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does viral gastroenteritis really increase the reports of clostridium difficile infection? 201121239080
the impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals.to determine the effect of enhanced cleaning of the near-patient environment on the isolation of hospital pathogens from the bed area and staff hands.201121242793
rapid stool-based diagnosis of clostridium difficile infection by real-time pcr in a children's hospital.clostridium difficile is a major cause of nosocomial antibiotic-associated infectious diarrhea and pseudomembranous colitis. detection of c. difficile by anaerobic bacterial culture and/or cytotoxicity assays has been largely replaced by rapid enzyme immunoassays (eia). however, due to the lack of sensitivity of stool eia, we developed a multiplex real-time pcr assay targeting the c. difficile toxin genes tcda and tcdb. stool samples from hospitalized pediatric patients suspected of having c. di ...201121209161
insulin-like growth factor-1 receptor transactivation modulates the inflammatory and proliferative responses of neurotensin in human colonic epithelial cells.neurotensin (nt) is a gastrointestinal neuropeptide that modulates intestinal inflammation and healing by binding to its high-affinity receptor ntr1. the dual role of nt in inflammation and healing is demonstrated in models of colitis induced by clostridium difficile toxin a and dextran sulfate sodium, respectively, and involves nf-κb-dependent il-8 expression and egf receptor-mediated mapk activation in human colonocytes. however, the detailed signaling pathways involved in these responses rema ...201121212273
difference in the biological effects of clostridium difficile toxin b in proliferating and non-proliferating cells.toxin a (tcda) and toxin b (tcdb) from clostridium difficile are the causative agents of the c. difficile-associated diarrhea (cdad) and its severe form, the pseudomembranous colitis. tcda and tcdb both glucosylate and thereby inactivate low molecular weight gtp-binding proteins of the rho, rac, and cdc42 subfamilies. in cultured cell lines, tcdb induces actin re-organization and bi-nucleation ("cytopathic effects") and cell death ("cytotoxic effects"). in this study, the role of cell cycle prog ...201121212934
optical density cut-off values for clostridium difficile enzyme immunoassays. 201121216035
neutralization of clostridium difficile toxin a with single-domain antibodies targeting the cell receptor binding domain.clostridium difficile is a leading cause of nosocomial infection in north america and a considerable challenge to healthcare professionals in hospitals and nursing homes. the gram-positive bacterium produces two high molecular weight exotoxins, toxin a (tcda) and toxin b (tcdb), which are the major virulence factors responsible for c. difficile-associated disease and are targets for c. difficile-associated disease therapy. here, recombinant single-domain antibody fragments (v(h)hs), which specif ...201121216961
us fda grants fast-trackdesignation to sanofi pasteur's investigational clostridium difficile vaccine. 201121217176
'game changer' antibiotic and others in works for superbug. 201121217660
clostridium difficile from healthy food animals: optimized isolation and prevalence.two isolation methods were compared for isolation of clostridium difficile from food animal feces. the single alcohol shock method (ss) used selective enrichment in cycloserine-cefoxitin fructose broth supplemented with 0.1% sodium taurocholate, followed by alcohol shock and isolation on tryptic soy agar supplemented with 5% sheep blood, and cycloserine-cefoxitin fructose agar. the double alcohol shock method (ds) used alcohol shock prior to and after selective enrichment in cycloserine-cefoxiti ...201121219775
infection acquisition following intensive care unit room privatization.patients in intensive care units (icus) often acquire infections, which impose a heavy human and financial burden. the use of private rooms may reduce the acquisition of certain pathogens, but the limited evidence on this topic is inconsistent.201121220658
systemic absorption of oral vancomycin in patients with clostridium difficile infection.oral vancomycin is utilized in the treatment of severe clostridium difficile infection (cdi). we prospectively measured serum vancomycin concentrations (svc) in patients treated with oral vancomycin. the svc was measured by immunoassay prior to, and at least 3 days after, the administration of oral vancomycin 125 mg every 6 h. patients treated with intravenous vancomycin were excluded. fifty-seven patients with a mean age of 74 y (± 18) were enrolled. there was no detectable svc in 56 patients ( ...201121198337
clostridium difficile infection in hospitalized children in the united states.to evaluate the trend in clostridium difficile infection (cdi) among hospitalized children in the united states and to evaluate the severity of and risk factors associated with these cases of cdi.201121199971
beyond the target pathogen: ecological effects of the hospital formulary.antibiotic therapy has the potential for intended as well as unintended consequences due to ecological effects that extend beyond the target pathogen. this review examines some of the collateral damage and collateral benefit that may occur when using antibiotic therapy.201121200181
clostridium difficile infection among children with cancer.we used data from the kids' inpatient database to examine clostridium difficile infection (cdi) among children with cancer. the cdi rate was 15 times greater among children with cancer compared with those without cancer. children with cancer accounted for 21% of all pediatric cdi cases. increased adherence to infection control recommendations is needed to address cdi in children with cancer.201121206395
typhlitis in children with malignancy: a single center experience.in a case-control study, medical records of all children (below 18 y of age) who were diagnosed with any malignancy between january 1988 and december 2008 were reviewed. children who developed typhlitis during the course of their malignancy were identified. age and sex-matched controls who were diagnosed with malignancy during the same time period but did not develop typhlitis were identified (1:4 ratio). the variables that were examined included underlying malignancy, chemotherapy, and final ou ...201121127432
the role of environmental cleaning in health care-associated infections.multidrug-resistant organisms such as methicillin-resistant staphylococcus aureus (mrsa) and toxin-producing organisms such as clostridium difficile have been a concern for over 30 years. an increasing focus is being placed on the role that an unclean environment can play in transmission. this article describes the pathogens of concern and the use of a robust environmental cleaning program to help reduce the chances for hospital-acquired infections.201121160295
pathogenic c difficile is here (and everywhere) to stay. 201121084110
clostridium difficile infection in europe: a hospital-based survey.little is known about the extent of clostridium difficile infection in europe. our aim was to obtain a more complete overview of c difficile infection in europe and build capacity for diagnosis and surveillance.201121084111
improving surveillance for pediatric clostridium difficile infection: derivation and validation of an accurate case-finding tool.the incidence of clostridium difficile infection (cdi) is increasing. multicenter studies of cdi have been limited by the lack of valid case-finding tools. to facilitate pediatric studies of cdi, we constructed a case-finding tool using administrative data.201121079527
ischemic colitis after capecitabine plus cisplatin treatment in advanced gastric cancer.systemic chemotherapy can be complicated by colonic toxicity, which usually determines the onset of pseudomembranous colitis and, rarely, of ischemic colitis in patients with cancer. this report describes the case of a 45-year-old man with advanced gastric cancer who developed severe ischemic colitis after chemotherapy with cisplatin and capecitabine. the patient developed symptoms of gastrointestinal toxicity with abdominal pain and bloody diarrhea. he had a normal white blood cell count throug ...201121069429
innate resistance to sporicides and potential failure to decontaminate.bacterial spores are frequently intrinsically resistant to biocides and only a number of alkylating and oxidising biocides are sporicidal under certain conditions. activity against spores is affected by several key factors such as concentration, exposure time, soiling, and the types of surface to be treated. sporicidal efficacy is usually achieved after an exposure time of several minutes with a high concentration of a biocide. failure to understand these factors will result in decreased sporici ...201120850897
currently available sporicides for use in healthcare, and their limitations.clostridium difficile has been recognised for some time as a pathogen which can contaminate the environment and which is associated with secondary spread via this route. unfortunately many of the disinfectants currently used in healthcare environments are inactive against this organism. for example, alcohol-containing hand rubs do not have sporicidal activity and some quaternary ammonium compounds and detergents may even encourage sporulation. european standards have been developed to allow a st ...201120850900
the attachment, internalization, and time-dependent, intracellular distribution of clostridium difficile toxin a in porcine intestinal explants.toxin a (tcda), secreted by toxigenic strains of clostridium difficile, produces lesions typical of c. difficile-associated disease (cdad) in susceptible mammal species. porcine colon explants maintained for 2 hours with tcda developed severe lesions characterized by cell swelling, swelling of mitochondria and other organelles, distension of cytoplasmic vesicles, expansion of paracellular spaces, apoptosis, and necrosis. severity of lesions was proportional to the dosage of toxin. no lesions wer ...201120861504
oral vancomycin may have significant absorption in patients with clostridium difficile colitis.a patient on haemodialysis with bowel ischemia was given vancomycin 500 mg orally every 6 h for superimposed clostridium difficile colitis resulting in a high vancomycin serum concentration. when treating c. difficile colitis in patients with significant renal impairment and bowel injury, we recommend administering the lower dose of oral vancomycin.201120831355
physician density and hospitalization for inflammatory bowel disease.inflammatory bowel diseases (ibds) are chronic illnesses that require frequent and regular healthcare contact. regular maintenance care may reduce complications or the need for hospitalization. availability of physicians may be an important determinant of ibd hospitalizations.201120848540
differential role of rho gtpases in intestinal epithelial barrier regulation in vitro.maintenance of intestinal epithelial barrier functions is crucial to prevent systemic contamination by microbes that penetrate from the gut lumen. gtpases of the rho-family such as rhoa, rac1, and cdc42 are known to be critically involved in the regulation of intestinal epithelial barrier functions. however, it is still unclear whether inactivation or activation of these gtpases exerts barrier protection or not. we tested the effects of rho gtpase activities on intestinal epithelial barrier func ...201120945370
recto-vesical fistulation complicating a faecal incontinence management product in clostridium difficile diarrhoea. 201121054743
laparoscopic colorectal surgery - why would you not want to have it and, more importantly, not be trained in it? a consecutive series of 500 elective resections with anastomoses.we analysed the outcome of a consecutive series of 500 unselected patients who underwent elective laparoscopic colorectal resection with anastomosis (elcra) under the care of a single surgeon.201119888953
is clostridium difficile infection a particular problem after reversal of ileostomy?clostridium difficile infection (cdi) is a cause of morbidity and mortality in hospitals. various independent risk factors have been identified, including age and antibiotic exposure. this study attempted to determine whether surgery and associated antibiotic use influence the development of cdi.201119925492
[first experiences with faecal bacteriotherapy in the treatment of relapsing pseudomembranous colitis due to clostridium difficile].the aim was to prove the effectiveness and safety of faecal bacteriotherapy in the treatment of relapsing pseudomembranous colitis due to clostridium difficile in clinical practice.201122247032
strategies for management of clostridium difficile infection in immunosuppressed patients. 201122298971
current issues on safety of prokinetics in critically ill patients with feed intolerance.feed intolerance in the setting of critical illness should be treated promptly given its adverse impact on morbidity and mortality. the technical difficulty of postpyloric feeding tube placement and the morbidities associated with parenteral nutrition prevent these approaches being considered as first-line nutrition. prokinetic agents are currently the mainstay of therapy for feed intolerance in the critically ill. current information is limited but suggests that erythromycin or metoclopramide ( ...201125083212
frequency of clostridium difficile among patients with gastrointestinal complaints.in this study, the prevalence of c. difficile, from patients with gastrointestinal complaints and its association with other enteropathogen microbes were investigated.201124834184
fidaxomicin for the treatment of clostridium difficile infection in the pediatric population - not quite so soon yet.fidaxomicin is a new narrow spectrum macrocyclic antibiotic. it inhibits bacterial rna polymerase and eradicates c difficile with minimal effect on normal intestinal flora. the us fda granted orphan drug designation for all formulations of fidaxomicin for the treatment of c difficile infections in pediatric patients on january 10, 2011. fidaxomicin has bactericidal activity against c difficile with a prolonged post-antibiotic effect. even though this medication has an orphan designation for pedi ...201127942322
diagnosis of clostridium difficile infection: comparison of four methods on specimens collected in cary-blair transport medium and tcdb pcr on fresh versus frozen samples.clostridium difficile infection (cdi) caused by toxigenic strains of c. difficile is primarily a nosocomial infection with increasing prevalence. stool specimens are typically collected in cary-blair transport medium to maximize culture-based detection of common stool pathogens. the goal of this study was to establish an analytically accurate and efficient algorithm for the detection of cdi in our patient population using samples collected in cary-blair transport medium. in addition, we wished t ...201124470904
clostridium difficile infection in patients with inflammatory bowel disease.clostridium difficile infection in patients with inflammatory bowel disease has become a serious clinical problem over the past few years. this review is focused on the current changes in epidemiology, pertinent clinical aspects, standard and newer diagnostic methods, established and novel therapies, and prevention of infection. there is emphasis on the importance of clinical awareness, rapid detection by stool testing, and appropriate antibiotic therapy, while newer technologies, antibiotics an ...201124713726
successful use of nitazoxanide in the treatment of recurrent clostridium difficile infection.a 78-year-old, retired caucasian male presented in emergency room with 3 days history of progressive watery diarrhoea. two weeks earlier, he received intravenous levofloxacin for community acquired pneumonia. the patient was diagnosed as severe clostridium difficile infection based on clinical presentation, labs and imaging studies. the patient was initially treated with intravenous metronidazole and oral vancomycin. while awaiting subacute rehabilitation placement, the patient relapsed twice. a ...201122674696
clostridium difficile dna polymerase iiic: basis for activity of antibacterial compounds.based on the finding that aerobic gram-positive antibacterials that inhibit dna polymerase iiic (pol iiic) were potent inhibitors of the growth of anaerobic clostridium difficile (cd) strains, we chose to clone and express the gene for pol iiic from this organism. the properties of the recombinant enzyme are similar to those of related pol iiics from gram-positive aerobes, e.g. b. subtilis. inhibitors of the cd enzyme also inhibited b. subtilis pol iiic, and were competitive with respect to the ...201122844265
the value of repeat clostridium difficile toxin testing during and after an outbreak of c difficile-associated diarrhea.the recent increase in clostridium difficile-associated diarrhea (cdad) has led to questions about the reproducibility and sensitivity of c difficile toxin testing (cdtt). while there have been recommendations to repeat cdtt following a negative result, previous studies have failed to show a benefit. however, no studies were performed during an outbreak of cdad. the value of repeat cdtt after an initial negative result in patients tested during and after an outbreak of cdad is reported in the pr ...201122654928
growing a "positive culture" of antimicrobial stewardship in a community hospital.promoting the appropriate use of antimicrobials is a core value of antimicrobial stewardship. prospective audit and feedback constitute an effective strategy for reducing the cost and use of antimicrobials, as well as their adverse effects, such as infection with clostridium difficile.201122479082
[molecular typing methods on clostridium difficile and their application]. 201122333093
lactoferrin for the prevention of post-antibiotic diarrhoea.antibiotic-associated diarrhoea (aad) is a common cause of morbidity and mortality. older individuals in long-term care facilities are particularly vulnerable due to multisystem illnesses and the prevailing conditions for nosocomial infections. lactoferrin, an antimicrobial protein in human breastmilk, was tested to determine whether it would prevent or reduce aad, including clostridium difficile in tube-fed long-term care patients. thirty patients were enrolled in a randomized double-blind stud ...201122283027
prospective evaluation of the meridian illumigene™ loop-mediated amplification assay and the gen probe progastro™ cd polymerase chain reaction assay for the direct detection of toxigenic clostridium difficile from fecal samples.clostridium difficile is the most common and important cause of toxigenic colitis in the health care setting. laboratory diagnostics have included bacterial culture with further identification of toxigenic stains, or more commonly, direct detection of preformed toxin in stool samples using biological or immunochemistry assays. recently, molecular amplification assays for the direct detection of toxin-encoding genes have become available commercially. we prospectively evaluated 2 fda-cleared mole ...201222015321
activity in vitro of hydrogen peroxide vapour against clostridium difficile spores.clostridium difficile spores are shed in high numbers by infected patients and are resistant to desiccation and some disinfectants. we explored the in vitro activity of hydrogen peroxide vapour (hpv) against several strains of c. difficile spores using a spore-carrier test. spores were dried on polyvinyl chloride or laminate carriers at mean concentrations of 4.7-6.9 log(10) spores/carrier, which were then decontaminated using hpv. c. difficile was completely eradicated from the exposed carriers ...201222099497
evaluation of vaporized hydrogen peroxide, citrox and ph neutral ecasol for decontamination of an enclosed area: a pilot study.hydrogen peroxide, ecasol and citrox aerosols were each tested for their ability to kill a range of nosocomial pathogens. hydrogen peroxide had the broadest microbicidal activity but operational issues limit its use. ecasol was effective against all micro-organisms, except clostridium difficile, while citrox aerosols were not effective against gram-negative bacilli.201222130097
evaluation of stethoscopes as vectors of clostridium difficile and methicillin-resistant staphylococcus aureus. 201222173532
vaccination with parenteral toxoid b protects hamsters against lethal challenge with toxin a-negative, toxin b-positive clostridium difficile but does not prevent colonization.toxin a has historically been regarded as the primary virulence determinant in clostridium difficile infection, but naturally occurring toxin a-negative, toxin b-positive (a-/b+) c. difficile strains are known to be virulent. to determine the role of toxin b in these strains, we immunized hamsters with a toxoid prepared from purified toxin b to determine whether they would be protected from lethal challenge with an a-/b+ strain of c. difficile.201222124129
emergence of new pcr ribotypes from the hypervirulent clostridium difficile 027 lineage.clostridium difficile is the most common cause of antibiotic-associated diarrhoea worldwide. over the past 10 years, the incidence and severity of disease have increased in north america and europe due to the emergence of a hypervirulent clone designated pcr ribotype 027. in this study, we sought to identify phenotypic differences among a collection of 26 presumed pcr ribotype 027 strains from the us and the uk isolated between 1988 and 2008 and also re-evaluated the pcr ribotype. we demonstrate ...201221903827
Verification of Performance Specifications for a US Food and Drug Administration-Approved Molecular Microbiology Test: Clostridium difficile Cytotoxin B Using the Becton, Dickinson and Company GeneOhm Cdiff Assay.Context.-US Food and Drug Administration (FDA)-approved diagnostic tests based on molecular genetic technologies are becoming available for an increasing number of microbial pathogens. Advances in technology and lower costs have moved molecular diagnostic tests formerly performed for research purposes only into much wider use in clinical microbiology laboratories. Objective.-To provide an example of laboratory studies performed to verify the performance of an FDA-approved assay for the detecti ...201222208483
Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options.The incidence and severity of Clostridium difficile infection (CDI) around the world has increased over the past 20 years due to the emergence of hypervirulent strains, increased use and misuse of antibiotics, and the increase of susceptible at-risk populations. Treatments currently available for CDI are inadequate to impede the increasing spread and virulence of the infection, avoid recurrence in chronic patients or prevent infection in at-risk populations.201222134217
clostridium difficile toxins: mediators of inflammation.clostridium difficile is a significant problem in hospital settings as the most common cause of nosocomial diarrhea worldwide. c. difficile infections (cdis) are characterized by an acute intestinal inflammatory response with neutrophil infiltration. these symptoms are primarily caused by the glucosylating toxins, tcda and tcdb. in the past decade, the frequency and severity of cdis have increased markedly due to the emergence of so-called hypervirulent strains that overproduce cytotoxic glucosy ...201222237401
the patient presenting with acute dysentery - a systematic review.objectives: the etiologies, clinical presentations and diagnosis of acute pathogen-specific dysentery in children and adults in industrialized and developing regions is described to help develop recommendations for therapy. methods: we conducted a systematic review of literature published between january 2000 and june 2011 to determine the frequency of occurrence of pathogen-specific dysentery. results: shigella, salmonella, and campylobacter remain the most frequent bacterial causes of dysenter ...201222266388
high prevalence of clostridium difficile colonization among nursing home residents in hesse, germany.clostridium difficile is the most common cause of antibiotic-associated diarrhoea in hospitals and other healthcare facilities. the elderly are particularly susceptible and at increased risk for adverse outcome as a result of c. difficile infection. the aim of this study was to determine the prevalence of c. difficile colonization among residents of nursing homes in hesse and to compare it with the prevalence in the general population living outside long-term care facilities (ltcf). we assessed ...201222253917
high occurrence of various clostridium difficile pcr ribotypes in pigs arriving at the slaughterhouse.background: clostridium difficile is recognized as an important cause of nosocomial diarrhoea in humans, especially in association with the administration of antibiotics. furthermore, c. difficile can not only cause neonatal enteritis in pigs but can also be found in pigs without any clinical disease symptoms. clostridium difficile had been found on pork samples destined for human consumption. however, little is known about the risk of food-borne transmission. objective: to elaborate the risk ...201222235856
clostridium difficile infection is associated with poor outcomes in end-stage renal disease.to investigate the association of clostridium difficile infection (cdi) with the outcomes of hospitalized patients with end-stage renal disease (esrd).201222222233
effects of probiotics and antibiotics on the intestinal homeostasis in a computer controlled model of the large intestine.antibiotic associated diarrhea and clostridium difficile infection are frequent complications of broad spectrum antibiotic therapy. probiotic bacteria are used as therapeutic and preventive agents in these disorders, but the exact functional mechanisms and the mode of action are poorly understood. the effects of clindamycin and the probiotic mixture vsl#3 (containing the 8 bacterial strains streptococcus thermophilus, bifidobacterium breve, bifidobacterium longum, bifidobacterium infantis, lacto ...201222452835
analysis of a clostridium difficile pcr ribotype 078 100 kilobase island reveals the presence of a novel transposon, tn6164.clostridium difficile is the main cause of antibiotic associated diarrhea. in the past decade, the number of c. difficile patients has increased dramatically, coinciding with the emergence of two pcr ribotypes 027 and 078. pcr ribotype 078 is also frequently found during c. difficile outbreaks in pigfarms. previously, the genome of the pcr ribotype 078 strain m120, a human isolate, was described to contain a unique insert of 100 kilobases.201222747711
fecal microbiota transplantation in relapsing clostridium difficile infection.clostridium difficile infection rates are climbing in frequency and severity, and the spectrum of susceptible patients is expanding beyond the traditional scope of hospitalized patients receiving antibiotics. fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. cure rates of > 90% are being consistently reported from multiple centers. transplantation ca ...201223152734
microevolutionary analysis of clostridium difficile genomes to investigate transmission.the control of clostridium difficile infection is a major international healthcare priority, hindered by a limited understanding of transmission epidemiology for these bacteria. however, transmission studies of bacterial pathogens are rapidly being transformed by the advent of next generation sequencing.201223259504
hemolytic uremic syndrome and clostridium difficile colitis.hemolytic uremic syndrome (hus) can be associated with different infectious etiologies, but the relationship between pseudomembranous colitis and hus was first described in the 1970s in some childhood patients. there is very limited published literature on clostridium difficile-associated hus. we report a case of c. difficile-related hus in an adult patient and provide a review of the literature.201223882375
modulation of toxin production by the flagellar regulon in clostridium difficile.we show in this study that toxin production in clostridium difficile is altered in cells which can no longer form flagellar filaments. the impact of inactivation of flic, cd0240, flif, flig, flim, and flhb-flir flagellar genes upon toxin levels in culture supernatants was assessed using cell-based cytotoxicity assay, proteomics, immunoassay, and immunoblotting approaches. each of these showed that toxin levels in supernatants were significantly increased in a flic mutant compared to that in the ...201222851750
amixicile, a novel inhibitor of pyruvate: ferredoxin oxidoreductase, shows efficacy against clostridium difficile in a mouse infection model.clostridium difficile infection (cdi) is a serious diarrheal disease that often develops following prior antibiotic usage. one of the major problems with current therapies (oral vancomycin and metronidazole) is the high rate of recurrence. nitazoxanide (ntz), an inhibitor of pyruvate:ferredoxin oxidoreductase (pfor) in anaerobic bacteria, parasites, helicobacter pylori, and campylobacter jejuni, also shows clinical efficacy against cdi. from a library of ∼250 analogues of ntz, we identified lead ...201222585229
automated detection of toxigenic clostridium difficile in clinical samples: isothermal tcdb amplification coupled to array-based detection.clostridium difficile can carry a genetically variable pathogenicity locus (paloc), which encodes clostridial toxins a and b. in hospitals and in the community at large, this organism is increasingly identified as a pathogen. to develop a diagnostic test that combines the strengths of immunoassays (cost) and dna amplification assays (sensitivity/specificity), we targeted a genetically stable paloc region, amplifying tcdb sequences and detecting them by hybridization capture. the assay employs a ...201222675134
antimicrobial activities of fidaxomicin.fidaxomicin is bactericidal against clostridium difficile. the combined results of 8 in vitro studies of 1323 c. difficile isolates showed the minimum inhibitory concentration (mic) range of fidaxomicin to be ≤ 0.001-1 μg/ml, with a maximum mic for inhibition of 90% of organisms (mic(90)) of 0.5 μg/ml. isolates from 2 phase iii clinical trials demonstrated that fidaxomicin mics of baseline isolates did not predict clinical cure, failure, or recurrence of c. difficile infections. no resistance to ...201222752863
clinical importance and representation of toxigenic and non-toxigenic clostridium difficile cultivated from stool samples of hospitalized patients.the aim of this study was to fortify the clinical importance and representation of toxigenic and non-toxigenic clostridium difficile isolated from stool samples of hospitalized patients. this survey included 80 hospitalized patients with diarrhea and positive findings of clostridium difficile in stool samples, and 100 hospitalized patients with formed stool as a control group. bacteriological examination of a stool samples was conducted using standard microbiological methods. stool sample were i ...201224031820
in silico analysis of sequenced strains of clostridium difficile reveals a related set of conjugative transposons carrying a variety of accessory genes.the human gut pathogen clostridium difficile contains many conjugative transposons that have an array of accessory genes. in the current study, recently sequenced genomes were analyzed to identify new putative conjugative transposons. eleven new elements in 5 c. difficile strains were identified and all had a similar structure to the previously described elements ctn1, ctn5 and ctn7 in c. difficile strain 630. each element identified did however contain a new set of accessory genes compared with ...201222754747
clostridium difficile mazf toxin exhibits selective, not global, mrna cleavage.clostridium difficile is an important, emerging nosocomial pathogen. the transition from harmless colonization to disease is typically preceded by antimicrobial therapy, which alters the balance of the intestinal flora, enabling c. difficile to proliferate in the colon. one of the most perplexing aspects of the c. difficile infectious cycle is its ability to survive antimicrobial therapy and transition from inert colonization to active infection. toxin-antitoxin (ta) systems have been implicated ...201222544268
fidaxomicin is an inhibitor of the initiation of bacterial rna synthesis.fidaxomicin was recently approved for the treatment of clostridium difficile infection. it inhibits transcription by bacterial rna polymerase. because transcription is a multistep process, experiments were conducted in which fidaxomicin was added at different stages of transcriptional initiation to identify the blocked step. dna footprinting experiments were also conducted to further elucidate the stage inhibited. fidaxomicin blocks initiation only if added before the formation of the "open prom ...201222752861
biocidal activity of metalloacid-coated surfaces against multidrug-resistant microorganisms. 201223148568
activity of the thiopeptide antibiotic nosiheptide against contemporary strains of methicillin-resistant staphylococcus aureus.the rapid rise in antimicrobial resistance in bacteria has generated an increased demand for the development of novel therapies to treat contemporary infections, especially those caused by methicillin-resistant staphylococcus aureus (mrsa). however, antimicrobial development has been largely abandoned by the pharmaceutical industry. we recently isolated the previously described thiopeptide antibiotic nosiheptide from a marine actinomycete strain and evaluated its activity against contemporary cl ...201223047246
implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital. 201223043720
use of uv-c radiation to disinfect non-critical patient care items: a laboratory assessment of the nanoclave cabinet.the near-patient environment is often heavily contaminated, yet the decontamination of near-patient surfaces and equipment is often poor. the nanoclave cabinet produces large amounts of ultraviolet-c (uv-c) radiation (53 w/m2) and is designed to rapidly disinfect individual items of clinical equipment. controlled laboratory studies were conducted to assess its ability to eradicate a range of potential pathogens including clostridium difficile spores and adenovirus from different types of surface ...201222856652
the potential economic value of screening hospital admissions for clostridium difficile.asymptomatic clostridium difficile carriage has a prevalence reported as high as 51-85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. accurately identifying carriers may limit the spread of clostridium difficile. since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for clostridium difficile from the hospital and third party payer perspective ...201222752150
national institute of allergy and infectious disease (niaid) funding for studies of hospital-associated bacterial pathogens: are funds proportionate to burden of disease? 201222958856
the impact of infection on population health: results of the ontario burden of infectious diseases study.evidence-based priority setting is increasingly important for rationally distributing scarce health resources and for guiding future health research. we sought to quantify the contribution of a wide range of infectious diseases to the overall infectious disease burden in a high-income setting.201222962601
clostridium difficile toxin b causes epithelial cell necrosis through an autoprocessing-independent mechanism.clostridium difficile is the most common cause of antibiotic-associated nosocomial infection in the united states. c. difficile secretes two homologous toxins, tcda and tcdb, which are responsible for the symptoms of c. difficile associated disease. the mechanism of toxin action includes an autoprocessing event where a cysteine protease domain (cpd) releases a glucosyltransferase domain (gtd) into the cytosol. the gtd acts to modify and inactivate rho-family gtpases. the presumed importance of a ...201223236283
clostridial toxins: sensing a target in a hostile gut environment.the current global outbreak of clostridium difficile infection exemplifies the major public health threat posed by clostridial glucosylating toxins. in the western world, c. difficile infection is one of the most prolific causes of bacterial-induced diarrhea and potentially fatal colitis. two pathogenic enterotoxins, tcda and tcdb, cause the disease. vancomycin and metronidazole remain readily available treatment options for c. difficile infection, but neither is fully effective as is evident by ...201222356854
mbx-500, a hybrid antibiotic with in vitro and in vivo efficacy against toxigenic clostridium difficile.clostridium difficile infection (cdi) causes moderate to severe disease, resulting in diarrhea and pseudomembranous colitis. cdi is difficult to treat due to production of inflammation-inducing toxins, resistance development, and high probability of recurrence. only two antibiotics are approved for the treatment of cdi, and the pipeline for therapeutic agents contains few new drugs. mbx-500 is a hybrid antibacterial, composed of an anilinouracil dna polymerase inhibitor linked to a fluoroquinolo ...201222733075
second infections independently increase mortality in hospitalized patients with cirrhosis: the north american consortium for the study of end-stage liver disease (nacseld) experience.bacterial infections are an important cause of mortality in cirrhosis, but there is a paucity of multicenter studies. the aim was to define factors predisposing to infection-related mortality in hospitalized patients with cirrhosis. a prospective, cohort study of patients with cirrhosis with infections was performed at eight north american tertiary-care hepatology centers. data were collected on admission vitals, disease severity (model for endstage liver disease [meld] and sequential organ fail ...201222806618
protective role of commensals against clostridium difficile infection via an il-1β-mediated positive-feedback loop.clostridium difficile is a gram-positive obligate anaerobic pathogen that causes pseudomembranous colitis in antibiotic-treated individuals. commensal bacteria are known to have a significant role in the intestinal accumulation of c. difficile after antibiotic treatment, but little is known about how they affect host immunity during c. difficile infection. in this article, we report that c. difficile infection results in translocation of commensals across the intestinal epithelial barrier that i ...201222888139
management and prevention of recurrent clostridium difficile infection in patients after total joint arthroplasty: a review.clostridium difficile infection (cdi) is the most common infectious cause of nosocomial diarrhea in elderly patients, accounting for 15% to 25% of all cases of antibiotic-induced diarrhea in those patients. virulent forms of this organism have developed, increasing the associated morbidity, mortality, and complication rates. the average patient undergoing total joint arthroplasty is at particular risk of cdi because of advanced age, the use of prophylactic antibiotic coverage in the perioperativ ...201223569710
clinical and microbiological profile of hiv/aids cases with diarrhea in north india.intestinal infections are a significant cause of morbidity and mortality in people living with hiv/aids (plwha) especially in developing countries. the present study was conducted to assess the clinical and microbiological spectrum in hiv/aids cases with diarrhea and to correlate the occurrence of such pathogens with stool characters, hiv seropositivity status, and cd4 counts. stools from 154 hiv seropositive subjects and 50 hiv negative controls were examined by direct microscopy, fecal culture ...201223326669
using rapid diagnostic tests to optimize antimicrobial selection in antimicrobial stewardship programs.new advances in rapid diagnostic tests provide several collaborative opportunities for stewardship teams, particularly in processes where delay in the initiation of appropriate therapy has significant consequences for patient outcomes. rapid molecular tests enhance one of the key functions of microbiology laboratories, which is to produce accurate organism identification and timely antimicrobial susceptibility testing data. these data are used to guide the choice of antimicrobial agents for trea ...201223307517
approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant staphylococcus aureus.a restrictive antibiotic policy banning routine use of ceftriaxone and ciprofloxacin was implemented in a 450-bed district general hospital following an educational campaign. monthly consumption of nine antibiotics was monitored in defined daily doses (ddds) per 1000 patient-occupied bed-days (1000 pt-bds) 9 months before until 16 months after policy introduction. hospital-acquired clostridium difficile, meticillin-resistant staphylococcus aureus (mrsa) and extended-spectrum β-lactamase (esbl)-p ...201223276500
mapk-activated protein kinase 2 contributes to clostridium difficile-associated inflammation.clostridium difficile infection (cdi) results in toxin-induced epithelial injury and marked intestinal inflammation. fecal markers of intestinal inflammation correlate with cdi disease severity, but regulation of the inflammatory response is poorly understood. previous studies demonstrated that c. difficile toxin tcda activates p38 kinase in tissue culture cells and mouse ilium, resulting in interleukin-8 (il-8) release. here, we investigated the role of phosphorylated mitogen-activated protein ...201223264053
clostridium difficile infection outbreak in a male rehabilitation ward, hong kong special administrative region (china), 2011. 201223908942
incidence of clostridium difficile associated diarrhoea in a tertiary care hospital.rampant and injudicious use of broad spectrum antibiotics in hospitalized patients has increased the incidence of clostridium difficile associated diarrhoea (cdad). though antibiotic use is the best known risk factor for cdad, the occurrence of community acquired c. difficile suggests the presence of other risk factors too. however cdad is still under-recognized in india and asia. therefore we undertook a prospective study to determine the incidence of clostridium difficile associated diarrhoea ...201223767199
clostridium difficile infection--is it coming at us? 201223767195
fecal transplant for clostridium difficile-reply. 201223752359
control of clostridium difficile-associated diarrhea by antibiotic stewardship in a small community hospital. 201223730314
[a case of diarrhoea by clostridium difficile].we present a patient who developed a pseudomembranous colitis due to clostridium difficile with a prolonged course. the diarrhoea symptoms worsened after two hospitalisations, but there was an improvement with outpatient treatment. the first diagnosis was made in primary care. we summarise the preventive measures, and present the severity criteria of this condition, as well as the failure antibiotic treatment with metronidazole and the possible aggravation by the use of other antibiotics in thes ...201223726735
clostridium difficile infection in children: current state and unanswered questions.the incidence of clostridium difficile infection (cdi) in children has increased over the past decade. in recent years, new and intriguing data on pediatric cdi have emerged. community-onset infections are increasingly recognized, even in children who have not previously received antibiotics. a hypervirulent strain is responsible for up to 20% of pediatric cdi cases. unique risk factors for cdi in children have been identified. advances in diagnostic testing strategies, including the use of nucl ...201223687578
effects of nisin and reutericyclin on resistance of endospores of clostridium spp. to heat and high pressure.the effects of high pressure, temperature, and antimicrobial compounds on endospores of clostridium spp. were examined. minimal inhibitory concentrations (mic) of nisin and reutericyclin were determined for vegetative cells and endospores of clostridium sporogenes atcc 7955, clostridium beijerinckii atcc 8260, and clostridium difficile 3195. endospores of c. sporogenes atcc 7955 and c. beijerinckii atcc 8260 were exposed to 90 °c and 90 °c/600 mpa in the presence of 16 mg l(-1) nisin or 6.4 mg l ...201223498177
portal vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity.portal vein thrombosis has been documented after laparoscopic general surgery and has been uncommonly observed after laparoscopic bariatric surgery. among bariatric operations, the sleeve gastrectomy is being performed with ever-increasing frequency. here we report the case of a man who presented with portal vein thrombosis after laparoscopic sleeve gastrectomy.201223484577
glutamine and alanyl-glutamine increase rhoa expression and reduce clostridium difficile toxin-a-induced intestinal epithelial cell damage.clostridium difficile is a major cause of antibiotic-associated colitis and is associated with significant morbidity and mortality. glutamine (gln) is a major fuel for the intestinal cell population. alanyl-glutamine (ala-gln) is a dipeptide that is highly soluble and well tolerated. iec-6 cells were used in the in vitro experiments. cell morphology was evaluated by atomic force microscopy (afm) and scanning electron microscopy (sem). cell proliferation was assessed by wst-1 and ki-67 and apopto ...201223484083
clostridium difficile infection in patients with inflammatory bowel disease. 201223483861
deadly diarrhea: clostridium difficile infection.diarrhea is often only a minor inconvenience, but sometimes it can be deadly--especially if it results from a clostridium difficile infection. clostridium difficile colitis is becoming increasingly common and more virulent, and patients with kidney failure are at increased risk for development of a clostridium disfficile infection. this article provides information about clostridium difficile infection, its incidence, diagnosis, and treatment. in addition, the article discusses how to combat the ...201223469412
detection of clostridium difficile in retail ground meat products in manitoba.the aim of the present study was to determine whether clostridium difficile was present in uncooked retail ground beef and ground pork products sold in winnipeg, manitoba. using an alcohol treatment protocol and inoculation of cultures on c difficile moxalactam norfloxacin (cdmn), toxigenic c difficile was found in 6.3% of 48 meat samples. the c difficile isolates belonged to different pulsotypes, all of which had been previously isolated from the stool of manitoba patients with c difficile dise ...201223450202
hospital-acquired infections.health-acquired infection (hai) is defined as a localized or systemic condition resulting from an adverse reaction to the presence of infectious agents or its toxins. this article focuses on hais that are well studied, common, and costly (direct, indirect, and intangible). the hais reviewed are catheter-related bloodstream infection, ventilator-associated pneumonia, surgical site infection, and catheter-associated urinary tract infection. this article excludes discussion of clostridium difficile ...201222269261
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