Publications

TitleAbstractYear(sorted ascending)
Filter
PMID
Filter
c-di-gmp turn-over in clostridium difficile is controlled by a plethora of diguanylate cyclases and phosphodiesterases.clostridium difficile infections have become a major healthcare concern in the last decade during which the emergence of new strains has underscored this bacterium's capacity to cause persistent epidemics. c-di-gmp is a bacterial second messenger regulating diverse bacterial phenotypes, notably motility and biofilm formation, in proteobacteria such as vibrio cholerae, pseudomonas aeruginosa, and salmonella. c-di-gmp is synthesized by diguanylate cyclases (dgcs) that contain a conserved ggdef dom ...201121483756
review of proton pump inhibitors for the initial treatment of heartburn: is there a dose ceiling effect?proton pump inhibitors (ppis) are widely used in clinical practice. however, concerns have been expressed about their long-term use, particularly with regard to bone health, clostridium difficile infections, and drug interactions with platelet aggregation inhibitors. there has been limited guidance for clinicians concerning appropriate dose selection of ppis for the initial treatment of heartburn. this review explored whether published clinical trials provide evidence of a ceiling above which hi ...201121484335
bacterial enteritis in dogs and cats: diagnosis, therapy, and zoonotic potential.a variety of bacteria are known or suspected of being able to cause enteritis in dogs and cats. campylobacter spp, clostridium difficile, clostridium perfringens, and salmonella spp are most commonly implicated, but many other organisms are likely involved. poor understanding of the intestinal microflora and the fact that many, if not all, of these microorganisms can also be found in healthy individuals complicates testing, thereby affecting the use of specific treatments and assessment of poten ...201121486637
rapid diagnosis of clostridium difficile infection by multiplex real-time pcr.the gold standards for the diagnosis of clostridium difficile infections (cdis) are the cytotoxicity assay and the toxigenic culture. however, both methods are time-consuming and the results are not available before 24-48 h. we developed and evaluated a multiplex in-house real-time polymerase chain reaction (pcr) assay for the simultaneous detection of toxigenic strains of c. difficile and the presumptive identification of the epidemic nap1/027/bi strain from stools. amplifications were performe ...201121487764
assessing the efficacy of different microfibre cloths at removing surface micro-organisms associated with healthcare-associated infections.this study investigated the ability of 10 different microfibre cloths to remove microbial contamination from three surfaces commonly found in hospital settings (stainless steel, furniture laminate and ceramic tile), under controlled laboratory conditions. tests were conducted using organisms known to cause healthcare-associated infections, i.e. meticillin-resistant staphylococcus aureus (mrsa), clostridium difficile (in spore form) and escherichia coli. for all the cloths tested, there was signi ...201121501897
treatment of refractory and recurrent clostridium difficile infection.the incidence of clostridium difficile infection (cdi) has increased since 2000, with greater numbers of severe cases reported, in part due to the emergence of a hypervirulent strain. initial therapy with metronidazole is still recommended for mild to moderate cdi, but vancomycin is recommended for first-line therapy of severe cdi. colectomy could be life-saving for some patients with severe disease that does not respond to maximal medical therapy. recurrent cdi is a challenge to treat; no singl ...201121502971
recognition of clostridium difficile pcr-ribotypes 001, 027 and 126/078 using an extended maldi-tof ms system.during the last decade, clostridium difficile infection (cdi) increased markedly inside as well as outside of hospitals. in association with the occurrence of new hypervirulent c. difficile strains, cdi became more important. until now typing of c. difficile strains has been enabled by pcr-ribotyping. however, this method is restricted to specialized laboratories combined with high maintenance cost. therefore, we tested maldi-tof mass spectrometry for typing of c. difficile to provide a fast met ...201121503840
evaluation of linezolid for the treatment of clostridium difficile infection caused by epidemic strains using an in vitro human gut model.objectives therapeutic options in clostridium difficile infection (cdi) are limited. we examined linezolid activity in vitro and potential therapeutic efficacy using a gut model of cdi. methods mics were determined by agar incorporation for 118 diverse c. difficile faecal isolates, including epidemic strains and strains with reduced susceptibility to metronidazole. cdi was established in two gut model experiments using c. difficile epidemic strains (ribotypes 027 and 106) and linezolid was dosed ...201121504940
epidemiology and control of clostridium difficile infections in healthcare settings: an update.purpose of review: the epidemiology of clostridium difficile infections (cdis) has dramatically changed over the last decade in both north america and europe. the objectives of this review are to highlight the recent epidemiological data and to provide an overview of the current knowledge of infection control measures. recent findings: since 2003, many countries have reported increased incidence of cdi and outbreaks of severe cases of cdi. this trend is assumed to be due, in part, to the emergen ...201121505332
infectious diseases in the critically ill patients.infection is common in the critically ill and often results due to the severity of the patient's illness. recent data suggest 51% of intensive care unit (icu) patients are infected, and 71% receive antimicrobial therapy. bacterial infection is the primary concern, although some fungal infections are opportunistic. infection more than doubles the icu mortality rate, and the costs associated with infection may be as high as 40% of total icu expenditures. there are many contemporary antimicrobial r ...201121507873
fourteen-genome comparison identifies dna markers for severe-disease-associated strains of clostridium difficile.clostridium difficile is a common cause of infectious diarrhea in hospitalized patients. a severe and increased incidence of c. difficile infection (cdi) is associated predominantly with the nap1 strain; however, the existence of other severe-disease-associated (sda) strains and the extensive genetic diversity across c. difficile complicate reliable detection and diagnosis. comparative genome analysis of 14 sequenced genomes, including those of a subset of nap1 isolates, allowed the assessment o ...201121508155
proton pump inhibitors in rheumatic diseases: clinical practice, drug interactions, bone fractures and risk of infections.platelet activation and aggregation are key elements of the pathogenesis of acute coronary syndromes, of endothelial damage in chronic inflammatory and connective tissue disease (i.e. systemic sclerosis-ssc). patients affected by chronic inflammatory diseases as well as by connective tissue diseases such as systemic sclerosis, often have the need to take anti-platelet therapy (e.g. asa or clopidogrel). current consensus recommendations state that patients prescribed clopidogrel plus aspirin shou ...201121509344
two case reports of clostridium difficile bacteremia, one with the epidemic nap-1 strain.clostridium difficile bacteremia is rare. here, we report two cases of c. difficile bacteremia in patients with significant underlying gastrointestinal pathology. in one case, the bacteremia was caused by the north american pulsed-field gel electrophoresis (pfge) type 1 (nap-1) strain, which is responsible for recent outbreaks of c. difficile infections of increased severity.201121509425
susceptibility of hamsters to infection by historic and epidemic bi clostridium difficile strains during daily administration of three fluoroquinolones.background: the recent epidemic of clostridium difficile infection (cdi) has been attributed largely to the rea strain group bi (aka nap1/027). current isolates of the bi group differ from historic non-epidemic bi strains in that they have developed resistance to the newer fluoroquinolone (fq), moxifloxacin. the acquisition of moxifloxacin resistance has been associated with the rise in frequency of cdi caused by these isolates. in order to explore the effect of fq resistance on cdi we compared ...201121511046
genetic characterisation of clinical isolates of clostridium difficile using an optimised rapd protocol and pcr ribotyping reveals strain diversity between two tertiary referral trusts in the west midlands, uk.epidemiological investigations of clostridium difficile often focus on differences between separate geographical areas. in this investigation, two populations of c. difficile recovered from separate tertiary referral trusts within the west midlands, uk, were characterised using both pcr ribotyping and an optimised rapd protocol. the pcr ribotyping and rapd methodologies identified differences between the two c. difficile populations, both in the prevalence and the diversity of types identified. ...201121511887
scottish antimicrobial prescribing group (sapg): development and impact of the scottish national antimicrobial stewardship programme.in 2008, the scottish management of antimicrobial resistance action plan (scotmarap) was published by the scottish government. one of the key actions was initiation of the scottish antimicrobial prescribing group (sapg), hosted within the scottish medicines consortium, to take forward national implementation of the key recommendations of this action plan. the primary objective of sapg is to co-ordinate and deliver a national framework or programme of work for antimicrobial stewardship. this prog ...201121515030
clostridium difficile pcr ribotype 176 in the czech republic and poland. 201121515161
systematic review of measurement and adjustment for colonization pressure in studies of methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, and clostridium difficile acquisition.colonization pressure is an important infection control metric. the aim of this study was to describe the definition and measurement of and adjustment for colonization pressure in nosocomial-acquisition risk factor studies of methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), and clostridium difficile.201121515979
clostridium difficile infection in a department of veterans affairs long-term care facility.in a veterans affairs medical center, 39% of healthcare facility-onset, healthcare facility-associated clostridium difficile infections had their onset in the affiliated long-term care facility (ltcf). eighty-five percent of ltcf-onset patients had been transferred from the hospital within the past month. delays in diagnosis and treatment were common for ltcf-onset patients.201121515985
toxin a-negative, toxin b-positive clostridium difficile infection diagnosed by polymerase chain reaction. 201121515990
increased health burden associated with clostridium difficile diarrhoea in patients with inflammatory bowel disease.background  clostridium difficile (c. difficile) infection in hospitals in developed countries continues to be a major public health hazard despite increased control measures including review of antibiotic policies and hygiene measures. patients with colitis are thought to be particularly vulnerable to c. difficile associated diarrhoea (cdad). identifying the clinical burden among hospitalised patients admitted with inflammatory bowel disease is an essential first step towards identifying and tr ...201121517920
lipopolysaccharide binding protein, interleukin-6 and c-reactive protein in acute gastrointestinal infections: value as biomarkers to reduce unnecessary antibiotic therapy.aim: several new biomarkers, such as lipopolysaccharide binding protein (lbp) and interleukin-6 (il-6), have the potential to determine the severity and outcome of infectious diseases. lbp and il-6 serum levels have not been reported in patients with gastrointestinal infections. the aim of this study was to compare established markers of infection with new markers, such as lbp and il-6, in patients with acute gastrointestinal infections method: lbp, c-reactive protein (crp), white blood cell cou ...201121523403
rectal prolapse in a child: an unusual presentation of clostridium difficile-associated pseudomembranous colitis.pseudomembranous colitis after short-course antibiotics is rare in children. we report a 14-month-old girl who presented with rectal prolapse complicated with clostridium difficile-associated pseudomembranous colitis after a 4-day course of oral cefuroxime for treatment of acute otitis media. abdominal sonogram showed a pelvic mass, and computed tomography revealed thickened wall of the rectum. sigmoidoscopy demonstrated discrete yellowish plaques adherent to an edematous mucosa. stool cultures ...201121524633
evaluation of a loop-mediated isothermal amplification (lamp) assay for the diagnosis of clostridium difficile infections.a new assay (illumigene c. difficile, meridian bioscience), based on original loop-mediated isothermal amplification (lamp) was evaluated on 472 unformed stools from patients suspected of c. difficile infection. compared to the toxigenic culture, the sensitivity, specificity, positive and negative predictive values were 91.8%, 99.1%, 91.8% and 99.1% for the illumigene c. difficile assay and 69.4%, 100%, 100%, and 96.6% for the cytotoxicity assay, respectively.201121525213
the 3d structure of thuricin cd, a two-component bacteriocin with cysteine sulfur to α-carbon cross-links.thuricin cd is an antimicrobial factor that consists of two peptides, trn-α and trn-β, that exhibit synergistic activity against drug resistant strains of clostridium difficile. trn-α and trn-β each possess three sulfur to α-carbon thioether bridges for which the stereochemistry is unknown. this report presents the three-dimensional solution structures of trn-α and trn-β. structure calculations were performed for the eight possible stereoisomers of each peptide based on the same nmr data. the st ...201121526839
the analysis of para-cresol production and tolerance in clostridium difficile 027 and 012 strains.abstract:201121527013
detection of clostridium difficile in animals: comparison of real-time pcr assays with the culture method.clostridium difficile has emerged as pathogen or commensal in food animals and overlap between isolates from animals, retail meat and humans suggests that animals may be a c. difficile reservoir. for direct detection of variant c. difficile strains in fecal samples of symptomatic and asymptomatic animals, we developed and validated a new taqman real-time pcr (tmrtpcr) targeting tcda, tcdb and cdtb genes. we compared it with enrichment culture method and with two real-time pcr assays brtpcr and p ...201121527548
providers' beliefs and behaviors regarding antibiotic prescribing and antibiotic resistance in persons with spinal cord injury or disorder.persons with spinal cord injury or disorder (sci/d) are at increased risk for antibiotic resistance because of recurrent infections and subsequent use of antibiotics. however, there are no studies focused on providers who care for these patients and their perceptions regarding antibiotic use and resistance.201121528622
epidemiology of clostridium difficile and vancomycin-resistant enterococcus colonization in patients on a spinal cord injury unit.patients with spinal cord injury (sci) are at risk of acquiring colonization with clostridium difficile and vancomycin-resistant enterococcus (vre) due to prolonged hospitalization and frequent antimicrobial use. we examined the frequency of stool, skin, and environmental contamination with c. difficile and vre in hospitalized patients with scl.201121528623
clostridium difficile infection in humans and animals, differences and similarities.clostridium difficile is well known as the most common cause of nosocomial infections in human patients. in recent years a change in epidemiology towards an increase in incidence and severity of disease, not only inside the hospital, but also in the community, is reported. c. difficile is increasingly recognized in veterinary medicine as well and is now considered the most important cause of neonatal diarrhea in swine in north america. research on the presence of c. difficile in production and c ...201121530110
roles of cysteine proteases cwp84 and cwp13 in biogenesis of the cell wall of clostridium difficile.clostridium difficile expresses a number of cell wall proteins, including the abundant s-layer proteins hmw slp and lmw slp. these proteins are generated by post-translational cleavage of the precursor slpa by the cysteine protease cwp84. here we compare the phenotypes of c. difficile strains containing insertional mutations in either cwp84 or its paralog cwp13 and complemented with plasmids expressing wild-type or mutant forms of their genes. we show that the presence of uncleaved slpa in the c ...201121531808
the clostridium difficile cell wall protein cwpv is antigenically variable between strains, but exhibits conserved aggregation-promoting function.clostridium difficile is the main cause of antibiotic-associated diarrhea, leading to significant morbidity and mortality and putting considerable economic pressure on healthcare systems. current knowledge of the molecular basis of pathogenesis is limited primarily to the activities and regulation of two major toxins. in contrast, little is known of mechanisms used in colonization of the enteric system. c. difficile expresses a proteinaceous array on its cell surface known as the s-layer, consis ...201121533071
effect of lactobacillus acidophilus & epidermal growth factor on experimentally induced clostridium difficile infection.background & objectives : clostridium difficile-associated disease (cdad) remains an important nosocomial ailment. antimicrobial therapy used for cdad gives inconsistent results. this experimental study was planned to investigate the beneficial effects of lactobacillus acidophilus and epidermal growth factor (egf) for cdad management. methods: among 10 groups of balb/c mice (6 in each), group 1 served as controls receiving no inoculum. animals in groups 2-10 received c. difficile, those in group ...201121537099
clostridium difficile infection in non-hiv-immunocompromised patients and in hiv-infected patients.clostridium difficile infection is a common cause of morbidity in patients with hiv infection and in patients with non-hiv immune deficiency. the frequency of c. difficile-associated diarrhea (cdad) seen in these two patient populations has been attributed to immune deficiency, as well as to increased exposure to hospital environments and antibiotic therapy, both of which are major risk factors for cdad. this article reviews recent data useful in the evaluation, treatment, and prevention of c. d ...201121541693
effectiveness of a novel ozone-based system for the rapid high-level disinfection of health care spaces and surfaces.background: vapor-based fumigant systems for disinfection of health care surfaces and spaces is an evolving technology. a new system (asepticsure) uses an ozone-based process to create a highly reactive oxidative vapor with broad and high-level antimicrobial properties. methods: ozone gas at 50-500 ppm was combined with 3% hydrogen peroxide vapor in a test chamber and upscaled in rooms measuring 82 m(3) and 90 m(3) in area. test organisms included methicillin-resistant staphylococcus aureus, van ...201121546123
intestinal lactoflora in estonian and norwegian patients with antibiotic associated diarrhea.the disruption of intestinal microbiota is an important risk factor for the development of clostridium difficile caused antibiotic associated diarrhea (aad). the role of intestinal lactoflora in protection against c. difficile is unclear. fecal samples (n = 74) from aad patients were investigated for c. difficile and lactobacilli by culture and real-time pcr. lactobacilli were identified by enterobacterial repetitive intergenic consensus pcr (eric-pcr) and sequencing of 16s rrna. in c. difficile ...201121549208
a complicated case of tacrolimus-induced rapid remission after cesarean section in the early third trimester for refractory severe ulcerative colitis flaring in the initial period of gestation.a 36-year-old woman who had been diagnosed with ulcerative colitis at the age of 17 years was referred to our hospital because of severe abdominal pain and repeated bloody diarrhea that persisted during pregnancy despite combination therapy with high-dose corticosteroids and weekly granulocyte and monocyte adsorptive apheresis (gma). she underwent combination therapy consisting of high-dose corticosteroids, intensive gma (two sessions per week) and vancomycin, which was used to eradicate clostri ...201121552436
prevalence and clinical course of clostridium difficile infection in a tertiary-care hospital: a retrospective analysis.the spectrum of clostridium difficile-associated diarrhea (cdad) is changing. apart from antibiotic use, other risk factors such as use of proton pump inhibitors (ppi) and immunosuppressive agents, intensive care unit (icu) stay and inflammatory bowel disease are being recognized. we retrospectively analyzed data on patients whose stool samples were tested for c. difficile toxin (cdt) by enzyme linked immunosorbent assay between june 2006 and may 2008. demographic and clinical data, and risk fac ...201121553102
lack of association of outcomes with treatment duration and microbiologic susceptibility data in clostridium difficile infections in a non-nap1/bi/027 setting.abstract background: concerns regarding the poor response of severe clostridium difficile infection (cdi) treated with metronidazole have arisen over the last 5 y. methods: we conducted a prospective, non-interventional study of cdi cases at our institution to evaluate the role of drug resistance, co-morbidities, and the emergence of hypervirulent strains on patient outcomes. a total of 118 adult inpatients with diarrhea and a positive stool for c. difficile toxin immunoassay had positive stoo ...201122077148
Silent menace. C. difficile and its threat to health care facilities. 201121882770
[Epidemiology of Clostridium difficile infection in Spain.]There has been increasing interest in Clostridium difficile infection (CDI) due its association with healthcare and its impact on morbidity and mortality in the elderly. During the last few years there has been a growing increase in the number of published studies on the incidence, changes on the clinical presentation and on the epidemiology, with the description of new risk factors. The frequency of CDI in Spain is not sufficiently characterised. The available data indicates that incidence is w ...201122136747
Diagnostic accuracy of real-time polymerase chain reaction in detection of Clostridium difficile in the stool samples of patients with suspected Clostridium difficile Infection: a meta-analysis.Current detection methods for Clostridium difficile infection (CDI) can be time-consuming and have variable sensitivities. Real-time polymerase chain reaction (PCR) may allow earlier and more accurate diagnosis of CDI than other currently available diagnostic tests. A meta-analysis was performed to determine the diagnostic accuracy of real-time PCR.201121890762
Asymptomatic colonization by Clostridium difficile in older adults admitted to a geriatric unit: a prospective cohort study. 201122098041
Multiplex PCR Method for Detection of Clostridium difficile tcdA, tcdB, cdtA, and cdtB and Internal In-Frame Deletion of tcdC.A multiplex PCR method was developed for the detection of Clostridium difficile toxin genes tcdA, tcdB, ctdA, and cdtB and the major in-frame deletion types (18, 39, and 54 bp) of tcdC. The method has high specificity for PCR ribotype 027 and may identify other C. difficile strains of clinical and epidemiological importance.201121976756
Moderate to High Use of Opioid Analgesics Are Associated With an Increased Risk of Clostridium difficile Infection.INTRODUCTION:: Risk factors for Clostridium difficile infection (CDI) include use of broad-spectrum antibiotics, advanced age and lack of an appropriate immune response. Whether antiperistaltics such as opioid analgesics also increase the risk of CDI is uncertain. The purpose of this preliminary study was to determine whether opioid analgesics increase the risk of developing CDI in hospitalized patients receiving broad-spectrum antibiotics. METHODS:: Hospitalized patients were assessed for incid ...201121934595
Characterisation and carriage ratio of Clostridium difficile strains isolated from a community-dwelling elderly population in the United Kingdom.Community-associated Clostridium difficile infection (CDI) appears to be an increasing problem. Reported carriage rates by C. difficile are debatable with suggestions that primary asymptomatic carriage is associated with decreased risk of subsequent diarrhoea. However, knowledge of potential reservoirs and intestinal carriage rates in the community, particularly in the elderly, the most susceptible group, is limited. We have determined the presence of C. difficile in the faeces of a healthy elde ...201121886769
Isolation and characterization of Clostridium difficile from shellfish and marine environments.This pilot study was carried out to evaluate the occurrence of Clostridium difficile in marine environments and in edible shellfish. Samples of seawater, sediment, and zooplankton were collected at five sampling stations in the Gulf of Naples. Six samples of edible shellfish, furthermore, were obtained: two from mussel farms and four from wholesalers. The isolation and the characterization of C. difficile strains were carried out using selective media and molecular techniques, respectively. C. d ...201121901293
relative frequency of health care-associated pathogens by infection site at a university hospital from 1980 to 2008.background: we describe the relative frequency of health care-associated pathogens by infection site over 29 years using hospital-wide surveillance data from a large academic hospital. methods: comprehensive hospital-wide surveillance was provided by trained infection preventionists using centers for disease control and prevention definitions. five 5-year blocks and one 4-year block were created for each site: bloodstream infections (bsi), urinary tract infections (uti), respiratory tract infect ...201121943832
implementation and outcomes of a hospital-wide computerised antimicrobial stewardship programme in a large medical centre in taiwan.antibiotic stewardship is important to address the problem of antimicrobial resistance, but a practical and sustainable strategy to provide stewardship in a large hospital setting is lacking. we developed a hospital-wide computerised antimicrobial approval system (hcaas) to guide the use of antimicrobial agents in late 2004 in a 3500-bed medical centre in taiwan. the objective of this study was to evaluate the impacts of hcaas on the hospital from 2003 to 2009. following hcaas deployment, the gr ...201121982143
clostridium difficile in retail meat and processing plants in texas.the incidence and severity of disease associated with toxigenic clostridium difficile have increased in hospitals in north america from the emergence of newer, more virulent strains. toxigenic c. difficile has been isolated from food animals and retail meat with potential implications of transfer to human beings. the objective of the present study was to determine the prevalence of c. difficile in pork from sausage manufacturing plants and retail meat in texas. twenty-three c. difficile isolates ...201121908329
clostridium difficile infection in newly diagnosed pediatric patients with inflammatory bowel disease: prevalence and risk factors.background: epidemiological and microbiological data suggest that clostridium difficile infection (cdi) plays a substantial role in the clinical initiation of inflammatory bowel disease (ibd). the aim of the present study was to investigate the prevalence and risk factors of cdi in newly diagnosed pediatric patients with ibd. methods: the current investigation was a retrospective study. all patients newly diagnosed with ibd in the pediatric gastroenterology clinic in warsaw between 2007 and 2010 ...201121936029
Do admissions and discharges to long-term care facilities influence hospital burden of Clostridium difficile infection?BACKGROUND: Substantial geographical clustering of Clostridium difficile infection (CDI) outbreaks in hospitals in the USA have previously been demonstrated. AIM: To test the hypothesis that hospital burden of CDI is associated with admission from and discharge to long-term care facilities (LTCFs). METHODS: Hospital discharge data from 19 states in the USA were used to identify all patients discharged with a diagnosis of CDI from 1 January 2002 to 31 December 2004. For every hospital, the propor ...201122137065
Spread and persistence of Clostridium difficile spores during and after cleaning with sporicidal disinfectants. 201122177022
Gas discharge plasmas are effective in inactivating Bacillus and Clostridium spores.Bacterial spores are the most resistant form of life and have been a major threat to public health and food safety. Nonthermal atmospheric gas discharge plasma is a novel sterilization method that leaves no chemical residue. In our study, a helium radio-frequency cold plasma jet was used to examine its sporicidal effect on selected strains of Bacillus and Clostridium. The species tested included Bacillus subtilis, Bacillus stearothermophilus, Clostridium sporogenes, Clostridium perfringens, Clos ...201122075631
Lack of Association between Clinical Outcome of Clostridium difficile Infections, Strain Type, and Virulence-Associated Phenotypes.Clostridium difficile strain NAP1/027 (North American pulsed-field gel electrophoresis [PFGE] type 1 and PCR ribotype 027 [R027]) has been associated with recent outbreaks in North America and Europe. It has been associated with more severe disease symptoms, higher mortality rates, and greater risk of relapse. This strain is thought to produce more toxins and sporulate to higher levels. However, recent studies suggest that this may not always be the case. The objective of our study was to assess ...201121956985
Lipolysis-stimulated lipoprotein receptor (LSR) is the host receptor for the binary toxin Clostridium difficile transferase (CDT).Clostridium difficile infection (CDI) causes antibiotic-associated diarrhea and pseudomembranous colitis. Hypervirulent strains of the pathogen, which are responsible for increased morbidity and mortality of CDI, produce the binary actin-ADP ribosylating toxin Clostridium difficile transferase (CDT) in addition to the Rho-glucosylating toxins A and B. CDT depolymerizes the actin cytoskeleton, increases adherence and colonization of Clostridia by induction of microtubule-based cell protrusions an ...201121930894
concomitant therapy with methotrexate and anti-tnf-α in pediatric patients with refractory crohn's colitis: a case series.background: crohn's colitis refractory to anti-tumor necrosis factor alpha (tnf-α) therapy is commonly seen in tertiary care centers for pediatric inflammatory bowel disease (ibd). we report our experience in managing pediatric refractory crohn's colitis with concomitant use of methotrexate and anti-tnf-α therapy. methods: we reviewed records from 2007 to 2010 at the mayo clinic pediatric ibd center. we included all patients with crohn's disease (cd) failing anti-tnf-α therapy who then received ...201121882301
acquisition of spores on gloved hands after contact with the skin of patients with clostridium difficile infection and with environmental surfaces in their rooms.in a prospective study of 30 patients with clostridium difficile infection, we found that acquisition of spores on gloved hands was as likely after contact with commonly touched environmental surfaces (ie, bed rail, bedside table, telephone, call button) as after contact with commonly examined skin sites (ie, chest, abdomen, arm, hand).201121982209
fidaxomicin: a macrocyclic antibiotic for the treatment of clostridium difficile infection.clostridium difficile is an emerging pathogen in certain health care systems and community-based populations that is associated with high rates of morbidity and mortality, as well as increased costs for the health care system. as recurrence rates increase, new pharmacologic agents to treat c. difficile infection are needed. fidaxomicin, a novel macrocyclic antibiotic, was recently approved by the united states food and drug administration for the treatment of c. difficile-associated diarrhea. or ...201121923589
probiotics for prevention and treatment of diarrhea.probiotics have been extensively studied over the past several years in the prevention and, to a larger extent, in the treatment of diarrheal diseases, especially in pediatric populations. diarrhea is a symptom, and not a disease. this review will not address chronic disorders associated with diarrhea, or clostridium difficile-induced diarrhea. rather it will focus on published clinical trials performed on acute-onset, likely infectious diarrhea occurring in the settings of day-care centers, in ...201121992955
mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy.both gastrointestinal microbiota composition and cesarean section have been linked to atopic manifestations. however, results are inconsistent, and the hypothesized intermediate role of the microbiota in the association between birth mode and atopic manifestations has not been studied yet.201121872915
mechanism for gene control by a natural allosteric group i ribozyme.an allosteric ribozyme consisting of a metabolite-sensing riboswitch and a group i self-splicing ribozyme was recently found in the pathogenic bacterium clostridium difficile. the riboswitch senses the bacterial second messenger c-di-gmp, thereby controlling 5'-splice site choice by the downstream ribozyme. the proximity of this allosteric ribozyme to the open reading frame (orf) for cd3246 suggests that coenzyme-mediated regulation of splicing controls expression of this putative virulence gene ...201121960486
prevalence of antimicrobial-resistant organisms in residential aged care facilities.to assess the frequency of, and risk factors for, colonisation with vancomycin-resistant enterococci (vre), clostridium difficile and extended-spectrum β-lactamase (esbl)-producing organisms in residential aged care facilities (racfs).201122060088
the clostridium difficile cell wall protein cwpv undergoes enzyme-independent intramolecular autoproteolysis.clostridium difficile infection is a leading cause of antibiotic-associated diarrhoea, placing considerable economic pressure on healthcare systems and resulting in significant morbidity and mortality. the pathogen produces a proteinaceous array on its cell surface known as the s-layer, consisting primarily of the major s-layer protein slpa and a family of slpa homologues. cwpv is the largest member of this family and is expressed in a phase variable manner. the protein is post-translationally p ...201122128177
fecal microbiota transplantation and emerging applications.fecal microbiota transplantation (fmt) has been utilized sporadically for over 50 years. in the past few years, clostridium difficile infection (cdi) epidemics in the usa and europe have resulted in the increased use of fmt, given its high efficacy in eradicating cdi and associated symptoms. as more patients request treatment and more clinics incorporate fmt into their treatment repertoire, reports of applications outside of cdi are emerging, paving the way for the use of fmt in several idiopath ...201122183182
clostridium difficile: a problem of concern in developed countries and still a mystery in latin america.clostridium difficile-associated disease (cdad) is caused by a spore-forming bacterium and can result in highly variable disease, ranging from mild diarrhoea to severe clinical manifestations. infections are most commonly seen in hospital settings and are often associated with on-going antibiotic therapy. incidences of cdad have shown a sustained increase worldwide over the last ten years and a hyper-virulent c. difficile strain, pcr ribotype 027/rea type bi/north american pulsed-field (nap) typ ...201122116982
public reporting of clostridium difficile and improvements in diagnostic tests. 201122080669
clostridium difficile infection and proton pump inhibitor use in hospitalized pediatric cystic fibrosis patients.children with cystic fibrosis (cf) often take proton pump inhibitors (ppis), which helps improve efficacy of fat absorption with pancreatic enzyme replacement therapy. however, ppi use is known to be associated with clostridium difficile-(c. diff-) associated diarrhea (cdad). we retrospectively evaluated the incidence of c. diff infection from all pediatric hospital admissions over a 5-year period at a single tertiary children's hospital. we found significantly more c. diff-positive stool tests ...201122144994
co-morbidities as predictors of mortality in clostridium difficile infection and derivation of the arc predictive score.clostridium difficile associated diarrhoea (cdad) has increased significantly in the last 15 years, but predictors of outcome are inadequately understood. this was a cohort study of 2761 patients in north east england between 2002 and 2009, with the end-point of mortality at 30 days. the role of age, gender and co-morbidities was examined by binary logistic regression. rounded odds ratios were used to develop a predictive score. a predictive score based on age, renal disease and cancer (arc scor ...201122047977
bacillus coagulans gbi-30 (bc30) improves indices of clostridium difficile-induced colitis in mice.abstract:201122014083
treating clostridium difficile infection with fecal microbiota transplantation.clostridium difficile infection is increasing in incidence, severity, and mortality. treatment options are limited and appear to be losing efficacy. recurrent disease is especially challenging; extended treatment with oral vancomycin is becoming increasingly common but is expensive. fecal microbiota transplantation is safe, inexpensive, and effective; according to case and small series reports, about 90% of patients are cured. we discuss the rationale, methods, and use of fecal microbiota transp ...201121871249
community-acquired clostridium difficile-associated diarrhea, montréal, 2005-2006: frequency estimates and their validity.a retrospective search for community-acquired clostridium difficile-associated diarrhea in 15 hospitals revealed important discrepancies with numbers for the same period reported in real time to the surveillance system. several of the observed problems could be solved by implementing case-by-case notification with subsequent investigation by local public health, as for other reportable diseases.201121931255
seasonal variations in clostridium difficile infections are associated with influenza and respiratory syncytial virus activity independently of antibiotic prescriptions: a time series analysis in quebec, canada.seasonal variations in clostridium difficile-associated diarrhea (cdad), with a higher incidence occurring during winter months, have been reported. although winter epidemics of respiratory viruses may be temporally associated with an increase in cdad morbidity, we hypothesized that this association is mainly due to increased antibiotic use for respiratory infections. the objective of this study was to evaluate the effect of the two most frequent respiratory viruses (influenza virus and respirat ...201122106208
Evaluation of chronic diarrhea.Chronic diarrhea, defined as a decrease in stool consistency for more than four weeks, is a common but challenging clinical scenario. It can be divided into three basic categories: watery, fatty (malabsorption), and inflammatory. Watery diarrhea may be subdivided into osmotic, secretory, and functional types. Watery diarrhea includes irritable bowel syndrome, which is the most common cause of functional diarrhea. Another example of watery diarrhea is microscopic colitis, which is a secretory dia ...201122085666
fluoroquinolones, antimicrobial resistance and neutropenic cancer patients.fluoroquinolone antibiotics are widely used in our communities and healthcare facilities. this review focuses upon the relationship between fluoroquinolone use and the rising prevalence in neutropenic cancer patients of multidrug resistant pathogens including methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci, clostridium difficile, and aerobic gram-negative bacilli.201122001945
postantibiotic effect of fidaxomicin and its major metabolite, op-1118, against clostridium difficile.fidaxomicin (fdx), a narrow-spectrum antibiotic recently shown to be superior to vancomycin in providing sustained clinical response to clostridium difficile infection, was investigated along with its major metabolite, op-1118, with regard to their postantibiotic effects (pae). fdx was found to have a prolonged pae (10 h versus atcc strains and 5.5 h versus a clinical isolate), and op-1118's pae was longer than that of the standard comparator, vancomycin (3 versus 0 to 1.5 h, respectively).201121709084
clostridium difficile infection: monoclonal or polyclonal genesis?clostridium difficile is considered to be a leading cause of hospital-acquired diarrhea. c. difficile (cdi) infection shows a high rate of recurrence. there would have to be a predominantly monoclonal mechanism of cdi within individual patients in order for molecular epidemiologic tools such as polymerase chain reaction (pcr) ribotyping to be useful in outbreak investigation or differentiation between infection relapse versus re-infection. it was the aim of our study to determine whether cdi is ...201121826436
Microbiology of regressive autism.This manuscript summarizes some of our earlier work on the microbiology of autism subjects' stool specimens, as compared with stools from control subjects. Our most recent data indicating that Desulfovibrio may play an important role in regressive autism is also presented. In addition, we present information on antimicrobial susceptibility patterns of Desulfovibrio using the CLSI agar dilution susceptibility technique. In addition, we summarize data from our earlier studies showing the impact of ...201122202440
the epidemiology of community-acquired clostridium difficile infection: a population-based study.clostridium difficile infection (cdi) is a common hospital-acquired infection with increasing incidence, severity, recurrence, and associated morbidity and mortality. there are emerging data on the occurrence of cdi in nonhospitalized patients. however, there is a relative lack of community-based cdi studies, as most of the existing studies are hospital based, potentially influencing the results by referral or hospitalization bias by missing cases of community-acquired cdi.201122108454
molecular and microbiological characterization of clostridium difficile isolates from single, relapse, and re-infection cases.in this study, we investigated the correlation between the microbiological characteristics of clostridium difficile clinical isolates and the recurrence of c. difficile-associated disease (cdad). twenty c. difficile isolates recovered from 20 single infection cases and 53 isolates from 20 recurrent cases were analyzed by pulsed-field gel electrophoresis (pfge) and pcr ribotyping, and cytotoxicity, antimicrobial susceptibility and sporulation/germination rates of the isolates were examined. recur ...201122205786
Seasonality of Clostridium difficile infections in Southern Germany.SUMMARYBetween 2000 and 2009, the total number of patients with Clostridium difficile infections increased considerably in Southeastern Germany. A clear seasonality was observed with a higher number of affected patients occurring in the winter months (January-March). Moxifloxacin and erythromycin-resistant C. difficile PCR ribotypes 001 (72%) and 027 (4·6%) were the most commonly isolated strains.201122152928
[Pathogenicity factors of bacteria with glycosylating activity].A and B toxins of Clostridium difficile, a-toxin of C. novyi, lehal toxin of C. sordellii, and TpeL toxin of C. perfringens belong to the group of the so-called large Clostridium toxins. These toxins modify low-molecular weight guanosine triphosphate-binding proteins of the Rho/Ras family by their glycosylation that results in inactivation of major signal pathways in eukaryotic cells. Lgt glycosyltransferases, a new group of pathogenicity factors also capable of inactivating eukaryotic substrate ...201122168036
Savings from the use of a probiotic formula in the prophylaxis of antibiotic-associated diarrhea.Abstract Objective: Antibiotic-associated diarrhea (AAD) and particularly Clostridium difficile-associated diarrhea (CDAD) are the most common causes of healthcare associated infectious diarrhea. A double-blind, dose response, placebo-controlled trial of the probiotic formula (Bio-K+ Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R formula) for prophylaxis of AAD and CDAD was published in 2010. The Bio-K+ Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R formula ...201122023067
[proton pump inhibitors and infection risk].gastric antisecretory drugs, especially proton pump inhibitors, are among the most used drugs both in ambulatory and hospital settings, and prescription does not always follows approved indications. experimental data suggest that gastric acid inhibition and the effects of proton pump inhibitors on the immune system can promote the development of infections. in recent years a number of observational studies have found an independent association between the use of proton pump inhibitors and an inc ...201121412664
the host immune response to clostridium difficile.clostridium difficile is the most common cause of nosocomial bacterial diarrhoea in the western world. diarrhoea and colitis are caused by the actions of toxins a and b released by pathogenic strains of c. difficile. adaptive immune responses to these toxins influence the outcomes of c. difficile infection (cdi). symptomless carriers of toxinogenic c. difficile and those with a single episode of cdi without recurrence show more robust antitoxin immune responses than those with symptomatic and re ...201121415200
characterization and antimicrobial susceptibility of clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in poland, 2004-2006.this study analysed 330 clostridium difficile strains isolated from patients with c. difficile infection who were hospitalized in two university hospitals (h1 and h2) in warsaw, poland, over the period 2004-2006. strains were investigated for the presence of tcda (a), tcdb (b) and binary toxin (cdt) genes, and antimicrobial susceptibility was determined against nine agents. among the 330 c. difficile isolates, 150 (45.4?%) were classified as a(+)b(+)cdt(-), 18 (5.5?%) as a(+)b(+)cdt(+), 144 (43. ...201121415206
antimicrobial photodynamic therapy in the colon: delivering a light punch to the guts?a paper in this issue of photochemistry and photobiology by cassidy et al. describes the use of a sophisticated drug delivery vehicle prepared by the hot melt extrusion process to deliver photosensitizers to the colon. the smart vehicle protects its cargo through the acidic environment of the stomach but releases the active photosensitizers in the higher ph and anaerobic environment of the colon. the goal is to use photodynamic therapy (pdt) to destroy pathogenic microorganisms that can cause di ...201121418077
increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients.to explore the clinical impact and economic burden of hospital-acquired infections (hais) in trauma patients using a nationally representative database.201121422331
[clostridium difficile-induced necrotizing enteritis].clostridium difficile infection usually manifests as pseudomembranous colitis. infection of the small intestine is rare. c. difficile enteritis has a high mortality rate due to secondary enteric necrosis and perforation.201122166175
Hypervirulent Clostridium difficile PCR-ribotypes exhibit resistance to widely used disinfectants.The increased prevalence of Clostridium difficile infection (CDI) has coincided with enhanced transmissibility and severity of disease, which is often linked to two distinct clonal lineages designated PCR-ribotype 027 and 017 responsible for CDI outbreaks in the USA, Europe and Asia. We assessed sporulation and susceptibility of three PCR-ribotypes; 012, 017 and 027 to four classes of disinfectants; chlorine releasing agents (CRAs), peroxygens, quaternary ammonium compounds (QAC) and biguanides. ...201122039420
Clostridium difficile infection in outpatients, Maryland and Connecticut, USA, 2002-2007.Clostridium difficile, the most commonly recognized diarrheagenic pathogen among hospitalized persons, can cause outpatient diarrhea. Of 1,091 outpatients with diarrhea, we found 43 (3.9%) who were positive for C. difficile toxin. Only 7 had no recognized risk factors, and 3 had neither risk factors nor co-infection with another enteric pathogen.201122000379
Comparison between the two-step and the three-step algorithms for the detection of toxigenic Clostridium difficile.To evaluate usefulness of applying either the two-step algorithm (Ag-EIAs and CCNA) or the three-step algorithm (all three assays) for better confirmation of toxigenic Clostridium difficile. The antigen enzyme immunoassays (Ag-EIAs) can accurately identify the glutamate dehydrogenase antigen of toxigenic and nontoxigenic Clostridium difficile. Therefore, it is used in combination with a toxin-detecting assay [cell line culture neutralization assay (CCNA), or the enzyme immunoassays for toxins A ...201121860113
Proceedings from the 3rd International Clostridium difficile Symposium 2010, September 22-24, 2010, Bled, Slovenia. 201121928503
clostridium difficile in the icu: the struggle continues.clostridium difficile infection (cdi) management has become more daunting over the past decade because of alarming increases in cdi incidence and severity both in the hospital and in the community. this increase has concomitantly caused significant escalation of the health-care economic burden caused by cdi, and it will likely be translated to increased icu admission and attributable mortality. some possible causes for difficulty in management of cdi are as follows: (1) inability to predict and ...201122147824
Infective aneurysm of the inferior pancreaticoduodenal artery.INTRODUCTION: Pancreaticoduodenal (PD) artery aneurysms account for less than 2% of all splanchnic aneurysms. A mycotic aetiology is extremely uncommon. INTRODUCTION: Two weeks following an episode of sepsis related to a prostatic biopsy, a 59-year-old man presented with abdominal pain and anaemia. Ultrasonography and computed tomography revealed an inferior PD artery pseudoaneurysm with an associated mesenteric root haematoma. This was treated successfully by transcatheter embolisation. INTRODU ...201121929894
Robotic presacral neurectomy - technique and results.BACKGROUND: The feasibility, safety and outcomes of robotic presacral neurectomy were evaluated. METHODS: A retrospective analysis was performed of 33 patients with midline chronic pelvic pain, who underwent robotic presacral neurectomy. Data were collected during the period March 2004-March 2010. RESULTS: All patients underwent robotic presacral neurectomy and additional robotic procedures. Mean operating time for robotic presacral neurectomy was 5.8 (range 4.4-6.9) min. Mean blood loss, includ ...201121984315
Novel One-Step Method for Detection and Isolation of Active-Toxin-Producing Clostridium difficile Strains Directly from Stool Samples.The alarming emergence of hypervirulent strains of Clostridium difficile with increased toxin production, severity of disease, morbidity, and mortality emphasizes the need for a culture method that permits simultaneous isolation and detection of virulent strains. The C. difficile toxins A and B are critical virulence factors, and strains can either be toxin-producing (virulent) or non-toxin-producing (nonvirulent). Strains that are isolated from human infections generally produce either toxin A ...201121976761
Effective utilization of evolving methods for the laboratory diagnosis of Clostridium difficile infection. 201121960717
Changing incidence and clinical manifestations of Clostridium difficile-associated diarrhea detected by combination of glutamate dehydrogenase and toxin assay in Northern Taiwan.BACKGROUND/PURPOSE: The incidence of Clostridium difficile-associated diarrhea (CDAD) is increasing worldwide. Spread of an epidemic hypervirulent strain in southern Taiwan was associated with poor outcome. This prospective study evaluates the incidence and clinical manifestation of CDAD following a hospital-wide hand hygiene promotion program in a 2,200-bed teaching hospital in northern Taiwan. PATIENTS AND METHODS: From June 1, 2010 to October 31, 2010, a predefined protocol was used to active ...201122209696
[clostridium difficile infections: what is new?].c. difficile is the most common infectious cause of healthcare-associated diarrhea but now is increasingly recognized as a cause of diarrhea in outpatients and persons without apparent health care contacts. emergence and spread of new epidemic clones of c. difficile 027 (pcr-ribotype) and 078/126 (toxinotype) with increase toxin production, an aditional binary toxin and high level resistance to fluoroquinolones and increasing incidence of more rapidly progressive severe disease, require prompt c ...201122046768
Refresh
firstprev
...61626364656667686970...
nextlast
Displaying items 6401 - 6500 of 12134