hospitals. Severe CDI was defined as CDI and at least 1 complication or =2 laboratory or clinical indicators consistent with severe dise ...201122031485
Liver Graft Failure and Hyperbilirubinemia in Liver Transplantation Recipients After Clostridium difficile Infection.Liver transplant recipients are at high risk for Clostridium difficile infection. We have recently encountered multiple cases of CDI in our liver transplant recipients and for some of them it led to severe hyperbilirubinemia, liver failure, and even death. Our goals are to report our experience and analyze the factors that contributed to unfavorable outcomes.201122172853
sporulation studies in clostridium difficile.clostridium difficile is a leading cause of healthcare-associated diarrhoea. in recent years, certain c. difficile types have become highly represented among clinical isolates and are associated with outbreaks of increased disease severity, higher relapse rates and an expanded repertoire of antibiotic resistance. endospores, produced during sporulation, play a pivotal role in infection and disease transmission and it has been suggested in the literature that these so-called 'hypervirulent' c. di ...201121864584
prevalence, enumeration, and antimicrobial agent resistance of clostridium difficile in cattle at harvest in the united states.to assess the potential for food contamination with clostridium difficile from food animals, we conducted a cross-sectional fecal prevalence study in 944 randomly selected cattle harvested at seven commercial meat processing plants, representing four distant regions (median distance of 1,500 km) of the united states. in all, 944 animals were sampled in the summer of 2008. c. difficile was isolated from 1.8% (17 of 944) of cattle, with median fecal shedding concentration of 2.2 log cfu/g (range ...201122004807
Evaluation of doripenem utilization and susceptibilities at a large urban hospital.Background Bacterial resistance presents a constant challenge in the treatment of hospitalized patients, particularly with Gram-negative infections. Carbapenems have an important role in the treatment of resistant nosocomial organisms. Doripenem, a recently approved carbapenem, has shown efficacy in clinical trials, but there is little published data on utilization in a general patient population. Objective The clinical utilization of doripenem in a general adult inpatient population was evaluat ...201121984226
extended multilocus variable-number tandem-repeat analysis of clostridium difficile correlates exactly with ribotyping and enables identification of hospital transmission.pcr ribotyping is currently used in many countries for epidemiological investigation to track transmission and to identify emerging variants of clostridium difficile. although pcr ribotyping differentiates over 300 types, it is not always sufficiently discriminatory for epidemiological investigations particularly for common ribotypes, e.g., ribotypes 027, 106, and 017. multilocus variable-number tandem-repeat analysis (mlva) is a highly discriminatory molecular subtyping method that has been app ...201121849691
Nosocomial and non-nosocomial Clostridium difficile infections in hospitalised patients in Belgium: compulsory surveillance data from 2008 to 2010.Surveillance of Clostridium difficile infection (CDI) is compulsory in Belgian hospitals. Our objectives were to compare incidence and case characteristics of nosocomial infections (Nc-CDI) with onset of diarrhoea more than two days after hospital admission, with non-nosocomial cases (Nnc-CDI). The database included inpatients from 2008 to 2010. Of 8,351 cases reported by 150 hospitals, 3,102 (37%) were classified as Nnc-CDI and 5,249 (63%) as Nc-CDI. In 2010, the mean incidence per 1,000 admiss ...201122085603
Spread and persistence of Clostridium difficile spores during and after cleaning with sporicidal disinfectants. 201122172407
The vermiform appendix and recurrent Clostridium difficile infection: a curious connection. 201121893132
High prevalence of toxinogenic Clostridium difficile in Nigerian adult HIV patients.Clostridium difficile is the most commonly identified bacterial cause of nosocomial and HIV-related diarrhea. In many developing countries, antibiotic access is unregulated. Nigeria has the third highest HIV burden worldwide. Due to perceptions of low prevalence and resource incapacity, patients with diarrhea are not tested for toxinogenic C. difficile infection (CDI). In this pilot study which included 97 HIV-positive patients at two hospitals in Nigeria, the estimated prevalence of CDI was 43% ...201121855100
Molecular detection of toxigenic cdifficile: toxin A or B gene? 201121882760
increasing hospital costs for clostridium difficile colitis: type of hospital matters.to assess differences in hospital costs for inpatients with clostridium difficile (cd) colitis based on hospital size, rural or urban hospital setting, and hospital designation as a teaching institution.201122000185
Engineered single-domain antibodies with high protease resistance and thermal stability.The extreme pH and protease-rich environment of the upper gastrointestinal tract is a major obstacle facing orally-administered protein therapeutics, including antibodies. Through protein engineering, several Clostridium difficile toxin A-specific heavy chain antibody variable domains (V(H)Hs) were expressed with an additional disulfide bond by introducing Ala/Gly54Cys and Ile78Cys mutations. Mutant antibodies were compared to their wild-type counterparts with respect to expression yield, non-ag ...201122140551
Bedpan washer disinfectors: an in-use evaluation of cleaning and disinfection.As part of a comprehensive approach to decreasing Clostridium difficile in our health authority, an evaluation of the in-use performance of 2 brands of bedpan decontaminators (BPDs) in 2 acute care facilities was performed.201121864763
clostridium difficile in dutch animals: their presence, characteristics and similarities with human isolates.clin microbiol infect abstract: the presence and characteristics of clostridium difficile were investigated in 839 faecal samples from seven different animal species in the netherlands. the number of positive samples ranged from 3.4% (cattle) to 25.0% (dogs). twenty-two different pcr ribotypes were identified. among 96 isolates, 53% harboured toxin genes. all c. difficile isolates from pigs, cattle and poultry were toxinogenic, whereas the majority of isolates from pet animals consisted of non-t ...201121919997
Development and characterization of a xylose-inducible gene expression system for Clostridium perfringens.A xylose-inducible gene expression vector for Clostridium perfringens was developed. Plasmid pXCH contains a chromosomal region from Clostridium difficile (xylR-P(xy)(lB)): xylR, encoding the xylose repressor, xylO, the xyl operator sequence, and P(xylB), the divergent promoter upstream of xylBA encoding xylulo kinase and xylose isomerase. pXCH allows tightly regulated expression of the chloramphenicol acetyltransferase reporter and the a-toxin genes in response to the inducer concentration. Thu ...201121965407
Recommendations for probiotic use-2011 update.This study describes the consensus opinion of the participants of the third Yale Workshop on probiotic use. There were 10 experts participating. The recommendations update those of the first 2 meetings that were published in 2005 and 2008. The workshop presentations and papers in this supplement relate to the involvement of normal microbiota involved in intestinal microecology, how the microbes interact with the intestine to affect our immunologic responses, the stability and natural history of ...201121992958
In vitro evaluation of Lactobacillus gasseri strains of infant origin on adhesion and aggregation of specific pathogens.Numerous Lactobacillus species are members of the normal healthy human intestinal microbiota, and members of the Lactobacillus family predominate among the current marketed probiotic strains. Most of the current commercial probiotic strains have not been selected for specific applications but rather have been chosen based on their technological properties. Often the ability of such strains to temporarily colonize the gastrointestinal tract may be lacking, and the interactions with intestinal mic ...201121902917
Control of an outbreak of diarrhoea in a vascular surgery unit caused by a high-level clindamycin-resistant Clostridium difficile PCR ribotype 106.This report describes an outbreak of Clostridium difficile infection (CDI) in a vascular surgery ward in 2009 caused by a high-level clindamycin-resistant ribotype 106. A case of CDI was defined as a patient with diarrhoea, positive for C. difficile toxin and negative for other enteric pathogens. Cultures were sent to the Scottish Salmonella Shigella and Clostridium difficile Reference Laboratory (SSSCDRL) for PCR ribotyping, antibiotic susceptibility testing and PCR detection of ermB. The mean ...201121864938
antibiotic treatment for clostridium difficile-associated diarrhea in adults.clostridium difficile is recognized as a frequent cause of antibiotic-associated diarrhea and colitis.201121901692
Novel therapy for C. difficile infections. Infusions of donated feces may help those with recurrent infections. 201122121560
[Newly recognized side-effects of proton pump inhibitors : Arguments in favour of fundoplication for GERD?]Among other indications proton pump inhibitors (PPIs) are used as medical treatment of gastroesophageal reflux disease (GERD) and are the most frequently prescribed and most frequently used drugs in gastroenterology. Until recently PPIs were regarded as very safe and associated with very few side-effects. However, during recent years study results have revealed many severe adverse events associated especially with long-term PPI use. We review the currently available evidence, regarding the side- ...201121909830
Laboratory diagnosis of Clostridium difficile infection can molecular amplification methods move us out of uncertainty?The laboratory diagnosis of Clostridium difficile infection (CDI) continues to be challenging. Recent guidelines from professional societies in the United States note that enzyme immunoassays for toxins A and B do not have adequate sensitivity to be used alone for detecting CDI, yet the optimal method for diagnosing this infection remains unclear. Nucleic acid amplification tests (NAATs) that target chromosomal toxin genes (usually the toxin B gene, tcdB) show high sensitivity and specificity, p ...201121854871
The anti-sigma factor TcdC modulates hypervirulence in an epidemic BI/NAP1/027 clinical isolate of Clostridium difficile.Nosocomial infections are increasingly being recognised as a major patient safety issue. The modern hospital environment and associated health care practices have provided a niche for the rapid evolution of microbial pathogens that are well adapted to surviving and proliferating in this setting, after which they can infect susceptible patients. This is clearly the case for bacterial pathogens such as Methicillin Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE) s ...201122022270
clostridium difficile pouchitis after proctocolectomy with ileal pouch-anal anastomosis. 201122196625
Group VIA PLA2 (iPLA2ß) is Activated Upstream of p38 MAP Kinase in Pancreatic Islet Beta Cell Signaling.Group VIA Phospholipase A(2) (iPLA(2)ß) in pancreatic islet ß-cells participates in glucose-stimulated insulin secretion and Sarco(endo)plasmic Reticulum ATPase (SERCA) inhibitor-induced apoptosis, and both are attenuated by pharmacologic or genetic reductions in iPLA(2)ß activity and amplified by iPLA(2)ß overexpression. While exploring signaling events that occur downstream of iPLA(2)ß activation, we found that p38 MAP Kinase (MAPK) is activated by phosphorylation in INS-1 insulinoma cells and ...201122194610
molecular analysis of relapses or reinfections of clostridium difficile-associated diarrhea.recurrence is a major complication of clostridium difficile-associated diarrhea and occurs in 15 to 20% of patients after discontinuation of therapy. strains from 53 patients with clostridium difficile recurrences were fingerprinted by pcr ribotyping. reinfection with a different strain occurred in 15 out of 53 patients (28,3%), while 38 patients relapsed. these data suggest the need to perform molecular typing for implementation of infection control procedures and for a more appropriate therape ...201122143813
Surface proteins from Lactobacillus kefir antagonize in vitro cytotoxic effect of Clostridium difficile toxins.In this work, the ability of S-layer proteins from kefir-isolated Lactobacillus kefir strains to antagonize the cytophatic effects of toxins from Clostridium difficile (TcdA and TcdB) on eukaryotic cells in vitro was tested by cell detachment assay. S-layer proteins from eight different L. kefir strains were able to inhibit the damage induced by C. difficile spent culture supernatant to Vero cells. Besides, same protective effect was observed by F-actin network staining. S-layer proteins from ag ...201122126976
Detection of Clostridium difficile Toxin A/B Genes by Multiplex Real-Time PCR for the Diagnosis of C. difficile infection.Toxigenic Clostridium difficile culture is considered to be a reference diagnostic method for C. difficile infection (CDI), but it is time-consuming. Enzyme immunoassay is rapid and ease-to-use, but has low sensitivity. We evaluated a real-time PCR kit, AdvanSure CD real-time PCR (RT-PCR; LG Life Sciences), which can simultaneously detect C. difficile toxins A and B. A total of 127 fresh diarrheal stool specimens submitted to the clinical microbiology laboratory for C. difficile culture were tes ...201121959205
[a study of patients with clostridium difficile infection hospitalized at brno clinic of infectious diseases in 2007-2010.]background: to describe a set of patients hospitalized at the clinic of infectious diseases of the university hospital brno with clostridium difficile infection (cdi), to interpret clinical and epidemiological data, and to determine the risk factors for the disease and its complications. material and methods: a retrospective study of 284 patients with confirmed diagnosis of clostridium difficile infection hospitalized between 1 january 2007 and 31 december 2010. epidemiological, clinical and lab ...201122247031
longitudinal study comparing the dynamics of clostridium difficile in conventional and antimicrobial free pigs at farm and slaughter.clostridium difficile is the leading cause of nosocomial diarrhea in humans and a major cause of enteritis in neonatal piglets, foals and calves. the aim of this longitudinal study was to determine and compare the prevalence, antimicrobial susceptibility, and toxinotype profiles of c. difficile isolated from pigs and their environment in the indoor conventional and outdoor antimicrobial free (abf) production systems. ten conventional and eight abf cohorts of 35 pigs each and their environment we ...201122243897
intestinal superinfections in patients with inflammatory bowel diseases.intestinal superinfections may occur in the setting of inflammatory bowel diseases (ibd), complicating the clinical picture and triggering flares of disease.201122325169
loop-mediated amplification accelerated by stem primers.isothermal nucleic acid amplifications (inaats) have become an important alternative to pcr for in vitro molecular diagnostics in all fields. amongst inaats loop-mediated amplification (lamp) has gained much attention over the last decade because of the simplicity of hardware requirements. lamp demonstrates performance equivalent to that of pcr, but its application has been limited by the challenging primer design. the design of six primers in lamp requires a selection of eight priming sites wit ...201122272122
how a bowel tumour led to meningitis.this report summarises a case history in which a 75-year-old man was admitted with bacterial meningitis caused by streptococcus bovis. a subsequent abdominal investigation in the light of the known association between invasive s bovis infection and colonic cancer confirmed the suspicion of a cancer located to the rectum. the patient died from clostridium difficile enterocolitis with sepsis and multi-organ failure. this is a highly relevant and interesting case presentation, which besides providi ...201122692778
one-day point prevalence of emerging bacterial pathogens in four secondary and five tertiary care german hospitals - results from a pilot study of the german society for hospital hygiene (deutsche gesellschaft für krankenhaushygiene, dgkh).objective: data on the prevalence of emerging bacterial pathogens like extended-spectrum-lactamase-building (esbl) gram negative organisms, multiresistant pseudomonas and acinetobacter species or toxin-building clostridium difficile in german hospitals are sparse. to provide data for different regions in germany, a one-day point prevalence study with five tertiary care hospitals and four secondary care hospitals was conducted on the 10(th) of february 2010.method: for participating hospitals, th ...201122242101
fidaxomicin: in clostridium difficile infection.fidaxomicin is a first-in-class macrocyclic antibacterial that primarily demonstrates activity against species of clostridia, predominantly clostridium difficile, while having limited or no activity against normal faecal microflora. fidaxomicin is minimally absorbed following oral administration and is excreted almost solely in the faeces. fidaxomicin displayed a high level of antibacterial activity against c. difficile in vitro, with a minimum inhibitory concentration required to inhibit 90% of ...201122141387
Indications and Relative Utility of Lower Endoscopy in the Management of Clostridium difficile Infection.Background. Diagnosis and management of Clostridium difficile infection (CDI) rely upon clinical assessments and diagnostic studies. Among diagnostic tests, lower gastrointestinal (GI) endoscopy in the setting of CDI remains controversial. Objective. To describe the role of lower endoscopy in CDI management. Methods. Retrospective study of lower endoscopies in CDI at four metropolitan hospitals, July 2005 through December 2007. Results. Of 1760 CDI inpatients, 45 lower endoscopies were performed ...201122028704
reduction in the microbial load on high-touch surfaces in hospital rooms by treatment with a portable saturated steam vapor disinfection system.background: recent scientific literature suggests that portable steam vapor systems are capable of rapid, chemical-free surface disinfection in controlled laboratory studies. this study evaluated the efficacy of a portable steam vapor system in a hospital setting. methods: the study was carried out in 8 occupied rooms of a long-term care wing of a hospital. six surfaces per room were swabbed before and after steam treatment and analyzed for heterotrophic plate count (hpc), total coliforms, methi ...201121641089
epidemiology of clostridium difficile on a veal farm: prevalence, molecular characterization and tetracycline resistance.concern has been raised about the potential for clostridium difficile to be a bovine and foodborne pathogen, yet limited study has been performed in cattle, and none in veal calves. this study evaluated the epidemiology and microbiology of c. difficile on one veal farm. rectal swabs were obtained from calves within 48h of arrival and at one, 17 and 21 weeks later. selective culture for c. difficile was performed. isolates were characterized by pcr ribotyping and pcr for tcda, tcdb and cdta. tetr ...201121641131
decline in incidence of clostridium difficile infection after relocation to a new hospital building with single rooms. 201121641679
low risk of clostridium difficile infections in hospitalized patients with inflammatory bowel disease in a german tertiary referral center.introduction: many reports, mainly from the us and canada but also a recent report from a center in europe, have documented the increasing impact of clostridium difficile infections in patients with inflammatory bowel disease (ibd) during the last years. to determine the prevalence of c. difficile infections in hospitalized ibd patients in a tertiary referral center in germany, we conducted this retrospective analysis. methods: data of all ibd in-patients treated due to an acute flare of their i ...201121646782
probiotics for prevention of antibiotic-associated diarrhea and clostridium difficile-associated disease in hospitalized adults-a meta-analysis.purpose: a serious complication associated with the use of most antibiotics is antibiotic-associated diarrhea (aad). the purpose of this article is to report findings from a meta-analysis of available studies on adult hospitalized populations to evaluate efficacy of probiotics for prevention of aad and clostridium difficile-associated disease (cdad). data sources: a comprehensive, systematic search was conducted to identify all relevant studies on probiotic efficacy for prevention of aad and cda ...201121649768
the impact of icd-9-cm code rank order on the estimated prevalence of clostridium difficile infections.us estimates of the clostridium difficile infection (cdi) burden have utilized international classification of disease, ninth revision, clinical modification (icd-9-cm) diagnosis codes. whether icd-9-cm code rank order affects cdi prevalence estimates is important because the national hospital discharge survey (nhds) and the nationwide inpatient sample (nis) have varying limits on the number of icd-9-cm codes collected.201121653298
cumulative antibiotic exposures over time and the risk of clostridium difficile infection.clostridium difficile infection (cdi) is a major cause of hospital-acquired diarrhea and is most commonly associated with changes in normal intestinal flora caused by administration of antibiotics. few studies have examined the risk of cdi associated with total dose, duration, or number of antibiotics while taking into account the complex changes in exposures over time.201121653301
country-to-country transfer of patients and the risk of multi-resistant bacterial infection.management of patients with a history of healthcare contact in multiple countries is now a reality for many clinicians. leisure tourism, the burgeoning industry of medical tourism, military conflict, natural disasters, and changing patterns of human migration may all contribute to this emerging epidemiological trend. such individuals may be both vectors and victims of healthcare-associated infection with multiresistant bacteria. current literature describes intercountry transfer of multiresistan ...201121653302
harnessing the glucosyltransferase activities of clostridium difficile for functional studies of toxins a and b.the incidence of clostridium difficile infection (cdi) has been increasing within the last decade. pathogenic strains of c. difficile produce toxin a and/or toxin b, which are important virulence factors in the pathogenesis of this bacterium. current methods for diagnosing cdi are mostly qualitative tests that detect either the bacterium or the toxins. we have developed an assay (cdifftox activity assay) to detect c. difficile toxin a and b activities that is quantitative and cost-efficient and ...201121653766
bowel preparation for colectomy and risk of clostridium difficile infection.mechanical bowel preparation before colectomy is controversial for several reasons, including a theoretically increased risk of clostridium difficile infection.201121654247
clostridium difficile--a moving target.clostridium difficile has been recognized as a pathogen in humans for over 40 years, but in the past decade the incidence has increased and, more importantly, the clinical presentation and consequences have become more serious, with increased morbidity and mortality. the emergence of a new, more pathogenic strain, bi/nap1/027, has driven these shifts. treatment of this disease has been with two antibiotics, metronidazole and vancomycin, but increasing recurrence, not uncommon with c. difficile i ...201121654927
advantages and challenges of increased antimicrobial copper use and copper mining.copper is a highly utilized metal for electrical, automotive, household objects, and more recently as an effective antimicrobial surface. copper-containing solutions applied to fruits and vegetables can prevent bacterial and fungal infections. bacteria, such as salmonellae and cronobacter sakazakii, often found in food contamination, are rapidly killed on contact with copper alloys. the antimicrobial effectiveness of copper alloys in the healthcare environment against bacteria causing hospital-a ...201121656137
tn916-like genetic elements: a diverse group of modular mobile elements conferring antibiotic resistance.antibiotic-resistant gram-positive bacteria are responsible for morbidity and mortality in healthcare environments. enterococcus faecium, enterococcus faecalis, staphylococcus aureus and streptococcus pneumoniae can all exhibit clinically relevant multidrug resistance phenotypes due to acquired resistance genes on mobile genetic elements. it is possible that clinically relevant multidrug-resistant clostridium difficile strains will appear in the future, as the organism is adept at acquiring mobi ...201121658082
zero prevalence of clostridium difficile in wild passerine birds in europe.clostridium difficile is an important bacterial pathogen of humans and a variety of animal species, where it can cause significant medical problems. the major public health concern is the possibility of inapparent animal reservoirs of c. difficile and shedding of bacteria to noninfected individuals or populations, as well as being a source of food contamination. migrating birds can be a key epizootiological factor for transmission and distribution of pathogens over a wide geographic range. there ...201121658108
clostridium difficile has two parallel and essential sec secretion systems.protein translocation across the cytoplasmic membrane is an essential process in all bacteria. the sec system, comprising at its core an atpase, seca, and a membrane channel, secyeg, is responsible for the majority of this protein transport. recently, a second parallel sec system has been described in a number of gram-positive species. this accessory sec system is characterized by the presence of a second copy of the energizing atpase, seca2; where it has been studied, seca2 is responsible for t ...201121659510
encapsulation of cwp84 into pectin beads for oral vaccination against clostridium difficile.we have designed an oral vaccine against clostridium difficile infection. the virulent factor cwp84, that is a cystein protease highly immunogenic in patients with c. difficile-associated disease, was entrapped within pectin beads. beads encapsulating cwp84 were shown to be stable in the simulated intestinal medium and to release the cystein protease once in the simulated colonic medium. three groups of hamsters were immunized, the first receiving pectin beads encapsulating cwp84, the second unl ...201121664462
in vivo lysogenization of a clostridium difficile bacteriophage ðñcd119.clostridium difficile is a nosocomial pathogen identified as the cause of antibiotic-associated diarrhea and colitis. in this study, we have documented the lysogeny of a c.┬ádifficile bacteriophage in hamsters during c.┬ádifficile infection. the lysogens isolated from the hamsters were toxin typed and their phage integration site was confirmed by pcr. through toxin elisa it was found that the toxin production in the in┬ávivo isolated lysogens was affected due to ðñcd119 lysogenization as in the ...201121664468
clostridium difficile in children: colonisation and disease.clostridium difficile is the commonest cause of hospital acquired diarrhoea in adults and is associated with significant mortality and morbidity. the clinical significance of c. difficile in children, however, is less certain. in this article we discuss colonisation and infection and describe c. difficile in childhood in terms of risk factors, epidemiology and management.201121664931
using electronic health information to risk-stratify rates of clostridium difficile infection in us hospitals.expanding hospitalized patients' risk stratification for clostridium difficile infection (cdi) is important for improving patient safety. we applied definitions for hospital-onset (ho) and community-onset (co) cdi to electronic data from 85 hospitals between january 2007 and june 2008 to identify factors associated with higher ho cdi rates.201121666394
clostridium difficile infection in a long-term care facility: hospital-associated illness compared with long-term care-associated illness.controversy exists over whether clostridium difficile infection (cdi) commonly occurs in long-term care facility residents who have not been recently transferred from an acute care hospital.201121666395
the role played by contaminated surfaces in the transmission of nosocomial pathogens.studies in the 1970s and 1980s suggested that environmental surface contamination played a negligible role in the endemic transmission of healthcare-associated infections. however, recent studies have demonstrated that several major nosocomial pathogens are shed by patients and contaminate hospital surfaces at concentrations sufficient for transmission, survive for extended periods, persist despite attempts to disinfect or remove them, and can be transferred to the hands of healthcare workers. e ...201121666400
using oral vancomycin prescriptions as a proxy measure for clostridium difficile infections: a spatial and time series analysis.sales for a drug may be correlated with the prevalence of a condition treated by the drug. we found that state data revealed a strong spatial association and national data a strong temporal association between clostridium difficile and oral vancomycin prescription sales, suggesting a new "signal" for detecting disease activity.201121666407
serum markers for severe clostridium difficile infection in immunosuppressed hospitalized patients.clostridium difficile infection (cdi) has emerged as the leading cause of nosocomial diarrhea in the developed world. the prompt recognition of severe cdi is essential in providing early aggressive therapy. though previous studies have identified leukocytosis, azotemia, and hypoalbuminemia as markers to differentiate severe from non-severe cdi in the general patient population, there is little data in immunosuppressed patients. we conducted a retrospective chart review of immunosuppressed patien ...201121667802
the economic burden of clostridium difficile.clin microbiol infect abstract: although clostridium difficile (c. difficile) is the leading cause of infectious diarrhoea in hospitalized patients, the economic burden of this major nosocomial pathogen for hospitals, third-party payers and society remains unclear. we developed an economic computer simulation model to determine the costs attributable to healthcare-acquired c. difficile infection (cdi) from the hospital, third-party payer and societal perspectives. sensitivity analyses explored ...201121668576
multi-locus variable number tandem repeat analysis for investigation of the genetic association of clostridium difficile isolates from food, food animals and humans.clostridium difficile is the primary known cause of antibiotic-associated diarrhea. diarrheal disease in food animals due to c. difficile infection has been well documented. recently, reports of c. difficile infections in patients with no known risk factors for disease have raised concern of community acquisition through food animals and food. in this study, multi-locus variable number tandem repeat analysis (mlva) was performed on a collection of 97c. difficile isolates of human, animal and ...201121669297
practice of gastroenterologists in treating flaring inflammatory bowel disease patients with clostridium difficile: antibiotics alone or combined antibiotics/immunomodulators?the optimal management of clostridium difficile infection (cdi) in flaring inflammatory bowel disease (ibd) patients has not been defined. limited data suggest that coadministration of immunomodulators (im) with antibiotics (ab) results in a worse outcome. we investigated the prevalent practice among north american gastroenterologists in this scenario.201121674710
clostron-mediated engineering of clostridium.the genus clostridium is a diverse assemblage of gram positive, anaerobic, endospore-forming bacteria. whilst certain species have achieved notoriety as important animal and human pathogens (e.g. clostridium difficile, clostridium botulinum, clostridium tetani, and clostridium perfringens), the vast majority of the genus are entirely benign, and are able to undertake all manner of useful biotransformations. prominent amongst them are those species able to produce the biofuels, butanol and ethano ...201121815105
the emergence of clostridium difficile infection among peripartum women: a case-control study of a c. difficile outbreak on an obstetrical service.objective. an outbreak of 20 peripartum clostridium difficile infections (cdi) occurred on the obstetrical service at the university of washington medical center (uwmc) between april 2006 and june 2007. in this report, we characterize the clinical manifestations, describe interventions that appeared to reduce cdi, and determine potential risk factors for peripartum cdi. methods. an investigation was initiated after the first three peripartum cdi cases. based on the findings, enhanced infection c ...201121811379
fidaxomicin: first-in-class macrocyclic antibiotic.the incidence of clostridium difficile has doubled over the past 15 years, and rising mortality rates associated with this infection have followed in its wake. c. difficile infection (cdi) has supplanted methicillin-resistant staphylococcus aureus as the major cause of nosocomial infection. an insufficient response rate to currently available cdi therapies has prompted the search for new and alternative treatment modalities for this disease. the investigational pipeline includes evaluation of ne ...201121810048
molecular epidemiology of clostridium difficile in a tertiary medical center in israel: emergence of the polymerase chain reaction ribotype 027.the rate of infection with clostridium difficile colitis and its associated mortality have been increasing in the last decade. the molecular epidemiology of c. difficile in israel has not been studied.201121809729
the management of clostridium difficile-associated diarrhoea in a community hospital.to review the management of patients with clostridium difficile-associated diarrhoea (cdad).201121809713
clostridium difficile infection causing multiple organ failure and small-bowel enteritis. 201121809490
a call to arms: the imperative for antimicrobial stewardship.antimicrobial resistance is a major public health crisis. the prevalence of drug-resistant organisms, such as the emerging nap1 strain of clostridium difficile, now highly resistant to fluoroquinolones, acinetobacter species, klebsiella pneumoniae carbapenemase-producing organisms, and methicillin-resistant staphylococcus aureus, is increasing nationwide. the sources of antimicrobial resistance are manifold, but there is a well-documented causal relationship between antimicrobial use and misuse ...201121795727
the insect peptide, coprisin, prevents clostridium difficile-mediated acute inflammation and mucosal damage through selective antimicrobial activity.clostridium difficile-associated diarrhea and pseudomembranous colitis are typically treated with vancomycin or metronidazole, but recent increases in relapse incidence and the appearance of drug-resistant strains of c. difficile indicate the need for new antibiotics. we previously isolated an antibacterial peptide from copris tripartitus, a korean dung beetle, and identified a nine-amino-acid peptide (coprisin: llcialrkk) that had antimicrobial activity. here, we examined whether coprisin treat ...201121807975
clostridium difficile-associated diarrhea in radiooncology: an underestimated problem for the feasibility of the radiooncological treatment?abstract: background and purpose: over the last years an increasing incidence of clostridium difficile-associated diarrhea (cdad) has been reported. especially haematology-oncology patients are at risk of developing cdad. the aim of this analysis is to determine the incidence of cdad in radiooncological patients and to find out what relevance cdad has for the feasibility of the radiooncological treatment, as well as to detect and describe risk factors. patients and methods: in a retrospective an ...201121806799
the interplay between microbiome dynamics and pathogen dynamics in a murine model of clostridium difficile infection.clostridium difficile infection (cdi) arises in the setting of antibiotic administration where disruption of the normal indigenous gut microbiota leads to susceptibility to c. difficile colonization and colitis. using a murine model of cdi, we demonstrate that changes in the community structure of the indigenous gut microbiota are associated with the loss of colonization resistance against c. difficile. several antibiotic regimens were tested in combination for the ability to overcome colonizati ...201121804357
both, toxin a and toxin b, are important in clostridium difficile infection.the bacterium clostridium difficile is the leading cause of healthcare associated diarrhoea in the developed world and thus presents a major financial burden. the main virulence factors of c. difficile are two large toxins, a and b. over the years there has been some debate over the respective roles and importance of these two toxins. to address this, we recently constructed stable toxin mutants of c. difficile and found that they were virulent if either toxin a or toxin b was functional. this u ...201121804353
disinfection methods for spores of bacillus atrophaeus, b. anthracis, clostridium tetani, c. botulinum and c. difficile.to evaluate disinfection methods for environments contaminated with bioterrorism-associated microorganism (bacillus anthracis), we performed the following experiments. first, the sporicidal effects of sodium hypochlorite on spores of five bacterial species were evaluated. bacillus atrophaeus was the most resistant to hypochlorite, followed in order by b. anthracis, clostridium botulinum and clostridium tetani, and clostridium difficile. subsequently, using b. atrophaeus spores that were the most ...201121804226
structure-based modification of a clostridium difficile targeting endolysin affects activity and host range.endolysin cd27l causes cell lysis of the pathogen c. difficile, a major cause of nosocomial infection. we report a structural and functional analysis of the catalytic activity of cd27l against c. difficile and other bacterial strains. we show that truncation of the endolysin to the n-terminal domain cd27l(1-179) gave an increased lytic activity against cells of c. difficile, while the c-terminal region cd27l(180-270) failed to produce lysis. cd27l(1-179) also has increased activity against other ...201121803993
evaluation of the sporicidal activity of different chemical disinfectants used in hospitals against clostridium difficile.decontamination of surfaces and medical equipment is integral to the control of clostridium difficile transmission, and many products claim to inactivate this bacterium effectively. thirty-two disinfectants were tested against spores of c. difficile in a suspension test based on european standard bs en 13704:2002, with contact times of 1 and 60min in simulations of clean (0.3% albumin) and dirty (3% albumin) conditions. the addition of a 1-min contact time was chosen as a more realistic simulati ...201121802172
fidaxomicin-the next step? a new narrow-spectrum macrocyclic antibiotic for the management of clostridium difficile infection. 201121801724
mortality and associated risk factors in consecutive patients admitted to a uk nhs trust with community acquired bacteraemia.purpose within the uk, there is lack of contemporary data on clinical outcomes in patients admitted to hospital with severe community acquired infection. the purpose of this study was to determine outcomes and risk factors associated with mortality in consecutive patients admitted to a uk nhs trust with community acquired infections that cause bacteraemia. methods from september 2007 to august 2008, demographic, clinical and microbiological data were collected on patients with laboratory confirm ...201121798969
high alpha-1 antitrypsin clearance predicts severity of gut graft-versus-host disease (gvhd) in children.hagen lem, schechter t, luk y, brodovitch a, gassas a, doyle jj. high alpha-1 antitrypsin clearance predicts severity of gut graft-versus-host disease (gvhd) in children. pediatr transplantation 2011. © 2011 john wiley & sons a/s. abstract: the clinical evaluation and management of gut gvhd is a significant challenge in pediatric hsct. it is often difficult to obtain pathological evidence to confirm diagnosis and/or to determine response to treatment. the severity of the disease itself may not ...201121797957
expression, purification, crystallization and preliminary crystallographic analysis of a putative clostridium difficile surface protein cwp19.cwp19 is a putatively surface-located protein from clostridium difficile. a recombinant n-terminal protein (residues 27-401) lacking the signal peptide and the c-terminal cell-wall-binding repeats (pfam04122) was crystallized using the sitting-drop vapour-diffusion method and diffracted to 2 å resolution. the crystal appeared to belong to the primitive monoclinic space group p2(1), with unit-cell parameters a = 109.1, b = 61.2, c = 109.2 å, ß = 111.85°, and is estimated to contain two molecules ...201121795789
a clostridium difficile infection "intervention": change in toxin assay results in fewer c difficile infection cases without changes in patient outcomes.background: clostridium difficile infection (cdi) is most commonly diagnosed using toxin enzyme immunoassays (eias). a sudden decrease in cdi incidence was noted after a change in the eia used at barnes-jewish hospital in st louis. the objective of this study was to determine whether the decreased cdi incidence related to the change in eia resulted in adverse patient outcomes. methods: electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients ...201121794950
[risk factors for clostridium difficile infections in hospitalized patients.]background and objectives: to identify risk factors, and to estimate the crude effects attributable to hospital acquired clostridium difficile infection (cdi). patients and methods: case-control study matched by age, gender, and admission date. patient and healthcare risk factors were evaluated. hospital stays and mortality were compared. results: thirty-eight cases and 76 controls were included (mean age 73 years). cases presented worse charlson index (p .02), higher pre-infection stay (median ...201121794881
impact of a multipronged education strategy on antibiotic prescribing in quebec, canada.background. antibiotic overuse and resistance have become a major threat in the last 2 decades. many programs tried to optimize antibiotic consumption in the inpatient setting, but the outpatient environment that represents the bulk of antibiotic use has been challenging. following a significant rise of clostridium difficile infections, all the health care stakeholders in the province of quebec, canada initiated a global education program targeting physicians and pharmacists. methods. a bundle a ...201121791439
clostridium difficile and methicillin-resistant staphylococcus aureus shedding by slaughter-age pigs.abstract: background: clostridium difficile and methicillin-resistant staphylococcus aureus are critical human pathogens and of increasing concern in food animals. because of the apparent impact of age on prevalence of these organisms, studies of slaughter age pigs are important when considering the potential for contamination of food. this study evaluated c. difficile and mrsa shedding by slaughter age pigs from farms across canada. results: clostridium difficile was isolated from 30/436 (6.9%) ...201121791057
update on the management of ulcerative colitis.the treatment options for inflammatory bowel disease have expanded with the introduction of biological therapies. recently published controlled clinical trials were searched and those that impact the clinical management of ulcerative colitis (uc) are discussed in this review. in the management of mild to moderate uc, mesalamine still remains the first choice of drug. the newly developed once daily formulations have shown equal efficacy to divided doses and possibly portend better compliance owin ...201121789495
mutagenic analysis of the clostridium difficile flagellar proteins, flic and flid, and their contribution to virulence in hamsters.although toxins a and b are known to be important contributors to the acute phase of clostridium difficile infection (cdi), the role of colonization and adherence to host tissues in the overall pathogenesis of these organisms remains unclear. consequently, we used the recently introduced intron-based clostron gene interruption system to eliminate the expression of two reported c. difficile colonization factors, the major flagellar structural subunit (flic) and the flagellar cap protein (flid), t ...201121788384
role of faecal gas analysis for the diagnosis of ibd.the diagnosis of ibd (inflammatory bowel disease) is based on the clinical evaluation of symptoms and signs leading to a series of investigations. the investigations used are often unpleasant for patients; they are invasive, costly and potentially dangerous. patients often report that the odour of flatus, or the gas emitted from faeces, is abnormal during a flare of their ibd. our group has characterized the vocs (volatile organic compounds) in the headspace gas emitted from faecal samples from ...201121787351
a quantitative proteomic analysis of the heat stress response in <i>clostridium difficile</i> strain 630.<i>clostridium difficile</i> is a serious nosocomial pathogen whose prevalence worldwide is increasing. post genomic technologies can now be deployed in order to develop understanding of the evolution and diversity of this important human pathogen, yet little is known about the adaptive ability of <i>c. difficile</i>. we used itraq labelling and 2d-lc-ms/ms driven proteomics to investigate the response of <i>c. difficile</i> 630 to a mild, but clinically relevant heat stress. a statistically val ...201121786815
localization of the clostridium difficile cysteine protease cwp84 and insights into its maturation process.clostridium difficile is a nosocomial pathogen involved in antibiotic-associated diarrhea. c. difficile expresses a cysteine protease, cwp84, which has been shown to degrade some proteins of the extracellular matrix and play a role in the maturation of the precursor of the s-layer proteins. we sought to analyze the localization and the maturation process of this protease. two identifiable forms of the protease were found to be associated in the bacteria: a form of about 80 kda and a cleaved one ...201121784932
the relation between farm specific factors and prevalence of clostridium difficile in slaughter pigs.foodborne ingestion through pork products of clostridium difficile has been suggested a possible route of transmission of c difficile from pigs to humans. to determine whether c. difficile bacteria are present in the intestines of slaughter pigs, rectum contents of 677 slaughter pigs from 52 farms were collected at the slaughterhouse. data on farm specific factors were collected and the association of these factors with the presence of c. difficile in pig herds from 39 farms was assessed. the pr ...201121783332
direct detection of clostridium difficile 027 in diarrhoeal stool samples. 201121783275
emergence of clostridium difficile ribotype 027 in korea.clostridium difficile infection (cdi) has markedly risen and is associated with hypervirulent ribotype 027 outbreaks in north america and europe since 2003. the aims of this study were to determine the prevalence of ribotype 027 among c. difficile isolates in korea, to characterize the ribotype 027 isolates, and to determine the clinical severity of cdi in patients infected with these isolates.201121779194
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