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epidemiology of community-associated clostridium difficile infection, 2009 through 2011.clostridium difficile infection (cdi) has been increasingly reported among healthy individuals in the community. recent data suggest that community-associated cdi represents one-third of all c difficile cases. the epidemiology and potential sources of c difficile in the community are not fully understood.201323780507
clostridium difficile leaves the hospital--what's next? 201323778358
clinical utility of retrograde terminal ileum intubation in the evaluation of chronic non-bloody diarrhea.the aims of this study were to investigate the frequency and factors involved in the terminal ileum intubation of patients with chronic, non-bloody diarrhea and to compare diagnostic yields of colonoscopy and ileocolonoscopy.201323777610
role of interleukin 23 signaling in clostridium difficile colitis.clostridium difficile is currently the leading cause of hospital-acquired infections in the united states. here, we observed increased interleukin 23 (il-23) protein levels in human colon biopsy specimens positive for c. difficile toxins, compared with levels in negative controls (p = .008) we also investigated the role of il-23 during c. difficile infection, using 2 distinct murine models. mice lacking il-23 signaling had a significant increase in survival (100% [12 mice]), compared with contro ...201323776194
clostridium difficile infection in the elderly.the incidence of c. difficile infections (cdi) in the elderly continues to rise and infection is associated with increased morbidity and mortality when compared to those affected in younger age-groups. immunosenescence may be a contributory factor yet the exact immune responses that may protect against cdi are incompletely understood. increased exposure to antibiotics, frequent and/or prolonged hospital admissions and residing in long-term care facilities provide multiple opportunities for host ...201323774972
clostridium difficile: restoring the balance--microbes for the management of clostridium difficile infection? 201323774772
effect of an oxygen-tolerant bifurcating butyryl coenzyme a dehydrogenase/electron-transferring flavoprotein complex from clostridium difficile on butyrate production in escherichia coli.the butyrogenic genes from clostridium difficile dsm 1296(t) have been cloned and expressed in escherichia coli. the enzymes acetyl-coenzyme a (coa) c-acetyltransferase, 3-hydroxybutyryl-coa dehydrogenase, crotonase, phosphate butyryltransferase, and butyrate kinase and the butyryl-coa dehydrogenase complex composed of the dehydrogenase and two electron-transferring flavoprotein subunits were individually produced in e. coli and kinetically characterized in vitro. while most of these enzymes wer ...201323772070
the agr locus regulates virulence and colonization genes in clostridium difficile 027.the transcriptional regulator agra, a member of the lyttr family of proteins, plays a key role in controlling gene expression in some gram-positive pathogens, including staphylococcus aureus and enterococcus faecalis. agra is encoded by the agracdb global regulatory locus, and orthologues are found within the genome of most clostridium difficile isolates, including the epidemic lineage 027/bi/nap1. comparative rna sequencing of the wild type and otherwise isogenic agra null mutant derivatives of ...201323772065
extraintestinal clostridium difficile infections.clostridium difficile causes diarrhea that ranges from a benign, self-limiting antibiotic use-associated disease to a life-threatening pseudomembranous colitis. clostridium difficile has rarely been isolated in extraintestinal infections. our objective was to characterize clinical features and risk factors of these infections. methods extraintestinal c. difficile infections (cdis) were searched for in an electronic database of all c. difficile-positive isolates found during a 10-year period. the ...201323771984
elevated lactoferrin is associated with moderate to severe clostridium difficile disease, stool toxin, and 027 infection.we evaluated blood and fecal biomarkers as indicators of severity in symptomatic patients with confirmed clostridium difficile infection (cdi). recruitment included patients with cdi based on clinical symptoms and supporting laboratory findings. disease severity was defined by physician's assessment and blood and fecal biomarkers were measured. toxigenic culture done using spore enrichment and toxin b detected by tissue culture were done as confirmatory tests. polymerase chain reaction (pcr) rib ...201323771554
clostridium difficile infection in hospitalized cancer patients in beijing, china is facilitated by receipt of cancer chemotherapy.the purpose of this study was to determine the presence of clostridium difficile infection (cdi) and risk factors for infection in hospitalized patients with diarrhea in a cancer hospital in beijing, china. a total of 277 patients with hospital-associated diarrhea (had) were studied of which 41 (15%) were positive for fecal c. difficile toxin a/b. for each cdi case identified, a control with had but negative c. difficile specimen was enrolled to look for cdi risk factors. receipt of cancer chemo ...201323770543
in vitro selective inhibitory effect of 8-hydroxyquinoline against bifidobacteria and clostridia.8-hydroxyquinoline (8hq) inhibited clostridium tertium, clostridium clostridioforme, clostridium difficile and clostridium perfringens in vitro with mics of 8, 16, 32 and 32 μg/ml, respectively. in contrast, mics of most bifidobacteria (84%) were 512 μg/ml or higher. thus, 8hq could be used as anti-clostridial agent or in selective media for bifidobacteria isolation.201323770542
diarrhea-associated pathogens, lactobacilli and cellulolytic bacteria in equine feces: responses to antibiotic challenge.antibiotics are important to equine medicine, but antibiotic-associated diarrhea (aad) can lead to poor performance and even mortality. aad is attributed to disruption of the hindgut microbiota, which permits proliferation of pathogenic microbes. the goal of this study was to evaluate the effects of common antibiotics on cellulolytic bacteria, lactobacilli, and aad-associated pathogens in the feces of healthy horses. fifteen horses were assigned to three treatment groups (blocked by age and sex) ...201323769300
declining cephalosporin and fluoroquinolone non-susceptibility among bloodstream enterobacteriaceae from the uk: links to prescribing change?the uk saw major increases in cephalosporin and quinolone resistance amongst enterobacteriaceae from 2001 to 2006, with cephalosporin resistance largely reflecting dissemination of ctx-m extended-spectrum β-lactamases (esbls). we review subsequent trends.201323766490
clostridium difficile infection. 201323764494
characterization of swine isolates of clostridium difficile in spain: a potential source of epidemic multidrug resistant strains?clostridium difficile is an emerging pathogen for humans and animals and there is concern about the possibility that livestock might serve as a reservoir of epidemic strains. in spain, ribotype 078 is one of the most prevalent in human episodes of c. difficile infection, but the distribution of this and other ribotypes in animals is yet unknown. we present the first report on the ribotype distribution and antimicrobial susceptibility of c. difficile in swine in spain. a total of 144 isolates wer ...201323764416
clostridium difficile infection: the importance of accurate diagnosis. 201323763047
effect of ribotype on all-cause mortality following clostridium difficile infection.clostridium difficile infection (cdi) is significantly associated with subsequent all-cause mortality. although a number of studies have investigated mortality associated with cdi, few have compared all-cause mortality between ribotypes.201323759667
evaluation of the effect of oritavancin on clostridium difficile spore germination, outgrowth and recovery.previous work suggests oritavancin may be inhibitory to clostridium difficile spores. we have evaluated the effects of oritavancin exposure on c. difficile spore germination, outgrowth and recovery.201323759507
acid suppression and the risk of clostridium difficile infection. 201323759424
fecal transplantation: re-discovering the value of stool.for over 1000 years, stool in various forms has been used to treat disease. within the past few decades, fecal infusion either rectally or via a nasogastric tube has become a viable option for the treatment of refractory clostridium difficile infection (cdi), and, more recently, it has shown promise in treating inflammatory bowel disease (ibd) and metabolic disease. the purpose of this article is to review the use of feces as a treatment option in pediatric disease.201323995428
leukemoid reaction: spectrum and prognosis of 173 adult patients.the prognosis of patients with leukemoid reaction (lr) depends mainly on their underlying illness. our aim was to investigate the etiologies and prognosis of a mixed group of patients with lr.201323994818
diagnostic testing for clostridium difficile infection in patients with inflammatory bowel disease. 201323751851
clostridium difficile erm(b)-containing elements and the burden on the in vitro fitness.in clostridium difficile, resistance to the macrolide-lincosamide-streptogramin b group of antibiotics generally relies on erm(b) genes. in this study, we investigated elements with a genetic organization different from tn5398, the mobilizable non-conjugative element identified in c. difficile strain 630. our results suggested that the elements most frequently found in strains isolated during the european surveillance study in 2005 were related to tn6194, the conjugative transposon recently dete ...201323741023
burden of hospital-onset clostridium difficile infection in patients discharged from rhode island hospitals, 2010-2011: application of present on admission indicators.the year 2010 is the first time that the rhode island hospital discharge database included present on admission (poa) indicators, which give us the opportunity to distinguish cases of hospital-onset clostridium difficile infection (cdi) from cases of community-onset cdi and to assess the burden of hospital-onset cdi in patients discharged from rhode island hospitals during 2010 and 2011.201323739074
prevalence of colonization and infection with methicillin-resistant staphylococcus aureus and vancomycin-resistant enterococcus and of clostridium difficile infection in canadian hospitals.to determine the prevalence of methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), and clostridium difficile infection (cdi) in canadian hospitals.201323739072
clostridium difficile infection associated with pig farms. 201323735347
challenges and opportunities for faecal microbiota transplantation therapy.the incidence, morbidity, and mortality associated with clostridium difficile gastrointestinal infections has increased greatly over recent years, reaching epidemic proportions; a trend due, in part, to the emergence of hypervirulent and antibiotic-resistant strains. the need to identify alternative, non-antibiotic, treatment strategies is therefore urgent. the ability of bacteria in faecal matter transplanted from healthy individuals to displace pathogen populations is well recognized. further, ...201323735045
hospital-acquired clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards.clostridum difficile (c. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. we aimed to determine the rate and characteristics of hospital-acquired c. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards.201323734349
clostridium difficile: a cause of diarrhea in children. 201323733223
expression and cytoprotective activity of the small gtpase rhob induced by the escherichia coli cytotoxic necrotizing factor 1.rhob is the only member of the rho subfamily of small gtpases, which is classified as an immediate early gene product. rhob is up-regulated in response to growth factors as well as cytotoxic and genotoxic agents. clostridial glucosylating toxins have been reported to evoke pronounced rhob expression, based on the inactivation of rho/ras proteins. in this study, we report on a long lasting expression of rhob in cultured cells upon activation of rho proteins by the cytotoxic necrotizing factor 1 ( ...201323732113
impact of toxigenic clostridium difficile polymerase chain reaction testing on the clinical microbiology laboratory and inpatient epidemiology.conversion from clostridium difficile toxin a/b eia to tcdb polymerase chain reaction for diagnosis of c. difficile infection (cdi) resulted in significant decreases in laboratory testing volume and largely unchanged c. difficile toxin detection rates. decreases in healthcare-associated cdi rates (p ≤ 0.05) reflected a clinical practice benefit of this conversion.201323731555
improved bacterial mutagenesis by high-frequency allele exchange, demonstrated in clostridium difficile and streptococcus suis.here we show that the frequency of mutant isolation by two-step allele exchange can be improved by increasing the length of homologous dna and the opportunity for recombination, obviating the need for counterselection markers. these principles are demonstrated in clostridium difficile and streptococcus suis but are likely to be generally applicable.201323728809
probiotics for the prevention of clostridium difficile-associated diarrhea in adults and children.antibiotics are widely prescribed; however they can cause disturbances in gastrointestinal flora which may lead to reduced resistance to pathogens such as clostridium difficile (c. difficile). probiotics are live organisms thought to balance the gastrointestinal flora.201323728658
[antimicrobial therapy of clostridium difficile infection. systematic review and meta-analysis of the scientific evidence].clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of clostridium difficile infection. the available scientific evidence is limited and hardly comparable.201323728312
a clinical and epidemiological review of non-toxigenic clostridium difficile.clostridium difficile is a significant nosocomial threat to human health and is the most commonly identified cause of antibiotic-associated diarrhea. the development of c. difficile colitis requires production of toxins a and/or b, but some strains do not express these proteins. these non-toxigenic c. difficile (ntcd) have garnered attention for their capacity to colonize humans and potentially reduce the risk for symptomatic colitis caused by toxigenic strains. isolates of ntcd have been obtain ...201323727391
depression, antidepressant medications, and risk of clostridium difficile infection.an ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing clostridium difficile infection (cdi). our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing cdi, using two distinct datasets and study designs.201323647647
indications and safety of proton pump inhibitor drug use in patients with cancer.although the exact prevalence of proton pump inhibitor (ppi) use in cancer patients is not known, it is generally perceived to be widespread. ppis are generally well tolerated and carry an excellent safety profile. however, increasing and longer term ppi use has raised concerns about the risk of pneumonia, bone fractures and enteric infections, and a possible interaction with clopidogrel that could increase the risk of cardiovascular events.201323647006
obesity as a risk factor for clostridium difficile infection.obesity and clostridium difficile infection (cdi) are both related to an increased firmicutes/bacteroidetes ratio in the intestinal microbiota. however, an association between obesity and cdi is unknown. we aimed to assess the association between obesity and cdi in hospitalized patients.201323645850
does empirical clostridium difficile infection (cdi) therapy result in false-negative cdi diagnostic test results?patients with suspected clostridium difficile infection (cdi) often receive empirical therapy prior to collection of stool specimens for diagnostic testing. the likelihood that such empirical therapy might result in false-negative cdi test results is unknown.201323645849
effects of clostridium difficile toxin a and b on human t lymphocyte migration.bacterial products such as toxins can interfere with a variety of cellular processes, leading to severe human diseases. clostridium difficile toxins, tcda and tcdb are the primary contributing factors to the pathogenesis of c. difficile-associated diseases (cdad). while the mechanisms for tcda and tcdb mediated cellular responses are complex, it has been shown that these toxins can alter chemotactic responses of neutrophils and intestinal epithelial cells leading to innate immune responses and t ...201323645153
effect of hospital disinfectants on spores of clinical brazilian clostridium difficile strains.the aim of this study was to evaluate the sporicidal activity of hospital disinfectants against spores of two brazilian clostridium difficile ribotypes and the bi/nap1/027. our results showed that clororio(®) and cidex opa(®) were the most efficient agents for eliminating spores of c difficile.201323644034
evaluation of the new ce-ivd marked bd max cdiff assay for the detection of toxigenic clostridium difficile harboring the tcdb gene from clinical stool samples.the evaluation of the fully automated bd max cdiff assay on a panel of 100 stool samples characterized by the xpert c. difficile assay reported a high concordance between the two molecular assays (kappa coefficient of 0.96), which makes this new assay suitable for routine detection of toxigenic clostridium difficile.201323643507
on the difficulties of isolating clostridium difficile from hospital environments.spores of clostridium difficile were deposited on to a stainless steel surface and subsequently exposed to a chlorine-releasing disinfectant (dichloroisocyanurate). recovery of the spores was carried out using rodac plates containing a variety of selective and non-selective agars. the non-selective agar media yielded higher recoveries of both control and chlorine-stressed spores. our results show that the antibiotics used in selective media imposed an additional stress on both disinfectant-treat ...201323643391
an overview of fecal microbiota transplantation: techniques, indications, and outcomes. 201323642791
clostridium difficile infection in horses: a review.clostridium difficile is considered one of the most important causes of diarrhea and enterocolitis in horses. foals and adult horses are equally susceptible to the infection. the highly resistant spore of c. difficile is the infectious unit of transmission, which occurs primarily via the fecal-oral route, with sources of infection including equine feces, contaminated soil, animal hospitals, and feces of other animals. two major risk factors for the development of c. difficile associated disease ...201323642413
mycotic iliac artery aneurysm caused by clostridium difficile in a patient with axillobifemoral bypass for leriche syndrome.a 74-year old man on hemodialysis developed a mycotic aneurysm caused by clostridium difficile. to the best of our knowledge, this is only the second case of such an aneurysm reported in the literature. he had previously undergone axillobifemoral bypass grafting because of symptomatic infrarenal aortic stenosis. although no blood flow was detected in his occluded right common iliac artery, it expanded rapidly despite intensive antibiotic therapy. as the blood supply to the lower limbs was alread ...201323641291
presence of clostridium difficile pcr ribotype clusters related to 033, 078 and 045 in diarrhoeic calves in germany.this study provides data on the distribution and relationship of c. difficile pcr ribotypes in diarrhoeic calves in germany. c. difficile was isolated from 176 of 999 (17.6 %) faecal samples or swabs of diarrhoeic calves from 603 farms collected between january 2010 and august 2012 by eight federal laboratories of six states. strains were assigned to 17 pcr ribotypes. pcr ribotypes 033 (57 %), 078 (17 %) and 045/fli01 (closest match to 045 in the webribo database; 9 %) were found the most freque ...201323639987
reply to wiegand et al.: proton pump inhibitor over-use and the ongoing battle to control clostridium difficile infection in hospitals. 201323639818
role of the environment in the transmission of clostridium difficile in health care facilities.recent data demonstrate that the contaminated hospital surface environment plays a key role in the transmission of clostridium difficile. enhanced environmental cleaning of rooms housing clostridium difficile-infected patients is warranted, and, if additional studies demonstrate a benefit of "no-touch" methods (eg, ultraviolet irradiation, hydrogen peroxide systems), their routine use should be considered.201323622740
interventions to improve antibiotic prescribing practices for hospital inpatients.the first publication of this review in issue 3, 2005 included studies up to november 2003. this update adds studies to december 2006 and focuses on application of a new method for meta-analysis of interrupted time series studies and application of new cochrane effective practice and organisation of care (epoc) risk of bias criteria to all studies in the review, including those studies in the previously published version. the aim of the review is to evaluate the impact of interventions from the ...201323633313
resolution of severe clostridium difficile infection following sequential fecal microbiota transplantation. 201323632358
clostridium difficile binary toxin cdt induces clustering of the lipolysis-stimulated lipoprotein receptor into lipid rafts.clostridium difficile is the leading cause of antibiotics-associated diarrhea and pseudomembranous colitis. hypervirulent c. difficile strains produce the binary actin-adp-ribosylating toxin cdt (c. difficile transferase), in addition to the rho-glucosylating toxins a and b. we recently identified the lipolysis-stimulated lipoprotein receptor (lsr) as the host receptor that mediates uptake of cdt into target cells. here we investigated in h1-hela cells, which ectopically express lsr, the influen ...201323631918
a novel approach to generate a recombinant toxoid vaccine against clostridium difficile.the clostridium difficile toxins a and b are primarily responsible for symptoms of c. difficile associated disease and are prime targets for vaccine development. we describe a plasmid-based system for the production of genetically modified toxins in a non-sporulating strain of c. difficile that lacks the toxin genes tcda and tcdb. tcda and tcdb mutations targeting established glucosyltransferase cytotoxicity determinants were introduced into recombinant plasmids and episomally expressed toxin mu ...201323629868
human monoclonal antibodies against clostridium difficile toxins a and b inhibit inflammatory and histologic responses to the toxins in human colon and peripheral blood monocytes.clostridium difficile infection (cdi) is a common and debilitating nosocomial infection with high morbidity and mortality. c. difficile mediates diarrhea and colitis by releasing two toxins, toxin a and toxin b. since both toxins stimulate proinflammatory signaling pathways in human colonocytes and both are involved in the pathophysiology of cdi, neutralization of toxin a and b activities may represent an important therapeutic approach against cdi. recent studies indicated that human monoclonal ...201323629713
fecal microbiota transplantation: a new standard treatment option for clostridium difficile infection. 201323627849
clostridium difficile is an autotrophic bacterial pathogen.during the last decade, clostridium difficile infection showed a dramatic increase in incidence and virulence in the northern hemisphere. this incessantly challenging disease is the leading cause of antibiotic-associated and nosocomial infectious diarrhea and became life-threatening especially among elderly people. it is generally assumed that all human bacterial pathogens are heterotrophic organisms, being either saccharolytic or proteolytic. so far, this has not been questioned as colonization ...201323626782
contemporary outcomes for ulcerative colitis inpatients admitted to pediatric hospitals in the united kingdom.pediatric ulcerative colitis (uc) care is variable with a lack of appropriate guidelines to guide practice until recently.201323624885
effect of age, dose and antibiotic therapy on the development of clostridium difficile infection in neonatal piglets.piglet diarrhea is associated with increased pre-weaning mortality, poor growth rates, and variation in weight at weaning. clostridium difficile is a known cause of enteric disease in neonatal piglets, yet risk factors associated with c. difficile infection in piglets are unknown. the objectives of this study were (1) to evaluate the consistency and severity of lesions in piglets challenged with c. difficile at different bacterial doses (dosage experiment), (2) evaluate the use of antibiotics as ...201323624068
asymptomatic clostridium difficile colonization in a tertiary care hospital: admission prevalence and risk factors.the role of clostridium difficile (cd) carriers in health care-associated cd transmission has been identified as an area needing research. we investigated the prevalence of, and risk factors for, asymptomatic cd colonization at hospital admission.201323622704
community-associated clostridium difficile infection and antibiotics: a meta-analysis.antibiotic exposure is the most important risk factor for clostridium difficile infection (cdi). most evaluations of antimicrobial risk factors have been conducted in healthcare settings. the objective of this meta-analysis was to evaluate the association between antibiotic exposure and community-associated cdi (ca-cdi) (i.e. symptom onset in the community with no healthcare facility admission within 12 weeks) and to determine the classes of antibiotics posing the greatest risk.201323620467
cytotoxicity of clostridium difficile toxin b does not require cysteine protease-mediated autocleavage and release of the glucosyltransferase domain into the host cell cytosol.clostridium difficile virulence requires secretion of two exotoxins: tcda and tcdb. the precise mechanism of toxin uptake and delivery is undefined, but current models predict that the cysteine protease domain (cpd)-mediated autocleavage and release of glucosyltransferase domain (gtd) are crucial for intoxication. to determine the importance of cpd-mediated cleavage to tcdb cytotoxicity, we generated two mutant toxins--tcdb-c698s and tcdb-h653a--and assayed their abilities to intoxicate cells. t ...201323620115
probiotic vsl#3 prevents antibiotic-associated diarrhoea in a double-blind, randomized, placebo-controlled clinical trial.antibiotic-associated diarrhoea (aad) is a frequent complication of systemic antibiotic therapy and clostridium difficile-associated diarrhoea (cdad) is its most serious form due to associated morbidity and mortality.201323618760
crofelemer, a novel antisecretory agent approved for the treatment of hiv-associated diarrhea.secretory diarrhea has a significant impact on morbidity and mortality worldwide and may be a predominant or minor component of pathogenesis in diarrhea of various etiologies. crofelemer is a first-in-class antidiarrheal medication with unique inhibitory mechanisms at both the cystic fibrosis transmembrane conductance regulator and the calcium-activated chloride channels which are responsible for chloride secretion and subsequent luminal hydration. the efficacy of crofelemer has been investigate ...201323616951
duodenal infusion of stool is more effective than vancomycin in patients with recurrent clostridium difficile. 201323616152
the relationship between phenotype, ribotype, and clinical disease in human clostridium difficile isolates.since 2000, clostridium difficile isolates of ribotype 027 have been linked to outbreaks in north america and europe and also an increased rate of colectomy and death among infected individuals. it has been proposed that enhanced sporulation and toxin production were associated with this apparent increase in virulence of 027 isolates. since only a limited number of isolates have been examined, the relationship of these phenotypes to a specific ribotype, and as well as to clinical disease severit ...201323608205
the antimicrobial effects of helium and helium-air plasma on staphylococcus aureus and clostridium difficile.healthcare-associated infections (hcai) affect 5-10% of acute hospital admissions. environmental decontamination is an important component of all strategies to prevent hcai as many bacterial causes survive and persist in the environment, which serve as ongoing reservoirs of infection. current approaches such as cleaning with detergents and the use of chemical disinfectant are suboptimal. we assessed the efficacy of helium and helium-air plasma in killing staphylococcus aureus and clostridium dif ...201323607860
site-directed mutations in the lanthipeptide mutacin 1140.the oral bacterium streptococcus mutans, strain jh1140, produces the antibiotic mutacin 1140. mutacin 1140 belongs to a group of antibiotics called lanthipeptides. more specifically, mutacin 1140 is related to the epidermin type a(i) lanthipeptides. mutagenesis experiments of this group of lanthipeptides have been primarily restricted to the posttranslationally modified meso-lanthionine and 3-methyllanthionine residues. site-directed mutagenesis of the core peptide of mutacin 1140 was performed ...201323603688
diagnostic accuracy of a multiplex real-time pcr to predict clostridium difficile ribotype 027. 201323603384
pouchitis: what every gastroenterologist needs to know.pouchitis is the most common complication among patients with ulcerative colitis who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis. pouchitis is actually a spectrum of diseases that vary in etiology, pathogenesis, phenotype, and clinical course. although initial acute episodes typically respond to antibiotic therapy, patients can become dependent on antibiotics or develop refractory disease. many factors contribute to the course of refractory pouchitis, such as the ...201323602818
evaluation of the bd max cdiff assay for the detection of the toxin b gene of clostridium difficile out of faecal specimens.in this evaluation study, 180 faecal specimens were tested in parallel with the new bd max™ cdiff assay, the premier™ toxins a&b, and toxigenic culture as reference method. bd max™ cdiff presented a high sensitivity (96.0%) and specificity (99.4%) with a negative predictive value of 99.4%.201323602785
attenuation of clostridium difficile toxin-induced damage to epithelial barrier by ecto-5'-nucleotidase (cd73) and adenosine receptor signaling.clostridium difficile (cdf) releases toxins (tcda and tcdb) that damage the intestinal epithelial barrier. ecto-5'-nucleotidase (cd73) is expressed on intestinal epithelial cells, and it is hypothesized to protect against toxin-induced epithelial damage through the cleavage of 5'-amp to adenosine (ado) and subsequent activation of adenosine receptors (adors). herein, we sought to assess the potential protective effects of cd73 and ador signaling on the injurious effects of cdf toxins.201323600886
structural and functional investigation into acetyl-coenzyme a synthase and methyltransferase from human pathogen clostridium difficile.methyltransferase (metrcd) and acetyl-coenzyme a synthase (acscd) are two key enzymes in the acetyl-coenzyme a synthesis pathway of the human pathogen clostridium difficile. the pathway is absent in humans and is essential for the survival of the pathogen. metrcd and acscd were cloned, expressed in e. coli, and characterized for the first time. structural and functional investigations of the two enzymes were performed using homology structure modeling, fluorescence spectroscopy, and steady state ...201323599026
concomitant typhlitis and clostridium difficile colitis developed after first r-chop chemotherapy in a non-hodgkin lymphoma patient.typhlitis or neutropenic enterocolitis (nec) is a life-threatening condition that occurs in neutropenic patients. early recognition is crucial owing to high death rate. we present a case of a 54-year-old man, diagnosed with non-hodgkin lymphoma who received a first cycle of rituximab, cyclophosphamide, hydroxydaunorubicin (doxorubicin), oncovin (vincristine), prednisolone (r-chop) chemotherapy 10 days prior presenting. he developed fever, mucositis, watery diarrhoea and right lower quadrant pain ...201323598937
clostridium difficile infection in the community: are proton pump inhibitors to blame?once a nosocomial disease, clostridium difficile infection (cdi) now appears frequently in the community in the absence of exposure to antibiotics. prior studies have shown that patients with community-acquired cdi are younger, more likely to be female, and have fewer comorbidities compared to patients with hospital-associated cdi. because most studies of cdi are hospital-based, comparatively little is known about community-acquired cdi. the recent study by chitnis has received widespread attent ...201324187445
[the use of molecular methods in the diagnosis of clostridium difficile infections].the aim of this study was to use molecular methods to identify selected strains of c. difficile isolated from patients hospitalized at independent public central teaching hospital [sp csk] between 2008 and 2011 in order to demonstrate their toxicgenic character and to determine their epidemic potential, including the incidence of a suspected c. difficile strain 027/nap1/b1.201324180138
possible association between obesity and clostridium difficile infection. 201324188730
fever in the postoperative patient.postprocedure fevers vary in the timing of their occurrence, duration, and severity. such fevers do not all have an infectious cause, but they all require thorough investigation to rule out life-threatening conditions. this article summarizes the principles of diagnosis and management of postprocedure fevers for the emergency care provider.201324176478
quality focus: clostridium difficile. 201324175503
clostridium difficile infection in hospitalized patients at university clinical center tuzla, bosnia and herzegovina: a 4 year experience.clostridium difficile (c. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of c. difficile infection (cdi) in bosnia and herzegovina.201324167425
clostridium difficile toxin b-induced necrosis is mediated by the host epithelial cell nadph oxidase complex.clostridium difficile infection (cdi) is a leading cause of health care-associated diarrhea and has increased in incidence and severity over the last decade. pathogenesis is mediated by two toxins, tcda and tcdb, which cause fluid secretion, inflammation, and necrosis of the colonic mucosa. tcdb is a potent cytotoxin capable of inducing enzyme-independent necrosis in both cells and tissue. in this study, we show that tcdb-induced cell death depends on assembly of the host epithelial cell nadph o ...201324167244
fulminant colitis.fulminant colitis is an ill-defined entity that is usually viewed as the most severe form of uncomplicated acute colitis. it usually occurs in the course of ulcerative colitis and infectious colitis, but can also be seen in other forms of colitis. every patient with clinical criteria for severe or fulminant colitis should be approached in a systematic way, based on two premises - intense medical treatment and early surgery in non-responders.201324160933
detection of toxins a/b and isolation of clostridium difficile and clostridium perfringens from dogs in minas gerais, brazil.the objective of this study was to detect c. difficile a/b toxins and to isolate strains of c. perfringens and c. difficile from diarrheic and non-diarrheic dogs in brazil. stool samples were collected from 57 dogs, 35 of which were apparently healthy, and 22 of which were diarrheic. c. difficile a/b toxins were detected by elisa, and c. perfringens and c. difficile were identified by multiplex pcr. c. difficile a/b toxins were detected in 21 samples (36.8%). of these, 16 (76.2%) were from diarr ...201324159295
epidemiology of clostridium difficile-associated disease (cdad): a shift from hospital-acquired infection to long-term care facility-based infection.previous epidemiological studies on clostridium-difficile-associated diarrhea (cdad) have focused on hospitalized patients with nosocomial transmission. however, increasing numbers of patients with cdad are being admitted to acute-care hospitals from long-term care facilities (ltcfs) and the local community. the purpose of our study was to study the changing epidemiological trends of cdad patients admitted to an acute-care hospital and examine factors contributing to this shift in epidemiology.201324154638
is fidaxomicin the drug of choice for treating clostridium difficile-associated diarrhea in patients with cancer? 201324166524
clostridium difficile surveillance: harnessing new technologies to control transmission.clostridium difficile surveillance allows outbreaks of cases clustered in time and space to be identified and further transmission prevented. traditionally, manual detection of groups of cases diagnosed in the same ward or hospital, often followed by retrospective reference laboratory genotyping, has been used to identify outbreaks. however, integrated healthcare databases offer the prospect of automated real-time outbreak detection based on statistically robust methods, and accounting for conta ...201324151834
quality of care delivered to hospitalized inflammatory bowel disease patients.hospitalized patients with inflammatory bowel disease (ibd) are at high risk for morbidity, mortality, and health care utilization costs. while the literature on trends in hospitalization rates for this disease is conflicting, there does appear to be significant variation in the delivery of care to this complex group, which may be a marker of suboptimal quality of care. there is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce admissions. moreover ...201324151354
the impact of cefepime as first line therapy for neutropenic fever on clostridium difficile rates among hematology and oncology patients.after changing empiric treatment of febrile neutropenia from meropenem to cefepime, the effect on clostridium difficile infection (cdi) was investigated. the change was assessed using an autoregressive model. a significant increase in cdi rates occurred following the introduction of cefepime. there may be an association between increased cefepime usage and cdi.201324140078
a polymorphic, mucocutaneous eruption in a patient with end-stage renal disease.an 81-year-old man is presented who developed cryptococcal infection after treatment for clostridium difficile infection.201324139366
linking clostridium difficile infection with depression. 201324137729
fidaxomicin: a review of its use in patients with clostridium difficile infection.oral fidaxomicin (dificid(®); dificlir(®)) is a first-in-class macrocyclic antibacterial that is approved in several countries for the treatment of adult patients with clostridium difficile-associated diarrhoea. fidaxomicin 200 mg twice daily for 10 days was an effective and generally well tolerated treatment in adult patients with a first episode or first recurrence of c. difficile infection. in two multinational phase iii trials, fidaxomicin treatment was noninferior to vancomycin treatment wi ...201324136090
clostridium difficile carriage and serum antitoxin responses in children with inflammatory bowel disease.adults with inflammatory bowel disease (ibd) have a high prevalence of clostridium difficile carriage, but little data exist regarding pediatric patients with ibd. serum antibody responses to c. difficile toxins in correlation with organism carriage are not described in ibd. this study determines the prevalence of c. difficile carriage and compares serum antibody responses to c. difficile toxins in pediatric outpatients with ibd and controls.201324145927
horizontal gene transfer converts non-toxigenic clostridium difficile strains into toxin producers.clostridium difficile is a major nosocomial pathogen and the main causative agent of antibiotic-associated diarrhoea. the organism produces two potent toxins, a and b, which are its major virulence factors. these are chromosomally encoded on a region termed the pathogenicity locus (paloc), which also contains regulatory genes, and is absent in non-toxigenic strains. here we show that the paloc can be transferred from the toxin-producing strain, 630δerm, to three non-toxigenic strains of differen ...201324131955
a quantitative method for assessment of prescribing patterns using electronic health records.most available quality indicators for hospitals are represented by simple ratios or proportions, and are limited to specific events. a generalized method that can be applied to diverse clinical events has not been developed. the aim of this study was to develop a simple method of evaluating physicians' prescription patterns for diverse events and their level of awareness of clinical practice guidelines.201324130689
[challenges of clostridium difficile infection].clostridium difficile infections remain a problem especially for patients in the intensive care unit. the fact that c. difficile infections are strongly associated with antibiotic therapy calls for more caution in the use of antibiotics, especially in patients with a high risk of developing c. difficle infections. severe infections and recurrent episodes are usually difficult to manage and therapeutic options are often limited. the method of stool transplantation, though not new, has received mo ...201324129852
severe clostridium difficile infection in new zealand associated with an emerging strain, pcr-ribotype 244.to compare disease severity and clinical outcome of clostridium difficile infection (cdi) due to pcr-ribotype (rt) 244 with cdi due to other strains present in auckland.201324126745
common gastrointestinal symptoms: risks of long-term proton pump inhibitor therapy.more than 11 million individuals receive proton pump inhibitor (ppi) prescriptions each year in the united states. although ppis are effective treatment for peptic ulcers and esophagitis and provide symptom relief for many other conditions, their use carries risks. they decrease gastric acid and can lower blood levels of drugs whose absorption is acid dependent, including several antiretroviral and cancer therapy drugs. other drugs, such as digoxin, may be absorbed more extensively when gastric ...201324124705
a retrospective study on the etiological diagnoses of diarrhea in neonatal piglets in ontario, canada, between 2001 and 2010.laboratory surveillance data from the animal health laboratory, university of guelph, on the etiological diagnoses of neonatal diarrhea in piglets were analyzed to determine the relative importance and trends of different enteric pathogens in ontario. a total of 237 cases, including live and dead 1- to 7-day-old piglets, were submitted for diagnosis of gastrointestinal illness between 2001 and 2010. the combined frequencies for cases of gastrointestinal illness involving escherichia coli, clostr ...201324124267
ultrastructure of clostridium difficile colonies.the ultrastructural colony architecture of six clostridium difficile strains belonging to four different ribotypes (001, 027, 078/126 and 036) was studied by scanning electron microscopy (sem). in 2-day-old colonies several microareas differing in cell length and organization could be differentiated. some cells at colony edges were extremely long and exhibited invasiveness into the agar. the ultrastructure of 5-day-old colonies is more homogenous and characterized by presence of sporulating cell ...201324120350
microbiological, pathological and histological findings in four danish pig herds affected by a new neonatal diarrhoea syndrome.neonatal diarrhoea is a frequent clinical condition in commercial swine herds, previously regarded to be uncomplicated to treat. however, since 2008 it seems that a new neonatal diarrhoeic syndrome unresponsive to antibiotics and common management practices has emerged. routine laboratory examinations have not detected any pathogen related to this syndrome. the primary purpose of this study was to evaluate if well-known enteric pathogens could be associated with outbreaks of neonatal diarrhoea, ...201324119974
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