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the diagnosis of clostridium difficile infection in outpatient pediatrics. 201626350428
trends in oral antibiotic, proton pump inhibitor, and histamine 2 receptor blocker prescription patterns for children compared with adults: implications for clostridium difficile infection in the community.the use of antibiotics, proton pump inhibitor (ppi), and histamine 2 receptor blocker (h2b) was compared between children and adults in the community from 2005 through 2011. antibiotic prescription rates remained stable for children, but increased significantly for adults, p = .03. ppi prescription rates increased for children, p = .02 and for adults, p = .009. h2b prescription rates increased for children, p = .03, but not for adults. antibiotic prescription rates were significantly higher in c ...201626350427
fecal microbiota transplantation for the treatment of clostridium difficile infection.clostridium difficile, a major cause of healthcare-associated diarrhea due to perturbation of the normal gastrointestinal microbiome, is responsible for significant morbidity, mortality, and healthcare expenditures. the incidence and severity of c difficile infection (cdi) is increasing, and recurrent disease is common. recurrent infection can be difficult to manage with conventional antibiotic therapy. fecal microbiota transplantation (fmt), which involves instillation of stool from a healthy d ...201626344412
identification of key taxa that favor intestinal colonization of clostridium difficile in an adult chinese population.fecal microbial transplantation provides a high curative rate for recurrent clostridium difficile infection (cdi). however, limitations associated with fmt drive the need to identify key taxa for selective probiotic therapy for prevention, treatment and cure of human cdi. cdi-associated changes in gut microbiota were investigated in adult patients in the western countries and among infant population in china. however, there has been no such study involving adult patients in china. therefore, usi ...201626383014
striving for optimal care: updates in quality, value, and patient experience.hospitalists are playing a growing role in quality improvement efforts, and they are increasingly spearheading programs to improve patient experience and healthcare value. we aimed to summarize and critique recent research related to quality, value, and patient experience in the clinical practice of hospital medicine.201626417871
fecal transplant is as effective and safe in immunocompromised as non-immunocompromised patients for clostridium difficile. 201626410257
pcr cycle threshold value predicts the course of clostridium difficile infection. 201626408277
comparison of whole-genome sequencing and molecular-epidemiological techniques for clostridium difficile strain typing.we analyzed in parallel 27 pediatric clostridium difficile isolates by repetitive sequence-based polymerase chain reaction (reppcr), pulsed-field gel electrophoresis (pfge), and whole-genome next-generation sequencing. next-generation sequencing distinguished 3 groups of isolates that were indistinguishable by reppcr and 1 isolate that clustered in the same pfge group as other isolates.201626407257
susceptibility of clostridium difficile isolates from a phase 2 clinical trial of cadazolid and vancomycin in c. difficile infection.the aim of this study was to evaluate the susceptibilities of clostridium difficile isolates to cadazolid, a novel antibiotic for the treatment of c. difficile infection.201626433782
faecal microbiota transplantation in recurrent clostridium difficile infection: recommendations from the french group of faecal microbiota transplantation.faecal microbiota transplantation is effective for treating recurrent forms of clostridium difficile infection and its use in this indication is recommended in the most recent european and north american guidelines. in this context, faecal microbiota transplantation is beginning to be performed in france in clinical practice, while the rules governing this procedure have been defined in france only for clinical trials. to unify, secure, and evaluate practice in this field in france, the french g ...201626433619
recurrent clostridium difficile infection in intensive care unit patients.the purpose of this study was to assess the 12-week cumulative incidence of recurrent clostridium difficile infection (rcdi) and identify risk factors for rcdi in patients that acquired index c difficile infection (cdi) while in the intensive care unit (icu).201626432184
slow intestinal transit contributes to elevate urinary p-cresol level in italian autistic children.the uremic toxin p-cresol (4-methylphenol) is either of environmental origin or can be synthetized from tyrosine by cresol-producing bacteria present in the gut lumen. elevated p-cresol amounts have been previously found in the urines of italian and french autism spectrum disorder (asd) children up until 8 years of age, and may be associated with autism severity or with the intensity of abnormal behaviors. this study aims to investigate the mechanism producing elevated urinary p-cresol in asd. u ...201626437875
recommendations for probiotic use--2015 update: proceedings and consensus opinion.this paper describes the consensus opinion of the participants in the 4th triennial yale/harvard workshop on probiotic recommendations. the recommendations update those of the first 3 meetings that were published in 2006, 2008, and 2011. recommendations for the use of probiotics in necrotizing enterocolitis, childhood diarrhea, inflammatory bowel disease, irritable bowel syndrome and clostridium difficile diarrhea are reviewed. in addition, we have added recommendations for liver disease for the ...201626447969
donor species richness determines faecal microbiota transplantation success in inflammatory bowel disease.faecal microbiota transplantation is a successful therapy for patients with refractory clostridium difficile infections. it has also been suggested as a treatment option for inflammatory bowel disease, given the role of the intestinal microbiota in this disease. we assessed the impact of faecal microbiota transplantation in patients with inflammatory bowel disease and studied predictors of clinical (non-)response in microbial profiles of donors and patients.201626519463
universal vs risk factor screening for methicillin-resistant staphylococcus aureus in a large multicenter tertiary care facility in canada.objective to assess the clinical effectiveness of a universal screening program compared with a risk factor-based program in reducing the rates of nosocomial methicillin-resistant staphylococcus aureus (mrsa) among admitted patients at the ottawa hospital. design quasi-experimental study. setting ottawa hospital, a multicenter tertiary care facility with 3 main campuses, approximately 47,000 admissions per year, and 1,200 beds. methods from january 1, 2006 through december 31, 2007 (24 months), ...201626470820
increasing incidence of and increased mortality associated with clostridium difficile-associated megacolon. 201626445319
distribution and characterization of clostridium difficile isolated from dogs in japan.we collected 204 nondiarrhoeic canine fecal samples and isolated 68 clostridium difficile strains from 62 of these samples. strains were grouped into 29 pcr ribotypes. only 47% of the strains were toxigenic.201626456188
performance management of clostridium difficile infection in hospitals - the carrot or stick approach?public and political pressure for healthcare quality indicator monitoring, specifically healthcare-associated infection (hai) has intensified the debate regarding the merits of public reporting and target setting as policy approaches. this paper reviews the evidence for these approaches with a focus on hai, including clostridium difficile infection (cdi). healthcare key performance indicators (kpis) and associated targets have been used widely with little evaluation. while targets are associated ...201626456187
interleukin-23 (il-23), independent of il-17 and il-22, drives neutrophil recruitment and innate inflammation during clostridium difficile colitis in mice.our objective was to determine the role of the inflammatory cytokine interleukin-23 (il-23) in promoting neutrophil recruitment, inflammatory cytokine expression and intestinal histopathology in response to clostridium difficile infection. wild-type (wt) and p19(-/-) (il-23ko) mice were pre-treated with cefoperazone in their drinking water for 5 days, and after a 2-day recovery period were challenged with spores from c. difficile strain vpi 10463. interleukin-23 deficiency was associated with si ...201626455347
racial and ethnic disparities in health care-associated clostridium difficile infections in the united states: state of the science.among health care-associated infections (hais), clostridium difficile infections (cdis) are a major cause of morbidity and mortality in the united states. as national progress toward cdi prevention continues, it will be critical to ensure that the benefits from cdi prevention are realized across different patient demographic groups, including any targeted interventions.201626454749
investigation of a cluster of clostridium difficile infections in a pediatric oncology setting.we investigated an increase in clostridium difficile infection (cdi) among pediatric oncology patients.201626601705
establishing a fecal microbiota transplant service for the treatment of clostridium difficile infection.recurrent or refractory clostridium difficile infection (cdi) has become an increasing problem in the past decade. fecal microbiota transplant (fmt) is a highly efficacious treatment for recurrent cdi; however, a number of technical, logistical, and regulatory issues have hampered the development of an fmt capability at many hospitals. the development of a frozen stool bank of screened donor stool is an important step in the standardization of the procedure. this gives clinicians rapid access to ...201626628567
problems after restorative proctocolectomy: assessment and therapy.restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. although the surgical procedure significantly improves the patients' quality of life, complications are common. mechanical or structural complications related to surgical techniques as well as chronic pouchitis are common after the procedure.201626628102
virulence factors of clostridium difficile and their role during infection.clostridium difficile is the prominent etiological agent of healthcare-associated diarrhea. the disease symptoms range from mild diarrhea to life-threatening pseudomembranous colitis. the main risk factor for developing an infection after contamination by the resistant spores is the disruption of the gut microbiota, allowing the spores to germinate. the colonization of the gut is likely to be governed by the bacterial resistance to the host response and the bacterial adhesion to the mucosa. to d ...201626596863
a whole new ball game: stem cell-derived epithelia in the study of host-microbe interactions.recent advances in developmental and stem cell biology have resulted in techniques that enable the generation and maintenance of complex epithelium in vitro. while these models have been utilized to study host development and disease, a renewed appreciation of host-microbe interactions has sparked interest in employing these new techniques to study microbes at the epithelial interface. here we review the current advances in host-microbe interactions that have resulted from experiments using thes ...201626549696
epidemiology and factors associated with candidaemia following clostridium difficile infection in adults within metropolitan atlanta, 2009-2013.we assessed prevalence of and risk factors for candidaemia following clostridium difficile infection (cdi) using longitudinal population-based surveillance. of 13 615 adults with cdi, 113 (0·8%) developed candidaemia in the 120 days following cdi. in a matched case-control analysis, severe cdi and cdi treatment with vancomycin + metronidazole were associated with development of candidaemia following cdi.201626608090
the effectiveness of lactobacillus beverages in controlling infections among the residents of an aged care facility: a randomized placebo-controlled double-blind trial.to clarify the usefulness of lactobacillus casei strain shirota (lcs)-fermented milk in the normalization of bowel movements and improvement of infection control for the elderly residents and staff of facilities for the elderly.201626599038
in the endemic setting, clostridium difficile ribotype 027 is virulent but not hypervirulent - erratum. 201626607744
analysis of morbidity and mortality outcomes in postoperative clostridium difficile infection in the veterans health administration.this study analyzes and reports clostridium difficile infection (cdi) rates, risk factors, and associations with postoperative outcomes in the veterans health administration (vha).201626606675
metagenomic approach for identification of the pathogens associated with diarrhea in stool specimens.the potential to rapidly capture the entire microbial community structure and/or gene content makes metagenomic sequencing an attractive tool for pathogen identification and the detection of resistance/virulence genes in clinical settings. here, we assessed the consistency between pcr from a diagnostic laboratory, quantitative pcr (qpcr) from a research laboratory, 16s rrna gene sequencing, and metagenomic shotgun sequencing (mss) for clostridium difficile identification in diarrhea stool sample ...201626637379
the high stakes of postoperative clostridium difficile infection. 201626606279
clostridium difficile outbreak caused by nap1/bi/027 strain and non-027 strains in a mexican hospital.clostridium difficile infections caused by the nap1/b1/027 strain are more severe, difficult to treat, and frequently associated with relapses.201626620948
incidence of clostridium difficile infection in patients receiving high-risk antibiotics with or without a proton pump inhibitor.considering the incidence and severity of clostridium difficile infection (cdi), risk reduction strategies are crucial. prior studies suggest that proton pump inhibitor (ppi) use can increase the risk of cdi over antibiotics alone; however, data and guidelines have been conflicting.201626616410
persistence of clostridium difficile rt 237 infection in a western australian piggery.clostridium difficile is commonly associated with healthcare-related infections in humans, and is an emerging pathogen in food animal species. there is potential for transmission of c. difficile from animals or animal products to humans. this study aimed to determine if c. difficile rt 237 had persisted in a western australian piggery or if there had been a temporal change in c. difficile diversity. c. difficile carriage in litters with and without diarrhea was investigated, as was the acquisiti ...201626679487
biomedical applications of nisin.nisin is a bacteriocin produced by a group of gram-positive bacteria that belongs to lactococcus and streptococcus species. nisin is classified as a type a (i) lantibiotic that is synthesized from mrna and the translated peptide contains several unusual amino acids due to post-translational modifications. over the past few decades, nisin has been used widely as a food biopreservative. since then, many natural and genetically modified variants of nisin have been identified and studied for their u ...201626678028
impact of variations in test method parameters on in vitro activity of surotomycin against clostridium difficile and surotomycin quality control limits for broth microdilution and agar dilution susceptibility testing.test parameter variations were evaluated for their effects on surotomycin mics. calcium concentration was the only variable that influenced mics; therefore, 50 μg/ml (standard for lipopeptide testing) is recommended. quality control ranges for clostridium difficile (0.12 to 1 μg/ml) and eggerthella lenta (broth, 1 to 4 μg/ml; agar, 1 to 8 μg/ml) were approved by the clinical and laboratory standards institute based on these data.201626677246
novel approaches to treating clostridium difficile-associated colitis.clostridium difficile is being recognized as a growing threat to many health-care systems. epidemiology data shows that infection rates are soaring and the disease burden is increasing. despite the efficacy of standard treatments, it is becoming evident that novel therapeutics will be required to tackle this disease. these new treatments aim to enhance the intestinal microbial barrier, activate the immune system and neutralize the toxins that mediate this disease. many of these therapies are sti ...201626643655
bacteriophage combinations significantly reduce clostridium difficile growth in vitro and proliferation in vivo.the microbiome dysbiosis caused by antibiotic treatment has been associated with both susceptibility to and relapse of clostridium difficile infection (cdi). bacteriophage (phage) therapy offers target specificity and dose amplification in situ, but few studies have focused on its use in cdi treatment. this mainly reflects the lack of strictly virulent phages that target this pathogen. while it is widely accepted that temperate phages are unsuitable for therapeutic purposes due to their transduc ...201626643348
use of the cobas 4800 system for the rapid detection of toxigenic clostridium difficile and methicillin-resistant staphylococcus aureus.the new cobas® cdiff and cobas® mrsa/sa tests were compared with conventional methods for the rapid detection of toxigenic clostridium difficile and methicillin-resistant staphylococcus aureus. the final concordance between cobas cdiff test and gdh/toxin gene screening was 97.62% and between cobas mrsa/sa test and chromogenic culture, 91.30%, respectively.201626611812
antimicrobial therapy of acute diarrhoea: a clinical review.diarrhoea is one of the most commonly occurring diseases. this article presents a review of the current state of the treatment of acute infectious diarrhoea, as well as of the most important pathogens. the general principles of the therapy of diarrhoea are exemplified, followed by a description of the targeted antimicrobial therapy of the most important bacterial gastrointestinal infections, including salmonellosis, shigellosis and campylobacter infections, as well as infections with pathogenic ...201626641310
toxicity assessment of clostridium difficile toxins in rodent models and protection of vaccination.clostridium difficile is the leading cause of hospital-acquired diarrhea, also known as c. difficile associated diarrhea. the two major toxins, toxin a and toxin b are produced by most c. difficile bacteria, but some strains, such as bi/nap1/027 isolates, produce a third toxin called binary toxin. the precise biological role of binary toxin is not clear but it has been shown to be a cytotoxin for vero cells. we evaluated the toxicity of these toxins in mice and hamsters and found that binary tox ...201626614590
clostridium difficile carriage in healthy pregnant women in china.infection with clostridium difficile has been shown to have particularly poor outcomes for pregnant women, including an increased risk of death. the purpose of this study was to investigate the prevalence, genotypic distribution, and characterization of c. difficile strains isolated from pregnant women without diarrhea in china. as part of this study, 3.7% (37 out of 1009) of samples acquired from pregnant females tested positive for c. difficile. of these positive samples, 27.0% (10) were toxig ...201626633756
clostridium difficile infection in texas hospitals, 2007-2011. 201626651237
clostridium difficile infection: a rarity in patients receiving chronic antibiotic treatment for crohn's disease.prolonged antibiotic use is limited by several adverse effects, one of which is clostridium difficile infection (cdi). the aim of this study was to determine the incidence of cdi in patients receiving chronic antibiotic treatment for crohn's disease (cd).201626650148
clinical significance of clostridium difficile in children less than 2 years old: a case-control study.the significance of clostridium difficile (cd) in the stools of children 2 years old or younger remains unclear. the aim of this study was to investigate risk factors and clinical evolution of diarrheic children ≤2 years old with or without cd in their stools.201626650114
peri-transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant.clostridium difficile infections (cdi) remain the leading cause of infectious diarrhea among hospitalized patients in this country. patients with hematologic malignancies, especially those who undergo hematopoietic progenitor cell transplants are particularly at risk for developing cdi. one hundred and forty seven consecutive allogeneic hematopoietic progenitor cell transplants were analyzed for peri-transplant clostridium difficile infections (pt-cdi). sixteen patients (11%) developed pt-cdi (m ...201626661725
persistence of clostridium difficile in wastewater treatment-derived biosolids during land application or windrow composting.to determine the persistence of clostridium difficile spores in biosolids during composting or when amended into soil and held under natural environmental climatic conditions.201626661445
the impact of the introduction of fidaxomicin on the management of clostridium difficile infection in seven nhs secondary care hospitals in england: a series of local service evaluations.clostridium difficile infection (cdi) is associated with high mortality. reducing incidence is a priority for patients, clinicians, the national health service (nhs) and public health england alike. in june 2012, fidaxomicin (fdx) was launched for the treatment of adults with cdi. the objective of this evaluation was to collect robust real-world data to understand the effectiveness of fdx in routine practice. in seven hospitals introducing fdx between july 2012 and july 2013, data were collected ...201626661400
effect of an antimicrobial stewardship bundle for patients with clostridium difficile infection.the study objective was to determine whether there was an improvement in compliance with recommended clostridium difficile infection (cdi) treatment after introduction of an institutional cdi bundle with daily antimicrobial stewardship assessment.201626661392
ultrasensitive detection and quantification of toxins for optimized diagnosis of clostridium difficile infection.recently developed ultrasensitive and quantitative methods for detection of clostridium difficile toxins provide new tools for diagnosis and, potentially, for management of c. difficile infection (cdi). compared to methods that detect toxigenic organism, ultrasensitive toxin detection may allow diagnosis of cdi with increased clinical specificity, without sacrificing clinical sensitivity; measurement of toxin levels may also provide information relevant to disease prognosis. this minireview prov ...201626659205
proton pump inhibitors affect the gut microbiome.proton pump inhibitors (ppis) are among the top 10 most widely used drugs in the world. ppi use has been associated with an increased risk of enteric infections, most notably clostridium difficile. the gut microbiome plays an important role in enteric infections, by resisting or promoting colonisation by pathogens. in this study, we investigated the influence of ppi use on the gut microbiome.201626657899
subinhibitory concentrations of metronidazole increase biofilm formation in clostridium difficile strains.resistance mechanism to metronidazole is still poorly understood, even if the number of reports on clostridium difficile strains with reduced susceptibility to this antibiotic is increasing. in this study, we investigated the ability of the c. difficile strains 7032994, 7032985 and 7032989, showing different susceptibility profiles to metronidazole but all belonging to the pcr ribotype 010, to form biofilm in vitro in presence and absence of subinhibitory concentrations of metronidazole. the qua ...201626656887
clostridium difficile-diagnostic and clinical challenges. 201626656133
the insect peptide copa3 increases colonic epithelial cell proliferation and mucosal barrier function to prevent inflammatory responses in the gut.the epithelial cells of the gut form a physical barrier against the luminal contents. the collapse of this barrier causes inflammation, and its therapeutic restoration can protect the gut against inflammation. egf enhances mucosal barrier function and increases colonocyte proliferation, thereby ameliorating inflammatory responses in the gut. based on our previous finding that the insect peptide copa3 promotes neuronal growth, we herein tested whether copa3 could increase the cell proliferation o ...201626655716
the uncertain benefits of combination therapy for clostridium difficile infection. 201626703863
colectomy in pediatric ulcerative colitis: a single center experience of indications, outcomes, and complications.there is a paucity of data on outcomes and complications of colectomy for pediatric ulcerative colitis (uc). this study reports the experience of a regional center for 18years.201626653944
prevention of infections in nursing homes: antibiotic prophylaxis versus infection control and antimicrobial stewardship measures.because of the lack of structural and human resources for implementing more effective and safe preventive procedures, antimicrobial prophylaxis is often used to prevent infections in nursing homes. however, if data on the efficacy of antibiotic prophylaxis in nursing homes are null, there is a plenty of evidence that the inappropriate use of antimicrobials in this setting is associated with a high rate of colonization and infection with multi-drug-resistant organisms (mdros), and of clostridium ...201626655286
clinical and healthcare burden of multiple recurrences of clostridium difficile infection.clostridium difficile infection (cdi) is associated with a high risk of recurrence (rcdi). few studies have focused on multiple recurrences. to evaluate the potential of novel treatments targeting recurrence, we assessed the burden and severity of rcdi.201626582748
development and evaluation of double locus sequence typing for molecular epidemiological investigations of clostridium difficile.despite the development of novel typing methods based on whole genome sequencing, most laboratories still rely on classical molecular methods for outbreak investigation or surveillance. reference methods for clostridium difficile include ribotyping and pulsed-field gel electrophoresis, which are band-comparing methods often difficult to establish and which require reference strain collections. here, we present the double locus sequence typing (dlst) scheme as a tool to analyse c. difficile isola ...201626581425
a high rate of alternative diagnoses in patients referred for presumed clostridium difficile infection.we evaluated a cohort of patients referred to our center for presumed recurrent clostridium difficile infection (cdi) to determine final diagnoses and outcomes.201626565971
novel therapeutic strategies for clostridium difficile infections.in recent years, clostridium difficile has become the primary cause of antibiotic-associated diarrhea and pseudomembranous colitis, resulting in long and complicated hospital stays that represent a serious burden for patients as well as health care systems. currently, conservative treatment of c. difficile infection (cdi) relies on the antibiotics vancomycin, metronidazole or fidaxomicin, or in case of multiple recurrences, fecal microbiota transplantation (fmt).201626565670
safety and durability of rbx2660 (microbiota suspension) for recurrent clostridium difficile infection: results of the punch cd study.managing recurrent clostridium difficile infection (cdi) presents a significant challenge for clinicians and patients. fecal microbiota transplantation (fmt) is a highly effective therapy for recurrent cdi, yet availability of a standardized, safe, and effective product has been lacking. our aim in this study was to assess the safety and effectiveness of rbx2660 (microbiota suspension), a commercially prepared fmt drug manufactured using standardized processes and available in a ready-to-use for ...201626565008
inactivation of clostridium difficile in sewage sludge by anaerobic thermophilic digestion.there has been an increase in community-associated clostridium difficile infections with biosolids derived from wastewater treatment being identified as one potential source. the current study evaluated the efficacy of thermophilic digestion in decreasing levels of c. difficile ribotype 078 associated with sewage sludge. five isolates of c. difficile 078 were introduced (final density of 5 log cfu/g) into digested sludge and subjected to anaerobic digestion at mesophilic (36 or 42 °c) or thermop ...201626564276
nisin is an effective inhibitor of clostridium difficile vegetative cells and spore germination.clostridium difficile is the most frequently identified enteric pathogen in patients with nosocomial antibiotic-associated diarrhoea and pseudomembranous colitis. several clinically isolated c. difficile strains are resistant to antibiotics other than metronidazole and vancomycin. recently, bacteriocins of lactic acid bacteria have been proposed as an alternative or complementary treatment. the aim of this study was to investigate the inhibitory effect of nisin, a bacteriocin produced by several ...201626555543
diagnostic testing for clostridium difficile in italian microbiological laboratories.a laboratory diagnosis survey of clostridium difficile infection (cdi) was performed in italy in 2012-2013. questionnaires from 278 healthcare settings from 15 regions of italy were collected and analysed. eighty seven percent of the laboratories declared to routinely perform cdi diagnosis, 99% of them only after the clinician's request. among the 216 laboratories providing information on the size of the hospitals in which they were located, 65 had more than 500 beds (large hospitals), while 151 ...201626555737
defining appropriate use of proton-pump inhibitors among medical inpatients.proton-pump inhibitors (ppis) are commonly used among medical inpatients, both for prophylaxis against upper gastrointestinal bleeding (ugib) and continuation of outpatient use. while ppis reduce the risk of ugib, they also appear to increase the risk of hospital-acquired pneumonia (hap) and clostridium difficile infection (cdi). depending upon the underlying risks of these conditions and the changes in those risks with ppis, use of proton-pump inhibitors may lead to a net benefit or net harm am ...201626553337
clostridium difficile colonization in asymptomatic infants 1 to 12 months old, admitted to a community hospital. 201626581362
multidisciplinary performance improvement team for reducing health care-associated clostridium difficile infection.clostridium difficile is the most frequent cause of health care-associated diarrhea and is a significant cause of morbidity and mortality. it is also associated with a considerable financial burden. a concerted multidisciplinary approach is required for prevention.201626541068
outcomes of clostridium difficile infection in pediatric solid organ transplant recipients.the incidence of clostridium difficile infection (cdi) is increasing in the pediatric population. pediatric recipients of solid organ transplantation (sot) may be at a higher risk for cdi in part because of chemotherapy and prolonged hospitalization.201626538348
the effect of broader, directed antimicrobial prophylaxis including fungal coverage on perioperative infectious complications after radical cystectomy.radical cystectomy (rc) with urinary diversion has a significant risk of infection. in an effort to decrease the rate of infectious complications, we instituted a broader, culture-based preoperative antimicrobial regimen, including fungal coverage, and studied its effect on infectious complications after rc.201626572724
routine detection of clostridium difficile in western australia.despite increasing infection rates, clostridium difficile is not currently routinely tested for in all diarrhoeal faecal specimens in australia. in july 2014, all diarrhoeal specimens submitted to a diagnostic laboratory in western australia were surveyed to determine the true prevalence of c. difficile. in total, 1010 diarrhoeal non-duplicate faecal specimens were received during the month. testing for c. difficile was requested, or the criteria for a c. difficile investigation were met, for 67 ...201626592987
assessment of clostridium difficile burden in patients over time with first episode infection following fidaxomicin or vancomycin.in patients with first episode clostridium difficile infection treated with vancomycin or fidaxomicin, more patients receiving fidaxomicin achieved at least 2 log10 colony-forming units/g reduction in spores at the follow-up visit (p=.02). similar to published literature, a higher proportion of patients receiving fidaxomicin demonstrated sustained clinical response.201626592763
inactivation of clostridium difficile spores by microwave irradiation.spores are a potent agent for clostridium difficile transmission. therefore, factors inhibiting spores have been of continued interest. in the present study, we investigated the influence of microwave irradiation in addition to conductive heating for c. difficile spore inactivation in aqueous suspension. the spores of 15 c. difficile isolates from different host origins were exposed to conductive heating and microwave irradiation. the complete inhibition of spore viability at 10(7) cfu/ml was en ...201626546732
predominance of clostridium difficile ribotypes 012, 027 and 046 in a university hospital in chile, 2012.in a 1-year survey at a university hospital we found that 20·6% (81/392) of patients with antibiotic associated diarrohea where positive for c. difficile. the most common pcr ribotypes were 012 (14·8%), 027 (12·3%), 046 (12·3%) and 014/020 (9·9). the incidence rate was 2·6 cases of c. difficile infection for every 1000 outpatients.201626489717
antibiotic prophylaxis and risk of clostridium difficile infection after coronary artery bypass graft surgery.antibiotic use, particularly type and duration, is a crucial modifiable risk factor for clostridium difficile. cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48 hours or less (vs ≤24 hours for noncardiac surgery), with increasing vancomycin use. we aimed to study associations between antibiotic prophylaxis (duration/vancomycin use) and c difficile among patients undergoing coronary artery bypass grafting.201626545971
ursodeoxycholic acid inhibits clostridium difficile spore germination and vegetative growth, and prevents the recurrence of ileal pouchitis associated with the infection.to test whether ursodeoxycholic acid (udca) is inhibitory to clostridium difficile and can be used in the treatment of c. difficile-associated ileal pouchitis.201626485102
defective mutations within the translocation domain of clostridium difficile toxin b impair disease pathogenesis.the clostridium difficile toxin b is one of the main virulence factors and plays an important role in the pathogenesis of c. difficile infection (cdi). we recently revealed crucial residues in the translocation domain of tcdb for the pore formation and toxin translocation. in this study, we investigated the effects of mutating a critical site involved in pore formation, leu-1106, to residues that differ in size and polarity (phe, ala, cys, asp). we observed a broad range of effects on tcdb funct ...201626507679
evaluating the use of the case mix index for risk adjustment of healthcare-associated infection data: an illustration using clostridium difficile infection data from the national healthcare safety network.background case mix index (cmi) has been used as a facility-level indicator of patient disease severity. we sought to evaluate the potential for cmi to be used for risk adjustment of national healthcare safety network (nhsn) healthcare-associated infection (hai) data. methods nhsn facility-wide laboratory-identified clostridium difficile infection event data from 2012 were merged with the fiscal year 2012 inpatient prospective payment system (ipps) impact file by cms certification number (ccn) t ...201626486597
transmission of clostridium difficile during hospitalization for allogeneic stem cell transplant.objective to determine the role of unit-based transmission that accounts for cases of early clostridium difficile infection (cdi) during hospitalization for allogeneic stem cell transplant. setting stem cell transplant unit at a tertiary care cancer center. methods serially collected stool from patients admitted for transplant was screened for toxigenic c. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. in addition, isolates retrieved from cases of ...201626486102
clostridium difficile infection after subarachnoid hemorrhage: a nationwide analysis.clostridium difficile infection (cdi) is an important cause of hospital-acquired morbidity and mortality.201626485334
clinical and microbiologic assessment of cases of pediatric community-associated clostridium difficile infection reveals opportunities for improved testing decisions.most children with clostridium difficile infection (cdi) experience community onset of cdi symptoms.201626517329
single fluorophore melting curve analysis for detection of hypervirulent clostridium difficile.this study demonstrates a novel detection assay able to identify and subtype strains of clostridium difficile. primers carefully designed for melting curve analysis amplify dna from three c. difficile genes, tcdb, tcdc and cdtb, during quantitative (q)pcr. the tcdb gene allows for confirmation of organism presence, whilst the tcdc and cdtb genes allow for differentiation of virulence status, as deletions in the tcdc gene and the concurrent presence of the cdtb gene, which produces binary toxin, ...201626516039
natural history of elderly-onset ulcerative colitis: results from a territory-wide inflammatory bowel disease registry.data on the natural history of elderly-onset ulcerative colitis [uc] are limited. we aimed to investigate clinical features and outcomes of patients with elderly-onset uc.201626512132
clinical utility of laboratory detection of clostridium difficile strain bi/nap1/027.clostridium difficile strain bi/nap1/027 is associated with increased c. difficile infection (cdi) rates and severity, and the efficacy of some cdi therapies may be strain dependent. although cultured c. difficile isolates can be reliably subtyped by various methods, the long turnaround times, high cost, and limited availability of strain typing preclude their routine use. nucleic acid amplification tests identify bi/nap1/027 rapidly from stool, but the emergence of closely related strains compr ...201626511742
an update on clostridium difficile toxinotyping.toxinotyping is a pcr-restriction fragment length polymorphism (rflp)-based method for differentiation of clostridium difficile strains according to the changes in the pathogenicity locus (paloc), a region coding for toxins a and b. toxinotypes are a heterogenous group of strains that are important in the development of molecular diagnostic tests and vaccines and are a good basis for c. difficile phylogenetic studies. here we describe an overview of the 34 currently known toxinotypes (i to xxxiv ...201626511734
clinical significance of direct cytotoxicity and toxigenic culture in clostridium difficile infection.clostridium difficile infection (cdi) is the leading cause of hospital-acquired diarrhoea in developed countries. although an optimal diagnosis is crucial, laboratory diagnostics remain challenging. currently, the reference methods are direct cytotoxicity assay and toxigenic culture; however there is controversy in the interpretation of discordant results of these tests.201626505927
immunogenic properties of the surface layer precursor of clostridium difficile and vaccination assays in animal models.clostridium difficile is an opportunistic pathogen causing gut inflammation generally associated with an intestinal dysbiosis due to antibiotics. several virulence factors have been identified as playing a key role in gut colonization. the surface-layer proteins, comprised of two proteins, the high molecular weight slpa (hmw-slp) and the low molecular weight slpa (lmw-slp), are the most abundant proteins on the c. difficile surface. these two proteins are derived from the cwp84-mediated cleavage ...201626505926
risk factors for recurrent clostridium difficile infection in allogeneic hematopoietic cell transplant recipients.clostridium difficile infection (cdi) is one of the leading causes of hospital-acquired infections in recent times. hematopoietic stem cell transplantation (hsct) confers increased risk for cdi because of prolonged hospital stay, immunosuppression, the need to use broad-spectrum antibiotics and a complex interplay of preparative regimen and gvhd-induced gut mucosal damage. our study evaluated risk factors (rf) for recurrent cdi in hsct recipients given the ubiquity of traditional rf for cdi in t ...201626726944
research in review: driving critical care practice change.during the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. this article summarizes some of this important work and considers it in the context of previous research and practice. examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma. care challenges addressed include eth ...201626724298
functional anatomy of the colonic bioreactor: impact of antibiotics and saccharomyces boulardii on bacterial composition in human fecal cylinders.sections of fecal cylinders were analyzed using fluorescence in situ hybridization targeting 180 bacterial groups. samples were collected from three groups of women (n=20 each) treated for bacterial vaginosis with ciprofloxacin+metronidazole. group a only received the combined antibiotic regimen, whereas the a/sb group received concomitant saccharomyces boulardii cncm i-745 treatment, and the a_sb group received s. boulardii prophylaxis following the 14-day antibiotic course. the number of stool ...201626723852
sentinel community clostridium difficile infection (cdi) surveillance in scotland, april 2013 to march 2014.surveillance of clostridium difficile infection (cdi) in scotland does not currently distinguish between cdi cases from hospitals and the community. therefore, the incidence of cdi in the community is unknown, and the burden of disease and the relationship with the hospital/healthcare setting is not well understood. a one-year sentinel community surveillance programme was initiated in collaboration with five scottish health boards in 2013 (representing 36% of all cdi cases reported in scotland). ...201626708405
nonclinical safety assessment of syn-004: an oral β-lactamase for the protection of the gut microbiome from disruption by biliary-excreted, intravenously administered antibiotics.syn-004 is a first in class, recombinant β-lactamase that degrades β-lactam antibiotics and has been formulated to be administered orally to patients receiving intravenous β-lactam antibiotics including cephalosporins. syn-004 is intended to degrade unmetabolized antibiotics excreted into the intestines and thus has the potential to protect the gut microbiome from disruption by these antibiotics. protection of the gut microbiome is expected to protect against opportunistic enteric infections suc ...201626700136
comparison of multilocus sequence typing and the xpert c. difficile/epi assay for identification of clostridium difficile 027/nap1/bi.clostridium difficile 027/nap1/bi is the most common c. difficile strain in the united states. the xpert c. difficile/epi assay allows rapid, presumptive identification of c. difficile nap1. we compared xpert c. difficile/epi to multilocus sequence typing for identification of c. difficile nap1 and found "very good" agreement at 97.9% (κ = 0.86; 95% confidence interval, 0.80 to 0.91).201626699700
epidemiology, outcomes, and predictors of mortality in hospitalized adults with clostridium difficile infection.studies have demonstrated an increasing clostridium difficile infection (cdi) incidence in hospitals and the community, with increasing morbidity and mortality. in this study, we analyzed data from the national hospital discharge survey (nhds) to evaluate cdi epidemiology, outcomes, and predictors of mortality in hospitalized adults. we identified cases of cdi (and associated comorbid conditions) from nhds data from 2005 through 2009 using icd-9 codes. weighted univariate and multivariate analys ...201626694494
reducing overutilization of testing for clostridium difficile infection in a pediatric hospital system: a quality improvement initiative.study objectives included addressing overuse of clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing.201626692547
identification of oligosaccharides in human milk bound onto the toxin a carbohydrate binding site of clostridium difficile.the oligosaccharides in human milk constitute a major innate immunological mechanism by which breastfed infants gain protection against infectious diarrhea. clostridium difficile is the most important cause of nosocomial diarrhea, and the c-terminus of toxin a with its carbohydrate binding site, tcda-f2, demonstrates specific abolishment of cytotoxicity and receptor binding activity upon diethylpyrocarbonate modification of the histidine residues in tcda. tcda-f2 was cloned and expressed in e. c ...201626718473
evaluation of xpert c. difficile, bd max cdiff, imdx c. difficile for abbott m2000, and illumigene c. difficile assays for direct detection of toxigenic clostridium difficile in stool specimens.we evaluated the performance of four commercial nucleic acid amplification tests (naats: xpert c. difficile, bd max cdiff, imdx c. difficile for abbott m2000, and illumigene c. difficile) for direct and rapid detection of clostridium difficile toxin genes.201626709260
clostridium difficile-related hospitalizations in madrid (spain) between 2003 and 2014, a rising trend. 201626709248
[identifying gaps between guidelines and clinical practice in clostridium difficile infection].the first aim was to determine whether patients are being treated in accordance with the society for healthcare epidemiology of america and the infectious diseases society of america (idsa/shea) clostridium difficile guidelines and whether adherence impacts patient outcomes. the second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation.201626708998
clostridium difficile-mediated effects on human intestinal epithelia: modelling host-pathogen interactions in a vertical diffusion chamber.clostridium difficile infection is one of the leading causes of healthcare associated diarrhoea in the developed world. although the contribution of c. difficile toxins to disease pathogenesis is now well understood, many facets of host-pathogen interactions between the human intestinal epithelia and the c. difficile bacterium that may contribute to asymptomatic carriage and/or clinical disease remain less clear. herein, we tested the hypothesis that c. difficile strains mediate intestinal epith ...201626708704
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