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collateral impact of a hospital outbreak of clostridium difficile: an unrecognized surge event requiring a system-level response.this paper discusses a unique surge event caused by an outbreak of clostridium difficile, resulting not from an increase in the demands on the healthcare system but, rather, from a substantial decrease in the capacity to provide care when the medical capacity in the facility was decreased by 50% due to bed closures. approaches to managing the situation using the staff, stuff and space paradigm are presented as strategies to prevent future adverse medical events.201222986569
development of a consensus method for culture of clostridium difficile from meat and its use in a survey of u.s. retail meats.three previously described methods for culture of clostridium difficile from meats were evaluated by microbiologists with experience in c. difficile culture and identification. a consensus protocol using bhi broth enrichment followed by ethanol shock and plating to selective and non-selective media was selected for use, and all participating laboratories received hands-on training in the use of this method prior to study initiation. retail meat products (n = 1755) were cultured for c. difficile ...201222986214
rapid detection of sequence variation in clostridium difficile genes using late-pcr with multiple mismatch-tolerant hybridization probes.a novel molecular assay for clostridium difficile was developed using linear-after-the-exponential polymerase chain reaction (late-pcr). single-stranded dna products generated by late-pcr were detected and distinguished by hybridization to fluorescent mismatch-tolerant probes, as the temperature was lowered after amplification in 5(°)c intervals between 65°c and 25°c. single-tube multiplex reactions for tcda, tcdb, tcdc, and cdtb (binary toxin) sequences were initially optimized using synthetic ...201222982259
clostridium difficile: an emerging pathogen in children.clostridium difficile is emerging as an important enteric pathogen in children. historically considered as an asymptomatic colonizer of the gastrointestinal tract, c. difficile infection (cdi) has not been well-studied in pediatric populations. while asymptomatic carriage remains high among infants, recent epidemiological surveillance has demonstrated a rise in the prevalence of cdi in both healthcare and community settings, particularly in children 1-5 years of age. the pathogenesis of pediatri ...201222935207
determination of serum antibodies to clostridium difficile toxin b in patients with inflammatory bowel disease.clostridium difficile infection has increased in prevalence among patients with inflammatory bowel disease (ibd). serum antibodies against c. difficile toxins have been detected in susceptible populations and may be protective; however, such antibodies have not been previously characterized in ibd patients. this study measured immunoglobulin g antibody levels to c. difficile toxin b in serum from ibd patients in remission and ibd patients in relapse. ibd patients demonstrated significantly highe ...201222933861
[treatment of refractory or recurrent clostridium difficile infection].the incidence and severity of clostridium difficile infection (cdi) has increased over the past decades. it is related to the emergence of hypervirulent strains and increased use of antibiotics. the incidence of refractory cdi to standard therapies and the risk for recurrent cdi are also increasing. current guidelines recommend the first recurrence to be treated with the same agent used for the initial episode. however, data are lacking to support any particular treatment strategy for severe ref ...201222926117
prevalence and genotypic characterization of clostridium difficile from ruminants in switzerland.clostridium difficile is an emerging enteric pathogen of humans and animals with a known main reservoir in the intestinal tract of various warm-blooded animals. this study was carried out to evaluate the prevalence of c. difficile in 150 rectal swab samples collected from cattle and goats in switzerland. the overall prevalence of c. difficile was 6.6%. the isolates belonged to the pcr ribotypes 033, 066, 070, 003, 001 and 137. in addition, the occurrence of c. difficile in faecal samples collect ...201222925279
contribution of spores to the ability of clostridium difficile to adhere to surfaces.clostridium difficile is the commonest cause of hospital-acquired infection in the united kingdom. we characterized the abilities of 21 clinical isolates to form spores; to adhere to inorganic and organic surfaces, including stainless steel and human adenocarcinoma cells; and to germinate. the composition of culture media had a significant effect on spore formation, as significantly more spores were produced in brain heart infusion broth (student's t test; p = 0.018). the spore surface relative ...201222923404
evidence of in vivo prophage induction during clostridium difficile infection.prophages contribute to the evolution and virulence of most bacterial pathogens, but their role in clostridium difficile is unclear. here we describe the isolation of four myoviridae phages, φmmp01, φmmp02, φmmp03, and φmmp04, that were recovered as free viral particles in the filter-sterilized stool supernatants of patients suffering from c. difficile infection (cdi). furthermore, identical prophages were found in the chromosomes of c. difficile isolated from the corresponding fecal samples. we ...201222923402
risk factors for development of clostridium difficile infection due to bi/nap1/027 strain: a meta-analysis.to identify risk factors for the development of clostridium difficile infection (cdi) due to c. difficile bi/nap1/027 strain.201222921930
toward a structural understanding of clostridium difficile toxins a and b.clostridium difficile is a toxin-producing bacterium that is a frequent cause of hospital-acquired and antibiotic-associated diarrhea. the incidence, severity, and costs associated with c. difficile associated disease are substantial and increasing, making c. difficile a significant public health concern. the two primary toxins, tcda and tcdb, disrupt host cell function by inactivating small gtpases that regulate the actin cytoskeleton. this review will discuss the role of these two toxins in pa ...201222919620
"community-acquired clostridium difficile infection: an emerging entity". 201222918999
the continually evolving clostridium difficile species.clostridium difficile is a spore-forming gram-positive bacterium that causes chronic diarrhea and sometimes life-threatening disease mainly in elderly and hospitalized patients. the reported incidence of c. difficile infection has changed dramatically over the last decade and has been related to the emergence of distinct clonal lineages that appear more transmissible and cause more severe infection. these include pcr ribotypes 027, 017 and more recently 078. population biology studies using mult ...201222913354
molecular basis of early stages of clostridium difficile infection: germination and colonization.clostridium difficile infections (cdis) occur when antibiotic therapy disrupts the gastrointestinal flora, favoring infected c. difficile spores to germinate, outgrow, colonize and produce toxins. during cdi, c. difficile vegetative cells initiate the process of sporulation allowing a fraction of the spores to remain adhered to the intestinal surfaces. these spores, which are unaffected by antibiotic therapy commonly used for cdis, then germinate, outgrow and recolonize the host's gi tract causi ...201222913353
tcdc does not significantly repress toxin expression in clostridium difficile 630δerm.in the past decade, clostridium difficile has emerged as an important gut pathogen. symptoms of c. difficile infection range from mild diarrhea to pseudomembranous colitis, sometimes resulting in colectomy or death. the main virulence factors of c. difficile are toxin a and toxin b. besides the genes encoding these toxins (tcda and tcdb), the pathogenicity locus (paloc) also contains genes encoding a sigma factor (tcdr) and a putative anti-sigma factor (tcdc). the important role of tcdr as a sig ...201222912837
utility of perirectal swab specimens for diagnosis of clostridium difficile infection.for 139 patients tested for clostridium difficile infection by polymerase chain reaction, the sensitivity, specificity, positive predictive value, and negative predictive value of testing perirectal swabs vs stool specimens were 95.7%, 100%, 100%, and 99.1%, respectively. for selected patients, perirectal swabs provide an accurate toxigenic c. difficile detection strategy.201222911648
acp journal club: review: proton-pump inhibitors are associated with increased risk for clostridium difficile infection. 201222910967
in vivo selection of rifamycin-resistant clostridium difficile during rifaximin therapy.we report the selection of clostridium difficile resistant to the rifamycin class of antibiotics in a patient within 32 h of receiving rifaximin for the treatment of recurrent c. difficile diarrhea. resistance was associated with single nucleotide substitutions within rpob.201222908175
clostridium difficile in young farm animals and slaughter animals in belgium.faecal carriage of clostridium difficile in healthy animals has been reported recently, especially in piglets and calves. however there is limited data about carriage in animals just prior to slaughter in europe. the main objective of this study was to determine the presence of c. difficile in pigs and cattle at the slaughterhouse. c. difficile was isolated in 6.9% of the cattle at the slaughterhouse. none of the pig slaughter samples were positive for c. difficile after an enrichment time of 72 ...201223041559
fecal microbiota transplantation for treating recurrent clostridium difficile infection. 201222937601
enteric pathogens through life stages.enteric infections and diarrheal diseases constitute pervasive health burdens throughout the world, with rates being highest at the two ends of life. during the first 2-3 years of life, much of the disease burden may be attributed to infection with enteric pathogens including salmonella, rotavirus, and many other bacterial, viral, and protozoan organisms; however, infections due to clostridium difficile exhibit steady increases with age. still others, like campylobacter infections in industriali ...201222937528
clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with clostridium difficile 027.clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial c. difficile transmission.201222902081
an evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of clostridium difficile infection in hospital settings.to evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital clostridium difficile infection (cdi) incidence rates. a secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool.201222899806
oritavancin does not induce clostridium difficile germination and toxin production in hamsters or a human gut model.to evaluate the relative propensities of oritavancin and vancomycin to induce clostridium difficile infection (cdi) in hamster and in vitro human gut models.201222899803
clinical and economic outcomes of a prospective antimicrobial stewardship program.a pre-post analysis of an antimicrobial stewardship program (asp) involving the use of data-mining software to prospectively identify cases for asp intervention was conducted.201222899745
modeling host-pathogen interactions: h. sapiens as a host and c. difficile as a pathogen.many complex mechanisms in immunological studies cannot be measured by experiments, but can be analyzed by mathematical simulations. using theoretical modeling techniques, general principles of host-pathogen system interactions can be explored and clinical treatment schedules can be optimized to lower the microbial toxin burden and side effects in the host system. in this study, we use a computational modeling technique that aims to explain the host-pathogen interactions and suggests how the hos ...201222899591
toxic megacolon from fulminant clostridium difficile infection induced by topical silver sulphadiazine.pseudomembranous colitis and toxic megacolon (tm) are well-known complications of clostridium difficile infections. systemic antibiotic is considered as the major risk factor for the development of c difficile colitis. however, topical antibiotics are rarely associated with the infection. as previously thought, the use of topical antibiotic is capable of systemic absorption in damaged and denuded skin; sufficient enough to suppress the normal bowel flora. here, we present an unusual case of tm f ...201222878997
sensitivity of pathogenic and commensal bacteria from the human colon to essential oils.the microbiota of the intestinal tract plays an important role in colonic health, mediating many effects of dietary components on colonic health and during enteric infections. in the context of the increasing incidence of antibiotic resistance in gut bacteria, complementary therapies are required for the prevention and treatment of enteric infections. here we report the potential application of essential oils (eo) and pure eo compounds to improve human gut health. nerolidol, thymol, eugenol and ...201222878397
impact of toxigenic clostridium difficile colonization and infection among hospitalized adults at a district hospital in southern taiwan.the impact of toxigenic clostridium difficile colonization (tcdc) in hospitalized patients is not clear.201222876321
fidaxomicin (dificid), a novel oral macrocyclic antibacterial agent for the treatment of clostridium difficile-associated diarrhea in adults. 201222876085
novel management strategies in the treatment of severe clostridium difficile infection.cdi is increasing in incidence and severity. clinicians must have a low threshold to consider the diagnosis and to treat patients with the clinical syndrome and risk factors before laboratory confirmation of the diagnosis. in patients who have signs of advanced disease, escalation of care with antimicrobial strategies and multidisciplinary care including surgical consultation is necessary. furthermore, lowering the threshold for surgery compared with traditional approaches likely results in impr ...201222873036
in vitro and in vivo activities of the novel ketolide rbx 14255 against clostridium difficile.the mic(90) of rbx 14255, a novel ketolide, against clostridium difficile was 4 μg/ml (mic range, 0.125 to 8 μg/ml), and this drug was found to be more potent than comparator drugs. an in vitro time-kill kinetics study of rbx 14255 showed time-dependent bacterial killing for c. difficile. furthermore, in the hamster model of c. difficile infection, rbx 14255 demonstrated greater efficacy than metronidazole and vancomycin, making it a promising candidate for c. difficile treatment.201222869573
current challenges in antimicrobial resistance and healthcare-associated infections: role and organization of arhai.the uk government specialist advisory committee on antimicrobial resistance and healthcare-associated infections (arhai) was established in 2007. it has responsibility for providing practical and scientific advice to government on healthcare-associated infections (hcais) and to maintain the effectiveness of antimicrobial agents in the treatment and prevention of infection in man and animals. the manner in which this has been approached by arhai is described. in essence, key themes have been defi ...201222855877
recommendations for surveillance priorities for healthcare-associated infections and criteria for their conduct.surveillance and feedback of results to clinical teams is central to performance improvement in managing healthcare-acquired infections. a major role of the advisory committee on antimicrobial resistance and healthcare-associated infections (arhai) is to advise on surveillance priorities. a sub-committee was set up to systematically review existing uk surveillance schemes. the following three systems were examined in detail: mandatory reporting of methicillin-resistant staphylococcus aureus (mrs ...201222855875
policy development for clostridium difficile.the advisory committee on antimicrobial resistance and healthcare associated infection (arhai) was created at the height of the incidence of clostridium difficile infection (cdi). this article describes the role of arhai in the evaluation of laboratory testing for cdi, a related consultation on the legal requirements for manufacturers of in vitro diagnostic medical devices, a cdi healthcare bundle and surveillance of cdi in children.201222855874
fidaxomicin: a new option for the treatment of clostridium difficile infection.the two drugs currently recommended for the treatment of clostridium difficile infection (cdi), namely vancomycin and metronidazole, are both associated with high rates of recurrence of infection. hence there is a need for new treatment options. the novel oral macrocyclic antibiotic fidaxomicin (previously known as par-101, opt-80 and difimicin) was recently approved in the usa and in europe for the treatment of cdi. clinical trials have shown non-inferiority with regard to clinical cure when co ...201222865382
is primary prevention of clostridium difficile infection possible with specific probiotics?the efficacy of probiotics for the prevention of clostridium difficile infection (cdi) is highly controversial, particularly with regard to the prevention of recurrent cdi. we hypothesize that primary prevention of cdi among patients receiving antibiotics might be a more achievable goal for probiotics than prevention in patients with previous cdi where the host flora is markedly altered.201222863358
comparative transcriptional analysis of clinically relevant heat stress response in clostridium difficile strain 630.clostridium difficile is considered to be one of the most important causes of health care-associated infections worldwide. in order to understand more fully the adaptive response of the organism to stressful conditions, we examined transcriptional changes resulting from a clinically relevant heat stress (41 °c versus 37 °c) in c. difficile strain 630 and identified 341 differentially expressed genes encompassing multiple cellular functional categories. while the transcriptome was relatively resi ...201222860125
surveillance of infection severity: a registry study of laboratory diagnosed clostridium difficile.changing clinical impact, as virulent clones replace less virulent ones, is a feature of many pathogenic bacterial species and can be difficult to detect. consequently, innovative techniques monitoring infection severity are of potential clinical value.201222859914
knowledge of clostridium difficile infection among uk health-care workers: development of a knowledge assessment tool.doctors' knowledge provides the basis to support good practice in infection prevention and control. however, there exists a paucity of validated knowledge assessment tools that can be reliably employed to identify poor knowledge levels of clostridium difficile infection (cdi) within populations of doctors, preventing the effective identification of knowledge deficiencies and focused targeting of educational interventions. here, we describe a development process to validate a novel cdi knowledge ...201222859801
probiotics for infectious diseases: more drugs, less dietary supplementation.according to current definitions, probiotics are live microorganisms that, when ingested in adequate quantities, exert a health benefit to the host. the action of probiotics in the host is exerted by three mechanisms: modulation of the content of gut microbiota; maintenance of the integrity of the gut barrier and prevention of bacterial translocation; and modulation of the local immune response by the gut-associated immune system. regarding their role for the prevention and treatment of infectio ...201222858373
pediatric physicians' knowledge, attitudes, and beliefs regarding clostridium difficile-associated disease prevention, testing, and treatment. 201222854381
repeat stool testing for clostridium difficile using enzyme immunoassay in patients with inflammatory bowel disease increases diagnostic yield.the incidence and severity of clostridium difficile infection (cdi) in patients with inflammatory bowel disease (ibd) is increasing. cdi is diagnosed by toxin enzyme immunoassay (eia) or real-time polymerase chain reaction (pcr) performed on stool samples. an earlier study evaluating eia in ibd patients with cdi suggested that more than one stool sample be tested to increase diagnostic yield. we investigated whether repeat stool testing improves diagnostic accuracy for cdi in hospitalized ibd pa ...201222852871
evaluation of an oral suspension of vp20621, spores of nontoxigenic clostridium difficile strain m3, in healthy subjects.vp20621, spores of nontoxigenic clostridium difficile (ntcd) strain m3, is protective against challenge with toxigenic strains in hamsters. human administration and colonization may prevent primary c. difficile infection (cdi) or recurrent cdi. healthy adult subjects 18 to 45 years old or ≥60 years old received single or multiple doses of an oral suspension of vp20621 (10(4), 10(6), or 10(8) spores) or placebo. group 4 (≥60 years old) received oral vancomycin for 5 days, followed by 14 days of v ...201222850511
impact of hospital-acquired clostridium difficile.to investigate the impact of hospital-acquired clostridium difficile infection (cdi) on hospital costs and patient length of stay.201222849881
higher rates of clostridium difficile infection among smokers.cigarette smoking has been shown to be related to inflammatory bowel disease. we investigated whether smoking affected the probability of developing clostridium difficile infection (cdi).201222848714
colonoscopic versus nasogastric fecal transplantation for the treatment of clostridium difficile infection: a review and pooled analysis.fecal microbiota transplantation (fmt) has been demonstrated to be highly effective for the treatment of recurrent clostridium difficile infection (cdi). however, the best route of administration has not been established. we present a pooled analysis of the reported cases of cdi treated with fmt via colonoscopy or nasogastric tube (ngt) to evaluate treatment efficacy.201222847629
conformational analysis of clostridium difficile toxin b and its implications for substrate recognition.clostridium difficile (c. difficile) is an opportunistic pathogen that can cause potentially lethal hospital-acquired infections. the cellular damage that it causes is the result of two large clostridial cytotoxins: tcda and tcdb which act by glucosylating cytosolic g-proteins, mis-regulation of which induces apoptosis. tcdb is a large flexible protein that appears to undergo significant structural rearrangement upon accommodation of its substrates: udp-glucose and a rho-family gtpase. to charac ...201222844485
irinotecan (cpt-11) chemotherapy alters intestinal microbiota in tumour bearing rats.intestinal microbiota mediate toxicity of irinotecan (cpt-11) cancer therapies and cause systemic infection after cpt-11-induced loss of barrier function. the intestinal microbiota and their functions are thus potential targets for treatment to mitigate cpt-11 toxicity. however, microbiota changes during cpt-11 therapy remain poorly described. this study analysed changes in intestinal microbiota induced by cpt-11 chemotherapy. qualitative and quantitative taxonomic analyses, and functional analy ...201222844397
clostridium difficile outbreak in costa rica: control actions and associated factors.to describe interventions implemented during a nosocomial outbreak of clostridium difficile in a general hospital in costa rica from december 2009 to april 2010 in order to achieve outbreak control and the factors determined to be associated with c. difficile infection.201223370184
probiotics for the prevention of clostridium difficile-associated diarrhea: a systematic review and meta-analysis.antibiotic treatment may disturb the resistance of gastrointestinal flora to colonization. this may result in complications, the most serious of which is clostridium difficile–associated diarrhea (cdad).201223362517
inpatient diarrhoea and clostridium difficile infection. 201223342416
surgical management of clostridium difficile colitis.clostridium difficile infection (cdi) will progress to fulminant disease in 3 to 5% of cases. with the emergence of hypervirulent, multidrug-resistant strains, the incidence and severity of disease are continuing to rise. prompt identification, early resuscitation, and treatment are critical in preventing morbidity and mortality in this increasingly common condition. discontinuation of antibiotics and treatment with oral vancomycin and intravenous or oral metronidazole are first-line treatments, ...201224294121
[segmental necrotizing colitis in a patient with e. coli o104:h4 infection].a 29-year-old man presented with abdominal cramps and bloody diarrhoea. blood tests revealed elevated c-reactive protein (21.3 mg/dl; normal range 0.01 - 0. 82 mg/dl) and white blood cells (28200/μl, normal range 4000 - 10000/μl). stool tests were negative for enteropathogenic bacteria and clostridium difficile toxins a/b. ultrasound and computed tomography showed massive swelling of the transverse colon and right colonic flexure. at endoscopy, circular necrosis of the mucosa was encountered in ...201222298100
inulin and fructo-oligosaccharides have divergent effects on colitis and commensal microbiota in hla-b27 transgenic rats.modulation of intestinal microbiota by non-digestible carbohydrates may reduce inflammation in inflammatory bowel disease (ibd). the aim of the present study was to assess the effects of inulin and fructo-oligosaccharides (fos) on intestinal microbiota and colitis in hla-b27 transgenic rats, a well-validated rodent model for ibd. in this study, 4-week-old rats were fed 8 g/kg body weight inulin or fos for 12 weeks, or not. faeces were collected at 4 and 16 weeks of age; and caecal samples were c ...201222243836
clinical and laboratory characteristics of clostridium difficile infection in patients with discordant diagnostic test results.the aim of this study was to compare the clinical and laboratory characteristics of clostridium difficile infection (cdi) in patients with discordant test results for the cytotoxin assay (cyt) and pcr assays. a retrospective study from may to august 2008 and march to may 2010 was performed. cdi was diagnosed in 128 patients. pcr increased the yield of c. difficile cases by 2-fold compared to that of the cyt assay. fifty-six cases (44%) were detected by pcr only (cyt negative). forty-nine percent ...201222238444
enveloped virus but not bacteria block il-13 responses in human cord blood t cells in vitro.infections that occur early in life may have a beneficial effect on the immune system and thereby reduce the risk of allergen sensitization and/or allergic disease. it is not yet clear to what extent specific virus and/or bacteria can mediate this effect. the purpose of this study was to assess the role of virus and bacteria in cd4(+) t cell-derived cytokine production in newborns. we compared the effects of five bacteria (staphlococcus aureus, escherichia coli, clostridium difficile, lactobacil ...201222229804
outcomes in community-acquired clostridium difficile infection.community-acquired clostridium difficile infection (ca-cdi) is an increasingly appreciated condition. it is being described in populations lacking traditional predisposing factors that have been previously considered at low-risk for this infection. as most studies of cdi are hospital-based, outcomes in these patients are not well known.201222229532
risk of secondary cases of clostridium difficile infection among household contacts of index cases.we aimed to estimate the risk of secondary cases of clostridium difficile infection (cdi) among household contacts of index cases.201222227466
gef-h1-rhoa signaling pathway mediates lps-induced nf-κb transactivation and il-8 synthesis in endothelial cells.secretion of proinflammatory cytokines by lps activated endothelial cells contributes substantially to the pathogenesis of sepsis. however, the mechanism involved in this process is not well understood. in the present study, we determined the roles of gef-h1 (guanine-nucleotide exchange factor-h1)-rhoa signaling in lps-induced interleukin-8 (il-8, cxcl8) production in endothelial cells. first, we observed that gef-h1 expression was upregulated in a dose- and time-dependent manner as consistent w ...201222226472
epidemiology and pathogenesis of c. difficile and mrsa in the light of current nhs control policies: a policy review.healthcare associated infections (hcais) cause significant morbidity and mortality, and are estimated to cost the united kingdom national health service £1 billion annually. the current health care infection rates suggest that the level of performance to avoid hcais is not maintained consistently. increasing screening, improving local accountability and performance management, careful use of antibiotics in the management of emergency patients, health economy wide approaches, and improved hand wa ...201226257907
metronidazole-induced encephalopathy in a patient with end-stage liver disease.purpose. metronidazole-induced encephalopathy (mie) has been rarely reported. we report a case in a patient with end-stage liver disease (esld). summary. a 63-year-old male with esld secondary to hepatitis c virus presented with progressively worsening fatigue, slurred speech, aphasia, vomiting, and left-sided facial droop after completing a 2-week course of metronidazole for recurrent clostridium difficile-associated diarrhea. he completed a previous course of metronidazole 3 weeks prior to pre ...201225374704
proton pump inhibitor use in hospitalized patients: is overutilization becoming a problem?proton pump inhibitors (ppis) are among the most common classes of medications prescribed. though they were previously thought of as safe, recent literature has shown risks associated with their use including increased risk for clostridium difficile infection, pneumonia, and fractures. due to these risks, it is important to determine if ppis are being used appropriately. this review evaluates seven studies in hospitalized patients. additionally, this review evaluates literature pertaining to rec ...201224833936
duration and cessation of antimicrobial treatment.shortening the duration of antimicrobial therapy is an important strategy for optimizing patient care and reducing the spread of antimicrobial resistance. it is best used in the context of an overall approach to infection management that includes a focus on selecting the right initial drug and dosing regimen for empiric therapy, and de-escalation to a more narrowly focused drug regimen (or termination) based on subsequent culture results and clinical data. in addition to reducing resistance, oth ...201223737335
antimicrobial de-escalation strategies in hospitalized patients with pneumonia, intra-abdominal infections, and bacteremia.increasing numbers of serious hospital/healthcare- or community-acquired infections are caused by resistant (often multi-drug resistant) bacterial pathogens. because delayed or ineffective initial therapy can have severe negative consequences, patients at risk for these types of infections typically receive initial empiric antibiotic therapy with a broad-spectrum regimen covering the most likely pathogens, based on local surveillance data and risk factors for infection with a resistant microorga ...201223737333
duration and cessation of antimicrobial treatment.shortening the duration of antimicrobial therapy is an important strategy for optimizing patient care and reducing the spread of antimicrobial resistance. it is best used in the context of an overall approach to infection management that includes a focus on selecting the right initial drug and dosing regimen for empiric therapy, and de-escalation to a more narrowly focused drug regimen (or termination) based on subsequent culture results and clinical data. in addition to reducing resistance, oth ...201223677632
antimicrobial de-escalation strategies in hospitalized patients with pneumonia, intra-abdominal infections, and bacteremia.increasing numbers of serious hospital/healthcare- or community-acquired infections are caused by resistant (often multi-drug resistant) bacterial pathogens. because delayed or ineffective initial therapy can have severe negative consequences, patients at risk for these types of infections typically receive initial empiric antibiotic therapy with a broad-spectrum regimen covering the most likely pathogens, based on local surveillance data and risk factors for infection with a resistant microorga ...201223677630
using machine-learned bayesian belief networks to predict perioperative risk of clostridium difficile infection following colon surgery.clostridium difficile (c-diff) infection following colorectal resection is an increasing source of morbidity and mortality.201223611947
outpatient parenteral antimicrobial therapy with ceftriaxone, a review.more than 30 years since it was developed for clinical use, the third-generation cephalosporin ceftriaxone remains the most commonly used agent for outpatient parental antimicrobial therapy (opat). recent antimicrobial stewardship programmes have tended to restrict ceftriaxone use in hospitals to control antibiotic resistance and outbreaks of clostridium difficle infection (cdi). considering the expansion of opat programmes both in the uk and worldwide, revisiting the role of ceftriaxone in opat ...201222527482
a culture-independent sequence-based metagenomics approach to the investigation of an outbreak of shiga-toxigenic escherichia coli o104:h4.identification of the bacterium responsible for an outbreak can aid in disease management. however, traditional culture-based diagnosis can be difficult, particularly if no specific diagnostic test is available for an outbreak strain.201323571589
high incidence of campylobacter concisus in gastroenteritis in north jutland, denmark: a population-based study.the incidence of non-thermophilic campylobacter species was assessed in an unselected population-based study in a mixed urban and rural community in north jutland, denmark. in a 2-year study period, 11,314 faecal samples from 8302 patients with gastroenteritis were cultured with supplement of the filter method. we recovered a high incidence of campylobacter concisus (annual incidence 35/100,000 inhabitants), almost as high as the common campylobacter jejuni/coli. in contrast, there was a very lo ...201322512739
[nosocomial diarrhea in intensive care unit: other than clostridium difficile].to investigate the incidence and clinical features of non-clostridium difficile (c. difficile) associated nosocomial diarrhea in intensive care unit (icu) caused by klebsiella oxytoca and clostridium perfringens.201324059125
safety of long-term ppi therapy.proton pump inhibitors have become the mainstay of medical treatment of acid-related disorders. long-term use is becoming increasingly common, in some cases without a proper indication. a large number of mainly observational studies on a very wide range of possible associations have been published in the past decade and are critically reviewed in this article and the existing evidence is evaluated and translated into possible clinical consequences. based on the existing evidence the benefits of ...201323998981
is clostridium difficile associated with relapse of inflammatory bowel disease? results from a retrospective and prospective cohort study in the netherlands.although clostridium difficile may be associated with exacerbations in inflammatory bowel diseases (ibd), prospective studies identifying the role of c. difficile in disease activity are currently lacking. we examined the prevalence of c. difficile in feces of (1) symptomatic ibd patients retrospectively and (2) consecutive outpatients in relation to disease activity prospectively.201323867869
systematic application of multiplex pcr enhances the detection of bacteria, parasites, and viruses in stool samples.to determine whether systematic testing of faecal samples with a broad range multiplex pcr increases the diagnostic yield in patients with diarrhoea compared with conventional methods and a clinician initiated testing strategy.201323603249
antibacterial and cytotoxic activity of isoprenylated coumarin mammea a/aa isolated from mammea africana.the stem bark of mammea africana is widely distributed in tropical africa and commonly used in traditional medicine. this study aims to identify the active compound in mammea africana and to evaluate its antimicrobial and antiproliferative activity.201323466248
[outcomes of clostridium difficile enterocolitis after administration of antibiotics along with probiotic supplement].clostridium difficile enterocolitis is a potentially fatal disease showing increasing incidence in hospital environment. therapeutic approach in the management of clostridium difficile enterocolitis is highly complex, particularly because of its tendency to relapse and reinfection. the study was aimed at investigating the factors influencing the development of clostridium difficile enterocolitis and outcomes of enterocolitis after administration of standard antimicrobial therapy combined with pr ...201323888728
a probiotics-containing biscuit modulates the intestinal microbiota in the elderly.evaluation of the impact of a biscuit containing the probiotics bifidobacterium longum bar33 and lactobacillus helveticus bar13 on the intestinal microbiota in the elderly.201323364497
essential oil composition and antimicrobial activity of aerial parts and ripe fruits of echinophora spinosa (apiaceae) from italy.the chemical composition and antimicrobial activity of the essential oils obtained from the flowering aerial parts and ripe fruits of echinophora spinosa l. (apiaceae) from central italy were analyzed by gc/ms. the major constituents of the oil from the aerial parts were beta-phellandrene (34.7%), myristicin (16.5%), delta3-carene (12.6%), alpha-pinene (6.7%) and alpha-phellandrene (6.2%), and of the oil from the ripe fruits p-cymene (50.2%), myristicin (15.3%), alpha-pinene (15.1%) and alpha-ph ...201323738471
in vitro evaluation of antimicrobial activity of lactic acid bacteria against clostridium difficile.clostridium difficile infection (cdi) has become a significant threat to public health. although broad-spectrum antibiotic therapy is the primary treatment option for cdi, its use has evident limitations. probiotics have been proved to be effective in the treatment of cdi and are a promising therapeutic option for cdi. in this study, 4 strains of lactic acid bacteria (lab), namely, lactobacillus rhamnosus (lr5), lactococcuslactis (sl3), bifidobacterium breve (br3), and bifidobacterium lactis (bl ...201324278635
antipathogenic activity of probiotics against salmonella typhimurium and clostridium difficile in anaerobic batch culture systems: is it due to synergies in probiotic mixtures or the specificity of single strains?probiotics are currently being investigated for prevention of infections caused by enteric pathogens. the aim of this in vitro study was to evaluate the influence of three single probiotics: lactobacillus casei ncimb 30185 (pxn 37), lactobacillus acidophilus ncimb 30184 (pxn 35), bifidobacterium breve ncimb 30180 (pxn 25) and a probiotic mixture containing the above strains plus twelve other strains belonging to the lactobacillus, bifidobacterium, lactococcus, streptococcus and bacillus genera o ...201324091275
loss of nhe3 alters gut microbiota composition and influences bacteroides thetaiotaomicron growth.changes in the intestinal microbiota have been linked to diabetes, obesity, inflammatory bowel disease, and clostridium difficile (c. difficile)-associated disease. despite this, it remains unclear how the intestinal environment, set by ion transport, affects luminal and mucosa-associated bacterial composition. na(+)/h(+)-exchanger isoform 3 (nhe3), a target of c. difficile toxin b, plays an integral role in intestinal na(+) absorption. thus the nhe3-deficient mouse model was chosen to examine t ...201324072680
microbiota-liberated host sugars facilitate post-antibiotic expansion of enteric pathogens.the human intestine, colonized by a dense community of resident microbes, is a frequent target of bacterial pathogens. undisturbed, this intestinal microbiota provides protection from bacterial infections. conversely, disruption of the microbiota with oral antibiotics often precedes the emergence of several enteric pathogens. how pathogens capitalize upon the failure of microbiota-afforded protection is largely unknown. here we show that two antibiotic-associated pathogens, salmonella enterica s ...201323995682
comparative in vitro activities of smt19969, a new antimicrobial agent, against clostridium difficile and 350 gram-positive and gram-negative aerobic and anaerobic intestinal flora isolates.the comparative in vitro activity of smt19969, a novel, narrow-spectrum, nonabsorbable agent, was studied against 50 ribotype-defined clostridium difficile strains, 174 gram-positive and 136 gram-negative intestinal anaerobes, and 40 gram-positive aerobes. smt19969 was one dilution more active against c. difficile isolates (mic range, 0.125 to 0.5 μg/ml; mic90, 0.25 μg/ml), including ribotype 027 strains, than fidaxomicin (range, 0.06 to 1 μg/ml; mic90, 0.5 μg/ml) and two to six dilutions lower ...201323877700
in vitro inhibition of clostridium difficile and clostridium perfringens by commercial probiotic strains.probiotics have gained importance in human and veterinary medicine to prevent and control clostridial enteric disease. limited information is available on the ability of different probiotic bacteria used in food products to inhibit clostridium difficile and clostridium perfringens. the objective of this study was to examine the in vitro inhibitory effects of selected commercial bacterial strains on pathogenic clostridia and their growth characteristics under simulated gastrointestinal conditions ...201323471038
protective effect of bifidobacteria in an experimental model of clostridium difficile associated colitis.the aim of this study was to evaluate the ability of bifidobacterium strains to prevent the effects associated with clostridium difficile infection in a hamster model of enterocolitis. after clindamycin treatment (30 mg/kg), animals were infected intragastrically with c. difficile (5×108 cfu per animal). seven days prior to antibiotic administration, probiotic treatment was started by administering bacterial suspensions of bifidobacteria in drinking water. strains cidca 531, cidca 5310, cidca 53 ...201323611644
temporal bacterial community dynamics vary among ulcerative colitis patients after fecal microbiota transplantation.fecal microbiota transplantation (fmt) from healthy donors, which is an effective alternative for treatment of clostridium difficile-associated disease, is being considered for several disorders such as inflammatory bowel disease, irritable bowel syndrome, and metabolic syndrome. disease remission upon fmt is thought to be facilitated by an efficient colonization of healthy donor microbiota, but knowledge of the composition and temporal stability of patient microbiota after fmt is lacking.201324060759
evaluation of nvb302 versus vancomycin activity in an in vitro human gut model of clostridium difficile infection.first-line treatment options for clostridium difficile infection (cdi) are limited. nvb302 is a novel type b lantibiotic under evaluation for the treatment of cdi. we compared the responses to nvb302 and vancomycin when used to treat simulated cdi in an in vitro gut model.201322966180
expanded therapeutic potential in activity space of next-generation 5-nitroimidazole antimicrobials with broad structural diversity.metronidazole and other 5-nitroimidazoles (5-ni) are among the most effective antimicrobials available against many important anaerobic pathogens, but evolving resistance is threatening their long-term clinical utility. the common 5-nis were developed decades ago, yet little 5-ni drug development has since taken place, leaving the true potential of this important drug class unexplored. here we report on a unique approach to the modular synthesis of diversified 5-nis for broad exploration of thei ...201324101497
growth-inhibiting and morphostructural effects of constituents identified in asarum heterotropoides root on human intestinal bacteria.the growth-inhibiting and morphostructural effects of seven constituents identified in asarum heterotropoides root on 14 intestinal bacteria were compared with those of the fluoroquinolone antibiotic ciprofloxacin.201324083511
impact of electronic surveillance on isolation practices.to assess the impact of an electronic surveillance system on isolation practices and rates of methicillin-resistant staphylococcus aureus (mrsa).201323739073
the spore differentiation pathway in the enteric pathogen clostridium difficile.endosporulation is an ancient bacterial developmental program that culminates with the differentiation of a highly resistant endospore. in the model organism bacillus subtilis, gene expression in the forespore and in the mother cell, the two cells that participate in endospore development, is governed by cell type-specific rna polymerase sigma subunits. σ(f) in the forespore, and σ(e) in the mother cell control early stages of development and are replaced, at later stages, by σ(g) and σ(k), resp ...201324098139
genome-wide analysis of cell type-specific gene transcription during spore formation in clostridium difficile.clostridium difficile, a gram positive, anaerobic, spore-forming bacterium is an emergent pathogen and the most common cause of nosocomial diarrhea. although transmission of c. difficile is mediated by contamination of the gut by spores, the regulatory cascade controlling spore formation remains poorly characterized. during bacillus subtilis sporulation, a cascade of four sigma factors, σ(f) and σ(g) in the forespore and σ(e) and σ(k) in the mother cell governs compartment-specific gene expressi ...201324098137
global analysis of the sporulation pathway of clostridium difficile.the gram-positive, spore-forming pathogen clostridium difficile is the leading definable cause of healthcare-associated diarrhea worldwide. c. difficile infections are difficult to treat because of their frequent recurrence, which can cause life-threatening complications such as pseudomembranous colitis. the spores of c. difficile are responsible for these high rates of recurrence, since they are the major transmissive form of the organism and resistant to antibiotics and many disinfectants. des ...201323950727
expression and display of clostridium difficile protein flid on the surface of bacillus subtilis spores.the endospores of bacillus subtilis can serve as a tool for surface presentation of heterologous proteins. the unique properties of the spore protective layers make them perfect vehicles for orally administered vaccines. in this study, we successfully displayed a fragment of clostridium difficile flid protein on the surface of b. subtilis spores using the cotb, cotc, cotg and cotz spore coat proteins. the presence of the fusion proteins in the spore coat was verified by western blotting and immu ...201323475909
in vitro biological effects of two anti-diabetic medicinal plants used in benin as folk medicine.extracts from polygonum senegalensis (polygonaceae) and pseudocedrela kotschyi (meliaceae) are two important traditionally used medicinal plants in rural benin to treat many diseases and notably type 2 diabetes. the aim of the study was to investigate the α-glucosidase inhibition, antioxidant and antibacterial activities of those plants extract: polygonum senegalensis leaves, and pseudocedrela kotschyi root.201323452899
spoiva and sipl are clostridium difficile spore morphogenetic proteins.clostridium difficile is a major nosocomial pathogen whose infections are difficult to treat because of their frequent recurrence. the spores of c. difficile are responsible for these clinical features, as they resist common disinfectants and antibiotic treatment. although spores are the major transmissive form of c. difficile, little is known about their composition or morphogenesis. spore morphogenesis has been well characterized for bacillus sp., but bacillus sp. spore coat proteins are poorl ...201323292781
in pursuit of protein targets: proteomic characterization of bacterial spore outer layers.bacillus cereus, responsible for food poisoning, and clostridium difficile, the causative agent of clostridium difficile-associated diarrhea (cdad), are both spore-forming pathogens involved in food spoilage, food intoxication, and other infections in humans and animals. the proteinaceous coat and the exosporium layers from spores are important for their resistance and pathogenicity characteristics. the exosporium additionally provides an ability to adhere to surfaces eventually leading to spore ...201323998435
probiotics for the treatment of clostridium difficile associated disease.the purpose of this review paper is to update the current and potential future role of probiotics for clostridium difficile-associated disease (cdad). included in this review, is an update on the testing of newer probiotics (e.g., bacillus coagulans gbi-30, 6086) in animal models of cdad. there is a focus on the modulation of signal transduction pathways (i.e., transcription factors like camp response element-binding, activator protein 1, and nuclear factor kappa b), as well as the inhibition of ...201323946887
identification of a novel zinc metalloprotease through a global analysis of clostridium difficile extracellular proteins.clostridium difficile is a major cause of infectious diarrhea worldwide. although the cell surface proteins are recognized to be important in clostridial pathogenesis, biological functions of only a few are known. also, apart from the toxins, proteins exported by c. difficile into the extracellular milieu have been poorly studied. in order to identify novel extracellular factors of c. difficile, we analyzed bacterial culture supernatants prepared from clinical isolates, 630 and r20291, using liq ...201324303041
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