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analysis of tcdb proteins within the hypervirulent clade 2 reveals an impact of rhoa glucosylation on clostridium difficile proinflammatory activities.clostridium difficile strains within the hypervirulent clade 2 are responsible for nosocomial outbreaks worldwide. the increased pathogenic potential of these strains has been attributed to several factors but is still poorly understood. during a c. difficile outbreak, a strain from this clade was found to induce a variant cytopathic effect (cpe), different from the canonical arborizing cpe. this strain (nap1v) belongs to the nap1 genotype but to a ribotype different from the epidemic nap1/rt027 ...201626755157
first recurrence of clostridium difficile infection: clinical relevance, risk factors, and prognosis.therapy for recurrent clostridium difficile-associated diarrhea (cdad) is challenging. we evaluated the frequency, associated risk factors, and prognosis of first cdad recurrences. prospective cohort study of all consecutive cases of primary cdad diagnosed in a university hospital from january 2006 to june 2013. recurrent infection was defined as reappearance of symptoms within 8 weeks of the primary diagnosis, provided that cdad symptoms had previously resolved and a new toxin test was positive ...201626753991
antimicrobial stewardship in a long-term acute care hospital using offsite electronic medical record audit.objective to offer antimicrobial stewardship to a long-term acute care hospital using telemedicine. methods we conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired clostridium difficile infection (cdi) rates and antimicrobial use. simple linear regression was used to analyze changes in antimicrobial use; poisson regression was used to estimate the incidence rate ratio in cdi rates. the preimplementation period was april 1, 2010-m ...201626752662
discontinuation of systematic surveillance and contact precautions for vancomycin-resistant enterococcus (vre) and its impact on the incidence of vre faecium bacteremia in patients with hematologic malignancies.objective to study the effect of discontinuation of systematic surveillance for vancomycin-resistant enterococcus (vre) and contact isolation of colonized patients on the incidence of vre bacteremia setting a hematology-oncology unit with high prevalence of vre colonization characterized by predominantly sporadic molecular epidemiology participants inpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantation methods the incidence of vre bacteremia was measur ...201626750087
susceptibility of clostridium difficile to the food preservatives sodium nitrite, sodium nitrate and sodium metabisulphite.clostridium difficile is an important enteric pathogen of humans and food animals. recently it has been isolated from retail foods with prevalences up to 42%, prompting concern that contaminated foods may be one of the reasons for increased community-acquired c. difficile infection (ca-cdi). a number of studies have examined the prevalence of c. difficile in raw meats and fresh vegetables; however, fewer studies have examined the prevalence of c. difficile in ready-to-eat meat. the aim of this s ...201626700884
spectrum of clostridium difficile infections: particular clinical situations.incidence, pathogenesis, diagnostic techniques and therapeutic management of cdi have prompted abundant and adequate recent literature. however, report on clinical manifestations of cdi is frequently biased by the type of patients selected, the retrospective nature of many papers, the epidemic or endemic characteristics of the population reported. this article seeks to review some less discussed clinical and epidemiological aspects of cdi trying to include the clinical manifestations of this dis ...201626700883
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
clostridium difficile infection in pediatric inflammatory bowel disease.children with inflammatory bowel disease (ibd) are disproportionately susceptible to clostridium difficile infection (cdi) and the incidence is increasing. there has also been growing recognition of asymptomatic c. difficile colonization in pediatric ibd, which can sometimes be very difficult to distinguish from symptomatic c. difficile-associated disease in this population. in this study, we discuss the current knowledge of c. difficile infection in children with ibd, reviewing epidemiology, ri ...201626689599
immunogenicity and protective efficacy of clostridium difficile spore proteins.clostridium difficile is a spore-forming, anaerobic, gram-positive organism that is the leading cause of antibiotic-associated infectious diarrhea, commonly known as c. difficile infection (cdi). c. difficile spores play an important role in the pathogenesis of cdi. spore proteins, especially those that are surface-bound may play an essential role in the germination, colonization and persistence of c. difficile in the human gut. in our current study, we report the identification of two surface-b ...201626688279
clostridium difficile: the more we learn, the less we know. 201626687712
contamination of australian newborn calf carcasses at slaughter with clostridium difficile.in north america and europe, reports of a genetic overlap between toxigenic strains of clostridium difficile isolated from humans, livestock and retail meat suggest that food-borne transmission may be occurring. we investigated the prevalence, concentration and genetic diversity of c. difficile on the carcasses (n = 300) and in the faeces (n = 30) of neonatal veal calves at three abattoirs in australia in 2013. selective culture (both direct and enrichment) was performed, and all isolates were c ...201626686811
clostridium difficile infections in veterans health administration long-term care facilities.a nationwide initiative was implemented in february 2014 to decrease clostridium difficile infections (cdi) in veterans affairs (va) long-term care facilities. we report a baseline of national cdi data collected during the 2 years before the initiative.201626686361
impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital.the role of contaminated environments in the spread of hospital-associated infections has been well documented. this study reports the impact of a pulsed xenon ultraviolet no-touch disinfection system on infection rates in a community care facility.201626684369
postdischarge decontamination of mrsa, vre, and clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-c-emitting devices.two ultraviolet-c (uvc)-emitting devices were evaluated for effectiveness in reducing methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), and clostridium difficile (cd).201626684367
crystal structure of the ctp1l endolysin reveals how its activity is regulated by a secondary translation product.bacteriophages produce endolysins, which lyse the bacterial host cell to release newly produced virions. the timing of lysis is regulated and is thought to involve the activation of a molecular switch. we present a crystal structure of the activated endolysin ctp1l that targets clostridium tyrobutyricum, consisting of a complex between the full-length protein and an n-terminally truncated c-terminal cell wall binding domain (cbd). the truncated cbd is produced through an internal translation sta ...201626683375
genome-based infection tracking reveals dynamics of clostridium difficile transmission and disease recurrence.accurate tracking of clostridium difficile transmission within healthcare settings is key to its containment but is hindered by the lack of discriminatory power of standard genotyping methods. we describe a whole-genome phylogenetic-based method to track the transmission of individual clones in infected hospital patients from the epidemic c. difficile 027/st1 lineage, and to distinguish between the 2 causes of recurrent disease, relapse (same strain), or reinfection (different strain).201626683317
editorial commentary: whole-genome sequencing of clostridium difficile: exquisitely sensitive but not yet optimally applied. 201626683316
a novel, sporicidal formulation of ethanol for glove decontamination to prevent clostridium difficile hand contamination during glove removal.decontamination of gloves before removal could reduce the risk for contamination of hands of personnel caring for patients with clostridium difficile infection. we demonstrated that a novel sporicidal formulation of ethanol rapidly reduced c. difficile spores on gloved hands without adverse odor, respiratory irritation, or staining of clothing.201626679745
clostridium difficile infection incidence: impact of audit and feedback programme to improve room cleaning.audit and feedback programmes (afps) using fluorescent marking lead to improvements in room cleaning but have not been linked to reduced clostridium difficile infection (cdi) incidence.201626679727
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
systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for clostridium difficile infection.clostridium difficile infection is a major cause of nosocomial diarrhoea.201626662643
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
recent advances in the understanding of antibiotic resistance in clostridium difficile infection.clostridium difficile epidemiology has changed in recent years, with the emergence of highly virulent types associated with severe infections, high rates of recurrences and mortality. antibiotic resistance plays an important role in driving these epidemiological changes and the emergence of new types. while clindamycin resistance was driving historical endemic types, new types are associated with resistance to fluoroquinolones. furthermore, resistance to multiple antibiotics is a common feature ...201626862400
opportunities for improvement in the care of patients hospitalized for inflammatory bowel disease-related colitis.algorithms for the diagnosis, management, and follow-up have been proposed for patients hospitalized for inflammatory bowel disease (ibd) colitis flare. the degree to which providers adhere to these algorithms is unknown. this study evaluated the quality of care in ibd patients hospitalized for disease-associated exacerbations and factors correlated with higher degrees of care.201626860508
the importance of matrix-assisted laser desorption ionization-time of flight mass spectrometry for correct identification of clostridium difficile isolated from chromid c. difficile chromogenic agar.the clinical workflow of using chromogenic agar and matrix-assisted laser desorption ionization time-of-fight mass spectrometry (maldi-tof ms) for clostridium difficile identification was evaluated. the addition of maldi-tof ms identification after the chromid c. difficile chromogenic agar culture could significantly improve the diagnostic accuracy of c. difficile.201626860352
a comparison of clostridium difficile diagnostic methods for identification of local strains in a south african centre.accurate diagnosis of clostridium difficile infection is essential for disease management. a clinical and molecular analysis of c. difficile isolated from symptomatic patients at groote schuur hospital, south africa, was conducted to establish the most suitable clinical test for the diagnosis and characterisation of locally prevalent strains. c. difficile was detected in stool samples using enzyme-based immunoassays (eia) and nucleic acid amplification methods, and their performance was compared ...201626860329
breakthroughs in the treatment and prevention of clostridium difficile infection.this review summarizes the latest advances in the treatment and prevention of clostridium difficile infection (cdi), which is now the most common health-care-associated infection in the usa. as traditional, standard cdi antibiotic therapies (metronidazole and vancomycin) are limited by their broad spectrum and further perturbation of the intestinal microbiota, which result in unacceptably high recurrence rates, novel therapeutic strategies for cdi are needed. emerging cdi therapies are focused o ...201626860266
identification of medicare recipients at highest risk for clostridium difficile infection in the us by population attributable risk analysis.population attributable risk percent (par%) is an epidemiological tool that provides an estimate of the percent reduction in total disease burden if that disease could be entirely eliminated among a subpopulation. as such, par% is used to efficiently target prevention interventions. due to significant limitations in current clostridium difficile infection (cdi) prevention practices and the development of new approaches to prevent cdi, such as vaccination, we determined the par% for cdi in variou ...201626859403
hospital clostridium difficile infection rates and prediction of length of stay in patients without c. difficile infection.background inpatient length of stay (los) has been used as a measure of hospital quality and efficiency. patients with clostridium difficile infections (cdi) have longer los. objective to describe the relationship between hospital cdi incidence and the los of patients without cdi. design retrospective cohort analysis. methods we predicted average los for patients without cdi at both the hospital and patient level using hospital cdi incidence. we also controlled for hospital characteristics (eg, ...201626858126
introduction to the special issue on clostridium difficile and the history of the international clostridium difficile symposium (icds). 201626856973
prevention of stress-related ulcer bleeding at the intensive care unit: risks and benefits of stress ulcer prophylaxis.stress-related mucosal disease is a typical complication of critically ill patients in the intensive care unit (icu). it poses a risk of clinically relevant upper gastrointestinal (gi) bleeding. therefore, stress ulcer prophylaxis (sup) is recommended in high-risk patients, especially those mechanically ventilated > 48 h and those with a manifest coagulopathy. proton pump inhibitors (ppi) and, less effectively, histamine 2 receptor antagonists (h2ra) prevent gi bleeding in critically ill patient ...201626855894
a response to the relationship between different types of sharps containers and clostridium difficile infection rates in acute care hospitals. 201626852081
reply to dikon in response to "a response to the relationship between different types of sharps containers and clostridium difficile infection rates in acute care hospitals". 201626851197
coexisting cytomegalovirus infection in immunocompetent patients with clostridium difficile colitis.cytomegalovirus (cmv) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents. however, cmv colitis is increasingly recognized in immunocompetent hosts. notably, cmv colitis coexisting with clostridium difficile infection (cdi) in apparently healthy individuals has been published in recent years, which could result in high morbidity and m ...201626850320
ultrastructural variability of the exosporium layer of clostridium difficile spores.the anaerobic sporeformer clostridium difficile is the leading cause of nosocomial antibiotic-associated diarrhea in developed and developing countries. the metabolically dormant spore form is considered the transmission, infectious, and persistent morphotype, and the outermost exosporium layer is likely to play a major role in spore-host interactions during the first contact of c. difficile spores with the host and for spore persistence during recurrent episodes of infection. although some stud ...201626850296
clostridium difficile associated risk of death score (cards): a novel severity score to predict mortality among hospitalised patients with c. difficile infection.clostridium difficile infection (cdi) is a public health threat and associated with significant mortality. however, there is a paucity of objectively derived cdi severity scoring systems to predict mortality.201626849527
telephone survey of infection-control and antibiotic stewardship practices in long-term care facilities in maryland.multidrug-resistant organisms are an emerging and serious threat to the care of patients. long-term care facilities are considered a reservoir of these organisms partly because of the over-prescribing of antibiotics. antibiotic use is common in long-term care facilities. antibiotic stewardship programs have been shown to reduce antibiotic consumption in acute-care facilities. the purpose of our study is to investigate existing infection-control practices and antibiotic stewardship programs in lo ...201626848066
beneficial effects of fecal microbiota transplantation on ulcerative colitis in mice.ulcerative colitis (uc) is a chronic condition and the most common form of inflammatory bowel disease. the goal of standard treatment is mainly to induce and maintain remission with anti-inflammatory, immunosuppressive agents, and/or colectomy. fecal microbiota transplantation (fmt) has been used successfully to treat relapsing or refractory clostridium difficile infection. the alteration of microbiota in mouse models of uc as well as in patients suggested the possibility of treating uc with fmt ...201626846120
predicting the risk of clostridium difficile infection upon admission: a score to identify patients for antimicrobial stewardship efforts.increasing morbidity and health care costs related to clostridium difficile infection (cdi) have heightened interest in methods to identify patients who would most benefit from interventions to mitigate the likelihood of cdi.201626845084
does alkaline colonic ph predispose to clostridium difficile infection?clostridium difficile caused nearly 500,000 infections and was associated with approximately 29,000 deaths in 2011, according to data from the centers for disease control and prevention. c. difficile is a bacterium that causes diarrhea and, often, severe illness in healthcare facilities, as well as the community. our objective was to determine whether alkaline colonic ph predisposes to colonization and infection with c. difficile.201626840963
immunogenicity and protective efficacy of recombinant clostridium difficile flagellar protein flic.clostridium difficile is a gram-positive bacillus and is the leading cause of toxin-mediated nosocomial diarrhea following antibiotic use. c. difficile flagella play a role in colonization, adherence, biofilm formation, and toxin production, which might contribute to the overall virulence of certain strains. human and animal studies indicate that anti-flagella immune responses may play a role in protection against colonization by c. difficile and subsequent disease outcome. here we report that r ...201626839147
clostridium difficile-associated diarrhoea in primary joint arthroplasty in aneurin bevan university health board south.the choice of perioperative antibiotics to reduce the prevalence of infection after joint arthroplasty should be considered carefully to minimise the risk of nosocomial infections. dramatic increases in the incidence and severity of healthcare-associated clostridium difficile infection with clostridium difficile-associated diarrhoea (cdad) have occurred since 2000.201626836055
bacterial probiotics as an aid in the control of clostridium difficile disease in neonatal pigs.although clostridium difficile infection (cdi) is a common disease in swine, there is a lack of prevention strategies. the objectives of this study were to evaluate: i) the effectiveness of lactobacillus spp. and ii) non-toxigenic c. difficile (ntcd) as prevention for the development of cdi in piglets. cesarean-derived piglets (n = 150) were randomly assigned to 6 groups: group 1 - negative control (n = 10); group 2 - ntcd only (n = 13); group 3 - lactobacillus spp. only (n = 14); group 4 - posi ...201626834271
antibacterials developed to target a single organism: mechanisms and frequencies of reduced susceptibility to the novel anti-clostridium difficile compounds fidaxomicin and lff571.clostridium difficile is the most common cause of antibacterial-associated diarrhea. clear clinical presentation and rapid diagnostics enable targeted therapy for c. difficile infection (cdi) to start quickly. cdi treatment includes metronidazole and vancomycin (van). despite decades of use for cdi, no clinically meaningful resistance to either agent has emerged. fidaxomicin (fdx), an rna polymerase inhibitor, is also approved to treat cdi. mutants with reduced susceptibility to fdx have been se ...201626834162
treatment of clostridium difficile infection using sq641, a capuramycin analogue, increases post-treatment survival and improves clinical measures of disease in a murine model.clostridium difficile infection (cdi) is a primary cause of antibiotic-associated diarrhoeal illness. current therapies are insufficient as relapse rates following antibiotic treatment range from 25% for initial treatment to 60% for treatment of recurrence. in this study, we looked at the efficacy of sq641 in a murine model of cdi. sq641 is an analogue of capuramycin, a naturally occurring nucleoside-based compound produced by streptomyces griseus.201626832756
host-microbiota interactions in the pathogenesis of antibiotic-associated diseases.improved understanding of the interplay between host and microbes stands to illuminate new avenues for disease diagnosis, treatment, and prevention. here, we provide a high-resolution view of the dynamics between host and gut microbiota during antibiotic-induced intestinal microbiota depletion, opportunistic salmonella typhimurium and clostridium difficile pathogenesis, and recovery from these perturbed states in a mouse model. host-centric proteome and microbial community profiles provide a nua ...201626832403
a multi-laboratory comparison of two molecular methods for the detection of toxigenic clostridium difficile.diarrheal disease due to toxigenic clostridium difficile (cd) accounts for an increased number of hospitalizations and deaths each year. published guidelines recommend reflex testing of cd antigen-positive samples to molecular testing or testing samples directly by a molecular assay. this multicenter study was designed to compare the accuracy of two different molecular methods targeting different cd genes: xpert c. difficile epi ruo rt-pcr assay (xpcr) which targets toxin b (cepheid, sunnyvale, ...201626829538
peripheral neuropathy after fecal microbiota transplantation for clostridium difficile infection: a case report.we present a case of a 71-year-old man with clostridium difficile infection who underwent fecal transplantation. the patient was found to have a predominantly demyelinating sensorimotor peripheral polyneuropathy upon electrodiagnostic testing. to our knowledge, only one case of peripheral neuropathy after fecal transplantation has previously been reported. although the exact cause of this patient's neuropathy cannot be confirmed, it has been speculated that the pathophysiology is an immune-media ...201626826616
genome sequence and analysis of peptoclostridium difficile strain zjcdc-s82.peptoclostridium difficile (clostridium difficile) is the major pathogen associated with infectious diarrhea in humans. concomitant with the increased incidence of c. difficile infection worldwide, there is an increasing concern regarding this infection type. this study reports a draft assembly and detailed sequence analysis of c. difficile strain zjcdc-s82. the de novo assembled genome was 4.19 mb in size, which includes 4,013 protein-coding genes, 41 rrna genes, and 84 trna genes. along with t ...201626823648
prevalence of probiotic use among inpatients: a descriptive study of 145 u.s. hospitals.to inform clinical guidance, public health efforts, and research directions, probiotic use in u.s. health care needs to be better understood. this work aimed to assess the prevalence of inpatient probiotic use in a sample of u.s. hospitals.201626822808
fecal transplantation for clostridium difficile-"all stool may not be created equal".clostridium difficile is a gram-positive bacterium that is recognized as a causative organism of pseudomembranous enterocolitis. this infection has become a major public health challenge and is a source of considerable morbidity and mortality in those infected. we present a 62-year-old african american female with a long history of hiv infection, who presented with abdominal pain and continuous diarrhea due to pseudomembranous colitis. after failing multiple episodes of conventional therapy, it ...201626821578
infection prevention in transplantation.the number of patients undergoing hematopoietic cell and solid organ transplantation are increasing every year, as are the number of centers both transplanting and caring for these patients. improvements in transplant procedures, immunosuppressive regimens, and prevention of transplant-associated complications have led to marked improvements in survival in both populations. infections remain one of the most important sources of excess morbidity and mortality in transplant, and therefore, infecti ...201626820654
difficult case of cronkhite-canada syndrome with small intestinal bacterial overgrowth, clostridium difficile infection and polymyalgia rheumatica.a 64-year-old woman presented with heavy diarrhoea, nausea and weight loss accompanied by alopecia and dystrophic fingernails and toenails. the preceding diagnosis of an inflammatory bowel disease, a common pitfall, was excluded by endoscopic work up. instead, cronkhite-canada syndrome (ccs), a rare polyposis condition, was identified as the reason for this almost pathognomonic combination of diagnostic findings including various polyps throughout the entire intestine and ectodermal abnormalitie ...201626818813
inappropriate antibiotic use and gastric acid suppression preceding clostridium difficile infection. 201626818749
decolonization in prevention of health care-associated infections.colonization with health care-associated pathogens such as staphylococcus aureus, enterococci, gram-negative organisms, and clostridium difficile is associated with increased risk of infection. decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (hais). this review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. alt ...201626817630
refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation.pseudomembranous colitis (pmc) is a nosocomial and opportunistic infection caused by clostridium difficile. pmc is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of c. difficile. metronidazole or vancomycin is considered to be the standard therapy for the management of pmc. however, pmc has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. here we describe a patient who experienced refractory pmc who ...201626884739
nicotine inhibits clostridium difficile toxin a-induced colitis but not ileitis in rats.nicotine is protective in ulcerative colitis but not crohn's disease of the small intestine, but little is known about the effects of nicotine on clostridium difficile toxin a-induced enteritis. isolated ileal or colonic segments in anesthetized rats were pretreated with nicotine bitartrate or other pharmacological agents before intraluminal injection of toxin a. after 3 hours, the treated segments were removed and inflammation was assessed. nicotine biphasically inhibited toxin a colitis but no ...201626881175
complications of hospital-onset healthcare facility-associated clostridium difficile infections among veterans.complications within 30 days of a clinically confirmed hospital-onset clostridium difficile infection diagnosis from july 1, 2012, through june 30, 2015, in 127 acute care veterans health administration facilities were evaluated. pooled rates for attributable intensive care unit admissions, colectomies, and deaths were 2.7%, 0.5%, and 0.4%, respectively. infect control hosp epidemiol 2016;37:717-719.201626880482
integrating time-varying and ecological exposures into multivariate analyses of hospital-acquired infection risk factors: a review and demonstration.objectives hospital-acquired infections (hais) develop rapidly after brief and transient exposures, and ecological exposures are central to their etiology. however, many studies of hais risk do not correctly account for the timing of outcomes relative to exposures, and they ignore ecological factors. we aimed to describe statistical practice in the most cited hai literature as it relates to these issues, and to demonstrate how to implement models that can be used to account for them. methods we ...201626880280
an integrated metabolomic and microbiome analysis identified specific gut microbiota associated with fecal cholesterol and coprostanol in clostridium difficile infection.clostridium difficile infection (cdi) is characterized by dysbiosis of the intestinal microbiota and a profound derangement in the fecal metabolome. however, the contribution of specific gut microbes to fecal metabolites in c. difficile-associated gut microbiome remains poorly understood. using gas-chromatography mass spectrometry (gc-ms) and 16s rrna deep sequencing, we analyzed the metabolome and microbiome of fecal samples obtained longitudinally from subjects with clostridium difficile infec ...201626871580
the challenge and potential of metagenomics in the clinic.the bacteria, fungi, and viruses that live on and in us have a tremendous impact on our day-to-day health and are often linked to many diseases, including autoimmune disorders and infections. diagnosing and treating these disorders relies on accurate identification and characterization of the microbial community. current sequencing technologies allow the sequencing of the entire nucleic acid complement of a sample providing an accurate snapshot of the community members present in addition to the ...201626870044
toxin b pcr cycle threshold as a predictor of poor outcome of clostridium difficile infection: a derivation and validation cohort study.prediction of patients with poor outcome is necessary in order to plan the proper management of clostridium difficile infection (cdi); however, clinical criteria are insufficient. in a previous study, we observed that high toxigenic c. difficile cfu stool counts at diagnosis were associated with a poor outcome. our objective was to investigate the role of the pcr toxin b amplification cycle threshold (ct) in the prediction of cdi poor outcome and to derive and validate a high-risk prediction rul ...201626869691
a prospective study of two isothermal amplification assays compared with real-time pcr, ccna and toxigenic culture for the diagnosis of clostridium difficile infection.new molecular methods of detecting clostridium difficile infection (cdi) provide the routine lab with a sensitive random access method to produce results that are available in a shorter time than traditional methods.201626868647
molecular characterization and antimicrobial susceptibility of tcda-negative clostridium difficile isolates from guangzhou, china.this study aimed to investigate the molecular characteristics and antimicrobial susceptibility of clostridium difficile clinical isolates in guangzhou, china. one hundred twenty isolates were collected from guangzhou general hospital at the guangzhou military command in china from march 2014 to april 2015, and 9 isolates were identified as tcda-negative/tcdb-positive (a(-)b(+)) strains. results showed that all of the strains were confirmed to be st37 and 0 single nucleotide variants (snvs) were ...201626867962
is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? a natural experiment with non-equivalent controls.a wide range of patient benefits have been attributed to single room hospital accommodation including a reduction in adverse patient safety events. however, studies have been limited to the us with limited evidence from elsewhere. the aim of this study was to assess the impact on safety outcomes of the move to a newly built all single room acute hospital.201626811373
tigecycline as last resort in severe refractory clostridium difficile infection: a case report. 201626810610
a detrimental role of immunosuppressive drug, dexamethasone, during clostridium difficile infection in association with a gastrointestinal microbial shift.we investigated the increased risk of clostridium difficile infection (cdi) caused by the combined use of antibiotics and an immunosuppressive drug in a mouse model. our data showed that an approximate return to pretreatment conditions of gut microbiota occurred within days after cessation of the antibiotic treatment, whereas the recovery of gut microbiota was delayed with the combined treatment of antibiotics and dexamethasone, leading to an increased severity of cdi. an alteration of gut micro ...201626809802
potassium acetate blocks clostridium difficile toxin a-induced microtubule disassembly by directly inhibiting histone deacetylase 6, thereby ameliorating inflammatory responses in the gut.clostridium difficile toxin a is known to cause deacetylation of tubulin proteins, which blocks microtubule formation and triggers barrier dysfunction in the gut. based on our previous finding that the clostridium difficile toxin a-dependent activation of histone deacetylase 6 (hdac-6) is responsible for tubulin deacetylation and subsequent microtubule disassembly, we herein examined the possible effect of potassium acetate (pa; whose acetyl group prevents the binding of tubulin to hdac-6) as a ...201626809801
effect of variation in test methods on performance of ultraviolet-c radiation room decontamination.to determine the effect of variation in test methods on performance of an ultraviolet-c (uv-c) room decontamination device.201626809607
older is not wiser, immunologically speaking: effect of aging on host response to clostridium difficile infections.clostridium difficile infection (cdi) is the most common cause of antibiotic-associated diarrhea and a significant burden on the health care system. aging has been identified in the literature as a risk factor for cdi as well as adverse outcome from cdi. although this effect of advanced age on cdi could be partially explained by clinical factors associated with aging, biologic factors are important. innate immune system, responsible for immediate response to acute infections, plays a major role ...201626809495
adverse events in faecal microbiota transplant: a review of the literature.faecal microbiota transplant (fmt) is the infusion of donor faeces into the gut with the aim of improving microbial diversity. the procedure has gained significant interest recently in the treatment of recurrent clostridium difficile infection (cdi). the literature is currently dominated by small case series and isolated case reports. there is no standardization of methods and recording of outcomes.201626803556
clostridium difficile recurrences in stockholm.sixty-eight hospital-admitted patients with a first episode of clostridium difficile infection (cdi) were included and followed up during 1 year. faeces samples were collected at 1, 2, 6 and 12 months after inclusion and analyzed for the presence of c. difficile toxin b, genes for toxin a, toxin b, binary toxin and tcdc deletion by pcr. all strains were also pcr-ribotyped and the mics of the isolates were determined against eight antimicrobial agents. in 68 patients initially included, antibioti ...201626802875
burden of nursing home-onset clostridium difficile infection in the united states: estimates of incidence and patient outcomes.background.  approximately 4 million americans receive nursing home (nh) care annually. nursing home residents commonly have risk factors for clostridium difficile infection (cdi), including advanced age and antibiotic exposures. we estimated national incidence of nh-onset (nho) cdi and patient outcomes. methods.  we identified nho-cdi cases from population-based surveillance of 10 geographic areas in the united states. cases were defined by c difficile-positive stool collected in an nh (or from ...201626798767
in vivo synthesis of cyclic-di-gmp using a recombinant adenovirus preferentially improves adaptive immune responses against extracellular antigens.there is a compelling need for more effective vaccine adjuvants to augment induction of ag-specific adaptive immune responses. recent reports suggested the bacterial second messenger bis-(3'-5')-cyclic-dimeric-guanosine monophosphate (c-di-gmp) acts as an innate immune system modulator. we recently incorporated a vibrio cholerae diguanylate cyclase into an adenovirus vaccine, fostering production of c-di-gmp as well as proinflammatory responses in mice. in this study, we recombined a more potent ...201626792800
association of healthcare exposure with acquisition of different clostridium difficile strain types in patients with recurrent infection or colonization after clinical resolution of initial infection.following the resolution of an episode of clostridium difficile infection (cdi), the factors associated with acquisition of different c. difficile strain types in patients with recurrent infection or persistent colonization have not been evaluated.201626792686
faecal microbiota transplantation for recurrent clostridium difficile infection and beyond: risks and regulation. 201626792682
clostridium difficile flagella predominantly activate tlr5-linked nf-κb pathway in epithelial cells.clostridium difficile has become the most common enteropathogen responsible for intestinal nosocomial post-antibiotic infections. this has coincided with the appearance of serious cases related to the emergence of hypervirulent strains. the toxins are the main virulence factors and elicit an inflammatory response during c. difficile infection. however, other bacterial components appear to be involved in the inflammatory process. in some pathogens, flagella play a role in pathogenesis through abn ...201626790921
changes in colonic bile acid composition following fecal microbiota transplantation are sufficient to control clostridium difficile germination and growth.fecal microbiota transplantation (fmt) is a highly effective therapy for recurrent clostridium difficile infection (r-cdi), but its mechanisms remain poorly understood. emerging evidence suggests that gut bile acids have significant influence on the physiology of c. difficile, and therefore on patient susceptibility to recurrent infection. we analyzed spore germination of 10 clinical c. difficile isolates exposed to combinations of bile acids present in patient feces before and after fmt. bile a ...201626789728
prevalence and clinical outcomes of clostridium difficile infection in the intensive care unit: a systematic review and meta-analysis.background.  intensive care unit (icu) patients are at higher risk for clostridium difficile infection (cdi).201626788544
the stealthy superbug: the role of asymptomatic enteric carriage in maintaining a long-term hospital outbreak of st228 methicillin-resistant staphylococcus aureus.whole-genome sequencing (wgs) of 228 isolates was used to elucidate the origin and dynamics of a long-term outbreak of methicillin-resistant staphylococcus aureus (mrsa) sequence type 228 (st228) sccmec i that involved 1,600 patients in a tertiary care hospital between 2008 and 2012. combining of the sequence data with detailed metadata on patient admission and movement confirmed that the outbreak was due to the transmission of a single clonal variant of st228, rather than repeated introductions ...201626787833
impact of surotomycin on the gut microbiota of healthy volunteers in a phase 1 clinical trial.clostridium difficile-associated diarrhea has been associated with disruption of the normal intestinal microbiota, particularly thebacteroides fragilisgroup andprevotellaspecies. surotomycin is a bactericidal cyclic lipopeptide in development for treatment ofclostridium difficile-associated diarrhea that has selective and potent activity againstc. difficileand other gram-positive bacteria and a minimal impact on intestinal gram-negative organisms. the impacts of ascending doses of surotomycin on ...201626787687
assessing the activity of microbicides against bacterial spores: knowledge and pitfalls.bacterial endospores (spores) have a higher intrinsic resistance to microbicides as compared to other microbial forms, most likely due to their impermeable outer layers and low water content. though structural differences between the spores of various bacterial species may account for observed variations in their resistance to microbicides, flaws in methods for testing the sporicidal activity of microbicides often exaggerate the differences. this has major implications when considering the selec ...201626784857
evaluation of a low-intensity ultraviolet-c radiation device for decontamination of computer keyboards.computer keyboards are a potential source for dissemination of pathogenic microorganisms. we demonstrated that a low-intensity ultraviolet-c (uv-c) radiation device was effective in reducing methicillin-resistant staphylococcus aureus, carbapenem-resistant escherichia coli, and clostridium difficile spores on steel carriers and significantly reduced bacterial counts on in-use keyboards.201626781219
a case of primary invasive aspergillus colitis masquerading as clostridium difficile infection. 201626780696
organism burden, toxin concentration, and lactoferrin concentration do not distinguish between clinically significant and nonsignificant diarrhea in patients with clostridium difficile.clostridium difficile infection is often overdiagnosed in patients with mild diarrhea. we evaluated 4 biomarkers as surrogates for clinically significant diarrhea (≥ 3 episodes in 24 hours) in 59 pcr-positive patients with and 59 pcr-positive patients without clinically significant diarrhea. organism burden (median tcdb cycle threshold value, 26.9 versus 27.1, p=0.25) and toxin a and b concentrations (toxin a, median, 0 versus 0 ng/ml, p=0.42; toxin b, median, 0 versus 0 ng/ml, p=0.25) were not ...201626778484
effects of a predictive preventive model for prevention of clostridium difficile infection in patients in intensive care units.health care-acquired clostridium difficile infection (hacdi) is associated with adverse outcomes at both the organization and patient level. factors that increase risk for development of hacdi have been identified. objectives of this study were to develop a predictive screening tool to identify patients at risk for hacdi and implement a bundle of mitigation interventions.201626775936
bile acid modifications at the microbe-host interface: potential for nutraceutical and pharmaceutical interventions in host health.bile acids have emerged as important signaling molecules in the host, as they interact either locally or systemically with specific cellular receptors, in particular the farnesoid x receptor (fxr) and tgr5. these signaling functions influence systemic lipid and cholesterol metabolism, energy metabolism, immune homeostasis, and intestinal electrolyte balance. through defined enzymatic activities, the gut microbiota can significantly modify the signaling properties of bile acids and therefore can ...201626772409
novel therapies for severe clostridium difficile colitis.clostridium difficile infection (cdi) is becoming a large healthcare burden with increasing incidence, high recurrence rates, and associated morbidity and mortality. disease severity varies from mild to severe and complicated presentations. current mainstays of therapy in severe cdi include: fluid resuscitation, support of organ dysfunction, discontinuation of inciting agents, and antibiotic treatment.201626771898
letter to the editor: the surge of type 2 diabetes mellitus in china - an international alert: physical exercise and low-caloric diet may reduce the risks of type 2 diabetes mellitus and dementia.the prevalence of diabetes in china has surged from 0.67% before 1980 to 11.6% currently. it is even higher than the prevalence in the united states. certainly, china's economic open-ups, improving living standard, and modernization have propagated the surge. from a traditional public-health point of view, increased food intake and decreased exercise were the main contributors. a new knowledge of colon microbiota could be applied to provide a second harvest of food energy; for example, large mol ...201626927355
faecal microbiota transplantation-a clinical view.faecal microbiota transplantation has gained increasing attention over the last decade as various phenotypes could be transferred from a donor to a recipient in different animal models. clinically, however, the sole indication with evidence from a randomized placebo controlled trial is refractory clostridium difficile infection. despite revealing successful clinical outcomes, questions concerning regulatory affairs, the identification of the best donor, the optimal mixture of the transplant as w ...201626924753
a comparison of the gut microbiome between long-term users and non-users of proton pump inhibitors.proton pump inhibitor (ppi) use is associated with an increased risk of clostridium difficile infection (cdi), though the mechanism is unclear. ppi induced alterations to the gut microbiome may facilitate the emergence of cdi, though the effects of ppis on gut microbiota are not well characterised. [correction added on 10 march 2016, after first online publication: microflora has been changed to microbiota throughout the article.]201626923470
environmental contamination in households of patients with recurrent clostridium difficile infection.recurrent clostridium difficile infection (r-cdi) is common and difficult to treat, potentially necessitating fecal microbiota transplantation (fmt). although c. difficilespores persist in the hospital environment and cause infection, little is known about their potential presence or importance in the household environment. households of r-cdi subjects in the peri-fmt period and of geographically matched and age-matched controls were analyzed for the presence ofc. difficile household environment ...201626921425
evaluation of an enclosed ultraviolet-c radiation device for decontamination of mobile handheld devices.mobile handheld devices used in health care settings may become contaminated with health care-associated pathogens. we demonstrated that an enclosed ultraviolet-c radiation device was effective in rapidly reducing methicillin-resistant staphylococcus aureus, and with longer exposure times, clostridium difficile spores, on glass slides and reducing contamination on in-use mobile handheld devices.201626921014
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