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long-term medical management of gastro-esophageal reflux disease: how long and when to consider surgery?gastro-esophageal reflux disease is a chronic, long standing disease. spontaneous remission of gerd is rare and conservative management including life style modification measures is unlikely to relieve symptoms. majority of patients with reflux disease require long-term acid suppressants. proton pump inhibitors are the choice of drugs in management of these patients. the end point of treatment is not clear. duration of treatment is individual based. the symptoms may be intermittent or on most da ...201222803292
a canadian working group report on fecal microbial therapy: microbial ecosystems therapeutics.a working group from across canada comprised of clinician and basic scientists, epidemiologists, ethicists, health canada regulatory authorities and representatives of major funding agencies (canadian institutes of health research and the crohn's and colitis foundation of canada) met to review the current experience with fecal microbial therapy and to identify the key areas of study required to move this field forward. the report highlights the promise of fecal microbial therapy and related synt ...201222803022
in vitro and in vivo characterization of cb-183,315, a novel lipopeptide antibiotic for treatment of clostridium difficile.cb-183,315 is a novel lipopeptide antibiotic structurally related to daptomycin currently in phase 3 clinical development for clostridium difficile-associated diarrhea (cdad). we report here the in vitro mechanism of action, spontaneous resistance incidence, resistance by serial passage, time-kill kinetics, postantibiotic effect, and efficacy of cb-183,315 in a hamster model of lethal infection. in vitro data showed that cb-183,315 dissipated the membrane potential of staphylococcus aureus witho ...201222802252
epidemiological features of clostridium difficile infection among inpatients at hamad general hospital in the state of qatar, 2006-2009.the aim of this retrospective study was to evaluate the epidemiology, clinical course and outcome of clostridium difficile infection among inpatients at hamad general hospital in qatar, from 2006 to 2009. during this period, 123 patients were diagnosed with c. difficile infection and the overall incidence was 1.6/10,000 patient days. the mean age (±sd) of patients was 50.9 ± 21.2 years. the most frequent underlying disease was hypertension 51/123 (41.5%) and 133 prescriptions of antimicrobials w ...201222800937
toxigenic clostridium difficile pcr ribotypes from wastewater treatment plants in southern switzerland.the occurrence of clostridium difficile in nine wastewater treatment plants in the ticino canton (southern switzerland) was investigated. the samples were collected from raw sewage influents and from treated effluents. forty-seven out of 55 characterized c. difficile strains belonged to 13 different reference pcr ribotypes (009, 010, 014, 015, 039, 052, 053, 066, 070, 078, 101, 106, and 117), whereas 8 strains did not match any of those available in our libraries. the most frequently isolated ri ...201222798376
anti-tumour necrosis factor treatment of inflammatory bowel disease in liver transplant recipients.ulcerative colitis (uc) and crohn's disease can sometimes relapse and be refractory to standard treatment following orthotopic liver transplantation (olt) despite post-transplantation immunosuppressive therapy.201222779779
overutilization of proton-pump inhibitors: what the clinician needs to know.proton-pump inhibitors (ppis) remain the leading evidence-based therapy for upper gastrointestinal disorders, including gastroesophageal reflux disease, dyspepsia, and peptic ulcer disease. the effectiveness of ppis has led to overutilization in multiple treatment arenas, exposing patients to an increasing number of potential risks. the overutilization of ppis in ambulatory care settings is often a result of failure to re-evaluate the need for continuation of therapy, or insufficient use of on-d ...201222778788
new horizons for host defense peptides and lantibiotics.antimicrobial peptides from either microbial sources, or based on host defense peptides (hdps) from higher organisms, show promising activity against human pathogens. lantibiotics have been extensively engineered by either molecular biology approaches or chemistry and both natural and modified entities have been shown to have good efficacy in animal models of infection. amongst hdps either truncated peptides or non-peptide mimetic molecules show substantial promise both for their direct antibiot ...201222776251
molecular techniques for diagnosis of clostridium difficile infection: systematic review and meta-analysis.to assess the usefulness of 2 rapid molecular diagnostic techniques, polymerase chain reaction (pcr) and loop-mediated isothermal amplification (lamp), in clostridium difficile infection (cdi).201222766084
gastric acid suppression and outcomes in clostridium difficile infection: a population-based study.to evaluate the association of gastric acid suppression medications, including proton pump inhibitors and histamine type 2 blockers, with outcomes in patients with clostridium difficile infection (cdi) in a population-based cohort.201222766083
synthesis and antibacterial activity against clostridium difficile of novel demethylvancomycin derivatives.to explore the structure-activity relationships (sar) of demethylvancomycin (2) and find more effective new chemical entities than known glycopeptides for the treatment of clostridium difficile (c. difficile), 17 novel n-substituted (n-arylmethylene or -aliphatic substituents) demethylvancomycin derivatives were prepared. these analogues have been evaluated in vitro for their antibacterial activities against c. difficile and enterococcus faecium (e. faecium). compounds 5d, 5h, and 5i with n-aryl ...201222765891
burden of clostridium difficile on the healthcare system.there are few high-quality studies of the costs of clostridium difficile infection (cdi), and the majority of studies focus on the costs of cdi in acute-care facilities. analysis of the best available data, from 2008, indicates that cdi may have resulted in $4.8 billion in excess costs in us acute-care facilities. other areas of cdi-attributable excess costs that need to be investigated are costs of increased discharges to long-term care facilities, of cdi with onset in long-term care facilities ...201222752870
current state of clostridium difficile treatment options.recent reports of reduced response to standard therapies for clostridium difficile infection (cdi) and the risk for recurrent cdi that is common with all currently available treatment agents have posed a significant challenge to clinicians. current recommendations include metronidazole for treatment of mild to moderate cdi and vancomycin for severe cdi. results from small clinical trials suggest that nitazoxanide and teicoplanin may be alternative options to standard therapies, whereas rifaximin ...201222752868
current status of clostridium difficile infection epidemiology.the dramatic changes in the epidemiology of clostridium difficile infection (cdi) during recent years, with increases in incidence and severity of disease in several countries, have made cdi a global public health challenge. increases in cdi incidence have been largely attributed to the emergence of a previously rare and more virulent strain, bi/nap1/027. increased toxin production and high-level resistance to fluoroquinolones have made this strain a very successful pathogen in healthcare settin ...201222752867
fidaxomicin inhibits spore production in clostridium difficile.fidaxomicin (fdx) is a novel antimicrobial agent with narrow-spectrum and potent bactericidal activity against clostridium difficile. in recent clinical trials, fdx was superior to vancomycin in preventing recurrences of c. difficile infection. a possible mechanism of reducing recurrence may be through an inhibitory effect on sporulation. the effect of fdx and its major metabolite, op-1118, on c. difficile growth and sporulation kinetics was compared with that of vancomycin, metronidazole, and r ...201222752866
treatment of first recurrence of clostridium difficile infection: fidaxomicin versus vancomycin.recurrence of clostridium difficile infection (cdi) occurs in approximately 25% of successfully treated patients. two phase 3 randomized, double-blind trials were conducted at 154 sites in the united states, canada, and europe to compare fidaxomicin vs vancomycin in treating cdi. patients with cdi received fidaxomicin 200 mg twice daily or vancomycin 125 mg 4 times daily for 10 days. the primary end point was clinical cure of cdi at end of treatment, and a secondary end point was recurrence duri ...201222752865
renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis.nonsevere clostridium difficile infection (cdi) and severe cdi, which carries a higher risk than nonsevere cdi for treatment failure and cdi recurrence, are difficult to distinguish at the time of diagnosis. to investigate the prognostic value of 3 markers of severe cdi suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with cdi. leukocytosis (risk ratio [rr], 2.29; 95% con ...201222752864
fidaxomicin preserves the intestinal microbiome during and after treatment of clostridium difficile infection (cdi) and reduces both toxin reexpression and recurrence of cdi.the microflora-sparing properties of fidaxomicin were examined during the conduct of a randomized clinical trial comparing vancomycin 125 mg 4 times per day versus fidaxomicin 200 mg twice per day for 10 days as treatment of clostridium difficile infection (cdi). fecal samples were obtained from 89 patients (45 received fidaxomicin, and 44 received vancomycin) at study entry and on days 4, 10, 14, 21, 28, and 38 for quantitative cultures for c. difficile and cytotoxin b fecal filtrate concentrat ...201222752862
reduced acquisition and overgrowth of vancomycin-resistant enterococci and candida species in patients treated with fidaxomicin versus vancomycin for clostridium difficile infection.fidaxomicin causes less disruption of anaerobic microbiota during treatment of clostridium difficile infection (cdi) than vancomycin and has activity against many vancomycin-resistant enterococci (vre). in conjunction with a multicenter randomized trial of fidaxomicin versus vancomycin for cdi treatment, we tested the hypothesis that fidaxomicin promotes vre and candida species colonization less than vancomycin. stool was cultured for vre and candida species before and after therapy. for patient ...201222752860
fidaxomicin attains high fecal concentrations with minimal plasma concentrations following oral administration in patients with clostridium difficile infection.fidaxomicin has recently been approved for the treatment of clostridium difficile infection (cdi). as part of phase iii studies, plasma and fecal samples were analyzed for concentrations of fidaxomicin and its metabolite, op-1118. plasma samples were collected before and after dose receipt on the first and last days of therapy, and fecal samples were collected on the last day of therapy. samples were analyzed for fidaxomicin and op-1118 (metabolite), using validated liquid chromatography/tandem ...201222752859
safety analysis of fidaxomicin in comparison with oral vancomycin for clostridium difficile infections.fidaxomicin is a novel macrocyclic antibiotic recently approved by the us food and drug administration for the treatment of clostridium difficile-associated diarrhea in adults. we reviewed safety data from nonclinical studies and clinical trials (phases 1, 2a, and 3) with fidaxomicin. in nonclinical studies, fidaxomicin was administered orally at approximately 1 g/kg/d to dogs for up to 3 months with no significant target-organ toxicities observed. a total of 728 adults have received oral fidaxo ...201222752858
relapse versus reinfection: recurrent clostridium difficile infection following treatment with fidaxomicin or vancomycin.our study sought to compare the strain types of clostridium difficile causing initial and recurrent episodes of c. difficile infection (cdi) in adult patients with a first episode of cdi or 1 prior episode of cdi within the previous 90 days. strains originated from patients who had been entered into two phase 3 randomized clinical trials of fidaxomicin versus vancomycin. isolates of c. difficile from the initial and recurrent episodes within 28 (± 2) days of cure of cdi were compared using restr ...201222752857
how much do ppis contribute to c. difficile infections?two separate systematic reviews and meta-analyses published in this edition of the american journal of gastroenterology conclude that proton pump inhibitor (ppi) use is associated with an ~70% increase in the risk of clostridium difficile infection (cdi). the two reviews employed different methodology but reached very similar conclusions. however, since the quality of evidence from the individual studies that were included in these analyses is relatively weak, their conclusions must be interpret ...201222764024
fighting fire with fire: is it time to use probiotics to manage pathogenic bacterial diseases?probiotics, when considered in clinical practice, have traditionally been used for prophylaxis; however, there is growing data suggesting treatment benefits in numerous disease states. in this review, we focus on probiotics as treatment for and prevention of several acute and chronic infectious processes including helicobacter pylori, clostridium difficile, necrotizing enterocolitis, ventilator-associated pneumonia, vancomycin-resistant enterococci, and nonalcoholic fatty liver disease. it is in ...201222763792
constipation in clostridium difficile infection.a patient presented to our hospital with worsening shortness of breath, cough and respiratory distress that slowly worsened over 7-10 days. she had a viral-like illness with runny nose and cough for 1 week, which became productive of yellowish sputum. she was treated with antibiotic and steroid with clinical improvement. her leucocyte count continued to increase despite discontinuation of both antibiotic and steroid. all culture results returned negative. she did not have any abdominal pain or d ...201222761206
evaluation of a new molecular test, the bd max cdiff, for detection of toxigenic clostridium difficile in fecal samples.a new molecular assay detecting toxigenic clostridium difficile, the bd max cdiff (becton, dickinson), was evaluated with 360 diarrheal feces samples. it exhibited high sensitivity (97.7%) and specificity (99.7%). the positive (97.7%) and negative (99.7%) predictive values of this test allow an accurate answer within 2 h.201222760042
lack of enhanced effect of a chlorine dioxide-based cleaning regimen on environmental contamination with clostridium difficile spores.spores of clostridium difficile may play a significant role in transmission of disease within the healthcare environment and are resistant to a variety of detergents and cleaning fluids. a range of environmental cleaning agents has recently become available, many of which claim to be sporicidal. we investigated the effect of changing to a chlorine dioxide-based cleaning regimen on c. difficile environmental contamination and patient infection rates. the prevalence of environmental contamination ...201222795136
the evolution of clostridium difficile infection in cancer patients: epidemiology, pathophysiology, and guidelines for prevention and management.clostridium difficile infection (cdi) has emerged as a significant challenge to the healthcare system. the availability of anti-cancer chemotherapeutic regimens has contemporaneously resulted in a larger population of patients who are susceptible to cdi. the outbreak of a novel, hypervirulent, resistant strain, nap-1/027 as well as resistance to antibiotic therapy have further contributed to an increase in prevalence as well as in disease severity. recent data show high fatality rates in cancer ...201222792862
risk factors for the development of clostridium difficile colitis in a surgical ward.clostridium difficile colitis (cdc) is a nosocomial infection. we attempted to discover the risk factors for the development of cdc in patients admitted to our surgical ward.201222792529
yersinia enterocolitica yopt and clostridium difficile toxin b induce expression of gilz in epithelial cells.glucocorticoid induced-leucine zipper (gilz) has been shown to be induced in cells by different stimuli such as glucocorticoids, il-10 or deprivation of il-2. gilz has anti-inflammatory properties and may be involved in signalling modulating apoptosis. herein we demonstrate that wildtype yersinia enterocolitica which carry the pyv plasmid upregulated gilz mrna levels and protein expression in epithelial cells. infection of hela cells with different yersinia mutant strains revealed that the prote ...201222792400
igg antibody response to toxins a and b in patients with clostridium difficile infection.igg antibodies against clostridium difficile toxins a and b were followed in controls and in patients with an initial c. difficile infection (cdi). of the 50 cdi patients, 38 were cured and 12 developed recurrence. compared to controls, patients had significantly lower anti-toxin a and b iggs at inclusion, but the subsequent levels rose slightly regardless of clinical outcome. the results imply that the general serum reactivity against toxins a and b in the population reduces the risk of cdi, wh ...201222787196
changing epidemiology of clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in england.marked increases in clostridium difficile infection (cdi) incidence, driven by epidemic strain spread, is a global phenomenon.201222784871
clostridium difficile infection and proton pump inhibitors.clostridium difficile is an intestinal infection associated with antibiotic use, commonly seen in patients with chronic medical issues. the purpose of this review is to discuss the association of c. difficile-associated diarrhea with use of proton pump inhibitors.201222781139
suppression of clostridium difficile in the gastrointestinal tracts of germfree mice inoculated with a murine isolate from the family lachnospiraceae.the indigenous microbial community of the gastrointestinal (gi) tract determines susceptibility to clostridium difficile colonization and disease. previous studies have demonstrated that antibiotic-treated mice challenged with c. difficile either developed rapidly lethal c. difficile infection or were stably colonized with mild disease. the gi microbial community of animals with mild disease was dominated by members of the bacterial family lachnospiraceae, while the gut community in moribund ani ...201222890996
isolation and characterization of clostridium difficile toxin-specific single-domain antibodies.camelidae single-domain antibodies (vhhs) are a unique class of small binding proteins that are promising inhibitors of targets relevant to infection and immunity. with vhh selection from hyperimmunized phage display libraries now routine and the fact that vhhs possess long, extended complementarity-determining region (cdr3) loop structures that can access traditionally immunosilent epitopes, vhh-based inhibition of targets such as bacterial toxins are being explored. toxin a and toxin b are hig ...201222886255
burden of gastrointestinal disease in the united states: 2012 update.gastrointestinal (gi) diseases account for substantial morbidity, mortality, and cost. statistical analyses of the most recent data are necessary to guide gi research, education, and clinical practice. we estimate the burden of gi disease in the united states.201222885331
clostridium difficile infection in a patient with crohn disease.crohn disease is a chronic inflammatory disorder, which is rare in pediatric patients. the definite etiology and mechanism to induce an acute exacerbation of crohn disease remains mostly unknown. the authors report on a 14-year-old girl with crohn disease who has acute gastrointestinal symptoms caused by toxin a-producing clostridium difficile, which mimicked a flare-up of crohn disease. there was no preceding antibiotic prescription before the episode. the disease activity did not improve after ...201222748626
presence and molecular characterization of clostridium difficile and clostridium perfringens in intestinal compartments of healthy horses.clostridium difficile and clostridium perfringens are commonly associated with colitis in equids, but healthy carriers exist. scarce information is available on the prevalence of clostridium spp. in gastrointestinal compartments other than faeces in healthy horses, and it is unknown whether faecal samples are representative of proximal compartments. the objectives were to investigate the prevalence of c. difficile and c. perfringens in different intestinal compartments of healthy adult horses an ...201222748233
the structure of clostridium difficile toxin a glucosyltransferase domain bound to mn2+ and udp provides insights into glucosyltransferase activity and product release.clostridiumdifficile toxin a (tcda) is a member of the large clostridial toxin family, and is responsible, together with c. difficile toxin b (tcdb), for many clinical symptoms d ring human infections. like other large clostridial toxins, tcda catalyzes the glucosylation of gtpases, and is able to inactivate small gtpases within the host cell. here, we report the crystal structures of the tcda glucosyltransferase domain (tcda-gt) in the apo form and in the presence of mn(2+) and hydrolyzed udp-g ...201222747490
application of copper to prevent and control infection. where are we now?the antimicrobial effect of copper has long been recognized and has a potential application in the healthcare setting as a mechanism to reduce environmental contamination and thus prevent healthcare-associated infection (hcai).201222738611
protection against clostridium difficile infection with broadly neutralizing antitoxin monoclonal antibodies.the spore-forming bacterium clostridium difficile represents the principal cause of hospital-acquired diarrhea and pseudomembranous colitis worldwide. c. difficile infection (cdi) is mediated by 2 bacterial toxins, a and b; neutralizing these toxins with monoclonal antibodies (mabs) provides a potential nonantibiotic strategy for combating the rising prevalence, severity, and recurrence of cdi. novel antitoxin mabs were generated in mice and were humanized. the humanized antitoxin a mab pa-50 an ...201222732923
risk factors for mortality in clostridium difficile infection in the general hospital population: a systematic review.clostridium difficile infection (cdi) is one of the most important healthcare-associated infections, causing considerable mortality. numerous severity scores have been proposed to identify patients with cdi at risk of mortality, but a systematic review of the evidence upon which these are based has never been published. such a review could permit future development of scores that better predict mortality.201222727824
association of clostridium difficile infection with outcomes of hospitalized solid organ transplant recipients: results from the 2009 nationwide inpatient sample database.diarrhea is a frequent and potentially severe complication in solid organ transplant (sot) recipients. one of the most common infectious etiologies of diarrhea in these patients is clostridium difficile. our objective was to investigate the association of c. difficile infection (cdi) with the outcomes of hospitalized sot patients.201222726461
conservative surgical treatment for toxic megacolon due to clostridium difficile infection in a transplanted pediatric patient.severe disease caused by clostridium difficile is frequently encountered in transplant recipients and carries a high mortality. numerous studies have been published on this subject in the adult population, but few in the pediatric setting. a 4-year-old boy who had undergone heart transplant 20 months earlier was admitted to the pediatric intensive care unit after humoral rejection. seven days after admission, he developed septic shock, abdominal distension, and paralytic ileus without diarrhea. ...201222726419
effectiveness of a short (4 day) course of oritavancin in the treatment of simulated clostridium difficile infection using a human gut model.we previously demonstrated that 7 days of oritavancin instillation effectively treats clostridium difficile infection (cdi) in a human gut model. oritavancin may be more effective than vancomycin due to apparently increased activity against spores. we compared the efficacy of shortened dosing duration (4 days) of oritavancin and vancomycin for cdi treatment using the gut model.201222723601
implementation of an antimicrobial stewardship program in a rural hospital.the implementation of a pharmacy-directed antimicrobial stewardship (ams) program involving the use of telemedicine technology is described.201222722593
prediction and prevention of upper gastrointestinal bleeding after cardiac surgery: a case control study.gastrointestinal (gi) complications of cardiovascular surgery, particularly bleeding, occur frequently.201222720275
evolution of testing algorithms at a university hospital for detection of clostridium difficile infections.we present the evolution of testing algorithms at our institution in which the c. diff quik chek complete immunochromatographic cartridge assay determines the presence of both glutamate dehydrogenase and clostridium difficile toxins a and b as a primary screen for c. difficile infection and indeterminate results (glutamate dehydrogenase positive, toxin a and b negative) are confirmed by the genexpert c. difficile pcr assay. this two-step algorithm is a cost-effective method for highly sensitive ...201222718938
probiotics for the prevention and treatment of clostridium difficile in older patients.clostridium difficile infection (cdi) is the leading cause of nosocomial diarrhoea in older people, causing substantial morbidity and mortality. the fact that cdi is almost exclusively a disease of older people and the debilitated indicates that patient susceptibility is a major determinant of who gets cdi. it would help efforts to combat this disease if we better understood and could reduce patient susceptibility. in this regard, several strategies are currently under investigation. the use of ...201222718155
fidaxomicin for clostridium difficile-associated diarrhoea: epidemiological method for estimation of warranted price.fidaxomicin is a macrocyclic antibiotic approved in 2011 by the us food and drug administration for treatment of clostridium difficile-associated diarrhoea (cdad).201222708825
[clostridium difficile infection in children--experience of clinical centre in bydgoszcz].clostridium difficile (cd) is one of the main factors of nosocomial infections both in children and adults and the number these infections is still growing. there is an increasing number of community-associated cdad and cdis with no exposure to antibiotics. tests for cd among children are not routinely conducted because of high rate of carrying (from 13 to 70% infants). the objective of a study was to assess the frequency cdi among children with diarrhea, analysis of the risk factors of cdi and ...201222708301
[clostridium difficile as etiological agent of pseudomembranous colitis]. 201222708300
evaluation of three enzyme immunoassays and a loop-mediated isothermal amplification test for the laboratory diagnosis of clostridium difficile infection.the laboratory diagnosis of clostridium difficile infection (cdi) consists of the detection of toxigenic clostridium difficile, and/or its toxins a or b in stool preferably in a two-step algorithm. in a prospective study, we compared the performance of three toxin enzyme immunoassays (eias)-immunocard toxins a & b, premier toxins a & b and c. diff quik chek complete, which combines a toxins test and a glutamate dehydrogenase (gdh) antigen eia in one device -and the loop-mediated isothermal ampli ...201222706512
prophage carriage and diversity within clinically relevant strains of clostridium difficile.prophages are encoded in most genomes of sequenced clostridium difficile strains. they are key components of the mobile genetic elements and, as such, are likely to influence the biology of their host strains. the majority of these phages are not amenable to propagation, and therefore the development of a molecular marker is a useful tool with which to establish the extent and diversity of c. difficile prophage carriage within clinical strains. to design markers, several candidate genes were ana ...201222706062
comparative analysis of an expanded clostridium difficile reference strain collection reveals genetic diversity and evolution through six lineages.clostridium difficile is an anaerobic bacillus that resides in the gut and has rapidly emerged as a leading cause of antibiotic associated diarrheal disease in humans. the genetic basis of the pathogenicity of c. difficile remains poorly understood. in this study we aimed at characterizing the genetic diversity of c. difficile strains by three different methods (pcr ribotyping, multilocus sequence typing and genetic markers) to improve the typing of c. difficile. our study was performed on a ref ...201222705462
you can teach old pathogens new tricks: the zoonotic potential of escherichia coli, clostridium difficile, staphylococcus aureus, and enterococci, or from noah's ark to pandora's box. 201222703445
efficacy and safety of fidaxomicin compared with oral vancomycin for the treatment of adults with clostridium difficile-associated diarrhea: data from the opt-80-003 and opt-80-004 studies.clostridium difficile is emerging as one of the most important and devastating pathogens affecting hospitalized populations around the world. the incidence of c. difficile infection is increasing and disease severity is worsening. thus, an effective alternative to metronidazole and oral vancomycin is urgently needed. two phase iii trials, opt-80-003 and opt-80-004, showed that oral fidaxomicin for 10 days was noninferior compared with treatment with oral vancomycin among adult patients with toxi ...201222702523
inappropriate use of gastric acid suppression therapy in hospitalized patients with clostridium difficile-associated diarrhea: a ten-year retrospective analysis.purpose. the incidence of clostridium difficile-associated diarrhea (cdad) has steadily increased over the past decade. a multitude of factors for this rise in incidence of cdad have been postulated, including the increased use of gastric acid suppression therapy (gast). despite the presence of practice guidelines for use of gast, studies have demonstrated widespread inappropriate use of gast in hospitalized patients. we performed a retrospective analysis of inpatients with cdad, with special em ...201222701180
diarrhea etiology in a pediatric emergency department: a case control study.the etiology of childhood diarrhea is frequently unknown.201222700832
implementation of standardised surveillance for clostridium difficile infections in australia: initial report from the victorian healthcare associated infection surveillance system.detection of a hypervirulent strain of clostridium difficile in victoria led to commencement of targeted surveillance for c. difficile infection in 2010. cases were reported through the victorian healthcare associated infection surveillance system. between 1 october 2010 and 31 march 2011, 477 cases of c. difficile infection were identified; 11 (2.3%) secondary to a hypervirulent strain. three hundred and seventy (1.7 per 10,000 occupied bed days) were healthcare associated. data reflect success ...201222697155
surgical treatment of clostridium colitides.infection with clostridium difficile (cdi) is the most frequent cause of nosocomial diarrhoeas. most cases are successfully treated by antibiotic therapy, but nearly 10% may progress to the fulminative form of this condition. the objective of the work is retrospective evaluation of the results of surgical treatment in patients with the fulminative form of clostridium colitis with revealing of risk factors leading to serious post-operative morbidity and mortality.201223373360
unusual localization of clostridium difficile infection in an isolated segment of the descending colon in a critical care patient.unrecognized severe pseudomembranous colitis may become life threatening. a typical clostridium difficile infection is associated with involvement of the colon; however, small bowel disease has also been described. here, we present a case of a 48-year-old man with clostridium difficile colitis of an isolated segment in the descending colon treated by a novel catheter intraluminal antibiotic irrigation. the intraluminal antibiotic irrigation was performed through a foley catheter inserted into th ...201223316409
understanding gut-immune interactions in management of acute infectious diarrhoea.this article discusses the role that immunity plays in the risk of diarrhoea and the potential role for probiotics in the management of acute infectious diarrhoea in older people, including antibiotic-associated diarrhoea and clostridium difficile-associated diarrhoea.201223311278
characterization of continued antibacterial therapy after diagnosis of hospital-onset clostridium difficile infection: implications for antimicrobial stewardship.to determine the proportion of hospitalized adults with hospital-onset clostridium difficile infection (cdi) who continued to receive concomitant non-cdi antibacterial agents, to characterize the antibacterial therapy that these patients received before and after the diagnosis of cdi, and to compare hospital outcomes between those patients who did and those who did not have their previous antibacterial therapy discontinued after cdi diagnosis.201223307522
[assessment of the usefulness of chromogenic medium for the isolation of clostridium difficile from the gastrointestinal tract of children with diarrhoea].clostridium difficile is well known as an important cause of nosocomial infection. laboratory diagnostics have included bacterial culture or more commonly, direct detection of preformed toxin in stool samples using different assays. the aim of this study was to evaluate and compare two selecitve media to isolation of c. difficile from paediatric diarrhoeal stool samples.201223285773
[report: clostridium difficile outbreak at the dr. alejandro del río emergency hospital in santiago, chile]. 201223282496
an economic evaluation of clostridium difficile infection management in an italian hospital environment.clostridium difficile infection (cdi) accounts for the majority of nosocomial cases of diarrhea, and with recent upsurge of multidrug-resistant strains, morbidity and mortality have increased. data on clinical impact of cdi come mostly from anglo-saxon countries, while in italy only two studies address the issue and no economic data exist on costs of cdi in the in hospital setting. a retrospective cross-sectional study with pharmacoeconomic analysis was performed on the cdi series of the policli ...201223280031
five years experience of clostridium difficile infection in children at a uk tertiary hospital: proposed criteria for diagnosis and management.clostridium difficile infection (cdi) is associated with significant morbidity and mortality in adults. there is increasing evidence of the pathogenic role of c. difficile in the paediatric population. we sought to ascertain the clinical presentation and severity of cdi in children at our institution and develop criteria to aid management.201223300561
phenome based analysis as a means for discovering context dependent clinical reference ranges.robust electronic medical records (emr's) have made large-scale phenome-based analysis feasible. the context-dependent phenome of a large icu-based emr database (mimic ii) was explored, as a function of a clinical feature: white blood cell count (wbc). phenome visualization led to the discovery that peak wbc in the range 15-45 k/μl was highly associated with the diagnoses of clostridium difficile and bacterial sepsis; thus, it is conceivable that clinicians might delay ordering targeted antimicr ...201223304424
clostridium difficile 027 infection in central italy.clostridium difficile (cd) has increasingly become recognised as a significant international health burden, often associated with the healthcare environment. the upsurge in incidence of cd coincided with the emergence of a hypervirulent strain of cd characterized as 027. in 2010, 8 cases of cd 027 infections were identified in italy. since then, no further reports have been published. we describe 10 new cases of cd 027 infection occurring in italy.201223259814
epidemiology, diagnosis and treatment of clostridium difficile infection.clostridium difficile infection (cdi) is considered to be the main cause of bacterial infectious diarrhea in nosocomial settings. since the beginning of the new century a continuous rise in the incidence of severe cdi has been observed worldwide. even though some cdi cases are not associated with previous antibiotic exposure, this remains as the principal risk factor for the development of cdi. the rate of recurrences represents perhaps one the most challenging aspect on the management of cdi. t ...201223253319
a cohort study for derivation and validation of a clinical prediction scale for hospital-onset clostridium difficile infection.to develop and validate a clinical prediction scale for hospital-onset clostridium difficile infection (cdi).201223248788
using a dog's superior olfactory sensitivity to identify clostridium difficile in stools and patients: proof of principle study.to investigate whether a dog's superior olfactory sensitivity can be used to detect clostridium difficile in stool samples and hospital patients.201223241268
cd44 promotes intoxication by the clostridial iota-family toxins.various pathogenic clostridia produce binary protein toxins associated with enteric diseases of humans and animals. separate binding/translocation (b) components bind to a protein receptor on the cell surface, assemble with enzymatic (a) component(s), and mediate endocytosis of the toxin complex. ultimately there is translocation of a component(s) from acidified endosomes into the cytosol, leading to destruction of the actin cytoskeleton. our results revealed that cd44, a multifunctional surface ...201223236484
association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.emerging epidemiological evidence suggests that proton pump inhibitor (ppi) acid-suppression therapy is associated with an increased risk of clostridium difficile infection (cdi).201223236397
characterisation of clostridium difficile biofilm formation, a role for spo0a.clostridium difficile is a gram-positive anaerobic, spore-forming bacillus that is the leading cause of nosocomial diarrhoea worldwide. we demonstrate that c. difficile aggregates and forms biofilms in vitro on abiotic surfaces. these polymicrobial aggregates are attached to each other and to an abiotic surface by an extracellular polymeric substance (eps). the eps matrix provides the scaffold bonding together vegetative cells and spores, as well as forming a protective barrier for vegetative ce ...201223236376
concomitant clostridium difficile colitis and cytomegalovirus colitis in an immunocompetent elderly female.a 78-year-old japanese woman with diarrhoea and abdominal pain was admitted for pcr test (pcr)-proven clostridium difficile colitis. the patient's symptoms persisted despite multiple courses of antibiotics including intravenous metronidazole, oral  vancomycin and oral fidaxomicin. she underwent a stool transplant without improvement. biopsies from a colonoscopy revealed concomitant cytomegalovirus (cmv) infection. the patient was immediately started on intravenous ganciclovir. unfortunately, she ...201223234822
nosocomial infections in leukemic and solid-tumor cancer patients: distribution, outcome and microbial spectrum of anaerobes.nosocomial infections cause significant morbidity and mortality in cancer patients. as a result of their debilitated immune system, cancer patients are likely candidates for colonization with anaerobes. we sought to compare the distribution of nosocomial infections in neutropenic and non-neutropenic cancer patients and to calculate the associated mortality rates.201223231490
[successful treatment of life-threatening, treatment resistant clostridium difficile infection associated pseudomembranous colitis with faecal transplantation].due to world-wide spread of hypervirulent and antibiotic resistant clostridium difficile strains, the incidence of these infections are dramatically increasing in hungary with appalling mortality and recurrence rates. authors present a case of a 59-year-old patient who developed a severe, relapsing pseudomembranous colitis after antibiotic treatment. life-threatening symptoms of fulminant colitis were successfully treated with prolonged administration of metronidazole and vancomycin, careful sup ...201223261996
clostridium difficile toxin a inhibits erythropoietin receptor-mediated colonocyte focal adhesion through inactivation of janus kinase-2.previously, we demonstrated that the erythropoietin receptor (epor) is present on fibroblasts, where it regulates focal contact. here, we assessed whether this action of epor is involved in the reduced cell adhesion observed in colonocytes exposed to clostridium difficile toxin a. epor was present and functionally active in cells of the human colonic epithelial cell line ht29 and epithelial cells of human colon tissues. toxin a significantly decreased activating phosphorylations of epor and its ...201223221524
[acute clostridium difficile gastroenteritis at the department of infectious diseases].clostridium difficile infection is known as the primary cause of nosocomial gastroenteritis, which accounts for approximately 20-25% of all diarrhea. infection can lead to a potentially fatal disease and the incidence of that is increasing worldwide.201223220365
[preliminary investigation of intestinal microflora in patients with hepatic cirrhosis].to examine the differential levels of fecal bifidobacterium, bacteroides, eubacterium rectale-clostridium, escherichia coli, enterococcus, and clostridium difficile between patients with hepatic cirrhosis and healthy controls. fecal samples were collected from 29 patients with hepatic cirrhosis treated in the department of digestive diseases at zunyi hospital between march and december of 2010.201223206299
effect of biotherapeutics on antitoxin igg in experimentally induced clostridium difficile infection.recurrent diarrhoea after successful treatment of primary clostridium difficile associated disease (cdad) occurs due to bowel flora alterations and failure to mount an effective antibody response. apart from antibiotics, risk factors include immunosuppressive and acid-suppressive drug administration. biotherapeutics such as probiotic and epidermal growth factor (egf) may offer potential effective therapy for cdad.201223183468
adenosine a2a receptor activation reduces recurrence and mortality from clostridium difficile infection in mice following vancomycin treatment.activation of the a2a adenosine receptor (a2aar) decreases production of inflammatory cytokines, prevents c. difficile toxin a-induced enteritis and, in combination with antibiotics, increases survival from sepsis in mice. we investigated whether a2aar activation improves and a2aar deletion worsens outcomes in a murine model of c. difficile (strain vpi10463) infection (cdi).201223217055
colonoscopic fecal microbiota transplant for recurrent clostridium difficile infection in a child. 201223211865
probiotics prevent clostridium difficile in people taking antibiotics. 201223169808
an unusual method of diagnosing a common disease.a 34-year-old woman presented with non-bloody diarrhoea of 14 days duration and vomiting. physical examination was unremarkable. she had hypokalaemia and metabolic acidosis. stool studies were negative for clostridium difficile toxin, faecal leucocytes and parasites. colon appeared normal on colonoscopy. pronounced scalloping of ileal folds was noted on ileoscopy. ileal biopsies revealed villous blunting, crypt hyperplasia, marked intraepithelial lymphocytosis and lymphocytic infiltration of the ...201223166167
isolation of clostridium difficile from peritoneal fluid. 201223163311
current and emerging management options for clostridium difficile infection: what is the role of fidaxomicin?until recently, treatment of clostridium difficile infection (cdi) was mainly limited to oral metronidazole and vancomycin, neither of which is optimal. up to 25% of patients with cdi experience recurrence of infection within 30 days following treatment with these agents, while c. 45-65% of these patients experience further (and sometimes multiple) recurrences. recurrent cdi represents a major treatment challenge for which new therapeutic options are sorely needed. fidaxomicin is a first-in-clas ...201223121552
can we identify patients at high risk of recurrent clostridium difficile infection?although most patients with clostridium difficile infection (cdi) can be managed effectively with discontinuation of prescribed antibiotics and additional treatment with oral metronidazole or vancomycin, up to 25% experience disease recurrence, usually within 30 days of treatment. failure to mount a systemic anti-toxin antibody response differentiates patients with cdi and recurrent cdi from symptomless carriers of toxinogenic c. difficile. the immunological senescence that accompanies ageing ma ...201223121551
overcoming barriers to effective recognition and diagnosis of clostridium difficile infection.with the frequency of cases of clostridium difficile infection (cdi) increasing in many developed countries, accurate and reliable laboratory diagnosis of cdi is more important than ever. however, the diagnosis of cdi has been handicapped by the existence of two reference standards, one of which detects c. difficile toxin (cytotoxin assay) and the other only toxigenic strains (cytotoxigenic culture). being relatively slow and laborious to perform, these reference methods were largely abandoned a ...201223121550
consequences of clostridium difficile infection: understanding the healthcare burden.clostridium difficile is the leading cause of infectious nosocomial diarrhoea in developed countries, with a measured incidence of approximately five episodes per 10,000 days of hospital stay in europe. accurate diagnosis of c. difficile infection (cdi) is a prerequisite for obtaining reliable epidemiological data, but in many european countries diagnosis is probably suboptimal. a significant percentage of cdi cases are missed because clinicians often fail to request tests for c. difficile toxin ...201223121549
breaking the cycle of recurrent clostridium difficile infections. 201223121548
time to act against clostridium difficile infection. 201223121547
[infection frequency in patients with chronic idiopathic ulcerative colitis].ulcerative colitis (uc) is a chronic inflammatory bowel disease characterized by diffuse inflammation of the mucosa of the colon. up to now, diverse observational studies have implicated a wide variety of pathogenic microorganisms as causal and exacerbating factors in uc. clostridium difficile (c. difficile) infection has been associated with recurrence and treatment failure and its incidence in patients with uc has been on the rise in the last few years.201223159238
fidaxomicin for the treatment of clostridium difficile infections.clostridium difficile infection (cdi), also known as c. difficile-associated disease or diarrhoea (cdad), is an important cause of hospital-acquired diarrhoea with disease severity ranging from mild diarrhoea to fulminant colitis. in addition, over 40% of new cases of cdi occur outside hospital. ▾ fidaxomicin (dificlir - astellas), the first antibiotic in a new class called macrocyclics, has recently been licensed for the treatment of c. difficile infection in adults. here we provide a brief ove ...201223154594
[clostridium difficile: is it time to start worrying?]. 201223153414
safety and efficacy of fidaxomicin in the treatment of clostridium difficile-associated diarrhea.clostridium difficile-associated diarrhea (cdad) is the most common cause of healthcare-associated diarrhea. the current recommended treatment regimens of metronidazole and vancomycin have not changed in nearly 25 years. fidaxomicin, an exceedingly narrow spectrum macrolide antibiotic, was recently approved for the treatment of cdad. in phase iii clinical trials, fidaxomicin was noninferior to vancomycin in achieving clinical cure of cdad. furthermore, fidaxomicin was associated with fewer recur ...201223152733
[recommendations for diagnosis and therapy of colitis caused by clostridium difficile].clostridium difficile infection (cdi) is a disease of varying severity. its manifestations range from mild diarrhea to life-threatening paralytic ileus, painful distension of the large bowel and sepsis. another possible manifestation of the disease is recurrent colitis that can exhaust the patient. for establishing the diagnosis, the patient's stool should be examined with two or three different microbiological methods. immunochemical testing for the presence of clostridial toxins a and b shows ...201223208871
efficacy of different cleaning and disinfection methods against clostridium difficile spores: importance of physical removal versus sporicidal inactivation.we tested the effectiveness of disinfectants and wipe methods against clostridium difficile spores. wiping with nonsporicidal agents (physical removal) was effective in removing more than 2.9 log(10) c. difficile spores. wiping with sporicidal agents eliminated more than 3.90 log(10) c. difficile spores (physical removal and/or inactivation). spraying with a sporicide eliminated more than 3.44 log(10) c. difficile spores but would not remove debris.201223143366
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