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increased hospital length of stay attributable to clostridium difficile infection in patients with four co-morbidities: an analysis of hospital episode statistics in four european countries.hospital-onset clostridium difficile infection (cdi) places a significant burden on health care systems throughout europe, estimated at around €3 billion per annum. this burden is shared between national payers and hospitals that support additional bed days for patients diagnosed with cdi while in hospital or patients re-admitted from a previous hospitalisation. this study was performed to quantify additional hospital stay attributable to cdi in four countries, england, germany, spain, and the n ...201323797490
vancomycin use for pediatric clostridium difficile infection is increasing and associated with specific patient characteristics.in adults with clostridium difficile infection (cdi), enteral vancomycin is considered the preferred initial regimen for severe disease; however, patterns of antimicrobial use for children with cdi are unknown. we sought to describe trends in and predictors of vancomycin use for the treatment of children with cdi admitted to tertiary-care children's hospitals in the united states. we used a database of freestanding children's hospitals to identify patients 1 to 18 years old with cdi between janu ...201323796942
renal impairment and clinical outcomes of clostridium difficile infection in two randomized trials.patients with chronic kidney disease (ckd) have increased risk for clostridium difficile infection (cdi) and for subsequent mortality. we determined the effect of ckd on response to treatment for cdi.201323796582
immunological evaluation of a synthetic clostridium difficile oligosaccharide conjugate vaccine candidate and identification of a minimal epitope.clostridium difficile is the cause of emerging nosocomial infections that result in abundant morbidity and mortality worldwide. thus, the development of a vaccine to kill the bacteria to prevent this disease is highly desirable. several recently identified bacterial surface glycans, such as ps-i and ps-ii, are promising vaccine candidates to preclude c. difficile infection. to circumvent difficulties with the generation of natural ps-i due to its low expression levels in bacterial cultures, impr ...201323795894
the clostridium difficile exosporium cysteine (cdec)-rich protein is required for exosporium morphogenesis and coat assembly.clostridium difficile is an important nosocomial pathogen that has become a major cause of antibiotic-associated diarrhea. there is a general consensus that c. difficile spores play an important role in c. difficile pathogenesis, contributing to infection, persistence, and transmission. evidence has demonstrated that c. difficile spores have an outermost layer, termed the exosporium, that plays some role in adherence to intestinal epithelial cells. recently, the protein encoded by cd1067 was sho ...201323794627
national variability in surveillance, testing, and infection prevention for clostridium difficile infection in pediatric populations.to assess national variability in methods of identifying and preventing clostridium difficile infection (cdi) in pediatric populations, an anonymous survey was sent to hospital epidemiologists at us children's hospitals. data from 30 hospitals indicate substantial variability in surveillance, testing, and infection control strategies, which may limit reliable interfacility comparison of cdi rates. in addition, only 60% of respondents perform surveillance for community-associated cdi.201323790613
rapid detection of clostridium difficile toxins from stool samples using real-time multiplex pcr.in this study, a total of 650 stool samples were tested to show that our method is capable of detecting four clostridium difficile genes; tcda, tcdb, encoding toxin a (tcda) and toxin b (tcdb), and the binary toxin c. difficile transferase genes (cdta and/or cdtb) encoding cdt toxin. besides detecting the targeted c. difficile genes, our method can be used to detect the presence of any inhibitory components in the pcr. this assay, combined with a selective culture medium, such as the chromid™ c. ...201323788597
clostridium difficile infections in south east scotland: mortality and recurrence in a region without pcr ribotype 027.three hundred and thirty-five patients with laboratory-confirmed clostridium difficile infections (cdis) were studied for epidemiological features, clinical presentation and laboratory markers. they were followed up for 1 year to determine recurrence and mortality. four hundred and thirty-two episodes were recorded. one year mortality was 41.8 % of which cdi was listed on 20 % of the death certificates. one year recurrence rate was 22.9 %. pcr ribotype 001 was the commonest epidemiological type ...201323788595
laboratory diagnosis of clostridium difficile infections: there is light at the end of the colon.single molecular or multistep assays (glutamate dehydrogenase, toxin a/b, ± molecular) are recommended for the diagnosis of cdi in patients with clinically significant diarrhea. rapid and accurate tests can improve resource allocations and improve patient care. enzyme immunoassay (eia) for toxins a/b is too insensitive for use as a stand-alone assay. this guideline will examine the use of molecular tests and multitest algorithms for the diagnosis of clostridium difficile infection (cdi). these n ...201323788237
impact of cleaning and other interventions on the reduction of hospital-acquired clostridium difficile infections in two hospitals in england assessed using a breakpoint model.clostridium difficile infection remains a major challenge for hospitals. although targeted infection control initiatives have been shown to be effective in reducing the incidence of hospital-acquired c. difficile infection, there is little evidence available to assess the effectiveness of specific interventions.201323787167
challenges for standardization of clostridium difficile typing methods.typing of clostridium difficile facilitates understanding of the epidemiology of the infection. some evaluations have shown that certain strain types (for example, ribotype 027) are more virulent than others and are associated with worse clinical outcomes. although restriction endonuclease analysis (rea) and pulsed-field gel electrophoresis have been widely used in the past, pcr ribotyping is the current method of choice for typing of c. difficile. however, global standardization of ribotyping r ...201323784128
clostridium difficile infection in newly diagnosed pediatric inflammatory bowel disease in the mid-southern united states.clostridium difficile is an emerging opportunistic pathogen that infects patients with underlying chronic disorders such as inflammatory bowel diseases (ibd) at high rates. an extremely high prevalence of clostridium difficile infection (cdi) was noted recently in new-onset pediatric ibd from eastern europe (poland). we examined the rate of cdi in our new pediatric ibd patients (123 tested) from 2010 to 2012. the overall prevalence of cdi at disease onset was 8.1%, significantly (p < 0.0001) low ...201323783013
the functional vangcd cluster of clostridium difficile does not confer vancomycin resistance.vangcd, a cryptic gene cluster highly homologous to the vang gene cluster of enterococcus faecalis is largely spread in clostridium difficile. since emergence of vancomycin resistance would have dramatic clinical consequences, we have evaluated the capacity of the vangcd cluster to confer resistance. we showed that expression of vangcd is inducible by vancomycin and that vangcd , vanxycd and vantcd are functional, exhibiting d-ala : d-ser ligase, d,d-dipeptidase and d-ser racemase activities res ...201323782343
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
candidemia subsequent to severe infection due to clostridium difficile: is there a link? 201323723197
diversity of cwp loci in clinical isolates of clostridium difficile.an increased incidence of clostridium difficile infection (cdi) is associated with the emergence of epidemic strains characterized by high genetic diversity. among the factors that may have a role in cdi is a family of 29 paralogues, the cell-wall proteins (cwps), which compose the outer layer of the bacterial cell and are likely to be involved in colonization. previous studies have shown that 12 of the 29 cwp genes are clustered in the same region, named after slpa (cwp1), the slpa locus, where ...201323722432
mortality in patients with clostridium difficile infection correlates with host pro-inflammatory and humoral immune responses.host anti-toxin immune responses play important roles in clostridium difficile disease and outcome. the relationship between host immune and inflammatory responses during severe c. difficile infection (cdi) and the risk of mortality has yet to be defined. we aimed to investigate the host systemic igg anti-toxin immune responses, the in vitro cytotoxicity of the infecting c. difficile ribotyped strain, and the host inflammatory markers and their relationship to cdi disease severity and risk of mo ...201323722431
evaluating the impact of a pharmacist's absence from an antimicrobial stewardship team.results of a study to determine the impact of a clinical pharmacist's temporary absence from a hospital's antimicrobial stewardship team are presented.201323719885
duodenal infusion of feces for recurrent clostridium difficile. 201323718172
duodenal infusion of feces for recurrent clostridium difficile. 201323718171
duodenal infusion of feces for recurrent clostridium difficile. 201323718170
duodenal infusion of feces for recurrent clostridium difficile. 201323718169
duodenal infusion of feces for recurrent clostridium difficile. 201323718168
protective efficacy induced by recombinant clostridium difficile toxin fragments.clostridium difficile is a spore-forming bacterium that can reside in animals and humans. c. difficile infection causes a variety of clinical symptoms, ranging from diarrhea to fulminant colitis. disease is mediated by tcda and tcdb, two large enterotoxins released by c. difficile during colonization of the gut. in this study, we evaluated the ability of recombinant toxin fragments to induce neutralizing antibodies in mice. the protective efficacies of the most promising candidates were then eva ...201323716610
impact of intensive infection control team activities on the acquisition of methicillin-resistant staphylococcus aureus, drug-resistant pseudomonas aeruginosa and the incidence of clostridium difficile-associated disease.the transmission of multidrug-resistant organisms (mdros) is an emerging problem in acute healthcare facilities. to reduce this transmission, we introduced intensive infection control team (ict) activities and investigated the impact of their introduction. this study was conducted at a single teaching hospital from 1 april 2010 to 31 march 2012. during the intervention period, all carbapenem use was monitored by the ict, and doctors using carbapenems inappropriately were individually instructed. ...201323715827
resolution of clostridium difficile-associated diarrhea in patients with cancer treated with fidaxomicin or vancomycin.patients with cancer are at increased risk for clostridium difficile-associated diarrhea (cdad). little is known about treatment response.201323715579
simultaneous detection of gastrointestinal pathogens with a multiplex luminex-based molecular assay in stool samples from diarrhoeic patients.we have evaluated the multiplex molecular method xtag(®) gastrointestinal panel (gpp) for detecting pathogens in stool samples of diarrhoeic patients. we collected 440 samples from 329 patients (male:female ratio of 1.2:1), including 102 immunosuppressed adults, 50 immunosuppressed children, 56 children attending the neonatal unit and 121 children attending the emergency unit. of these, 176 samples from 162 patients were xtag(®) gpp positive (102 viruses, 61 bacteria and 13 parasites) and the as ...201323714194
the impact of pseudomembrane formation on the outcome of clostridium difficile-associated disease.although pseudomembranes are the hallmark manifestation of clostridium difficile-associated diarrhea (cdad), there are scant data specifically addressing their impact on the clinical outcome. we investigated whether the formation of pseudomembranes predicts a worse cdad outcome.201323709307
genetic characteristics of toxigenic clostridia and toxin gene evolution.clostridia comprise a heterogenous group of environmental bacteria containing 15 pathogenic species, which produce the most potent toxins. the origin of toxins is still enigmatic. it is hypothesized that toxins exhibiting an enzymatic activity have derived from hydrolytic enzymes, which are abundantly secreted by these bacteria, and that pore-forming toxins have evolved from an ancestor transmembrane protein. the presence of related toxin genes in distinct clostridium species and the variability ...201323707611
susceptibility of hamsters to clostridium difficile isolates of differing toxinotype.clostridium difficile is the most commonly associated cause of antibiotic associated disease (aad), which caused ∼21,000 cases of aad in 2011 in the u.k. alone. the golden syrian hamster model of cdi is an acute model displaying many of the clinical features of c. difficile disease. using this model we characterised three clinical strains of c. difficile, all differing in toxinotype; cd1342 (paloc negative), m68 (toxinotype viii) & bi-7 (toxinotype iii). the naturally occurring non-toxic strain ...201323704976
is fidaxomicin worth the cost? an economic analysis.in may 2011, the food and drug administration approved fidaxomicin for the treatment of clostridium difficile infection (cdi). it has been found to be noninferior to vancomycin; however, its cost-effectiveness for the treatment of cdi remains undetermined.201323704121
polymerase chain reaction assay to detect clostridium difficile tcdc variants is valuable in characterizing hospital epidemiology.the epidemiology of nosocomial clostridium difficile infection (cdi), acquired at two hospitals in vancouver over a one-year period, was reviewed. cases were analysed by tcdc polymerase chain reaction, with tcdc variants (18 base pair deletion) highly associated with the nap1 strain. of the 214 cases identified, 51.9% were caused by these tcdc variants; these cases occurred more frequently in older patients admitted to the community hospital where the strain was endemic. overall, at least five o ...201323702278
clinical factors associated with development of severe-complicated clostridium difficile infection.clostridium difficile infection (cdi) can cause life-threatening complications. severe-complicated cdi is characterized by hypotension, shock, sepsis, ileus, megacolon, and colon perforation. we created a model to identify clinical factors associated with severe-complicated cdi.201323702192
gut solutions to a gut problem: bacteriocins, probiotics and bacteriophage for control of clostridium difficile infection.clostridium difficile infection (cdi) is a major cause of morbidity and mortality among hospitalized patients and imposes a considerable financial burden on health service providers in both europe and the usa. the incidence of cdi has dramatically increased in recent years, partly due to the emergence of a number of hypervirulent strains. the most commonly documented risk factors associated with cdis are antibiotic usage leading to alterations of the gut microbiota, age >65 years and long-term h ...201323699066
determination of the attp and attb sites of phage cd27 from clostridium difficile nctc 12727.the attp region of the clostridium difficile phage cd27 was identified, located immediately downstream of the putative recombinase. the phage could integrate into two specific sites (attb) in the c. difficile genome, one of which was in an open reading frame encoding a putative atpase of an abc transporter and the other in an open reading frame encoding a putative atpase of the flagella protein export apparatus. the prophage was capable of excision and formation of a circular molecule and phages ...201323699063
polymerase chain reaction test for clostridium difficile toxin b gene reveals similar prevalence rates in children with and without inflammatory bowel disease.clinicians often evaluate for clostridium difficile infection (cdi) in patients with inflammatory bowel disease (ibd) presenting with exacerbations. a highly sensitive polymerase chain reaction (pcr) test for the toxin b gene of c difficile is increasingly used to diagnose cdi. the aim of this study was to determine the prevalence of positive c difficile pcr results in children and young adults with and without active ibd compared with patients with non-ibd gastrointestinal disease.201323698022
novel molecular type of clostridium difficile in neonatal pigs, western australia.clostridium difficile causes neonatal enteritis in piglets; strains of pcr ribotype 078 are most commonly identified. we investigated c. difficile prevalence in piglets in australia and isolated a novel strain with a unique pathogenicity locus. in a mouse infection model, this strain produced more weight loss than did a ribotype 078 strain.201323697508
characterisation of the spoilage bacterial microbiota in oyster gills during storage at different temperatures.the spoilage bacterial community in oyster gill was investigated during storage at 4, 10 and 20 °c. aerobic plate counts and ph values were determined. total bacterial dna was extracted from oyster gill and bulk cells of plate count media. the major bacterial species during fresh or different temperatures storage were determined by polymerase chain reaction-denaturing gradient gel electrophoresis (pcr-dgge).201323696433
[immunosuppressive treatment as a risk factor for the occurrence of clostridium difficile infection (cdi)].toxigenic clostridium difficile strains are known as the most common infectious cause of antibiotic-associated intestinal disease and nosocomial diarrhoea. the increased incidence of hypervirulent strains gives rise to worldwide concern. in particular, courses with multiple recurrences are observed in the presence of immunosuppression.201323696115
inflammatory bowel disease epidemiology.the occurrence of inflammatory bowel disease (ibd) is increasing worldwide, yet the reasons remain unknown. new therapeutic approaches have been introduced in medical ibd therapy, but their impact on the natural history of ibd remains uncertain. this review will summarize the recent findings in the epidemiology of ibd.201323695429
multidetector computed tomography features of positive endoscopic or toxin assay clostridium difficile colitis.pancolonic colonic wall thickening is a common ctfeature in patients diagnosed with clostridium difficile colitis (cdc).201323691703
transcriptional analysis of temporal gene expression in germinating clostridium difficile 630 endospores.clostridium difficile is the leading cause of hospital acquired diarrhoea in industrialised countries. under conditions that are not favourable for growth, the pathogen produces metabolically dormant endospores via asymmetric cell division. these are extremely resistant to both chemical and physical stress and provide the mechanism by which c. difficile can evade the potentially fatal consequences of exposure to heat, oxygen, alcohol, and certain disinfectants. spores are the primary infective a ...201323691138
short-term genome stability of serial clostridium difficile ribotype 027 isolates in an experimental gut model and recurrent human disease.clostridium difficile whole genome sequencing has the potential to identify related isolates, even among otherwise indistinguishable strains, but interpretation depends on understanding genomic variation within isolates and individuals.201323691061
upregulation of the host slc11a1 gene by clostridium difficile toxin b facilitates glucosylation of rho gtpases and enhances toxin lethality.pseudomembranous enterocolitis associated with clostridium difficile infection is an important cause of morbidity and mortality in patients being treated with antibiotics. two closely related large protein toxins produced by c. difficile, tcda and tcdb, which act identically but at different efficiencies to glucosylate low-molecular-weight rho gtpases, underlie the microbe's pathogenicity. using antisense rna encoded by a library of human expressed sequence tags (ests), we randomly inactivated h ...201323690404
interobserver variability and feasibility of polymerase chain reaction-based assay in distinguishing ischemic colitis from clostridium difficile colitis in endoscopic mucosal biopsies.polymerase chain reaction (pcr)-based assays using stool samples are currently the most effective method of detecting clostridium difficile. this study examines the feasibility of this assay using mucosal biopsy samples and evaluates the interobserver reproducibility in diagnosing and distinguishing ischemic colitis from c difficile colitis. thirty-eight biopsy specimens were reviewed and classified by 3 observers into c difficile and ischemic colitis. the findings were correlated with clinical ...201323690114
acp journal club. review: probiotics reduce clostridium difficile-associated diarrhea in patients receiving antibiotics. 201323689777
fecal microbiota therapy for recurrent clostridium difficile infection in hiv-infected persons. 201323689775
mbx-500 is effective for treatment of clostridium difficile infection in gnotobiotic piglets.the novel antibiotic mbx-500, dosed at 100, 200, or 400 mg/kg twice daily for 7 days, was evaluated for the treatment of clostridium difficile infection (cdi) in the gnotobiotic pig model. mbx-500 increased survival at all doses and at high doses improved clinical signs and reduced lesion severity, similar to vancomycin. our results show that mbx-500 is an effective antibiotic for the treatment of diarrhea associated with cdi and prevents severe systemic disease.201323689716
tcda as a diagnostic target in a loop-mediated amplification assay for detecting toxigenic clostridium difficile.the illumigene® (meridian bioscience, inc., cincinnati, oh) and geneohm® (bd diagnostics, la jolla, ca) clostridium difficile assays target the tcda gene and tcdb gene, respectively. we assessed the use of tcda as the molecular target in the illumigene® c. difficile loop-mediated amplification assay in detecting a wide variety of c. difficile strains including those with tcda deletions.201323686774
pathology and diagnostic criteria of clostridium difficile enteric infection in horses.clostridium difficile is commonly associated with diarrhea and colitis in humans and other mammals, including horses. to this date, the epidemiologic, microbiologic, clinical, and diagnostic aspects of c. difficile-associated disease (cdad) in horses have been thoroughly described. however, reports describing the enteric pathology of this disease in horses are limited. this study presents a comprehensive description of the pathologic characteristics of cdad in 21 horses and discusses the criteri ...201323686768
the effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated clostridium difficile infection in a community hospital.there is evidence that contamination of patient rooms from previous occupants is associated with hospital-associated clostridium difficile infection (ha-cdi). during january 2011, the use of 2 portable pulsed xenon ultraviolet light devices (ppx-uv) to disinfect patient rooms was added to routine hospital discharge cleaning in a community hospital. in 2010, the ha-cdi rate was 9.46 per 10,000 patient-days; in 2011, the ha-cdi rates was 4.45 per 10,000 patient-days (53% reduction, p = .01). the n ...201323685092
evaluation of bacteriophage therapy to control clostridium difficile and toxin production in an in vitro human colon model system.clostridium difficile is a leading cause of hospital-acquired diarrhoea and represents a major challenge for healthcare providers. due to the decreasing efficacy and associated problems of antibiotic therapy there is a need for synergistic and alternative treatments. in this study we investigated the use of a specific bacteriophage, φcd27, in a human colon model of c. difficile infection. our findings demonstrate a significant reduction in the burden of c. difficile cells and toxin production wi ...201323685029
fidaxomicin for treatment of clostridium difficile-associated diarrhea and its potential role for prophylaxis.clostridium difficile has become the most important healthcare-associated infection worldwide within the past decade. this is in part due to the emergence of a highly virulent epidemic strain of c. difficile as well as the relative ineffectiveness of current therapies at producing a sustained response. fidaxomicin is a novel antibiotic that demonstrates a greater sustained response for c. difficile-associated diarrhea (cdad) compared to existing drugs and its potential role as a prophylactic age ...201323683070
detection of clostridium difficile toxins a, b and binary toxin with slow off-rate modified aptamers.rapid and accurate diagnostic tests for clostridium difficile infections (cdi) are crucial for management of patients with suspected cdi and for infection control. enzyme immunoassays for detection of the toxins are routinely used but lack adequate sensitivity. we generated slow off-rate modified aptamers (somamer™ reagents) via in vitro selection (selex) that bind toxins a, b and binary toxin with high affinity and specificity. using somamers alone or in conjunction with antibodies, we have dev ...201323680240
easily modified factors contribute to delays in diagnosis of clostridium difficile infection: a cohort study and intervention.although rapid laboratory tests are available for diagnosis of clostridium difficile infection (cdi), delays in completion of cdi testing are common in clinical practice. we conducted a cohort study of 242 inpatients tested for cdi to determine the timing of different steps involved in diagnostic testing and to identify modifiable factors contributing to delays in diagnosis. the average time from test order to test result was 1.8 days (range, 0.2 to 10.6), with time from order to stool collectio ...201323678072
[multidisciplinary approach of clostridium difficile infection].clostridium difficile is the most common cause of infectious diarrhea in adults healthcare institutions. recent studies have shown an increase in the incidence, severity and recurrence of c. difficile infection (cdi). factors associated with the patient and medical care provided contribute to establishing colonization and, in some cases, subsequent progression to symptomatic disease. the availability of new microbiological techniques has contributed greatly to improving care for these patients. ...201323677156
genomic and expression analysis of the vang-like gene cluster of clostridium difficile.primary antibiotic treatment of clostridium difficile intestinal diseases requires metronidazole or vancomycin therapy. a cluster of genes homologous to enterococcal glycopeptides resistance vang genes was found in the genome of c. difficile 630, although this strain remains sensitive to vancomycin. this vang-like gene cluster was found to consist of five orfs: the regulatory region consisting of vanr and vans and the effector region consisting of vang, vanxy and vant. we found that 57 out of 83 ...201323676437
genome-wide identification of regulatory rnas in the human pathogen clostridium difficile.clostridium difficile is an emergent pathogen, and the most common cause of nosocomial diarrhea. in an effort to understand the role of small noncoding rnas (srnas) in c. difficile physiology and pathogenesis, we used an in silico approach to identify 511 srna candidates in both intergenic and coding regions. in parallel, rna-seq and differential 5'-end rna-seq were used for global identification of c. difficile srnas and their transcriptional start sites at three different growth conditions (ex ...201323675309
bile acid recognition by the clostridium difficile germinant receptor, cspc, is important for establishing infection.clostridium difficile spores must germinate in vivo to become actively growing bacteria in order to produce the toxins that are necessary for disease. c. difficile spores germinate in vitro in response to certain bile acids and glycine. in other sporulating bacteria, proteins embedded within the inner membrane of the spore sense the presence of germinants and trigger the release of ca⁺⁺-dipicolinic acid (ca⁺⁺-dpa) from the spore core and subsequent hydrolysis of the spore cortex, a specialized p ...201323675301
advances in the treatment of clostridium difficile with fidaxomicin: a narrow spectrum antibiotic.clostridium difficile infection, also known as c. difficile-associated diarrhea (cdad), is the most common cause of nosocomial diarrhea, typically initiated by the use of broad-spectrum antibiotics that disrupt gut flora, thereby allowing c. difficile to proliferate. it is an increasing cause of morbidity and mortality, especially in hospitals and long-term care facilities. a particularly challenging aspect to treating cdad has been maintenance of clinical response: following initial treatment s ...201323672600
transient flare of ulcerative colitis after fecal microbiota transplantation for recurrent clostridium difficile infection.clostridium difficile infection (cdi) is a common cause of infectious diarrhea and is usually treated with metronidazole or vancomycin. cdi recurs in 15%-30% of patients after the initial episode and in up to 65% after a second episode. recurrent infections are a challenge to treat, and patients are usually managed with prolonged pulsed or tapered vancomycin. fecal microbiota transplantation is an alternative treatment that has a 91% rate of success worldwide, with no reported complications. we ...201323669309
acute infection of mice with clostridium difficile leads to eif2α phosphorylation and pro-survival signalling as part of the mucosal inflammatory response.the current study sought to delineate the gene expression profile of the host response in the caecum and colon during acute infection with clostridium difficile in a mouse model of infection, and to investigate the nature of the unfolded protein response in this process. the infected mice displayed a significant up-regulation in the expression of chemokines (cxcl1, cxcl2 and ccl2), numerous pro-inflammatory cytokines (ifng, il1b, il6, and il17f), as well as il22 and a number of anti-microbial pe ...201323668260
[clostridium difficile infections - still a major challenge]. 201323668179
a case of clostridium difficile bacteremia in a patient with loop ileostomy.clostridium difficile, an anaerobic, spore-forming, gram-positive, rod-shaped bacterium, is the most common nosocomial pathogen causing pseudomembranous colitis. c. difficile is not intrinsically invasive and rarely infects extraintestinal sites. the bacterium, therefore, is not commonly detected in blood cultures. here, we report a case of c. difficile bacteremia in a patient who had underwent loop ileostomy because of rectal obstruction following metastatic colon cancer originated from prostat ...201323667848
controversies in the management of the critically ill: the role of probiotics.probiotics are commercially available, viable, non-pathogenic micro-organisms that, when ingested in sufficient quantities, exert a health benefit to the host derived through modification of the gut flora, local release of antimicrobial factors, maintenance of integrity of the gut barrier, competition for epithelial adherence, prevention of bacterial translocation, and modulation of the local immune response. in critically ill patients, probiotics appear to lead to decreased susceptibility to an ...201323664676
clostridium difficile infections: do we know the real dimensions of the problem?clostridium difficile infection (cdi) is the primary cause of nosocomial diarrhoea in industrialised countries, usually occurring as a complication of antibiotic therapy in elderly patients. landmark events contributed to boosting interest in cdi over the last 10 years, including the emergence of unusually severe and recurrent cdi due to the nap1/bi/027 strain, as well as reports suggesting that cdi is also significantly encountered in patients previously considered at no risk, such as community ...201323664578
changes of poultry faecal microbiota associated with clostridium difficile colonisation.bacterial, fungal and archaeal microbiota was analysed in 143 chicken faecal samples from a single poultry farm. after dhplc (denaturing high performance liquid chromatography) 15 bacterial groups, 10 fungal groups and a single archaeal species were differentiated. samples were grouped into two clusters with significantly different frequencies of c. difficile positive and negative samples in each cluster. acidaminococcus intestini, described here for the first time as a part of poultry faecal mi ...201323664184
appropriateness of empiric therapy in patients with suspected clostridium difficile infection.the objective of this study was to test the hypothesis that many patients with suspected clostridium difficile infection (cdi) receive inappropriate empiric therapy and/or receive continued therapy despite negative test results.201323663129
the co-seasonality of pneumonia and influenza with clostridium difficile infection in the united states, 1993-2008.seasonal variations in the incidence of pneumonia and influenza are associated with nosocomial clostridium difficile infection (cdi) incidence, but the reasons why remain unclear. our objective was to consider the impact of pneumonia and influenza timing and severity on cdi incidence. we conducted a retrospective cohort study using the us national hospital discharge survey sample. hospitalized patients with a diagnosis of cdi or pneumonia and influenza between 1993 and 2008 were identified from ...201323660799
disinfection of ipad to reduce contamination with clostridium difficile and methicillin-resistant staphylococcus aureus. 201323660112
clostridium difficile infection in children: a comprehensive review.to provide a comprehensive review of the literature relating to clostridium difficile (c. difficile) infection (cdi) in the pediatric population.201323659563
detection of mixed infection from bacterial whole genome sequence data allows assessment of its role in clostridium difficile transmission.bacterial whole genome sequencing offers the prospect of rapid and high precision investigation of infectious disease outbreaks. close genetic relationships between microorganisms isolated from different infected cases suggest transmission is a strong possibility, whereas transmission between cases with genetically distinct bacterial isolates can be excluded. however, undetected mixed infections-infection with ≥2 unrelated strains of the same species where only one is sequenced-potentially impai ...201323658511
understanding increased mortality in clostridium difficile-infected older adults. 201323658435
clostridium difficile infection in patients with hiv/aids.clostridium difficile infection (cdi) affects significant numbers of hospitalized patients and is an increasing problem in the community. it is also among the most commonly isolated pathogens in hiv patients with diarrheal illness and is ≥2 fold more common in hiv-seropositive individuals. this association is stronger in those with low absolute cd4 t cell counts or meeting clinical criteria for an aids diagnosis, and was most pronounced before the wide availability of highly active antiretrovira ...201323657793
clostridium difficile in children: a review of existing and recently uncovered evidence.the clinical significance of the presence of clostridium difficile in children's faeces remains uncertain using current diagnostic procedures. clostridium difficile is a relatively common finding in infants with no symptoms of gastrointestinal disease, suggesting it may be an incidental finding and form part of the normal gut micro-flora in this age group. on the other hand, particularly in older children or those with significant co-morbidity, there are examples where c. difficile causes diseas ...201323654056
[antibiotic-associated diarrhea in clinical practice].antibiotic-associated diarrhea (aad) is considered to mean at least 3 shapeless stool episodes within 2 or more consecutive days when using antibacterial agents. due to the fact that antibiotics are used most commonly to treat many diseases, aad is one of the topical problems for different clinical specialists. there has recently been increased interest in this condition due to its higher morbidity and mortality rates and the emergence of novel treatment-resistant virulent strains of clostridium ...201323653946
clostridium difficile surveillance: a multicenter comparison of labid events and use of standard definitions. 201323651906
unnecessary antimicrobial use in the context of clostridium difficile infection: a call to arms for the veterans affairs antimicrobial stewardship task force. 201323651905
has improved hand hygiene compliance reduced the risk of hospital-acquired infections among hospitalized patients in ontario? analysis of publicly reported patient safety data from 2008 to 2011.prospective, observational, ecological, time series, cross-sectional study examining the association between hand hygiene compliance (hhc) rates and the incidence of hospital-acquired infections.201323651891
attributable burden of hospital-onset clostridium difficile infection: a propensity score matching study.to determine the attributable in-hospital mortality, length of stay (los), and cost of hospital-onset clostridium difficile infection (ho-cdi).201323651889
antibacterial effect of manuka honey on clostridium difficile.manuka honey originates from the manuka tree (leptospermum scoparium) and its antimicrobial effect has been attributed to a property referred to as unique manuka factor that is absent in other types of honey. antibacterial activity of manuka honey has been documented for several bacterial pathogens, however there is no information on clostridium difficile, an important nosocomial pathogen. in this study we investigated susceptibility of c. difficile to manuka honey and whether the activity is ba ...201323651562
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