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intravenous immunoglobulin in the treatment of severe clostridium difficile colitis.intravenous immunoglobulin (ivig) has been utilized in patients with recurrent and refractory clostridium difficile colitis. it is increasingly being used in patients with initial clinical presentation of severe colitis. herein, we report a case of severe c. difficile colitis successfully treated with ivig with a review of the medical literature to identify the optimal timing and clinical characteristics for this treatment strategy.201424926170
staggered and tapered antibiotic withdrawal with administration of kefir for recurrent clostridium difficile infection.daily administration of the probiotic kefir given in combination with a staggered and tapered antibiotic withdrawal regimen may resolve recurrent clostridium difficile infection as effectively as fecal microbiota transplantation.201424917658
occurrence of clostridium difficile infections due to pcr ribotype 027 in bucharest, romania.little is known about prevailing ribotypes of clostridium difficile infection in romania where cdi is not a mandatory notifiable disease.201424916866
structural, spectroscopic and functional investigation into fe-substituted mnsod from human pathogen clostridium difficile.clostridium difficile, which inhabits the human digestive tract, is an etiological agent that causes pseudomembranous colitis and antibiotic-associated diarrhea. the oxidative stress tightly relates to its virulence, which highlights the function of its superoxide dismutase (sod). the sod from clostridium difficile (sodcd) is a mn/fe cambialistic sod with mnsodcd exhibiting an optimal activity while fe-sub-mnsodcd showing 10-fold less activity. to explain why the fe-loaded protein exhibits a muc ...201424915901
hospital clostridium difficile infection testing rates: is "don't ask, don't tell" at play? 201424915231
pediatric clostridium difficile infection: 6-year active surveillance in a defined patient population. 201424915227
the prediction of complicated clostridium difficile infections in children.we validated proposed definitions for severe clostridium difficile infection (cdi) in adults for prediction of complicated cdi in children. complicated cdi occurred in 9 of 202 cases. definitions for severe cdi in adults showed poor measures for discrimination of complicated cdi in children, which calls into question the usefulness of such definitions in pediatric cohorts.201424915226
protein expression, characterization, crystallization and preliminary x-ray crystallographic analysis of a fic protein from clostridium difficile.fic domains in proteins are found in abundance in nature from the simplest prokaryotes to animals. interestingly, fic domains found in two virulence factors of gram-negative bacteria have recently been demonstrated to catalyse the transfer of the amp moiety from atp to small host gtpases. this post-translational modification has attracted considerable interest and a role for adenylylation in pathology and physiology is emerging. this work was aimed at the structural characterization of a newly i ...201424915103
clostridium difficile infection in the hematopoietic unit: a meta-analysis of published studies.hematopoietic stem cell transplant (hsct) recipients are at high risk of contracting clostridium difficile infection (cdi). we systematically searched the pubmed and embase databases through march 2014 and performed a random-effects meta-analysis to estimate the prevalence and trends of cdi over time. among 48 eligible articles that included 12,025 patients at risk, we estimated that 7.9% (95% confidence interval [ci], 6.5% to 9.5%) of hsct patients are diagnosed with cdi during the peri-transpl ...201424914822
hematologic diseases: high risk of clostridium difficile associated diarrhea.to investigate the incidence and clinical outcome of clostridium difficile (c. difficile) associated diarrhea (cdad) in patients with hematologic disease.201424914383
antibiotics for treatment of clostridium difficile infection in hospitalized patients with inflammatory bowel disease.patients with inflammatory bowel disease (ibd), namely ulcerative colitis (uc) and crohn's disease (cd), have worse outcomes with clostridium difficile infection (cdi), including increased readmissions, colectomy, and death. oral vancomycin is recommended for the treatment of severe cdi, while metronidazole is the standard of care for nonsevere infection. we aimed to assess treatment outcomes of cdi in ibd. we conducted a retrospective observational study of inpatients with cdi and ibd from janu ...201424913174
multidisciplinary analysis of a nontoxigenic clostridium difficile strain with stable resistance to metronidazole.stable resistance to metronidazole in a nontoxigenic clostridium difficile strain was investigated at both the genomic and proteomic levels. alterations in the metabolic pathway involving the pyruvate-ferredoxin oxidoreductase were found, suggesting that reduction of metronidazole, required for its activity, may be less efficient in this strain. proteomic studies also showed a cellular response to oxidative stress.201424913157
initiation of sporulation in clostridium difficile: a twist on the classic model.the formation of dormant endospores is a complex morphological process that permits long-term survival in inhospitable environments for many gram-positive bacteria. sporulation for the anaerobic gastrointestinal pathogen clostridium difficile is necessary for survival outside of the gastrointestinal tract of its host. while the developmental stages of spore formation are largely conserved among endospore-forming bacteria, the genus clostridium appears to be missing a number of conserved regulato ...201424910370
clostridium difficile infection among immunocompromised patients in rio de janeiro, brazil and detection of moxifloxacin resistance in a ribotype 014 strain.clostridium difficile is a gram-positive spore forming anaerobic bacterium, often associated with nosocomial diarrhea and pseudomembranous colitis. the acquisition of this organism occurs primarily in hospitals through accidental ingestion of spores, and its establishment and proliferation in the colon results from the removal of members of the normal intestinal flora during or after antibiotic therapy. in this study, stool samples from patients admitted to the university hospital clementino fra ...201424907488
haemorrhagic toxin and lethal toxin from clostridium sordellii strain vpi9048: molecular characterization and comparative analysis of substrate specificity of the large clostridial glucosylating toxins.large clostridial glucosylating toxins (lcgts) are produced by toxigenic strains of clostridium difficile, clostridium perfringens, clostridium novyi and clostridium sordellii. while most c. sordellii strains solely produce lethal toxin (tcsl), c. sordellii strain vpi9048 co-produces both hemorrhagic toxin (tcsh) and tcsl. here, the sequences of tcsh-9048 and tcsl-9048 are provided, showing that both toxins retain conserved lcgt features and that tcsl and tcsh are highly related to toxin a (tcda ...201424905543
rhode island clostridium difficile infection trends and laboratory id events ranking. 201424905379
[development of gastrointestinal infectious diseases between 2000 and 2012].infectious gastroenterological diseases are of increasing medical and health-economic significance.201424905106
study of the frequency of clostridium difficile tcda, tcdb, cdta and cdtb genes in feces of calves in south west of iran.clostridium difficile (c. difficile) is a gram-positive, toxin-producing bacillus which is an intestinal pathogen in both humans and animals and causes a range of digestive disorders including inflammation of the bowel, abdominal pain, fever and diarrhea. c. difficile toxins include enterotoxin (toxin a), cytotoxin (toxin b) and a binary toxin. two large protein toxins a and b are encoded by separate genes, tcda and tcdb. clostridium difficile infection (cdi) mainly caused by the activity of the ...201424903619
severe clostridium difficile infection: incidence and risk factors at a tertiary care university hospital in vienna, austria.clostridium difficile infection (cdi) is the major cause of hospital-acquired bacterial diarrhoea. the incidence of cdi has been increasing in canada, the us and europe and severe cases are becoming more common.201424903143
clostridium difficile infection in liver transplant recipients: a retrospective study of rates, risk factors and outcomes.clostridium difficile infection (cdi) occurs in 3-7% of liver transplant recipients (ltr). however, few data exist on the recent epidemiology, predictors and outcomes of cdi in ltr. a cohort study was performed including ltr from 2000 to 2010 at a tertiary care hospital in detroit. cdi was defined as diarrhea with a stool c. difficile positive test. data analyzed included demographics, comorbidities, length of stay (los), severity of cdi, rates of recurrence (<12 weeks), relapse (<4 weeks) and o ...201424902610
abundant and diverse clustered regularly interspaced short palindromic repeat spacers in clostridium difficile strains and prophages target multiple phage types within this pathogen.clostridium difficile is an important human-pathogenic bacterium causing antibiotic-associated nosocomial infections worldwide. mobile genetic elements and bacteriophages have helped shape c. difficile genome evolution. in many bacteria, phage infection may be controlled by a form of bacterial immunity called the clustered regularly interspaced short palindromic repeats/crispr-associated (crispr/cas) system. this uses acquired short nucleotide sequences (spacers) to target homologous sequences ( ...201425161187
opinions and practice of stress ulcer prophylaxis in australian and new zealand intensive care units.intensivists frequently prescribe proton pump inhibitors (ppis) or histamine-2 receptor blockers (h2rbs) to intensive care unit patients for stress ulcer prophylaxis (sup). despite the common use of sup medicines, there is limited high-level evidence to support the choice between them.201425161018
a multicentre feasibility study evaluating stress ulcer prophylaxis using hospital-based registry data.it is unclear whether histamine-2 receptor blockers (h2rbs) or proton pump inhibitors (ppis) are preferred for stress ulcer prophylaxis (sup) in intensive care unit patients. suitably powered comparative effectiveness trials are warranted.201425161016
the magnitude and duration of clostridium difficile infection risk associated with antibiotic therapy: a hospital cohort study.antibiotic therapy is the principal risk factor for clostridium difficile infection (cdi), but little is known about how risks cumulate over the course of therapy and abate after cessation. we prospectively identified cdi cases among adults hospitalized at a tertiary hospital between june 2010 and may 2012. poisson regression models included covariates for time since admission, age, hospitalization history, disease pressure, and intensive care unit stay. impacts of antibiotic use through time we ...201425157757
in vitro antibiotic susceptibility profile of clostridium difficile excluding pcr ribotype 027 outbreak strain in hungary.our study showed the antibiotic susceptibility profile of toxigenic clostridium difficile isolated from nosocomial and community-acquired cdi between 2008 and 2010. mics of 200 c. difficile strains were determined using e®test method in the case of erythromycin, clindamycin, moxifloxacin, rifampicin, and metronidazole. all strains were susceptible to metronidazole in the study period. resistance rates to erythromycin, clindamycin and moxifloxacin were 31%, 29.5%, and 21.5%, respectively. in the ...201425150212
factors influencing the development of antibiotic associated diarrhea in ed patients discharged home: risk of administering iv antibiotics.antibiotic-associated diarrhea (aad) and clostridium difficile infection (cdi) are well-known outcomes from antibiotic administration. because emergency department (ed) visits frequently result in antibiotic use, we evaluated the frequency of aad/cdi in adults treated and discharged home with new prescriptions for antibiotics to identify risk factors for acquiring aad/cdi.201425149599
use of adenosine 5'-triphosphate bioluminescence assays to measure cleaning: the role of spores and clostridium difficile infection rates. 201425148937
performance of severity of illness classification for clostridium difficile infection to predict need-for-colectomy or inpatient death.in current state of practice, disease severity assessment for clostridium difficile infection (cdi) lacks consensus between different organizations. in the latest guidelines for management of cdi, authors have proposed a new disease severity classification. this classification has been derived from expert opinion and includes previously reported patient related factors that predict unfavorable outcome in cdi.201425147642
can rapid integrated polymerase chain reaction-based diagnostics for gastrointestinal pathogens improve routine hospital infection control practice? a diagnostic study.every year approximately 5000-9000 patients are admitted to a hospital with diarrhoea, which in up to 90% of cases has a non-infectious cause. as a result, single rooms are 'blocked' by patients with non-infectious diarrhoea, while patients with infectious diarrhoea are still in open bays because of a lack of free side rooms. a rapid test for differentiating infectious from non-infectious diarrhoea could be very beneficial for patients.201425146932
reverse transcription polymerase chain reaction-based method for selectively detecting vegetative cells of toxigenic clostridium difficile.the laboratory diagnostic methods for clostridium difficile infection (cdi) include toxigenic culture, enzyme immunoassays (eias) to detect the toxins of c. difficile, and nucleic acid amplification tests (naats) to detect c. difficile toxin genes, but each of these methods has disadvantages; toxigenic cultures require a long time to produce results, eias have low sensitivity, and naats that target dna cannot distinguish vegetative cells from spores and dead cells. here we report a new detection ...201425145894
a bundle strategy including patient hand hygiene to decrease clostridium difficile infections.prevention strategies for clostridium difficile infection traditionally have addressed barrier precautions, environmental disinfection, and health care worker hand hygiene. when applied as a bundle, this approach has been used widely as an evidence-based strategy to prevent hospital-acquired c. difficile infection. expanding the bundle to include patient hand hygiene is a nurse-driven approach to prevent c. difficile transmission.201425137788
[diagnosis and therapy of clostridium difficile infection: czech national guidelines].clostridium difficile infection (cdi) is a disease of varying severity. its manifestations range from mild diarrhea to life-threatening paralytic ileus, painful distension of the large bowel, and sepsis. another possible manifestation of the disease is recurring colitis that can exhaust the patient. for establishing the diagnosis, the patient's stool should be examined with two or three different microbiological methods (testing for clostridial toxins a and b; testing for clostridial glutamate d ...201425135141
pharmacological therapy of feed intolerance in the critically ills.feed intolerance in the setting of critical illness is associated with higher morbidity and mortality, and thus requires promptly and effective treatment. prokinetic agents are currently considered as the first-line therapy given issues relating to parenteral nutrition and post-pyloric placement. currently, the agents of choice are erythromycin and metoclopramide, either alone or in combination, which are highly effective with relatively low incidence of cardiac, hemodynamic or neurological adve ...201425133043
comparative nutritional and chemical phenome of clostridium difficile isolates determined using phenotype microarrays.clostridium difficile infection (cdi) is the leading cause of infectious diarrhea in north america and europe. the risk of cdi increases significantly in the case where antimicrobial treatment reduces the number of competing bacteria in the gut, thus leading to the increased availability of nutrients and loss of colonization resistance. the objective of this study was to determine comprehensive nutritional utilization and the chemical sensitivity profile of historic and newer c. difficile isolat ...201425130165
concordance of the shea-idsa severity classification for clostridium difficile infection and the atlas bedside scoring system in hospitalized adult patients.the society for healthcare epidemiology of america and infectious diseases society of america (shea-idsa) guidelines for the treatment of clostridium difficile infection (cdi) recommend initial treatment of cdi based on disease severity. this severity definition has not been validated or evaluated based on clinical outcomes. the atlas scoring system is a validated tool useful in predicting treatment response and mortality in cdi. the main purpose of this study is to evaluate the concordance of t ...201425129565
action of nitroheterocyclic drugs against clostridium difficile.the nitroheterocyclic classes of drugs have a long history of use in treating anaerobic infections, as exemplified by metronidazole as a first-line treatment for mild-to-moderate clostridium difficile infection (cdi). since direct comparisons of the three major classes of nitroheterocyclic drugs (i.e. nitroimidazole, nitazoxanide and nitrofurans) and nitrosating agents against c. difficile are under-examined, in this study their actions against c. difficile were compared. results show that whils ...201425129314
fulminant pseudomembranous colitis caused by clostridium difficile pcr ribotype 027 in a healthy young woman in japan.in the past two decades, clostridium difficile polymerase chain reaction ribotype 027 strain has rapidly emerged as the leading cause of antibiotic-associated colitis in north america and europe; however, it has been reported only occasionally in japan. we report a case of fulminant pseudomembranous colitis caused by this strain in a healthy young woman in japan without any previous medical history. the strain isolated from our patient was susceptible to both gatifloxacin and moxifloxacin, thus ...201425127156
environmental sampling for clostridium difficile on alcohol-based hand rub dispensers in an academic medical center.clostridum difficile is a gram-positive, spore-forming anaerobic bacillus that has substantial associated morbidity, mortality, and associated healthcare burdens. clostridium difficile spores are not destroyed by alcohol. alcohol gel dispensers are used commonly as the hand sanitization method of choice in hospitals. it is possible that gel dispensers are fomites for c. difficile.201425126976
clinical characteristics of patients who test positive for clostridium difficile by repeat pcr.the high sensitivity of pcr assays for diagnosing clostridium difficile infection (cdi) has greatly reduced the need for repeat testing after a negative result. nevertheless, a small subset of patients do test positive within 7 days of a negative test. the aim of this study was to evaluate the clinical characteristics of these patients to determine when repeat testing may be appropriate. the results of all xpert c. difficile pcr (cepheid, sunnyvale ca) tests performed in the clinical microbiolog ...201425122866
laboratory detection of clostridium difficile in piglets in australia.clostridium difficile is a well-known enteric pathogen of humans and the causative agent of high-morbidity enteritis in piglets aged 1 to 7 days. c. difficile prevalence in australian piglets is as high as 70%. the current diagnostic assays have been validated only for human infections, and there are no published studies assessing their performance in australian piglets. we evaluated the suitability of five assays for detecting c. difficile in 157 specimens of piglet feces. the assays included a ...201425122859
proton pump inhibitors and risk for clostridium difficile associated diarrhea.increased incidence of clostridium difficile infection (cdi) among in-patients is associated with significant increased mortality, morbidity, and stay in the hospitals. this has occurred despite heightened awareness of the risks of broad-spectrum antibiotics, overall reduction in antibiotic use and increased focus on hospital hygiene. so though the main risk factor for cdi is use of broad-spectrum antibiotics, the use of proton pump inhibitors (ppis) as a novel potential contributor has been imp ...201425116712
association of clostridium difficile infections with acid suppression medications in children.multiple studies have confirmed associations between acid suppression medication and clostridium difficile infections (cdis) in adults. therefore, we sought to evaluate an association between acid suppression medications and cdi in children.201425112692
clostridium difficile: improving the prevention paradigm in healthcare settings.clostridium difficile infection (cdi) is a major public health problem worldwide with significant morbidity and mortality that is spread by spores and fecal oral transmission. a variety of risk factors have been identified. some risk factors such as age, are not amenable to change, while others such as antimicrobial utilization have resulted in broadly implemented antimicrobial stewardship programs. new risk factors are emerging such as proton pump inhibitor (ppi) use, irritable bowel disease (i ...201425109301
corticosteroid use is associated with a reduced incidence of clostridium difficile-associated diarrhea: a retrospective cohort study.the impact of corticosteroid use on the incidence of clostridium difficile-associated diarrhea (cdad) was examined retrospectively in 532 patients receiving antibiotic treatment for respiratory infections. as determined by logistic regression, corticosteroids were associated with a decreased incidence of cdad (odds ratio 0.12, 95% confidence interval 0.006-0.95).201425108272
emergence of fecal microbiota transplantation as an approach to repair disrupted microbial gut ecology.in the recent years fecal microbiota transplantation (fmt) has emerged as an effective therapeutic option for patients with refractory clostridium difficile infection that is not responding to antibiotic therapy. it results in implantation of donor microbiota into recipients and restoration of normal distal gut microbial community structure. we anticipate that this form of therapy represents merely the first entry into a new class of therapeutics. there is great interest in application of fmt or ...201425106113
community hospital experience of refractory clostridium difficile colitis: treatment and efficacy of diverting loop ileostomy and colonic lavage. 201425105383
evaluation of the luminex xtag gastrointestinal pathogen panel and the savyon diagnostics gastrointestinal infection panel for the detection of enteric pathogens in clinical samples.infectious gastrointestinal disease is caused by a diverse array of pathogens, and is a challenging syndrome to correctly diagnose and manage. conventional laboratory diagnostic methods are often time-consuming and frequently suffer from low detection rates. two commercial multiplex nucleic acid amplification tests [luminex xtag gastrointestinal pathogen panel (gpp) and savyon diagnostics gastrointestinal infection panel (gip)] were applied to 1000 stored diarrhoeal clinical stool samples. the l ...201425102908
vancomycin-resistant clostridium innocuum bacteremia following oral vancomycin for clostridium difficile infection.an 85 year-old male initially admitted for septic shock due to urinary tract infection experienced clostridium difficile-associated diarrhea during hospitalization and was treated by oral vancomycin. his clinical course was complicated by cytomegalovirus colitis and then vancomycin-resistant clostridium innocuum bacteremia, which was cured by uneventfully parenteral piperacillin-tazobactam therapy.201425102472
clostridium difficile infection in patients with inflammatory bowel disease.clostridium difficile is a bacterium widely distributed in the human environment. in the last decade the incidence and severity of clostridium difficile infection has grown, particularly in europe and north america, making it one of the more common nosocomial infections. a group particularly susceptible to clostridium difficile infection are patients with inflammatory bowel disease, especially those with involvement of the colon. this paper presents relevant data on clostridium difficile infecti ...201425097707
cost-effectiveness analysis of fidaxomicin versus vancomycin in clostridium difficile infection.fidaxomicin was non-inferior to vancomycin with respect to clinical cure rates in the treatment of clostridium difficile infections (cdis) in two phase iii trials, but was associated with significantly fewer recurrences than vancomycin. this economic analysis investigated the cost-effectiveness of fidaxomicin compared with vancomycin in patients with severe cdi and in patients with their first cdi recurrence.201425096079
nursing staff can be a source of clostridium difficile infection. 201425095957
[recurrent clostridium difficile infection treated with faecal microbiota transplantation].treatment of severe clostridium difficile infection (cdi) poses a clinical challenge. emerging evidence supports the use of faecal microbiota transplantation (fmt). an 81-year-old man was admitted with a third recurrent episode of cdi within two months. because of clinical deterioration with development of pancolitis in spite of two weeks of metronidazole and vanco-mycin treatment, fmt was performed using a duodenal tube. the patient recovered completely without further relapse during follow-up. ...201425095866
[faecal transplantation as a treatment for clostridium difficile infection, ulcerative colitis and the metabolic syndrome].faecal transplantation as a therapeutic tool is increasingly reported in the scientific literature. faecal transplantation is currently becoming a treatment for nosocomial, refractory infections with c. difficile. furthermore, faecal transplantation has been suggested as a treatment for ulcerative colitis as well as for the metabolic syndrome. in the accumulated literature faecal transplantations appear to be safe, effective and superior to current treatments. faecal transplantation remains a sp ...201425095865
[clostridium difficile ribotype 027 is a challenge].infection with clostridium difficile is the primary infective cause of antibiotic-associated diarrhoea. in 2008, a major outbreak of cd027 took place in north zealand, denmark. we described this infection in a single medical department. patients positive for c. difficile enlisted at medical department o, herlev hospital, in 2009 were included and demographic data were recorded. in total, 69 patients were included, average age 83 years, charlson comorbidity score 4. of all patients 24 died. furth ...201425095864
[successful measures to combat clostridium difficile at herlev hospital].clostridium difficile is a common cause of health-care associated diarrhoea. we describe the supplementary measures taken at herlev hospital to combat a concerning rise in number of cases. the measures taken involve implementation of antibiotic stewardship; meetings every two weeks between the cleaning department, head nurses, infection control nurse and a clinical microbiologist with plans for near future actions; prompt isolation of patients with diarrhoea; rapid, pcr-based diagnostics; room d ...201425095863
[antibiotic stewardship has been established at herlev hospital].a high incidence of clostridium difficile and multiresistant organisms and increasing consumption of cephalosporins and quinolones have required an antibiotic stewardship programme, and antibiotic audits with feedback, revised guidelines and stringent prescription rules have been successful. the hospital intervention was managed by an antibiotic team combined with contact persons in all departments, a pocket edition of the guideline was available, and monthly commented reports about antibiotic c ...201425095862
antibiotics and community clostridium difficile infection. 201425095570
clostridium difficile infection after colorectal surgery: a rare but costly complication.the incidence and virulence of clostridium difficile infection (cdi) are on the rise. the characteristics of patients who develop cdi following colorectal resection have been infrequently studied.201425091840
clostridium difficile infection and candida colonization of the gut: is there a correlation? 201425091308
delayed presentation of dpd deficiency in colorectal cancer.case study  mr. d., a 55-year-old male, presented to the medical oncology service with a diagnosis of stage iii adenocarcinoma of the sigmoid colon. he presented 7 weeks post sigmoid colectomy with lymph node resection and was initiated on adjuvant chemotherapy with capox (capecitabine [xeloda] and oxaliplatin [eloxatin]). standard dosing was used: oxaliplatin at 130 mg/m(2) on day 1 and capecitabine at approximately 2,000 mg/m(2)/day (rounded to the nearest 500-mg tablet size) for 14 days on an ...201425089219
clostridium difficile infection: clinical challenges and management strategies.clostridium difficile has become the leading cause of nosocomial diarrhea in adults. a substantial increase has occurred in morbidity and mortality associated with disease caused by c difficile and in the identification of new hypervirulent strains, warranting a high clinical index of suspicion for infections due to this organism. prevention of infection requires a multidisciplinary approach, including early recognition of disease, effective contact isolation precautions, adherence to disinfecta ...201425086091
helicobacter pylori: friend or foe?helicobacter pylori (h. pylori) is a gram-negative spiral bacterium that is present in nearly half the world's population. it is the major cause of peptic ulcer disease and a recognized cause of gastric carcinoma. in addition, it is linked to non-ulcer dyspepsia, vitamin b12 deficiency, iron-deficient anemia and immune thrombocytopenic purpura. these conditions are indications for testing and treatment according to current guidelines. an additional indication according to the guidelines is "anyo ...201425083071
three-week summer period prevalence of clostridium difficile in farm animals in a temperate region of the united states (ohio).the cross-sectional (period) prevalence of clostridium difficile in 875 farm animals from 29 commercial operations during the summer of 2008 in ohio, usa was quantified. compared to an external referent population of intensively managed race horses (12.7%), intensively managed commercially mature food animals (poultry, cattle, swine; < 0.6%) were infrequent shedders of c. difficile (p < 0.00001) during the warmest weeks of 2008.201425082995
first clinical and microbiological characterization of clostridium difficile infection in a croatian university hospital.clinical background and molecular epidemiology of clostridium difficile infection (cdi) in the university hospital centre split were investigated from january 2010 to december 2011. in total, 54 patients with first episode of cdi were consecutively included in the study based on the positive eia test specific for a and b toxins. demographic and clinical data were prospectively analyzed from medical records. cdi incidence rate was 0.6 per 10,000 patient-days. thirty six cases (70.6%) were healthc ...201425079669
passive and active immunization strategies against clostridium difficile infections: state of the art.the pathophysiology of clostridium difficile infections (cdi) could be considered as a three-step process that takes place after disruption of the digestive microbiota by antibiotics: 1) germination of spores; 2) multiplication and persistence of c. difficile in the colonic niche thanks to colonization factors; 3) production of the two toxins tcda and tcdb and for some strains an additional toxin, the binary toxin cdt. different immunization strategies against c. difficile have been developed, f ...201425079668
risk factors for the development of clostridium difficile infection in hospitalized children.this article defines the risk factors for clostridium difficile infection (cdi) in hospitalized children in light of recent studies demonstrating a change in the epidemiology of these infections in both adults and children.201425032717
the bristol stool scale and its relationship to clostridium difficile infection.the bristol stool form scale classifies the relative density of stool samples. in a prospective cohort study, we investigated the associations between stool density, c. difficile assay positivity, hospital-onset c. difficile infection, complications, and severity of c. difficile. we describe associations between the bristol score, assay positivity, and clinical c. difficile infection.201425031446
comparison of the verigene clostridium difficile, simplexa c. difficile universal direct, bd max cdiff, and xpert c. difficile assays for the detection of toxigenic c. difficile.we compared the verigene clostridium difficile test (nanosphere, northbrook, il, usa), the simplexa c. difficile universal direct (focus diagnostics, cypress, ca, usa), the bd max cdiff (becton dickinson, franklin lakes, nj, usa), and the xpert c. difficile (cepheid, sunnyvale, ca, usa) assays for the detection of toxigenic c. difficile. one hundred and ninety deidentified, remnant diarrheal specimens were included in this study. after resolution of discordant results by toxigenic culture, the x ...201425027069
effectiveness of screening hospital admissions to detect asymptomatic carriers of clostridium difficile: a modeling evaluation.both asymptomatic and symptomatic clostridium difficile carriers contribute to new colonizations and infections within a hospital, but current control strategies focus only on preventing transmission from symptomatic carriers. our objective was to evaluate the potential effectiveness of methods targeting asymptomatic carriers to control c. difficile colonization and infection (cdi) rates in a hospital ward: screening patients at admission to detect asymptomatic c. difficile carriers and placing ...201425026622
clostridium difficile infections in veterans health administration acute care facilities.an initiative was implemented in july 2012 to decrease clostridium difficile infections (cdis) in veterans affairs (va) acute care medical centers nationwide. this is a report of national baseline cdi data collected from the 21 months before implementation of the initiative.201425026621
[does the hospital cost of care differ for inflammatory bowel disease patients with or without gastrointestinal infections? a case-control study].gastrointestinal infections have been implicated as possible causes of exacerbation of inflammatory bowel disease (ibd) or risk factors for severe flares in general. the introduction of the g-drg reimbursement system has greatly increased the pressure to provide cost effective treatment in german hospitals. few studies have compared the costs of treating ibd patients with or without gastrointestinal infections and none of them have specifically considered the german reimbursement situation.201425026005
[diagnosis of clostridium difficile infections: comparative study of two immuno enzyme assays with confirmation by pcr and culture followed by pcr ribotyping].comparison of two commercially avail-able tests for the detection of clostridium difficile glutamate dehydrogenase (gdh) and toxins a and b for their sensitivity and specificity.201425025672
an optimized, synthetic dna vaccine encoding the toxin a and toxin b receptor binding domains of clostridium difficile induces protective antibody responses in vivo.clostridium difficile-associated disease (cdad) constitutes a large majority of nosocomial diarrhea cases in industrialized nations and is mediated by the effects of two secreted toxins, toxin a (tcda) and toxin b (tcdb). patients who develop strong antitoxin antibody responses can clear c. difficile infection and remain disease free. key toxin-neutralizing epitopes have been found within the carboxy-terminal receptor binding domains (rbds) of tcda and tcdb, which has generated interest in devel ...201425024365
efficacy of fecal microbiota transplantation in 2 children with recurrent clostridium difficile infection and its impact on their growth and gut microbiome.fecal microbiota transplantation (fmt) is recognized as an alternative therapeutic modality for recurrent clostridium difficile infection (rcdi); however, data on its efficacy in children are lacking, including its effect on their growth and fecal microbiota. we report on 2 young children (<3 years old) who failed available therapeutics for rcdi, but responded remarkably well to fmt. besides resolution of clinical features of c difficile infection (cdi), fmt administration led to marked improvem ...201425023578
in vivo assessment of smt19969 in a hamster model of clostridium difficile infection.smt19969 [2,2'-bis(4-pyridyl)3h,3'-h 5,5-bibenzimidazole] is a novel narrow-spectrum nonabsorbable antibiotic currently in development for the treatment of clostridium difficile infection. the comparative activities of smt19969 and vancomycin against nonepidemic and epidemic strains of c. difficile were studied in an established hamster model. against nonepidemic (va11) strains, the survival rates of smt19969-treated animals ranged from 80% to 95%. vancomycin exhibited 100% protection during tre ...201425022586
synergistic effects of antimicrobial peptides and antibiotics against clostridium difficile.accelerating rates of health care-associated infections caused by clostridium difficile, with increasing recurrence and rising antibiotic resistance rates, have become a serious problem in recent years. this study was conducted to explore whether a combination of antibiotics with human antimicrobial peptides may lead to an increase in antibacterial activity. the in vitro activities of the antimicrobial peptides hbd1 to hbd3, hnp1, hd5, and ll-37 and the antibiotics tigecycline, moxifloxacin, pip ...201425022581
pharmacokinetic evaluation of esomeprazole for the treatment of gastroesophageal reflux disease.proton pump inhibitors (ppis) are widely used for the treatment of acid-related diseases such as gastroesophageal reflux disease (gerd). they are recommended by the american college of gastroenterology for healing erosive esophagitis (eo) and as long-term treatment in patients with healed eo. the available ppis differ somewhat in their pharmacokinetics and clinical properties, but whether these differences are of clinical relevance is a matter of debate. some safety concerns have been raised wit ...201425019289
in vitro activity of mcb3681 against clostridium difficile strains.one hundred fourteen clostridium difficile strains were collected from 67 patients and analyzed for the presence of c. difficile toxin b by the cell cytotoxoicity neutralization assay, genes for toxin a, toxin b, binary toxin and tcdc deletion by pcr. all strains were also pcr-ribotyped. the mics of the isolates were determined against mcb3681 and nine other antimicrobial agents by the agar dilution method. all isolates were positive for toxin b as well as for toxin a and b genes. in addition, 1 ...201425016084
clostridium difficile infection in diabetes.diabetes-related hospitalization and hospital utilization is a serious challenge to the health care system, a situation which may be further aggravated by nosocomial clostridium difficile (c. difficile) infection (cdi). studies have demonstrated that diabetes increases the risk of recurrent cdi with or (95% ci) 2.99 (1.88, 4.76). c. difficile is a gram-positive, spore-forming anaerobic bacterium which is widely distributed in the environment. up to 7% of healthy adults and up to 45% of infants m ...201425015315
efficacy and safety of, and patient satisfaction with, colonoscopic-administered fecal microbiota transplantation in relapsing and refractory community- and hospital-acquired clostridium difficile infection.to report the efficacy and safety of, and patient satisfaction with, colonoscopic fecal microbiota transplantation (fmt) for community- and hospital-acquired clostridium difficile infection (cdi).201425014180
clostridium difficile 027 increasing detection in a teaching hospital in rome, italy. 201425012877
challenges and opportunities in the management of clostridium difficile infection.clostridium difficile infection (cdi) is increasing in all regions of the world where sought. there is no gold standard for diagnosis of cdi, with available tests having limitations. prevention of cdi will be seen with antibiotic stewardship, improved disinfection of hospitals and nursing homes, chemo- and immuno-prophylaxis and next generation probiotics. the important therapeutic agents are oral vancomycin and fidaxomicin with metronidazole being used only in mild cases or when oral therapy ca ...201425012255
detecting clostridium difficile spores from inanimate surfaces of the hospital environment: which method is best?the recovery of clostridium difficile spores from hospital surfaces was assessed using rayon swabs, flocked swabs, and contact plates. the contact plate method was less laborious, achieved higher recovery percentages, and detected spores at lower inocula than swabs. rayon swabs were the least efficient method. however, further studies are required in health care settings.201425009047
the impact of clostridium difficile on paediatric surgical practice: a systematic review.the pathogenic potential of clostridium difficile in children remains a controversial subject as healthy infants can be colonised by this organism. however recent analyses have clarified that c. difficile is an important enteropath in paediatric populations, particularly in antibiotic-associated diarrhoea. paediatric surgical patients including those with hirschsprung's disease (hd) may be especially vulnerable to c. difficile infection (cdi) and complicated c. difficile enterocolitis such as ps ...201425008231
effects of polysaccharopeptide from trametes versicolor and amoxicillin on the gut microbiome of healthy volunteers: a randomized clinical trial.interactions between the microbial flora of the intestine and the human host play a critical role inmaintaining intestinal health and in the pathophysiology of a wide variety of disorders such as antibiotic associated diarrhea, clostridium difficile infection, and inflammatory bowel disease. prebiotics can confer health benefits by beneficial effects on the intestinal microbiome, whereas antibiotics can disrupt the microbiome leading to diarrhea andother side effects.201425006989
serine/threonine protein phosphatase-mediated control of the peptidoglycan cross-linking l,d-transpeptidase pathway in enterococcus faecium.the last step of peptidoglycan polymerization involves two families of unrelated transpeptidases that are the essential targets of β-lactam antibiotics. d,d-transpeptidases of the penicillin-binding protein (pbp) family are active-site serine enzymes that use pentapeptide precursors and are the main or exclusive cross-linking enzymes in nearly all bacteria. however, peptidoglycan cross-linking is performed mainly by active-site cysteine l,d-transpeptidases that use tetrapeptides in mycobacterium ...201425006233
the structure of the cysteine protease and lectin-like domains of cwp84, a surface layer-associated protein from clostridium difficile.clostridium difficile is a major problem as an aetiological agent for antibiotic-associated diarrhoea. the mechanism by which the bacterium colonizes the gut during infection is poorly understood, but undoubtedly involves a myriad of components present on the bacterial surface. the mechanism of c. difficile surface-layer (s-layer) biogenesis is also largely unknown but involves the post-translational cleavage of a single polypeptide (surface-layer protein a; slpa) into low- and high-molecular-we ...201425004975
structural and biochemical analyses of alanine racemase from the multidrug-resistant clostridium difficile strain 630.clostridium difficile, a gram-positive, spore-forming anaerobic bacterium, is the leading cause of infectious diarrhea among hospitalized patients. c. difficile is frequently associated with antibiotic treatment, and causes diseases ranging from antibiotic-associated diarrhea to life-threatening pseudomembranous colitis. the severity of c. difficile infections is exacerbated by the emergence of hypervirulent and multidrug-resistant strains, which are difficult to treat and are often associated w ...201425004969
organization and scope of surveillance of infections in polish hospitals. results of the project prohibit.the paper presents results of a survey on organization of surveillance programs in polish hospitals. survey was performed by means of the standardized questionnaire in the year 2012. materialand method: completed questionnaires were obtained from 9 hospitals of different size and type: 3 small, 2 medium and 4 large, most of them public (6 hospitals). questions concerning general organization of the infection control in hospitals were answered by infection control teams.201425004628
the evolution of urban c. difficile infection (cdi): cdi in 2009-2011 is less severe and has better outcomes than cdi in 2006-2008.over the past decade, the epidemiology of clostridium difficile infection (cdi) has shown a remarkable increase in incidence with an associated increase in severity. this study was designed to compare the demographics, medication exposure, evaluation, treatment patterns, and outcomes of patients with cdi in two different time periods: 2006-2008 and 2009-2011. we hypothesized that mortality is decreasing with increasing appropriateness of medical management.201425001255
clostridium difficile recurrence is characterized by pro-inflammatory peripheral blood mononuclear cell (pbmc) phenotype.clostridium difficile infection (cdi) is a prevalent nosocomial and increasingly community-acquired problem. little is known about the productive cellular response in patients. we used flow cytometry to define inflammatory (th1 and th17) and regulatory [foxp3(+) t-regulatory (treg)] cells present in circulating peripheral blood mononuclear cells (pbmc) from cdi patients. we consented 67 inpatients that tested either positive or negative for cdi and 16 healthy controls and compared their pbmc phe ...201425001105
extended antimicrobial use in patients undergoing percutaneous nephrolithotomy and associated antibiotic related complications.despite global concern about antibiotic related complications the duration of antibiotic therapy at percutaneous nephrolithotomy varies based on individual physician practice. we evaluated perioperative antibiotic related complications in patients who received extended antimicrobial therapy at percutaneous nephrolithotomy.201424998482
hospitalization stay and costs attributable to clostridium difficile infection: a critical review.in most healthcare systems, third-party payers fund the costs for patients admitted to hospital for clostridium difficile infection (cdi) whereas, for cdi cases arising as complications of hospitalization, not all related costs are refundable to the hospital. we therefore aimed to critically review and categorize hospital costs and length of hospital stay (los) attributable to clostridium difficile infection and to investigate the economic burden associated with it. a comprehensive literature re ...201424996516
role of microbiota and innate immunity in recurrent clostridium difficile infection.recurrent clostridium difficile infection represents a burdensome clinical issue whose epidemiology is increasing worldwide. the pathogenesis is not yet completely known. recent observations suggest that the alteration of the intestinal microbiota and impaired innate immunity may play a leading role in the development of recurrent infection. various factors can cause dysbiosis. the causes most involved in the process are antibiotics, nsaids, acid suppressing therapies, and age. gut microbiota im ...201424995345
high rates of intestinal colonisation with fluoroquinolone-resistant esbl-harbouring enterobacteriaceae in hospitalised patients with antibiotic-associated diarrhoea.the purposes of this study were to investigate the intestinal carriage of extended-spectrum β-lactamase-harbouring enterobacteriaceae (esbl-en) and associated fluoroquinolone resistance (fq-r) in 120 hospitalised patients with antibiotic-associated diarrhoea, and to investigate a correlation between clostridium difficile (c. difficile) infection and intestinal colonisation with esbl-en in these patients. stool samples were screened for c. difficile infection by toxin a/b enzyme-linked immunosorb ...201424993152
clostridium difficile infection: epidemiology, pathogenesis, risk factors, and therapeutic options.the incidence and mortality rate of clostridium difficile infection have increased remarkably in both hospital and community settings during the last two decades. the growth of infection may be caused by multiple factors including inappropriate antibiotic usage, poor standards of environmental cleanliness, changes in infection control practices, large outbreaks of c. difficile infection in hospitals, alteration of circulating strains of c. difficile, and spread of hypervirulent strains. detectio ...201424991448
funding may influence trial results examining probiotics and clostridium difficile diarrhea rates. 201424989097
clostridium difficile infection in patients with ileal pouches.clostridium difficile (c. difficile) infection (cdi) following total proctocolectomy and ileal pouch-anal anastomosis has been increasingly recognized over the past 5 years. cdi of the ileal pouch has been recognized in ∼10% of symptomatic patients seen at a tertiary referral center for pouch dysfunction. in contrast to colonic cdi in the general population or in patients with inflammatory bowel disease, postoperative antibiotic exposure and the use of immunosuppressive agents or proton pump inh ...201424989088
lactobacillus rhamnosus l34 and lactobacillus casei l39 suppress clostridium difficile-induced il-8 production by colonic epithelial cells.clostridium difficile is the main cause of hospital-acquired diarrhea and colitis known as c. difficile-associated disease (cdad).with increased severity and failure of treatment in cdad, new approaches for prevention and treatment, such as the use of probiotics, are needed. since the pathogenesis of cdad involves an inflammatory response with a massive influx of neutrophils recruited by interleukin (il)-8, this study aimed to investigate the probiotic effects of lactobacillus spp. on the suppre ...201424989059
metabolomics analysis identifies intestinal microbiota-derived biomarkers of colonization resistance in clindamycin-treated mice.the intestinal microbiota protect the host against enteric pathogens through a defense mechanism termed colonization resistance. antibiotics excreted into the intestinal tract may disrupt colonization resistance and alter normal metabolic functions of the microbiota. we used a mouse model to test the hypothesis that alterations in levels of bacterial metabolites in fecal specimens could provide useful biomarkers indicating disrupted or intact colonization resistance after antibiotic treatment.201424988418
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