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risks associated with the therapeutic use of fluoroquinolones.quinolones are among the most often prescribed antimicrobial agents. some types of toxicity observed during therapy with these drugs have gained much attention.201323651367
probiotics for the prevention of clostridium difficile-associated diarrhea. in response. 201323648957
probiotics for the prevention of clostridium difficile-associated diarrhea. 201323648956
probiotics for the prevention of clostridium difficile-associated diarrhea. 201323648955
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
diagnostic testing for clostridium difficile infection in patients with inflammatory bowel disease. 201323751851
assessment of 30-day all-cause mortality in metronidazole-treated patients with clostridium difficile infection.the society for healthcare epidemiology (shea) and the infectious diseases society of america (idsa) clinical practice guidelines for clostridium difficile infection (cdi) help to define and make recommendations for the treatment of mild to moderate disease with metronidazole and severe disease with vancomycin. we retrospectively evaluated 285 patients who were initially treated with metronidazole and stratified them by severity of illness using the guideline criteria. we compared the outcomes i ...201323746336
the role of the surface environment in healthcare-associated infections.this article reviews the evidence demonstrating the importance of contamination of hospital surfaces in the transmission of healthcare-associated pathogens and interventions scientifically demonstrated to reduce the levels of microbial contamination and decrease healthcare-associated infections.201323743816
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
advances in molecular surveillance of clostridium difficile in bulgaria.the increasing incidence of clostridium difficile infection (cdi) in bulgaria has indicated the need to implement better surveillance approaches. the aim of the present work was to improve the current surveillance of cdi in bulgaria by introducing innovative methods for identification and typing. one hundred and twenty stool samples obtained from 108 patients were studied over 4 years from which 32 c. difficile isolates were obtained. an innovative duplex evagreen real-time pcr assay based on si ...201323598377
clostridium difficile psi polysaccharide: synthesis of pentasaccharide repeating block, conjugation to exotoxin b subunit, and detection of natural anti-psi igg antibodies in horse serum.clostridium difficile is the most common cause of antimicrobial-associated diarrhea in humans and may cause death. previously, we discovered that c. difficile expresses three polysaccharides, named psi, psii, and psiii. it has now been established that psii is a conserved antigen abundantly present on the cell-surface and biofilm of c. difficile. in contrast, the expression of psi and psiii appears to be stochastic processes. in this work, the total chemical synthesis of the psi pentasaccharide ...201323597587
clostridium difficile vertebral osteomyelitis.clostridium difficile is the most common cause of antibiotic-associated diarrhea, and it occasionally causes extraintestinal infections. we present a case of c. difficile-associated diarrhea that led to vertebral osteomyelitis associated with hardware. the osteomyelitis became symptomatic 2 years after the initial diarrheal event. c. difficile recovered from internal hardware sites cannot simply be regarded as a contaminant but should be treated.201323594589
prebiotics, faecal transplants and microbial network units to stimulate biodiversity of the human gut microbiome.accumulating evidence demonstrates the intimate association between human hosts and the gut microbiome. starting at birth, the sterile gut of the newborn acquires a diverse spectrum of microbes, needed for immunological priming. however, current practices (caesarean sections, use of formula milk) deprive newborns from being exposed to this broad spectrum of microbes. unnecessary use of antibiotics and excessive hygienic precautions (e.g. natural versus chlorinated drinking water) together with t ...201323594389
reply to "comparison of detection methods for clostridium difficile". 201323592855
comparison of detection methods for clostridium difficile. 201323592854
effect of occurrence of infection-related never events on length of stay and hospital charges in patients undergoing radical neck dissection for head and neck cancer.to estimate the impact of infection-related never events (postoperative pneumonia, clostridium difficile infection, infection with microorganisms resistant to penicillin, postoperative infections, and decubitus ulcers) following radical neck dissections for head and neck cancers.201323591100
specialty care delivery: bringing infectious disease expertise to the residents of a veterans affairs long-term care facility.to initiate a long-term care facility (ltcf) infectious disease (lid) service that provides on-site consultations to ltcf residents to improve the care of residents with possible infections.201323590125
what is hot in the anaerobe literature? clostridium difficile infections. 201323587754
evaluation of multiplex pcr with enhanced spore germination for detection of clostridium difficile from stool samples of the hospitalized patients.clostridium difficile poses as the most common etiologic agent of nosocomial diarrhea. although there are many diagnostic methods to detect c. difficile directly from stool samples, the nucleic acid-based approach has been largely performed in several laboratories due to its high sensitivity and specificity as well as rapid turnaround time. in this study, a multiplex pcr was newly designed with recent accumulated nucleotide sequences. the pcr testing with various c. difficile ribotypes, other cl ...201323586062
clostridium septicum gas gangrene in a previously healthy 8-year-old female with survival.we present the only reported case of an immunocompetent pediatric patient in the literature to have fulminate gas gangrene of the lower extremity and concomitant gastrointestinal tract infection due to clostridium septicum coinfected with clostridium difficile colitis respectively. the patient survived with aggressive medical and surgical treatment.201323583163
isolation of clostridium difficile from faecal specimens--a comparison of chromid c. difficile agar and cycloserine-cefoxitin-fructose agar.the culture of toxigenic clostridium difficile from stool specimens is still seen as the gold standard for the laboratory diagnosis of c. difficile infection (cdi). biomérieux have released chromid cdiff chromogenic agar (cdif) for the isolation and identification of c. difficile in 24 h. in this study, we compared cdif to pre-reduced cycloserine-cefoxitin-fructose agar with sodium taurocholate (tccfa) in the examination of glutamate dehydrogenase-positive faecal specimens that were either geneo ...201323579394
if microbial ecosystem therapy can change your life, what's the problem?the increased incidence of morbidity and mortality due to clostridium difficile infection, had led to the emergence of fecal microbial transplantation (fmt) as a highly successful treatment. from this, a 32 strain stool substitute has been derived, and successfully tested in a pilot human study. these approaches could revolutionize not only medical care of infectious diseases, but potentially many other conditions linked to the human microbiome. but a second revolution may be needed in order for ...201323575749
longitudinal study of clostridium difficile and methicillin-resistant staphylococcus aureus associated with pigs from weaning through to the end of processing.there has been a recent increase in community-associated infections linked to methicillin-resistant staphylococcus aureus (mrsa) and clostridium difficile. it is established that both pathogens can be recovered from retail pork, although it is unclear to what degree contamination is acquired at the farm in comparison to that acquired during processing. to address this gap, the following study reports on the carriage of mrsa and c. difficile on pigs from birth through to the end of processing. c. ...201323575124
diagnosing clostridial enteric disease in poultry.the world's poultry industry has grown into a multibillion-dollar business, the success of which hinges on healthy intestinal tracts, which result in effective feed conversion. enteric disease in poultry can have devastating economic effects on producers, due to high mortality rates and poor feed efficiency. clostridia are considered to be among the most important agents of enteric disease in poultry. diagnosis of enteric diseases produced by clostridia is usually challenging, mainly because man ...201323572451
impact of preoperative organ failures on survival in intensive care unit patients with colectomy.the present study aimed to evaluate the prognostic value of preoperative changes in sequential organ failure assessment (sofa) score, daily norepinephrine (ne) dose, lactate, c-reactive protein, and white blood cell count among patients with colectomy in the intensive care unit (icu).201323571867
total colectomy for ulcerative colitis in children: when are we operating?ulcerative colitis (uc) in children is frequently severe and treatment-refractory. while medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric uc patients.201323571824
analysis of anti-clostridium difficile activity of thuricin cd, vancomycin, metronidazole, ramoplanin, and actagardine, both singly and in paired combinations.due to the ongoing problem of recurrence of clostridium difficile-associated diarrhea following antibiotic treatment, there is an urgent need for alternative treatment options. we assessed the mics of five antimicrobials singly and in combinations against a range of c. difficile clinical isolates. ramoplanin-actagardine combinations were particularly effective, with partial synergistic/additive effects observed against 61.5% of c. difficile strains tested.201323571539
rapid hospital room decontamination using ultraviolet (uv) light with a nanostructured uv-reflective wall coating.we tested the ability of an ultraviolet c (uv-c)-reflective wall coating to reduce the time necessary to decontaminate a room using a uv-c-emitting device (tru-d smartuvc). the reflective wall coating provided the following time reductions for decontamination: for methicillin-resistant staphylococcus aureus, from 25 minutes 13 seconds to 5 minutes 3 seconds ([formula: see text]), and for clostridium difficile spores, from 43 minutes 42 seconds to 9 minutes 24 seconds ([formula: see text]).201323571373
beyond the hawthorne effect: reduction of clostridium difficile environmental contamination through active intervention to improve cleaning practices.education and passive observation resulted in a significant improvement in housekeeper disinfection of nontoxigenic clostridium difficile spores artificially inoculated onto surfaces in c. difficile infection rooms. a further significant reduction occurred with direct supervision and real-time feedback, suggesting that optimal disinfection is achieved by working closely with housekeepers.201323571372
decontamination of targeted pathogens from patient rooms using an automated ultraviolet-c-emitting device.objective. to determine the effectiveness of an automated ultraviolet-c (uv-c) emitter against vancomycin-resistant enterococci (vre), clostridium difficile, and acinetobacter spp. in patient rooms. design. prospective cohort study. setting. two tertiary care hospitals. participants. convenience sample of 39 patient rooms from which a patient infected or colonized with 1 of the 3 targeted pathogens had been discharged. intervention. environmental sites were cultured before and after use of an au ...201323571362
an environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of clostridium difficile isolation rooms.objective. effective disinfection of hospital rooms after discharge of patients with clostridium difficile infection (cdi) is necessary to prevent transmission. we evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in cdi rooms after cleaning. design. prospective intervention. setting. a veterans affairs hospital. interventions. during a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide ...201323571361
nanolitre real-time pcr detection of bacterial, parasitic, and viral agents from patients with diarrhoea in nunavut, canada.little is known about the microbiology of diarrhoeal disease in canada's arctic regions. there are a number of limitations of conventional microbiology testing techniques for diarrhoeal pathogens, and these may be further compromised in the arctic, given the often long distances for specimen transport.201323570023
detection of clostridium difficile in small and medium-sized wild mammals in southern ontario, canada.we sampled 325 small and medium-sized wild mammals in ontario, canada in 2007 and 2010 to determine the prevalence and characteristics of clostridium difficile in wild mammals living in proximity to captive wildlife and livestock. clostridium difficile was isolated from five of 109 animals (4.6%) on four of 25 farms (16%), but was not isolated from any of the 216 samples from raccoons (procyon lotor) living on the grounds of the toronto zoo. the positive animals included two raccoons from one be ...201323568920
antimicrobial susceptibility profiles of human and piglet clostridium difficile pcr-ribotype 078.in the last decade, outbreaks of nosocomial clostridium difficile infections (cdi) occurred worldwide. a new emerging type, pcr-ribotype 027, was the associated pathogen. antimicrobial susceptibility profiles of this type were extensively investigated and used to partly explain its spread. in europe, the incidence of c. difficile pcr-ribotype 078 recently increased in humans and piglets. using recommendations of the european committee on antimicrobial susceptibility testing (eucast) and the clin ...201323566553
calcineurin inhibitors and clostridium difficile infection in adult lung transplant recipients: the effect of cyclosporine versus tacrolimus.tacrolimus (fk506) has a superior immunosuppressive effect compared with cyclosporine (csa) without a significant increase in generalized infectious complications. differences in specific infections such as clostridium difficile (cdi) have not been reported. we investigated the relationship between calcineurin inhibitors and cdi, hypothesizing that choice of calcineurin inhibitor (csa or fk506) after lung transplantation would have no effect on the incidence of cdi.201323566442
do statins protect against the development of clostridium difficile-associated diarrhoea?to assess whether prior statin use protects against the development of clostridium difficile-associated diarrhoea (cdad) in hospitalized patients.201323563740
emergence of a highly resistant clostridium difficile strain (nap/bi/027) in a tertiary care center in saudi arabia. 201323563012
carbohydrate-based clostridium difficile vaccines.clostridium difficile is responsible for thousands of deaths each year and a vaccine would be welcomed, especially one that would disrupt bacterial maintenance, colonization and persistence in carriers and convalescent patients. structural explorations at the university of guelph (on, canada) discovered that c. difficile may express three phosphorylated polysaccharides, named psi, psii and psiii; this review captures our recent efforts to create vaccines based on these glycans, especially psii, ...201323560922
intracolonic vancomycin for severe clostridium difficile colitis.clostridium difficile colitis is associated with increased age, antibiotic usage, and hospitalization. severe c. difficile colitis refractory to medical therapy may require surgical intervention including subtotal colectomy. we initiated an adjuvant intracolonic vancomycin (icv) enema protocol for inpatients with severe c. difficile colitis and compared the response to this therapy in patients from the community and nursing homes.201323560732
impact of ribotype 027 on clostridium difficile infection in a geriatric department.the purposes of this study were to describe the epidemiology (2001-2009) of clostridium difficile infections (cdi) in a geriatric department and to compare the clinical data of patients infected with a 027 or non-027 strain. we retrospectively identified all geriatric patients with cdi and analysed the clinical and microbiological data of 133 patients for whom a ribotype was available between march 2003 and december 2009. the incidence of cdi in our geriatric department increased from 0.2 per 10 ...201323558363
cellular uptake of clostridium difficile tcda and truncated tcda lacking the receptor binding domain.the combined repetitive oligopeptides (crops) of clostridium difficile toxins a (tcda) and b (tcdb) induce clathrin-mediated endocytosis of the toxins. inconsistently, crop-truncated tcda(1-1874) is also capable of entering host cells and displaying full cytotoxic properties although with less potency. pre-incubation of cells with isolated crops, however, reconstitutes the reduced uptake of tcda(1-1874) to the level of the full-length toxin. we believe that tcda exhibits an additional binding mo ...201323558138
two cases of fulminant colitis due to binary toxin-positive clostridium difficile that are not pcr ribotype 027 or type 078.two cases of fulminant colitis due to clostridium difficile occurred within ten weeks of each other on the same ward of a hospital in japan. the patients died 2 and 4 days after the onset of colitis. c. difficile isolates obtained from both patients were toxin a-positive, toxin b-positive and binary toxin-positive. these isolates yielded identical results by both pcr ribotyping and slpa sequence typing. however, the banding patterns and slpa sequences of the isolates differed from those of pcr r ...201323558137
evaluation of antimicrobial activity of ceftaroline against clostridium difficile and propensity to induce c. difficile infection in an in vitro human gut model.to examine the effects of exposure to ceftaroline or ceftriaxone on the epidemic clostridium difficile strain pcr ribotype 027 and the indigenous gut microflora in an in vitro human gut model. additionally, the mics of ceftriaxone and ceftaroline for 60 c. difficile isolates were determined.201323557928
clostridium difficile enteritis: a report of two cases and systematic literature review.clostridium difficile (c. difficile) is the most common cause of healthcare associated infectious diarrhea. in the last decade, the incidence of c. difficile infection has increased dramatically. the virulence of c. difficile has also increased recently with toxigenic strains developing. c. difficile is generally a disease of the colon and presents with abdominal pain and diarrhea due to colitis. however, c. difficile enteritis has been reported rarely. the initial reports suggested mortality ra ...201323556059
low cost extraction and isothermal amplification of dna for infectious diarrhea diagnosis.in order to counter the common perception that molecular diagnostics are too complicated to work in low resource settings, we have performed a difficult sample preparation and dna amplification protocol using instrumentation designed to be operated without wall or battery power. in this work we have combined a nearly electricity-free nucleic acid extraction process with an electricity-free isothermal amplification assay to detect the presence of clostridium difficile (c. difficile) dna in the st ...201323555883
clostridium difficile ribotype diversity at six health care institutions in the united states.capillary-based pcr ribotyping was used to quantify the presence/absence and relative abundance of 98 clostridium difficile ribotypes from clinical cases of disease at health care institutions in six states of the united states. regionally important ribotypes were identified, and institutions in close proximity did not necessarily share more ribotype diversity than institutions that were farther apart.201323554188
appendectomy is not associated with adverse outcomes in clostridium difficile infection: a population-based study. 201323552320
nisin and clostridium difficile: a potentially effective treatment for an increasingly problematic disease. 201323552318
fecal bacteriotherapy for recurrent clostridium difficile infection: what's old is new again?in recent years, effective management of recurrent clostridium difficile infection (cdi) has emerged as an important issue for those clinicians who treat patients with cdi. in addition to antibiotic-based therapies, including alternating use, chaser, and tapering protocols, interest has increased in the potential utility of a variety of nonantibiotic forms of adjunctive therapy. among these alternative forms of treatment, the concept of transferring extracts of a stool from donors to patients wi ...201323549617
clostridium difficile infection in the hospitalized pediatric population: increasing trend in disease incidence.to determine whether the incidence of clostridium difficile infection continues to increase in hospitalized pediatric patients, we evaluated data from a united states national inpatient database. for the period of 2003 to 2009, we found an increasing trend in the incidence of c. difficile infection. these data suggest greater effort be given to prevent and treat this infection in children.201323546535
new opportunities for improved ribotyping of c. difficile clinical isolates by exploring their genomes.clostridium difficile causes outbreaks of infectious diarrhoea, most commonly occurring in healthcare institutions. recently, concern has been raised with reports of c. difficile disease in those traditionally thought to be at low risk i.e. community acquired rather than healthcare acquired. this has increased awareness for the need to track outbreaks and pcr-ribotyping has found widespread use to elucidate epidemiologically linked isolates. pcr-ribotyping uses conserved regions of the 16s rrna ...201323545446
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