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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
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
synergistic efficacy of 405 nm light and chlorinated disinfectants for the enhanced decontamination of clostridium difficile spores.the ability of clostridium difficile to form highly resilient spores which can survive in the environment for prolonged periods causes major contamination problems. antimicrobial 405 nm light is being developed for environmental decontamination within hospitals, however further information relating to its sporicidal efficacy is required. this study aims to establish the efficacy of 405 nm light for inactivation of c. difficile vegetative cells and spores, and to establish whether spore susceptib ...201626708703
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
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
reactive oxygen species as additional determinants for cytotoxicity of clostridium difficile toxins a and b.clostridium difficile infections can induce mild to severe diarrhoea and the often associated characteristic pseudomembranous colitis. two protein toxins, the large glucosyltransferases tcda and tcdb, are the main pathogenicity factors that can induce all clinical symptoms in animal models. the classical molecular mode of action of these homologous toxins is the inhibition of rho gtpases by mono-glucosylation. rho-inhibition leads to breakdown of the actin cytoskeleton, induces stress-activated ...201626797634
asymptomatic rectal colonization with carbapenem-resistant enterobacteriaceae and clostridium difficile among residents of a long-term care facility in new york city.residents of long-term care facilities (ltcfs) are at increased risk for colonization and development of infections with multidrug-resistant organisms. this study was undertaken to determine prevalence of asymptomatic rectal colonization with clostridium difficile (and proportion of 027/nap1/bi ribotype) or carbapenem-resistant enterobacteriaceae (cre) in an ltcf population.201626796684
development and validation of a clostridium difficile health-related quality-of-life questionnaire.patients with clostridium difficile infection (cdi) can experience long-term symptoms and poor quality of life due to the disease. despite this, a health-related quality of life (hrqol) instrument specific for patients with cdi does not exist. the aim of this study was to develop and validate a disease-specific instrument to assess hrqol in patients with cdi.201626796081
acquisition of clostridium difficile on hands of healthcare personnel caring for patients with resolved c. difficile infection.in an observational study, we found that healthcare personnel frequently acquired clostridium difficile on their hands when caring for patients with recently resolved c. difficile infection (cdi) (<6 weeks after treatment) who were no longer under contact precautions. continuing contact precautions after diarrhea resolves may be useful to reduce transmission.201626795900
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
shaping public health initiatives in kidney diseases: the peer kidney care initiative.while broad-based societal efforts to improve public health have targeted disorders such as cardiovascular disease and cancer for several decades, efforts devoted to kidney disease have developed only more recently. the peer kidney care initiative, a novel effort designed to address knowledge gaps in the care of patients with kidney disease, examines key disease processes, the roles of geography and seasonality on outcomes, and longitudinal trends in outcomes over time.201626765683
non-toxigenic clostridium difficile to prevent recurrent c. difficile infection. 201626763618
clostridium perfringens type a netf and nete positive and clostridium difficile co-infection in two adult dogs.the aim of this study was to report two cases of clostridium perfringens type a and clostridium difficile co-infection in adult dogs. both animals were positive for a/b toxin. toxigenic c. difficile and c. perfringens type a positive for nete and netf-encoding genes were isolated. this report reinforces the necessity of studying a possible synergism of c. difficile and c. perfringens in enteric disorders.201626762654
potential of lactoferrin to prevent antibiotic-induced clostridium difficile infection.clostridium difficile infection (cdi) is a global healthcare problem. recent evidence suggests that the availability of iron may be important for c. difficile growth. this study evaluated the comparative effects of iron-depleted (1% fe(3+) saturated) bovine apo-lactoferrin (apo-blf) and iron-saturated (85% fe(3+) saturated) bovine holo-lactoferrin (holo-blf) in a human in vitro gut model that simulates cdi.201626759363
frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent clostridium difficile infection: a randomized clinical trial.clostridium difficile infection (cdi) is a major burden in health care and community settings. cdi recurrence is of particular concern because of limited treatment options and associated clinical and infection control issues. fecal microbiota transplantation (fmt) is a promising, but not readily available, intervention.201626757463
expanded evidence for frozen fecal microbiota transplantation for clostridium difficile infection: a fresh take. 201626757461
probiotics for the prevention of antibiotic-associated diarrhea in children.this article provides recommendations, developed by the working group (wg) on probiotics of the european society for pediatric gastroenterology, hepatology, and nutrition, for the use of probiotics for the prevention of antibiotic-associated diarrhea (aad) in children based on a systematic review of previously completed systematic reviews and of randomized controlled trials published subsequently to these reviews. the use of probiotics for the treatment of aad is not covered. the recommendations ...201626756877
oral and parenteral versus parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery (jmto prev 07-01): a phase 3, multicenter, open-label, randomized trial.to confirm the efficacy of oral and parenteral antibiotic prophylaxis (abx) in the elective laparoscopic colorectal surgery.201626756752
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
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
does the donor matter? donor vs patient effects in the outcome of a next-generation microbiota-based drug trial for recurrent clostridium difficile infection.to evaluate the impact of the donor material versus the patient in outcomes achieved with rbx2660, a microbiota-based drug under study for recurrent clostridium difficile infection (cdi).201626986546
quantifying transmission of clostridium difficile within and outside healthcare settings.to quantify the effect of hospital and community-based transmission and control measures on clostridium difficile infection (cdi), we constructed a transmission model within and between hospital, community, and long-term care-facility settings. by parameterizing the model from national databases and calibrating it to c. difficile prevalence and cdi incidence, we found that hospitalized patients with cdi transmit c. difficile at a rate 15 (95% ci 7.2-32) times that of asymptomatic patients. long- ...201626982504
fecal microbiota transplantation in children: a brief review.there has been a growing interest in fecal microbiota transplantation (fmt) over recent years, in part due to the increasing prevalence of clostridium difficile infection (cdi) and expanding association of intestinal dysbiosis with a wide range of human diseases. many adult studies have shown that fmt is an effective treatment for recurrent cdi and may possibly have applications in other illnesses such as inflammatory bowel disease (ibd); however, there is a paucity of data available in children ...201626982451
impact of a prospective audit and feedback antimicrobial stewardship program at a veterans affairs medical center: a six-point assessment.prospective audit and feedback is a core antimicrobial stewardship program (asp) strategy; however its impact is difficult to measure.201626978263
effect of surotomycin, a novel cyclic lipopeptide antibiotic, on intestinal colonization with vancomycin-resistant enterococci and klebsiella pneumoniae in mice.surotomycin (formerly called cb-183,315) is a novel, orally administered cyclic lipopeptide antibacterial in development for the treatment of clostridium difficile infection (cdi) that has potent activity against vancomycin-resistant enterococci (vre) but limited activity against gram-negative bacilli, including bacteroides spp. we used a mouse model to investigate the impact of surotomycin exposure on the microbiome, and to test the consequences of the disruption on colonization by vancomycin-r ...201626976870
bloom and bust: intestinal microbiota dynamics in response to hospital exposures and clostridium difficile colonization or infection.clostridium difficile infection (cdi) is the leading infectious cause of nosocomial diarrhea. hospitalized patients are at increased risk of developing cdi because they are exposed to c. difficile spores through contact with the hospital environment and often receive antibiotics and other medications that can disrupt the integrity of the indigenous intestinal microbiota and impair colonization resistance. using whole metagenome shotgun sequencing, we examined the diversity and composition of the ...201626975510
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
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
fecal microbiota transplantation: current applications, effectiveness, and future perspectives.fecal microbiota transplantation (fmt) is the infusion of liquid filtrate feces from a healthy donor into the gut of a recipient to cure a specific disease. a fecal suspension can be administered by nasogastric or nasoduodenal tube, colonoscope, enema, or capsule. the high success rate and safety in the short term reported for recurrent clostridium difficile infection has elevated fmt as an emerging treatment for a wide range of disorders, including parkinson's disease, fibromyalgia, chronic fat ...201626956193
clostridium difficile infection: epidemiology, diagnosis and understanding transmission.clostridium difficile infection (cdi) continues to affect patients in hospitals and communities worldwide. the spectrum of clinical disease ranges from mild diarrhoea to toxic megacolon, colonic perforation and death. however, this bacterium might also be carried asymptomatically in the gut, potentially leading to 'silent' onward transmission. modern technologies, such as whole-genome sequencing and multi-locus variable-number tandem-repeat analysis, are helping to track c. difficile transmissio ...201626956066
probiotics are effective at preventing clostridium difficile-associated diarrhea: a systematic review and meta-analysis.clostridium difficile infection (cdi) is the leading cause of antibiotic-associated diarrhea. cdi has increased in incidence and severity over the past decade, and is a growing worldwide health problem associated with substantial health care costs and significant morbidity and mortality. this meta-analysis examines the impact of probiotics on the incidence of clostridium difficile-associated diarrhea (cdad) among children and adults, in both hospital and outpatient settings.201626955289
host immune response to clostridium difficile infection in inflammatory bowel disease patients.clostridium difficile infection (cdi) affects patients with inflammatory bowel disease (ibd). the aim of this study was to compare humoral response to c. difficile toxins in ibd patients and control outpatients.201626954708
impact of evidence-based guidelines on outcomes of hospitalized patients with clostridium difficile infection.clostridium difficile infection (cdi) is the most common healthcare-associated infection in the united states. clinical practice guidelines for the treatment of cdi were updated in 2010 by the society for healthcare epidemiology of america and the infectious diseases society of america. an institutional guideline for the classification and management of cdi in accordance with the 2010 society for healthcare epidemiology of america/infectious diseases society of america guideline was developed an ...201626954650
toxin immunoassays and clostridium difficile infection-reply. 201626954051
toxin immunoassays and clostridium difficile infection. 201626954050
toxin immunoassays and clostridium difficile infection. 201626954049
toxin immunoassays and clostridium difficile infection. 201626954047
high variability in nosocomial clostridium difficile infection rates across hospitals after colorectal resection.hospital-acquired clostridium difficile infection is associated with adverse patient outcomes and high medical costs. the incidence and severity of c. difficile has been rising in both medical and surgical patients.201626953991
percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy.the length of antimicrobial therapy in complicated intra-abdominal infections (ciais) is controversial. a recent prospective, multicenter, randomized controlled trial found that 4 days of antimicrobial therapy after source control of ciai resulted in similar outcomes when compared with longer duration. we sought to examine whether outcomes remain similar in the subpopulation who received percutaneous drainage for source control of ciai.201626953758
[fulminant clostridium difficile colitis]. 201626947736
improving the reproducibility of the nap1/b1/027 epidemic strain r20291 in the hamster model of infection.comparative analysis of the clostridium difficile bi/nap1/027 strain r20291 and clostron-derived ermb mutants in the hamster infection model are compromised by the clindamycin susceptibility of the parent. mutants can appear more virulent. we have rectified this anomaly by genome engineering. the variant created (crg20291) represents an ideal control strain for virulence assays of clostron mutants.201626946361
clostridium difficile infection after restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis.clostridium difficile infection (cdi) of the ileal pouch following restorative proctocolectomy (rpc) is becoming increasingly recognized. we aimed to understand better (i) the associated risk factors, (ii) treatment practices and (iii) the pouch diversion and failure rate in patients who developed cdi of the pouch after rpc for ulcerative colitis (uc).201626945555
efficacy of two hydrogen peroxide vapour aerial decontamination systems for enhanced disinfection of meticillin-resistant staphylococcus aureus, klebsiella pneumoniae and clostridium difficile in single isolation rooms.hydrogen peroxide vapour (hpv) disinfection systems are being used to reduce patients' exposure to hospital pathogens in the environment. hpv whole-room aerial disinfection systems may vary in terms of operating concentration and mode of delivery.201626944907
clostridium difficile infections: analysis of recurrence in an area with low prevalence of 027 strain. 201626944905
fecal microbiota transplantation for recurrent clostridium difficile infection: the patient experience.although effectiveness of fecal microbiota transplantation (fmt) has been adequately documented, the patient experience of undergoing fmt has not.201626944009
hospital clostridium difficile infection (cdi) incidence as a risk factor for hospital-associated cdi.environmental risk factors for clostridium difficile infections (cdis) have been described at the room or unit level but not the hospital level. to understand the environmental risk factors for cdi, we investigated the association between institutional- and individual-level cdi.201626944007
cronkhite-canada syndrome: a rare cause of chronic diarrhoea in a young man.a young indian man presented with nine-month history of chronic diarrhea, occasionally mixed with blood and intermittent colicky abdominal pain. he also complained of generalized body swelling for the last three months. on examination, he had diffuse hyperpigmentation of the skin and dystrophic nail changes. upper and lower gastrointestinal endoscopy revealed multiple sessile polyps in the stomach, small bowel, and colon and rectum. biopsy of polyps showed adenomatous changes with stromal edema ...201626941798
colorectal surgery in patients with hiv and aids: trends and outcomes over a 10-year period in the usa.hiv has become a chronic disease, which may render this population more prone to developing the colorectal pathologies that typically affect older americans.201626940943
bacterial contamination of computer touch screens.the goal of this study was to determine the occurrence of opportunistic bacterial pathogens on the surfaces of computer touch screens used in hospitals and grocery stores. opportunistic pathogenic bacteria were isolated on touch screens in hospitals; clostridium difficile and vancomycin-resistant enterococcus and in grocery stores; methicillin-resistant staphylococcus aureus. enteric bacteria were more common on grocery store touch screens than on hospital computer touch screens.201626940596
predictors of fecal transplant failure.clostridium difficile infection (cdi) is a significant healthcare burden, with increased morbidity and mortality. traditional treatment regimens using antibiotics for recurrent cdi are significantly less successful compared with 80-90% with fecal microbiota transplantation (fmt). there is a paucity of data on failure rates and mortality after fmt in cdi. this study aims to identify the rates of failure, relapse, and mortality associated with fmt as well as the risk factors for fmt failure.201626934528
therapies on the horizon for clostridium difficile infections.clostridium difficile infections are a leading cause of healthcare facility outbreaks of gastrointestinal illness that may have serious complications and a high rate of recurrent disease. despite the availability of standard antibiotic treatments, data from national surveillance programs indicate that the incidence of this disease continues to increase, placing a heavy burden on healthcare systems. new emerging strategies are being tested to replace or augment these standard antibiotics.201626934513
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