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cyclodextrin derivatives as anti-infectives.cyclodextrin derivatives can be utilized as anti-infectives with pore-forming proteins as the targets. the highly efficient selection of potent inhibitors was achieved because per-substituted cyclodextrins have the same symmetry as the target pores. inhibitors of several bacterial toxins produced by bacillus anthracis, staphylococcus aureus, clostridium perfringens, clostridium botulinum, and clostridium difficile were identified from a library of ∼200 cd derivatives. it was demonstrated that mu ...201324011515
architecture and assembly of the gram-positive cell wall.the bacterial cell wall is a mesh polymer of peptidoglycan--linear glycan strands cross-linked by flexible peptides--that determines cell shape and provides physical protection. while the glycan strands in thin 'gram-negative' peptidoglycan are known to run circumferentially around the cell, the architecture of the thicker 'gram-positive' form remains unclear. using electron cryotomography, here we show that bacillus subtilis peptidoglycan is a uniformly dense layer with a textured surface. we f ...201323600697
identification of novel host-targeted compounds that protect from anthrax lethal toxin-induced cell death.studying how pathogens subvert the host to cause disease has contributed to the understanding of fundamental cell biology. bacillus anthracis, the causative agent of anthrax, produces the virulence factor lethal toxin to disarm host immunity and cause pathology. we conducted a phenotypic small molecule screen to identify inhibitors of lethal toxin-induced macrophage cell death and used an ordered series of secondary assays to characterize the hits and determine their effects on cellular function ...201323343607
a severe case of rat lungworm disease in hawa'i.a 23-year-old man living on the island of hawa'i developed a life threatening case of eosinophilic meningitis caused by infection with angiostrongylus cantonensis (rat lungworm disease: rlwd). he was comatose for 3 months, incurring brain and nerve damage sufficiently extensive that he was not expected to recover. the case was complicated by secondary infections of methicillin-resistant staphylococcus aureus, clostridium difficile, and pneumonia, which resulted in an empyema requiring a thoracos ...201323900708
the rise of carbapenem-resistant acinetobacter baumannii.acinetobacter spp. are gram-negative bacteria that have become one of the most difficult pathogens to treat. the species a. baumannii, largely unknown 30 years ago, has risen to prominence particularly because of its ability to cause infections in immunocompromised patients. it is now a predominant pathogen in many hospitals as it has acquired resistance genes to virtually all antibiotics capable of treating gram-negative bacteria, including the fluoroquinolones and the cephalosporins. some memb ...201322894617
microbial and metabolic interactions between the gastrointestinal tract and clostridium difficile infection.antibiotics disturb the gastrointestinal tract microbiota and in turn reduce colonization resistance against clostridium difficile. the mechanism for this loss of colonization resistance is still unknown but likely reflects structural (microbial) and functional (metabolic) changes to the gastrointestinal tract. members of the gut microbial community shape intestinal metabolism that provides nutrients and ultimately supports host immunity. this review will discuss how antibiotics alter the struct ...201324335555
equine hyperimmune serum protects mice against clostridium difficile spore challenge.clostridium (c.) difficile is a common cause of nosocomial diarrhea in horses. vancomycin and metronidazole have been used as standard treatments but are only moderately effective, which highlights the need for a novel alternative therapy. in the current study, we prepared antiserum of equine origin against both c. difficile toxins a and b as well as whole-cell bacteria. the toxin-neutralizing activities of the antibodies were evaluated in vitro and the prophylactic effects of in vivo passive im ...201324136208
gut microbiota patterns associated with colonization of different clostridium difficile ribotypes.c. difficile infection is associated with disturbed gut microbiota and changes in relative frequencies and abundance of individual bacterial taxons have been described. in this study we have analysed bacterial, fungal and archaeal microbiota by denaturing high pressure liquid chromatography (dhplc) and with machine learning methods in 208 faecal samples from healthy volunteers and in routine samples with requested c. difficile testing. the latter were further divided according to stool consisten ...201323469128
risk factors of mild rectal bleeding in very low birth weight infants: a case control study.mild rectal bleeding (mrb) is a particular clinical entity different from necrotizing enterocolitis, which significantly influences neonatal care in preterm infants. we aimed to determine the risk factors and to evaluate prospectively the clinical course of mrb.201324283213
bacteriotherapy for the treatment of intestinal dysbiosis caused by clostridium difficile infection.faecal microbiota transplantation (fmt) has been used for more than five decades to treat a variety of intestinal diseases associated with pathological imbalances within the resident microbiota, termed dysbiosis. fmt has been particularly effective for treating patients with recurrent clostridium difficile infection who are left with few clinical options other than continued antibiotic therapy. our increasing knowledge of the structure and function of the human intestinal microbiota and c. diffi ...201323866975
genetically diverse clostridium difficile strains harbouring abundant prophages in an estuarine environment.clostridium difficile is the leading cause of antibiotic-associated diarrhoeal disease in healthcare settings across the world. despite its pathogenic capacity, it can be carried asymptomatically and has been found in terrestrial and marine ecosystems outside hospital environments. less is known about these environmental strains and few studies have been conducted on estuarine systems. although prophage abundance and diversity is known within in clinical strains, prophage carriage within environ ...201323913427
norovirus gastroenteritis after fecal microbiota transplantation for treatment of clostridium difficile infection despite asymptomatic donors and lack of sick contacts. 201323912408
adaptive strategies and pathogenesis of clostridium difficile from in vivo transcriptomics.clostridium difficile is currently the major cause of nosocomial intestinal diseases associated with antibiotic therapy in adults. in order to improve our knowledge of c. difficile-host interactions, we analyzed the genome-wide temporal expression of c. difficile 630 genes during the first 38 h of mouse colonization to identify genes whose expression is modulated in vivo, suggesting that they may play a role in facilitating the colonization process. in the ceca of the c. difficile-monoassociated ...201323897605
active surveillance for carbapenem-resistant enterobacteriaceae using stool specimens submitted for testing for clostridium difficile.active surveillance to identify asymptomatic carriers of carbapenem-resistant enterobacteriaceae (cre) is a recommended strategy for cre control in healthcare facilities. active surveillance using stool specimens tested for clostridium difficile is a relatively low-cost strategy to detect cre carriers. further evaluation of this and other risk factor-based active surveillance strategies is warranted.201324334803
evaluation of a new automated homogeneous pcr assay, genomera c. difficile, for rapid detection of toxigenic clostridium difficile in fecal specimens.we evaluated a new automated homogeneous pcr assay to detect toxigenic clostridium difficile, the genomera c. difficile assay (abacus diagnostica, finland), with 310 diarrheal stool specimens and with a collection of 33 known clostridial and nonclostridial isolates. results were compared with toxigenic culture results, with discrepancies being resolved by the genexpert c. difficile pcr assay (cepheid). among the 80 toxigenic culture-positive or genexpert c. difficile assay-positive fecal specime ...201323804386
use of rifamycin drugs and development of infection by rifamycin-resistant strains of clostridium difficile.the relationship between rifamycin drug use and the development of resistant strains of clostridium difficile was studied at a large university hospital in houston, tx, between may 2007 and september 2011. in 49 of 283 (17.3%) patients with c. difficile infection (cdi), a rifamycin-resistant strain of c. difficile was identified that compares to a rate of 8% using the same definitions in 2006-2007 (p = 0.59). the 49 patients infected by a resistant organism were matched by date of admission to 9 ...201323545528
sequencing of bacterial genomes: principles and insights into pathogenesis and development of antibiotics.the impact of bacterial diseases on public health has become enormous, and is partly due to the increasing trend of antibiotic resistance displayed by bacterial pathogens. sequencing of bacterial genomes has significantly improved our understanding about the biology of many bacterial pathogens as well as identification of novel antibiotic targets. since the advent of genome sequencing two decades ago, about 1,800 bacterial genomes have been fully sequenced and these include important aetiologica ...201324705262
novel strategies for enhanced removal of persistent bacillus anthracis surrogates and clostridium difficile spores from skin.removing spores of clostridium difficile and bacillus anthracis from skin is challenging because they are resistant to commonly used antimicrobials and soap and water washing provides only modest efficacy. we hypothesized that hygiene interventions incorporating a sporicidal electrochemically generated hypochlorous acid solution (vashe(®)) would reduce the burden of spores on skin.201323844234
clinical approach to fever in the neurosurgical intensive care unit: focus on drug fever.as fever is one of the cardinal signs of infection, the presence of fever in a patient in the neurosurgical intensive care unit (nsicu) raises the question of whether it is infectious in etiology. infectious and noninfectious causes of fever in the nsicu may be determined based upon assessment of clinical signs and symptoms, the degree of temperature elevation, the relationship of the pulse to the fever (e.g., an infectious process resulting in hyperpyrexia and bradycardia), and when the fever o ...201323878765
development of novel sugar isomerases by optimization of active sites in phosphosugar isomerases for monosaccharides.phosphosugar isomerases can catalyze the isomerization of not only phosphosugar but also of monosaccharides, suggesting that the phosphosugar isomerases can be used as sugar isomerases that do not exist in nature. determination of active-site residues of phosphosugar isomerases, including ribose-5-phosphate isomerase from clostridium difficile (cdrpi), mannose-6-phosphate isomerase from bacillus subtilis (bsmpi), and glucose-6-phosphate isomerase from pyrococcus furiosus (pfgpi), was accomplishe ...201323204422
recent advances in antibacterial drugs.the incidence of antimicrobial resistance is on continued rise with a threat to return to the "pre-antibiotic" era. this has led to emergence of such bacterial infections which are essentially untreatable by the current armamentarium of available treatment options. various efforts have been made to develop the newer antimicrobials with novel modes of action which can act against these multi-drug resistant strains. this review aims to focus on these newly available and investigational antibacteri ...201323776832
structure of clostridium difficile pilj exhibits unprecedented divergence from known type iv pilins.type iv pili are produced by many pathogenic gram-negative bacteria and are important for processes as diverse as twitching motility, cellular adhesion, and colonization. recently, there has been an increased appreciation of the ability of gram-positive species, including clostridium difficile, to produce type iv pili. here we report the first three-dimensional structure of a gram-positive type iv pilin, pilj, demonstrate its incorporation into type iv pili, and offer insights into how the type ...201324362261
biological evaluation of benzothiazole ethyl urea inhibitors of bacterial type ii topoisomerases.the type ii topoisomerases dna gyrase (gyra/gyrb) and topoisomerase iv (parc/pare) are well-validated targets for antibacterial drug discovery. because of their structural and functional homology, these enzymes are amenable to dual targeting by a single ligand. in this study, two novel benzothiazole ethyl urea-based small molecules, designated compound a and compound b, were evaluated for their biochemical, antibacterial, and pharmacokinetic properties. the two compounds inhibited the atpase act ...201324041906
bacterial complications of respiratory tract viral illness: a comprehensive evaluation.respiratory tract infection is one of the most common reasons for hospitalization among adults, and recent evidence suggests that many of these illnesses are associated with viruses. although bacterial infection is known to complicate viral infections, the frequency and impact of mixed viral-bacterial infections has not been well studied.201323661797
discovery of a cyclic phosphodiesterase that catalyzes the sequential hydrolysis of both ester bonds to phosphorus.the bacterial c-p lyase pathway is responsible for the metabolism of unactivated organophosphonates under conditions of phosphate starvation. the cleavage of the c-p bond within ribose-1-methylphosphonate-5-phosphate to form methane and 5-phospho-ribose-1,2-cyclic phosphate (prcp) is catalyzed by the radical sam enzyme phnj. in escherichia coli the cyclic phosphate product is hydrolyzed to ribose-1,5-bisphosphate by phnp. in this study, we describe the discovery and characterization of an enzyme ...201324147537
pang, a new ketopantoate reductase involved in pantothenate synthesis.pantothenate, commonly referred to as vitamin b(5), is an essential molecule in the metabolism of living organisms and forms the core of coenzyme a. unlike humans, some bacteria and plants are capable of de novo biosynthesis of pantothenate, making this pathway a potential target for drug development. francisella tularensis subsp. tularensis schu s4 is a zoonotic bacterial pathogen that is able to synthesize pantothenate but is lacking the known ketopantoate reductase (kpr) genes, pane and ilvc, ...201323243306
the protective effect of recombinant lactococcus lactis oral vaccine on a clostridium difficile-infected animal model.oral immunization with vaccines may be an effective strategy for prevention of clostridium difficile infection (cdi). however, application of previously developed vaccines for preventing cdi has been limited due to various reasons. here, we developed a recombinant lactococcus lactis oral vaccine and evaluated its effect on a c. difficile-infected animal model established in golden hamsters in attempt to provide an alternative strategy for cdi prevention.201323865596
inhaled colistin for treatment of pneumonia due to colistin-only-susceptible acinetobacter baumannii.colistin is used for the treatment of pneumonia associated with multidrug- resistant acinetobacter baumannii and pseudomonas aeruginosa. however, the best route of administration and dosage is not known. we report our experience with aerosolized colistin in twelve patients with pneumonia caused by colistin-only-susceptible (cos) a. baumannii.201324339296
a rare case intractable diarrhea secondary to clostridium difficile and cytomegalovirus coinfection.male, 63 final diagnosis: cytomegalo virus (cmv) infection symptoms: diarrhea medication:- clinical procedure:- specialty: infectious diseases.201324298304
clostridium difficile and inflammatory bowel disease: role in pathogenesis and implications in treatment.clostridium difficile (c. difficile) is the leading cause of antibiotic associated colitis and nosocomial diarrhea. patients with inflammatory bowel disease (ibd) are at increased risk of developing c. difficile infection (cdi), have worse outcomes of cdi-including higher rates of colectomy and death, and experience higher rates of recurrence. however, it is still not clear whether c. difficile is a cause of ibd or a consequence of the inflammatory state in the intestinal environment. the burden ...201324282348
the role of the bacterial flagellum in adhesion and virulence.the bacterial flagellum is a complex apparatus assembled of more than 20 different proteins. the flagellar basal body traverses the cell wall, whereas the curved hook connects the basal body to the whip-like flagellar filament that protrudes several µm from the bacterial cell. the flagellum has traditionally been regarded only as a motility organelle, but more recently it has become evident that flagella have a number of other biological functions. the major subunit, flagellin or flic, of the fl ...201324833223
the nose knows not: poor predictive value of stool sample odor for detection of clostridium difficile. 201323166192
the intestinal microbiota dysbiosis and clostridium difficile infection: is there a relationship with inflammatory bowel disease?gut microbiota is a compilation of microorganisms dwelling in the entire mammalian gastrointestinal tract. they display a symbiotic relationship with the host contributing to its intestinal health and disease. even a slight fluctuation in this equipoise may be deleterious to the host, leading to many pathological conditions like clostridium difficile infection or inflammatory bowel disease (ibd). in this review, we focus on the role of microbial dysbiosis in initiation of c. difficile infection ...201323320050
fecal microbiota transplantation: the state of the art.clostridium difficile infection (cdi) is an emerging problem in terms of incidence, morbidity and mortality. currently available treatment options are not always effective, especially in cases of recurrent/refractory or complicated cdi. the gut microbiota transplantation is a technique that has been sporadically practiced since the '50s, but its clinical efficacy has only recently been supported by scientific evidence. in the present article, we report the pathophysiological basis and the clinic ...201324470963
treatment of clostridium difficile infection: recent trial results.clostridium difficile is a major cause of infection worldwide and is associated with increasing morbidity and mortality in vulnerable patient populations. metronidazole and oral vancomycin are the currently recommended therapies for the treatment of c. difficile infection (cdi) but are associated with unacceptably high rates of disease recurrence. novel therapies for the treatment of cdi and prevention of recurrent cdi are urgently needed. important developments in the treatment of cdi are curre ...201325525499
evaluation of luminex xtag gastrointestinal pathogen analyte-specific reagents for high-throughput, simultaneous detection of bacteria, viruses, and parasites of clinical and public health importance.acute diarrheal disease (add) can be caused by a range of pathogens, including bacteria, viruses, and parasites. conventional diagnostic methods, such as culture, microscopy, biochemical assays, and enzyme-linked immunosorbent assays (elisa), are laborious and time-consuming and lack sensitivity. combined, the array of tests performed on a single specimen can increase the turnaround time (tat) significantly. we validated a 19plex laboratory-developed gastrointestinal pathogen panel (gpp) using l ...201323850948
a laboratory-developed taqman array card for simultaneous detection of 19 enteropathogens.the taqman array card (tac) system is a 384-well singleplex real-time pcr format that has been used to detect multiple infection targets. here we developed an enteric taqman array card to detect 19 enteropathogens, including viruses (adenovirus, astrovirus, norovirus gii, rotavirus, and sapovirus), bacteria (campylobacter jejuni/c. coli, clostridium difficile, salmonella, vibrio cholerae, diarrheagenic escherichia coli strains including enteroaggregative e. coli [eaec], enterotoxigenic e. coli [ ...201323175269
proton pump inhibitor use and recurrent clostridium difficile-associated disease: a case-control analysis matched by propensity score.clostridium difficile has been increasingly diagnosed in hospitalized patients. an association between proton pump inhibitors (ppis) use and clostridium difficile-associated disease (cdad) and between recurrent cdad has been suggested. the aim of this study is to investigate whether ppi use is associated with the development of recurrent cdad.201322298089
urinary tract infection in male veterans: treatment patterns and outcomes.lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. the optimal treatment duration and current treatment patterns for urinary tract infection (uti) in men are unknown. we used veterans affairs administrative data to study male uti treatment and outcomes.201323212273
[clostridium difficile infections, specific issues in the elderly].clostridium difficile is a well-established cause of infectious nosocomial diarrhea in adults. each time diarrhea is observed in a patient receiving antibiotic treatment, clostridium colitis should be suspected; diagnosis should be confirmed by the identification of toxin in the patient's stools. its incidence is increasing due to growing use of several classes of antibiotics, and is associated with a high relapse rate and a significant case-fatality rate. the elderly are particularly at risk fo ...201324308141
predictors of clostridium difficile infection severity in patients hospitalised in medical intensive care.to describe and analyse factors associated with clostridium difficile infection (cdi) severity in hospitalised medical intensive care unit patients.201324307797
microbiota dynamics in patients treated with fecal microbiota transplantation for recurrent clostridium difficile infection.clostridium difficile causes antibiotic-associated diarrhea and pseudomembraneous colitis and is responsible for a large and increasing fraction of hospital-acquired infections. fecal microbiota transplantation (fmt) is an alternate treatment option for recurrent c. difficile infection (rcdi) refractory to antibiotic therapy. it has recently been discussed favorably in the clinical and scientific communities and is receiving increasing public attention. however, short- and long-term health conse ...201324303043
immunization using groel decreases clostridium difficile intestinal colonization.clostridium difficile is a pathogen which is responsible for diarrhea and colitis, particularly after treatment with antibiotics. clinical signs are mainly due to two toxins, tcda and tcdb. however, the first step of pathogenesis is the colonization process. we evaluated c. difficile surface proteins as vaccine antigens in the hamster model to prevent intestinal colonization. this vaccination induced a partial protection of hamsters against death after a c. difficile challenge. a proteomic analy ...201324303034
a high-dose preparation of lactobacilli and bifidobacteria in the prevention of antibiotic-associated and clostridium difficile diarrhoea in older people admitted to hospital: a multicentre, randomised, double-blind, placebo-controlled, parallel arm trial (placide).antibiotic-associated diarrhoea (aad) occurs most commonly in older people admitted to hospital and within 12 weeks of exposure to broad-spectrum antibiotics. although usually a mild and self-limiting illness, the 15-39% of cases caused by clostridium difficile infection [c. difficile diarrhoea (cdd)] may result in severe diarrhoea and death. previous research has shown that probiotics, live microbial organisms that, when administered in adequate numbers, are beneficial to health, may be effecti ...201324309198
[recurrent clostridium difficile infections: the importance of the intestinal microbiota].clostridium difficile infections (cdi) represent 20-30% of diarrhea caused by antibiotics and relapse in more than 25% of cases after treatment with metronidazole or vancomycin. given the high prevalence of cdi and the significant rate of recurrence despite successful initial treatment, cdi therapy represents a real challenge. a better understanding of the intestinal microbiota and its role in cdi opens the way to promising new therapeutic approaches, such as fecal transplantation. the studies p ...201324298714
proton pump inhibitors: clostridium difficile infections.data on the adverse effect profile of proton pump inhibitors continue to accumulate. in addition to increasing the risk of bacterial pneumonia, proton pump inhibitors appear to increase the risk of intestinal clostridium difficile infection. a meta-analysis of epidemiological studies showed a statistically significant increase in c. difficile infection among patients taking proton pump inhibitors, most of whom were hospital patients.the estimated relative risk was 1.7 for primary infections (95% ...201324298587
cags clinical practice committee report: the science of clostridium difficile and surgery. 201324284142
[new treatment options for infections with clostridium difficile].currently available broad spectrum antibiotics are not sufficiently effective against recurrent clostridium difficile infections (cdi). donor faecal microbiota transplantation is a very effective treatment for second and recurrent infection but is time-consuming and requires careful screening of donors. the new narrow spectrum antibiotic fidaxomicin is a good alternative in a first cdi or a first recurrence, but treatment is expensive and there are no data on its effectiveness in a second or lat ...201324279951
more on antidepressant drugs and infectious disease.three observational studies have suggested that depression and/or antidepressant drug use is associated with an increased risk of developing clostridium difficile (c. difficile) infection (cdi), which is a clinically significant cause of diarrhea typically associated with the use of antibiotic drugs. establishing causality from observed associations requires evidence from a variety of different scientific perspectives. the authors of these studies do not consider the complex relationship among d ...201324278963
the p2y6 receptor mediates clostridium difficile toxin-induced cxcl8/il-8 production and intestinal epithelial barrier dysfunction.c. difficile is a gram-positive spore-forming anaerobic bacterium that is the leading cause of nosocomial diarrhea in the developed world. the pathogenesis of c. difficile infections (cdi) is driven by toxin a (tcda) and toxin b (tcdb), secreted factors that trigger the release of inflammatory mediators and contribute to disruption of the intestinal epithelial barrier. neutrophils play a key role in the inflammatory response and the induction of pseudomembranous colitis in cdi. tcda and tcdb alt ...201324278446
a simulation-based assessment of strategies to control clostridium difficile transmission and infection.clostridium difficile is one of the most common and important nosocomial pathogens, causing severe gastrointestinal disease in hospitalized patients. although "bundled" interventions have been proposed and promoted, optimal control strategies remain unknown.201324278304
variations in virulence and molecular biology among emerging strains of clostridium difficile.clostridium difficile is a gram-positive, spore-forming organism which infects and colonizes the large intestine, produces potent toxins, triggers inflammation, and causes significant systemic complications. treating c. difficile infection (cdi) has always been difficult, because the disease is both caused and resolved by antibiotic treatment. for three and a half decades, c. difficile has presented a treatment challenge to clinicians, and the situation took a turn for the worse about 10 years a ...201324296572
environmental contaminants in hospital settings and progress in disinfecting techniques.medical devices, such as stethoscopes, and other objects found in hospital, such as computer keyboards and telephone handsets, may be reservoirs of bacteria for healthcare-associated infections. in this cross-over study involving an italian teaching hospital we evaluated microbial contamination (total bacterial count (tbc) at 36°c/22°c, staphylococcus spp., moulds, enterococcus spp., pseudomonas spp., e. coli, total coliform bacteria, acinetobacter spp., and clostridium difficile) of these devic ...201324286078
identification of clostridium difficile: evaluation of genotypic, phenotypic and proteomic methods. 201324273901
investigating clostridium difficile. 201324273764
diagnosis of clostridium difficile infection: the molecular approach.diagnosis of clostridium difficile infection is based on clinical presentation and laboratory tests. although numerous laboratory methods are now available, the diagnosis of c. difficile infection remains challenging. nucleic acid amplification tests (naats) are the most recent marketed methods. these methods detect genes for toxins a and/or b. they are very sensitive compared with the reference method (toxigenic culture) and are thus very promising, despite their cost. however, a positive naat ...201324266358
clinical and microbiologic characteristics of clostridium difficile infection caused by binary toxin producing strain in korea.binary toxin-producing clostridium difficile infections (cdi) are known to be more severe and to cause higher case fatality rates than those by binary toxin-negative isolates. there has been few data of binary toxin-producing cdi in korea. objective of the study is to characterize clinical and microbiological trait of cdi cause by binary-toxin producing isolates in korea.201324265965
asymptomatic clostridium difficile colonisation and onward transmission.combined genotyping/whole genome sequencing and epidemiological data suggest that in endemic settings only a minority of clostridium difficile infection, cdi, is acquired from other cases. asymptomatic patients are a potential source for many unexplained cases.201324265690
surface-layer protein a (slpa) is a major contributor to host-cell adherence of clostridium difficile.clostridium difficile is a leading cause of antibiotic-associated diarrhea, and a significant etiologic agent of healthcare-associated infections. the mechanisms of attachment and host colonization of c. difficile are not well defined. we hypothesize that non-toxin bacterial factors, especially those facilitating the interaction of c. difficile with the host gut, contribute to the initiation of c. difficile infection. in this work, we optimized a completely anaerobic, quantitative, epithelial-ce ...201324265687
pseudomembranous colitis associated with a triple therapy for helicobacter pylori eradication.helicobacter pylori (h. pylori) is one of the most common chronic bacterial infections in humans, affecting half of world's population. therapy for h. pylori infection has proven to be both effective and safe. the one-week triple therapy including proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate h. pylori infection in countries with low clarithromycin resistance. generally, this therapy is well-tolerated, with onl ...201324259981
mortality following rasburicase-induced methemoglobinemia.to report a case of mortality following rasburicase-induced methemoglobinemia.201324259700
phage ϕc2 mediates transduction of tn6215, encoding erythromycin resistance, between clostridium difficile strains.in this work, we show that clostridium difficile phage ϕc2 transduces erm(b), which confers erythromycin resistance, from a donor to a recipient strain at a frequency of 10(-6) per pfu. the transductants were lysogenic for ϕc2 and contained the erm(b) gene in a novel transposon, tn6215. this element is 13,008 bp in length and contains 17 putative open reading frames (orfs). it could also be transferred at a lower frequency by filter mating.201324255122
prospects and challenges for intestinal microbiome therapy in pediatric gastrointestinal disorders.fecal microbiome (microbiota) transplantation is an emerging treatment not only for refractory/recurrent clostridium difficile infections and chronic gastrointestinal diseases, but also for metabolic syndrome, and even possibly for neurological disorders. this non-conventional therapy has been perhaps more appropriately designated as fecal bacteriotherapy (fb) as well. the employment of fb is spreading into pediatric gastroenterology. this focused review highlights the pediatric applications of ...201324244876
bile salt inhibition of host cell damage by clostridium difficile toxins.virulent clostridium difficile strains produce toxin a and/or toxin b that are the etiological agents of diarrhea and pseudomembranous colitis. treatment of c. difficile infections (cdi) has been hampered by resistance to multiple antibiotics, sporulation, emergence of strains with increased virulence, recurrence of the infection, and the lack of drugs that preserve or restore the colonic bacterial flora. as a result, there is new interest in non-antibiotic cdi treatments. the human conjugated b ...201324244530
differential stress transcriptome landscape of historic and recently emerged hypervirulent strains of clostridium difficile strains determined using rna-seq.c. difficile is the most common cause of nosocomial diarrhea in north america and europe. genomes of individual strains of c. difficile are highly divergent. to determine how divergent strains respond to environmental changes, the transcriptomes of two historic and two recently isolated hypervirulent strains were analyzed following nutrient shift and osmotic shock. illumina based rna-seq was used to sequence these transcriptomes. our results reveal that although c. difficile strains contain a la ...201324244315
histologic findings and clinical characteristics in acutely symptomatic ulcerative colitis patients with superimposed clostridium difficile infection.to examine biopsy specimens for histologic features suggestive of clostridium difficile infection in patients with ulcerative colitis (uc).201324225751
clostridium difficile 027 emerging outbreak in marseille, france. 201324225631
the impact of observation units on the rate of hospital-acquired infection.using clostridium difficile as an example, we calculated the impact that reduced inpatient-day denominators resulting from implementation of hospital observation units would have on hospital-acquired infection rates. using proposed scenarios of reduced inpatient-days, we estimated an increase in the hospital-acquired c. difficile infection rate of up to 12%.201324225619
spo0a differentially regulates toxin production in evolutionarily diverse strains of clostridium difficile.clostridium difficile is an important pathogen of humans and animals, representing a significant global healthcare problem. the last decade has seen the emergence of epidemic bi/nap1/027 and ribotype 078 isolates, associated with the onset of more severe disease and higher rates of morbidity and mortality. however, little is known about these isolates at the molecular level, partly due to difficulties in the genetic manipulation of these strains. here we report the development of an optimised tn ...201324236153
role of lactobacillus in the prevention of clostridium difficile-associated diarrhea: a meta-analysis of randomized controlled trials.clostridium difficile-associated diarrhea (cdad) is a major public health problem because of significant morbidity and mortality, and many clinicians pay attention to lactobacillus as a potentially effective treatment. the purpose of this meta-analysis was to evaluate the efficacy of lactobacillus in the prevention of cdad.201324229690
more nutritional research needed to prevent and treat clostridium difficile infections. 201324192962
editorial: ppis and recurrent c. difficile infection: no association?a rigorously conducted cohort study published in this edition of the american journal of gastroenterology shows that the use of a proton-pump inhibitor is not associated with recurrent clostridium difficile infection among hospitalized patients. this contradicts the findings of previous studies that, however, were at a high risk of bias. where does the truth lie? regardless of the answer, it is important that proton-pump inhibitors, not dissimilar to any other drug, are used appropriately.201324192949
gastrointestinal infections, active component, u.s. armed forces, 2002-2012.acute gastroenteritis and other infectious disorders of the gastrointestinal system are common in civilian and military populations. during the years 2002 through 2012, there were 286,305 cases of gastrointestinal infection (gi) diagnosed among members of the active component of the u.s. armed forces. the distribution of presumed causes of these illnesses (as reported in administrative medical records) was bacterial (29%), viral (68%), and parasitic (3%). most recorded diagnoses did not specify ...201324191767
combination of culture, antigen and toxin detection, and cytotoxin neutralization assay for optimal clostridium difficile diagnostic testing.there has been a growing interest in developing an appropriate laboratory diagnostic algorithm for clostridium difficile, mainly as a result of increases in both the number and severity of cases of c difficile infection in the past decade. a c difficile diagnostic algorithm is necessary because diagnostic kits, mostly for the detection of toxins a and b or glutamate dehydrogenase (gdh) antigen, are not sufficient as stand-alone assays for optimal diagnosis of c difficile infection. in addition, ...201324421808
treatment of relapsing clostridium difficile infection using fecal microbiota transplantation.clostridium difficile infection (cdi) has become a global concern over the last decade. in the united states, cdi escalated in incidence from 1996 to 2005 from 31 to 64/100,000. in 2010, there were 500,000 cases of cdi with an estimated mortality up to 20,000 cases a year. the significance of this problem is evident from the hospital costs of over 3 billion dollars annually. fecal microbiota transplant (fmt) was first described in 1958 and since then about 500 cases have been published in litera ...201324421645
use of fidaxomicin through a nasogastric tube for the treatment of septic shock caused by clostridium difficile infection in a patient with oral cancer admitted to the surgical critical care unit. 201324399354
clostridium difficile-associated disease: adherence with current guidelines at a tertiary medical center.to assess adherence with the the society for healthcare epidemiology of america (shea)/ the infectious diseases society of america (idsa) guidelines for management of clostridium difficile (c. difficile)-associated disease (cdad) at a tertiary medical center.201324379582
parameters for the mathematical modelling of clostridium difficile acquisition and transmission: a systematic review.mathematical modelling of clostridium difficile infection dynamics could contribute to the optimisation of strategies for its prevention and control. the objective of this systematic review was to summarise the available literature specifically identifying the quantitative parameters required for a compartmental mathematical model of clostridium difficile transmission.201324376797
epidemiology of clostridium difficile infection among active duty united states military personnel (1998-2010).clostridium difficile associated disease (cdad) has risen in incidence and the experience in the us military has not been described.201324373384
predictors of first recurrence in clostridium difficile-associated disease. a study of 306 patients hospitalized in a romanian tertiary referral center.clostridium difficile is recognized as the major cause of nosocomial gastroenteritis usually related to antibiotic treatment. although treatable, c. difficile--associated disease (cdad) tends to recur in many patients. the purpose of the study was to analyze the risk factors for recurrence in patients with cdad after the first treatment with vancomycin, metronidazole or both.201324369321
antibiotic prophylaxis for hip fracture surgery: three-dose cefuroxime versus single-dose gentamicin and amoxicillin.to compare a 3-dose cefuroxime regimen with a single-dose gentamicin and amoxicillin regimen as antibiotic prophylaxis for hip hemiarthroplasty in terms of microbiological outcome.201324366793
probiotics for the prevention of antibiotic-associated diarrhea and clostridium difficile infection among hospitalized patients: systematic review and meta-analysis.antibiotic-associated diarrhea (aad) and clostridium difficile infection (cdi) are associated with high morbidity, mortality, and health care costs. probiotics may mitigate the existing disease burden. we performed a systematic review and meta-analysis to evaluate the efficacy of co-administration of probiotics with antibiotics in preventing these adverse outcomes in adult inpatients.201324348885
ecological modeling from time-series inference: insight into dynamics and stability of intestinal microbiota.the intestinal microbiota is a microbial ecosystem of crucial importance to human health. understanding how the microbiota confers resistance against enteric pathogens and how antibiotics disrupt that resistance is key to the prevention and cure of intestinal infections. we present a novel method to infer microbial community ecology directly from time-resolved metagenomics. this method extends generalized lotka-volterra dynamics to account for external perturbations. data from recent experiments ...201324348232
analysis of the intestinal microbiome of a recovered clostridium difficile patient after fecal transplantation.clostridium difficile infections upon antibiotic disruption of the gut microbiota are potentially lethal. fecal microbiota transplantation (fmt) is a promising treatment option for recurrent c. difficile-associated disease (cdad). here, we present a patient with recurrent cdad that received fmt, leading to full recovery for what has now been 3 years. we performed metagenomic sequencing on stool samples to assess if there are indications for recolonization with c. difficile and changes in the gut ...201324335204
long term effect of infection control practices and associated factors during a major clostridium difficile outbreak in costa rica.the c. difficile bi/nap 1 hyper virulent strain has been responsible for the nosocomial outbreaks in several countries. the present study describes the infection control strategies utilized to achieve outbreak control as well as the factors associated with a c. difficile bi/nap 1 hyper virulent strain outbreak in costa rica.201324334937
antimicrobial effects of virgin coconut oil and its medium-chain fatty acids on clostridium difficile.clostridium difficile is the leading cause of hospital-acquired antibiotic-associated diarrhea worldwide; in addition, the proliferation of antibiotic-resistant c. difficile is becoming a significant problem. virgin coconut oil (vco) has been shown previously to have the antimicrobial activity. this study evaluates the lipid components of vco for the control of c. difficile. vco and its most active individual fatty acids were tested to evaluate their antimicrobial effect on c. difficile in vitro ...201324328700
characterization of the sigd regulon of c. difficile and its positive control of toxin production through the regulation of tcdr.clostridium difficile intestinal disease is mediated largely by the actions of toxins a (tcda) and b (tcdb), whose production occurs after the initial steps of colonization involving different surface or flagellar proteins. in b. subtilis, the sigma factor sigd controls flagellar synthesis, motility, and vegetative autolysins. a homolog of sigd encoding gene is present in the c.difficile 630 genome. we constructed a sigd mutant in c. difficile 630 ∆erm to analyze the regulon of sigd using a glob ...201324358307
treatment strategies for recurrent clostridium difficile infection.recurrent clostridium difficile infection represents a major clinical challenge. treatment is often based on empiric selection from relatively few options supported by limited clinical evidence.201324357868
an analysis of risk factors of clostridiumdifficile infection in patients hospitalized in the teaching hospital in 2008.the last decade saw an increase in the incidence of clostridium difficile infections.approximately 80% of these infections occur in hospitalized patients. there are ongoing studies on the increase in the incidence of infections with this microorganism.201324340558
postoperative clostridium difficile infection with pcr ribotype 078 strain identified at necropsy in five thoroughbred racehorses.clostridium difficile is an important cause of acute enterocolitis in horses. we describe five cases of c difficile infection occurring postoperatively in thoroughbred racehorses. following diarrhoea or colic accompanied by a marked increase in packed cell volume (to ≥60 per cent) and leucopenia (≤4000 cells/μl) within two to four days after surgery in all five horses, four of them died or were euthanased because of colitis or severe diarrhoea. in these four horses, necrotising entero-typhlo-col ...201324336792
prevention and treatment of diarrhoea with saccharomyces boulardii in children with acute lower respiratory tract infections.the aim of this study was to determine whether saccharomyces boulardii prevents and treats diarrhoea and antibiotic-associated diarrhoea (aad) in children. a total of 333 hospitalised children with acute lower respiratory tract infection were enrolled in a 2-phase open randomised controlled trial. during the 1st phase, all children received intravenous antibiotics (ab). they were randomly allocated to group a (s. boulardii 500 mg/day + ab, n=167) or group b (ab alone, n=166) and followed for 2 w ...201324311316
intestinal microbiota transplantation: a case of crohn's colitis with superimposed clostridium difficile infection. 201324831911
[experience with laboratory diagnosis of clostridium difficile].clostridium difficile is currently a significant cause of nosocomial diarrhea. for several years, the number of infectious cases in the community has also been increasing. since the beginning of 2010, quite a large increase in the number of clostridium difficile infections (cdis) has been noted in pardubice regional hospital (prh). the objectives of this study were to describe and evaluate the methods used in the laboratory diagnosis of cdis in prh, and to describe the laboratory diagnostic algo ...201324579451
antimicrobial susceptibility of clostridium difficile clinical isolates in iran.clostridium difficile infection (cdi) is major growing problem in hospitals and its high incidence has been reported in recent years.201324578839
why were molecular studies not considered to classify clostridium difficile isolates implicated in an outbreak? 201324553766
why were molecular studies not considered to classify clostridium difficile isolates implicated in an outbreak? 201324553765
therapeutic approaches for clostridium difficile infections.metronidazole and vancomycin remain the front-line therapies for most clostridium difficile infections (cdi). however, recurrent cdi occurs in ∼ 25% of patients, causing significant morbidity and mortality and healthcare costs. for this population, traditional antibiotic therapies fail and new treatment options are greatly needed. the us food and drug administration recently approved fidaxomicin for cdi treatment. this narrow-spectrum antibiotic preserves the normal gut microbiota and shows prom ...201324510892
[the problem of clostridium dlfficile infection in children with inflammatory bowel disease].the last decade has seen a significant increase in the incidence of diseases related to infection by clostridium difficile (clostridium difficile-associated disease--cdad) in the u.s.a., canada and european countries, which is probably due to the widespread environmental hipervirulent c. difficile strain nap 1 / bi / 027. those particularly affected by cdad are patients with inflammatory bowel disease (ibd) who observed more severe infections, prolonged hospital stay, higher risk of complication ...201324490471
[steroid-resistant nephrotic syndrome complicated with severe streptococcus pneumonlae peritonitis in a 10-year-old girl--case report].primary bacterial peritonitis is a rare complication of idiopathic nephrotic syndrome (ins) in children, found in 1.5-3.7% cases. the 10-year-old girl was admitted with ins relapse: generalized edema, proteinuria 630 mg/kg/24 h, hypoalbuminemia 1.8 g/dl, hypogammaglobulinemia 74.0 mg/dl (n: 618-1537 mg/dl), gfr 71.6 ml/min/1.73 m2. she was treated with prednisone 60 mg/24 h. on 5th day severe pain, fever, crp (15.5 mg/dl) and leukocytosis (19.5 tys/mm3) rise occurred. on 6th day due to suspicion ...201324490466
[screening for opportunistic infections and vaccination before introduction of biologic therapy].patients on anti-tnfalpha medications carry a higher risk for developing opportunistic infections. in order to introduce anti-tnfalpha therapy, screening for hepatitis viruses b and c, hiv, ebv, hpv, tbc, bacterial, fungal and parasitic infections should be performed. screening involves patient's history of earlier infectious diseases, vaccinations and traveling to parts of the world with endemic diseases. clinical examination should be supplemented with stomatologic and gynecologic exams. labor ...201324471299
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