Publications

multicenter in vitro comparison of piperacillin and nine other antibacterials against 1,629 clinical isolates.	the antibacterial spectrum of activity of piperacillin was compared with that of other antibiotics against isolates of escherichia coli, enterobacter cloacae, haemophilus influenzae, klebsiella pneumoniae, pseudomonas aeruginosa, pseudomonas cepacia, pseudomonas maltophilia, serratia marcescens, enterococcus sp, bacteroides fragilis, bacteroides bivius, and clostridium difficile obtained from laboratories at hospitals in st. louis, in memphis, and in newark, new jersey. of the 1,629 isolates tes ...	1990	2183941
the influence of the normal flora on clostridium difficile colonisation of the gut.	the normal stable flora of the gut of man and other adult animal species provides an effective barrier to infection by clostridium difficile. attempts to understand this mechanism have involved continuous flow and batch culture systems and colonisation of antibiotic pre-treated or germ free animals with gut flora from the same or unrelated species. in general attempts to re-create the barrier effect with the whole caecal or faecal flora have been successful both in vitro and in vivo, whereas att ...	1990	2184849
escherichia coli o157:h7-associated colitis. a clinical and histological study of 11 cases.	hemorrhagic colitis is characterized by abdominal cramps, bloody diarrhea, and no or low-grade fever. most cases are caused by the shiga-like toxin-producing bacteria, escherichia coli o157:h7. nineteen colonic biopsy specimens and one resection specimen were reviewed from 11 patients with e. coli o157:h7-associated colitis to determine whether histologic features could be useful in diagnosis or in suggesting pathogenesis. all specimens showed hemorrhage and edema in the lamina propria. specimen ...	1990	2188868
prevention of clostridium difficile-induced experimental pseudomembranous colitis by saccharomyces boulardii: a scanning electron microscopic and microbiological study.	the ability of saccharomyces boulardii to protect mice against intestinal pathology caused by toxinogenic clostridium difficile was studied. different regions of the intestine of experimental mice were prepared for observation by scanning electron microscopy or homogenized for c. difficile enumeration and quantification of toxin a by enzyme immunoassay and toxin b by cytotoxicity. the test group was treated for 6 d with an s. boulardii suspension in drinking water and challenged with c. difficul ...	1990	2200843
open trial of cefepime (bmy 28142) for infections in hospitalized patients.	the safety and efficacy of cefepime, a new broad-spectrum, semisynthetic parenteral cephem antibiotic, were evaluated in an open trial at a single hospital. seventy patients were treated with cefepime: 44 had lower respiratory tract infections, 4 had urinary tract infections, and 22 had skin or soft tissue infections. of 65 clinically evaluable patients, 64 (98%) had satisfactory responses. no mortality or superinfections occurred. of 57 respiratory and urinary tract pathogens, 54 (95%) were era ...	1990	2203309
faecal excretion of ciprofloxacin after a single oral dose and its effect on faecal bacteria in healthy volunteers.	high concentrations of ciprofloxacin have been shown to persist in the faeces of volunteers for several days after a week of oral treatment with this drug, which was also found to have a prolonged effect on aerobic gram-negative intestinal bacteria. to determine whether a shorter course of ciprofloxacin would have the same prolonged effect, we treated ten healthy adult volunteers with a single oral dose of 750 mg ciprofloxacin and found that this was not followed by any significant changes in th ...	1990	2211433
the effect of cefuroxime axetil on the faecal flora of healthy volunteers.	the effect on the faecal flora of cefuroxime axetil, an oral ester of cefuroxime, was examined in ten healthy volunteers following a dose of 250 mg twice a day for 41/2 days. the mean blood concentration 2 h after the ninth dose was 3.6 mg/l and the urinary excretion was approximately 40% in 6 h and 50% in 24 h. two volunteers developed mild diarrhoea and one candida vaginitis. although there was variation between volunteers in the changes found in the faecal flora, the major effects were a redu ...	1990	2211457
clostridium difficile-associated disease in long-term care facilities.		1990	2212583
loperamide related toxic megacolon in clostridium difficile colitis.		1990	2217023
[acute segmental hemorrhagic penicillin-associated colitis].	four days after beginning a perioperative antibiotic prophylaxis with amoxicillin and clavulanic acid a 33-year-old patient developed an acute haemorrhagic diarrhoea with cramp-like lower abdominal pain. coloscopy revealed diffuse mucosal oedema with map-like ulcerations, increased susceptibility to trauma and submucous haemorrhages extending from the middle of the ascending to the middle of the descending colon. granulocytic inflammation with cryptal atrophy was seen histologically. stool cultu ...	1990	2226187
comparative in vitro activity of cefpirome and cefepime, two new cephalosporins.	in in vitro tests the broad-spectrum cephalosporins cefpirome and cefepime were highly active against enterobacteriaceae, although often less so against strains resistant to amoxicillin-clavulanate and ticarcillin-clavulanate, and against most strains of acinetobacter spp. and aeromonas hydrophila. they were also active against pseudomonas aeruginosa, although strains with non-plasmid mediated beta-lactam resistance were sometimes less sensitive. other pseudomonas spp. varied in their sensitivit ...	1990	2226498
effect of ceftazidime and gentamicin on the oropharyngeal and faecal flora of patients with haematological malignancies.	thirty-four patients with haematological malignancies were studied to investigate the effect of empirical broad-spectrum antibiotic therapy (ceftazidime and gentamicin) on the gastro-intestinal flora. twenty-five patients with acute myeloid leukaemia or post-autologous bone-marrow transplantation were given framycetin, nystatin and colistin (fracon), and two patients with non-hodgkin's lymphoma were on co-trimoxazole, as long-term gut prophylaxis. semi-quantitative microbiology was carried out o ...	1990	2228830
characterization of flagella of clostridium difficile and their role in serogrouping reactions.	slide agglutination with rabbit antisera allows the differentiation of 10 serogroups of clostridium difficile, namely, a, b, c, d, f, g, h, i, k, and x. each serogroup displays a specific protein profile in sodium dodecyl sulfate-polyacrylamide gel electrophoresis, except for a, which displays 12 different protein profiles (a1 to a12). in the present work, electron microscopy revealed the presence of uniformly distributed flagella in the reference strains of serogroups g and k and in all strains ...	1990	2229343
ciprofloxacin as a cause of clostridium difficile-associated diarrhoea in an hiv antibody-positive patient.	ciprofloxacin is an uncommon cause of pseudomembranous colitis. a case is described in which diarrhoea was associated with the presence of clostridial toxin in an hiv-infected patient and the possible implications are discussed.	1990	2230180
virulence of ten serogroups of clostridium difficile in hamsters.	a slide agglutination technique identifying 10 serogroups of clostridium difficile (a,b,c,d,f,g,h,i,k and x) has been described previously. in this study, we have used the hamster to compare the ability of the 10 serogroup reference strains to colonise and produce disease. groups of four hamsters were each given a single intraperitoneal injection of either clindamycin or cefoxitin, and an oral challenge dose of c. difficile. the time taken to establish faecal colonisation and the length of survi ...	1990	2231680
[influence of cefodizime via intravenous bolus injection on human fecal flora].	cefodizime (cdzm), a newly developed injectable cephem antibiotic, was given to 8 healthy male volunteers with ages 23-28 years (mean: 24 years) and body weights 54-73 kg (mean: 64 kg). 4 volunteers received 2 g b.i.d., intravenous infusion for 5 days, and 4 volunteers had 4 g b.i.d. for the same duration. we studied changes in bacterial flora and drug levels in feces, as well as changes in susceptibility of isolated microbes to cdzm, cefmetazole, cefotaxime (ctx) and cefoperazone. adverse drug ...	1990	2232150
role of surgery in antibiotic-induced pseudomembranous enterocolitis.	with the increased use of prophylactic and broad-spectrum antibiotics, pseudomembranous colitis has emerged as a significant clinical problem. management with specific anti-clostridium difficile therapy (vancomycin or metronidazole) has reduced mortality to less than 2%. nevertheless, the disease may progress to a fulminant toxic colitis or colonic perforation. additionally, another subset of patients will present with a dramatic clinical picture, suggesting acute peritonitis, eventuating in unn ...	1990	2240392
control of clostridium difficile colitis outbreak by treating asymptomatic carriers with metronidazole.		1990	2252226
nosocomial escherichia coli o157:h7 diarrhea.		1990	2252229
12th c. l. oakley lecture. pathogenesis of clostridium difficile infection of the gut.	on the basis of the above findings it is possible to propose a sequence of events following exposure to c. difficile. exposure of neonates to c. difficile leads to transient colonisation which is almost invariably asymptomatic; the reasons why colonisation is asymptomatic are not known. exposure of antibiotic-treated adults to c. difficile does not invariably lead to colonisation; however, in those instances where colonisation occurs, it may be transient and asymptomatic or transient and symptom ...	1990	2258909
prevalence of clostridium difficile on a mixed-function ward for the elderly.	we studied the prevalence of clostridium difficile over a period of 2 months on a mixed-function geriatric ward. seven (14%) of the 49 patients were long-stay but the remainder were in hospital for acute illness or required a short period of active rehabilitation. although 69% patients had recently received antibiotics, from only two (4%) was c. difficile isolated from their faeces. our results show that c. difficile is not endemic in patients on all geriatric wards as has been previously sugges ...	1990	2273275
incidence of clostridium difficile in infants in rural and urban areas of nigeria.	stool specimens collected from 320 infants under 5 years of age resident in both rural and urban centres of nsukka and enugu towns in anambra state, nigeria were examined for the presence of clostridium difficile and the frequency of occurrence determined. clostridium difficile was isolated from 156 out of 320 samples (48.8%). the frequency was higher in infants resident in rural areas (52.5-48.3%) than in their urban counterparts (47.8-42%). a high frequency rate (77%) was obtained in diarrheal ...	1990	2273987
detection of capsule in strains of clostridium difficile of varying virulence and toxigenicity.	nine toxigenic and six non-toxigenic strains of clostridium difficile, of varying virulence in the hamster model of antibiotic-associated colitis, were examined for the presence of a capsule. antibody stabilisation of the capsule with heterologous and/or homologous antiserum fixed in glutaraldehyde, or direct fixation in glutaraldehyde/diamine, were used with added ruthenium red to stain the capsular glycocalyx. all strains possessed a capsule which was either loose-knit or compact, sometimes wi ...	1990	2277588
[preventive effect of clostridium butyricum m588 against the proliferation of clostridium difficile during antimicrobial therapy].	fecal flora of the patients without remarkable gastrointestinal diseases were studied. all patients were treated with antimicrobial drugs with or without miya-bm (the preparation of clostridium butyricum m588). the stools were examined before and after (during) antimicrobial treatment. fecal flora of 69 patients before medication was almost the same with that of healthy adults as has been reported by mitsuoka et al. after giving antimicrobials, most bacterial genus except enterococcus and yeasts ...	1990	2286785
[effect of bmy-28100 on bacterial flora in adult human feces].	we investigated effects of bmy-28100 on fecal bacteria. bmy-28100 was administered orally to 8 healthy male volunteers between 20 and 24 years of age weighing between 58.0 and 79.5 kg. all subjects were given one 250 mg capsule 3 times a day at 30 minutes after meal for 7 days. fecal bacterial counts were examined 5 days before the start of administration, the day of the start of administration, 3, 5 and 7 days after the start of administration, and 3, 5, 10, 20 and 30 days after the end of admi ...	1990	2287057
pseudomembranous colitis: how useful is endoscopy?	clostridium difficile colitis may be diagnosed either by endoscopy or by laboratory tests. to determine the role of endoscopy, we reviewed 59 cases of confirmed c. difficile colitis. in all patients, the etiology was confirmed by stool tests. twenty-nine underwent lower gastrointestinal endoscopy. in 16 (55%) there was endoscopic confirmation of pseudomembranes while 4 (14%) had only nonspecific colitis. there was no apparent difference in the rate of detection of pseudomembranes between rigid s ...	1990	2291163
in vitro activity of ly 264826 compared with that of vancomycin against 100 clinical isolates each of methicillin-resistant staphylococcus aureus and clostridium difficile.	the in vitro activity of ly 264826, a new glycopeptide antibiotic, was compared with that of vancomycin against 100 strains each of methicillin-resistant staphylococcus aureus and clostridium difficile. ly 264826 was more active, by weight, than vancomycin against the isolates tested. the human serum protein binding of ly 264826 was 15.3% (range, 9.8 to 21.8%).	1990	2291667
inappropriate testing for diarrheal diseases in the hospital.	to assess the degree to which routine stool cultures, ova and parasite examinations, and clostridium difficile toxin assays may be inappropriately ordered on hospitalized patients, we conducted a retrospective study to determine the relative yield of these tests on specimens collected from outpatients and inpatients as a function of time after admission. during a 3-year period, only 1 of 191 positive stool cultures and none of the 90 ova and parasite examinations with positive results were from ...	1990	2299766
prospective, controlled study of vinyl glove use to interrupt clostridium difficile nosocomial transmission.	despite recognition that clostridium difficile diarrhea/colitis is a nosocomial infection, the manner in which this organism is transmitted is still not clear. hands of health care workers have been shown to be contaminated with c. difficile and suggested as a vehicle of transmission. therefore, we conducted a controlled trial of the use of disposable vinyl gloves by hospital personnel for all body substance contact (prior to the institution of universal body substance precautions) to study its ...	1990	2301439
clostridium difficile diarrhea and colonization after treatment with abdominal infection regimens containing clindamycin or metronidazole.	one hundred fifty-six patients with presumed or documented abdominal infections were treated with amikacin/metronidazole/placebo (group 1, 56 patients), amikacin/clindamycin/placebo (group 2, 57 patients), or amikacin/clindamycin/ampicillin (group 3, 43 patients) to determine both the therapeutic efficacy of the various regimens and the type of complications due to clostridium difficile. c. difficile diarrhea occurred in 15 of 156 patients (9.6%), and c. difficile colonization occurred in 14 of ...	1990	2301715
effect of bismuth subsalicylate on fecal microflora.	several studies have documented the efficacy of bismuth subsalicylate (bss) for the prophylaxis and treatment of bacterial diarrhea. it is not known what effect, if any, bss has on the normal bowel flora. we quantitated the fecal flora in healthy volunteers before and after they took bss. in the first group, 8 ounces of bss was given on two successive days. in the second group, a standard oral intestinal lavage preparation (golytely) was used to clean the colon and then 8 ounces of bss was given ...	1990	2305174
effect of bismuth subsalicylate on clostridium difficile colitis in hamsters.	the therapeutic effect of bismuth subsalicylate (bss, pepto-bismol) in clostridium difficile colitis was studied in golden syrian hamsters. c. difficile was fed to the hamsters by orogastric intubation 2-3 days after their arrival. clindamycin (1.5 mg per animal) was given intraperitoneally 4 days later. twenty-four hours after challenge with clindamycin, animals were given bss at dosages of 5, 10, and 15 mg twice daily for 5 days by orogastric intubation. controls included untreated animals and ...	1990	2305177
in vitro antibacterial activity of bismuth subsalicylate.	this study was undertaken to determine the in vitro activity of bismuth subsalicylate (bss) and sodium salicylate (ss) against various groups of pathogenic bacteria. bss had the greatest activity against clostridium difficile, which had a minimal inhibitory concentration for 90% of the strains (mic90) of 128 micrograms/ml. the bacteroides fragilis group also had a relatively low mic90 of 512 micrograms/ml. bss had the least activity against pseudomonas (mic90, 6,144 micrograms/ml). ss was as act ...	1990	2305178
anaerobic bacteria and bacterial infections: perspectives on treatment and resistance in italy.	results of laboratory tests of 2,000 samples obtained from 1984 to 1987 from patients with suspected anaerobic infections and the clinical experience of these patients are reported. of these samples, 395 were positive for anaerobes; 36.5% of these 395 samples contained single organisms, and 63.5% contained a mixture of anaerobes and aerobes. abdominal infections were the infections most frequently caused by anaerobes. the bacteroides fragilis group and strains of peptostreptococcus were the micr ...	1990	2305181
cefamandole versus cefonicid prophylaxis in cardiovascular surgery: a prospective study.	we randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. three hundred fifty-seven patients were evaluable for prophylactic efficacy. chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) (p = 0.05). three patients, all in the cefonicid ...	1990	2310250
detection of specific antigens for ten serogroups of clostridium difficile.	we previously described a serogrouping technique for clostridium difficile based on slide agglutination with rabbit antisera raised against formol-treated cells. it allows the differentiation of ten serogroups, namely a, b, c, d, f, g, h, i, k and x. each serogroup displays a specific profile with several distinctive bands by polyacrylamide gel electrophoresis (page). in this study we investigated the common and specific antigenic determinants of the ten serogroups by immunoblotting. in a first ...	1990	2314395
cytotoxin-negative clostridium difficile.		1990	2322209
clostridium difficile-associated diarrhea after norfloxacin.	although theoretically the spectrum of antimicrobial quinolone antibiotics are at low risk of producing clostridium difficile overgrowth and diarrhea, a patient developed this clinical problem while receiving norfloxacin. we review the antimicrobial activity of the quinolone antibiotics, with respect to their predisposition for producing c. difficile-induced diarrhea.	1990	2324482
enzyme immunoassay (elisa) for detection of clostridium difficile toxin b in specimens of faeces.	antisera against clostridium difficile toxin b were prepared in sheep and rabbit and were used in indirect and sandwich enzyme-linked immunosorbent assays (elisa) for the detection of toxin b. polyvinyl chloride and polystyrene microtitration plates were tested as solid phases for the assay. both assays had a lower limit of detection for toxin b of 1 ng/ml. they were used to detect the presence of toxin b in 210 human faecal specimens and also in the culture supernatant fluids of c. difficile st ...	1990	2325114
postantibiotic colonization with clostridium difficile in nursing home patients.	clostridium difficile causes pseudomembranous colitis and is responsible for 20% to 25% of cases of postantibiotic diarrhea. in an earlier study, nursing-home patients with c. difficile infection were noted to have a high mortality rate. because most of these infected patients had been treated with antibiotics, it was not clear whether this high mortality rate was associated with c. difficile infection or simply with antibiotic treatment. a prospective study was carried out to determine the rate ...	1990	2329250
incidence of clostridium difficile in hospitalized children. a prospective study.	a total of 394 children, aged 0-14 years, referred to a paediatric department were investigated for the occurrence of clostridium difficile, its cytotoxin in faeces, and its clinical significance in a prospective study over one year. of the children in the investigation, 337 suffered from gastrointestinal diseases or had been treated with antibiotics prior to the investigation. twenty-four percent of these children had cl. difficile in one or more faecal samples and toxin was demonstrated in hal ...	1990	2333742
[low incidence of pseudomembranous colitis associated with antibiotics at a general hospital in lima].	clostridium difficile is associated to episodes of diarrhea related to the use of antibiotics in general hospitals. the aim of this study has been to determine the incidence of this complication among the patients admitted in a 400 bed general hospital in lima, perú; we registered every day, in all the wards of the hospital, the presence of diarrhea in patients under antibiotic treatment. in every patient with diarrhea we investigated the presence of cytotoxin and cultivated for c. difficile in ...	1990	2346679
low-dose ciprofloxacin for selective decontamination of the digestive tract in human volunteers.	the effect on the faecal aerobic and anaerobic flora of ciprofloxacin given in low doses for selective decontamination of the digestive tract was investigated in ten human volunteers. the volunteers received 50, 100 and 200 mg of ciprofloxacin every 12 h for five days at intervals of three and five weeks respectively. no significant differences in the numbers of aerobes or anaerobes were seen after the 2 x 50 mg regime. the colony counts of most anaerobes and the total aerobe count were signific ...	1990	2351146
relapsing clostridium difficile colitis and reiter's syndrome.	we describe a patient with recurrent clostridium difficile-associated colitis who suffered severe arthritis and urethritis with each of three episodes of diarrhea. although immune complex formation was demonstrated in synovial fluid, neutralizing antibodies to c. difficile cytotoxin a and b were not found in either serum or synovial fluid. cholestyramine did not prevent a third episode of colitis which followed the use of amikacin. this patient was hla-b27 positive; she developed sacroiliitis, t ...	1990	2353699
[effect of rokitamycin on bacterial flora in human feces].	rokitamycin, a newly developed macrolide antibiotic was orally administered to 7 healthy male volunteers (22-25 years) for 7 consecutive days to study changes in bacterial flora and concentrations of the drug in feces, and to observe adverse reactions and laboratory test parameters. a dose of 200 mg (2 tablets: 100 mg/tablet) was given 3 times daily before meals and the fecal studies were done on the 5 days before administration (adm.) [b.a.], at the time of administration (0), and the 3rd, 5th, ...	1990	2362352
inappropriate antibiotic use and the development of clostridium difficile colitis.	a three-year, retrospective, community-wide study reviewed all patients (n = 60) with positive clostridium difficile stool cytotoxin assays. the appropriateness of antibiotic administration in hospitalized patients (n = 48) who developed antibiotic-associated colitis (aac) was studied. only 25 per cent had antibiotics used appropriately with positive culture results and organisms susceptible to the antibiotic(s) given. another 25 per cent of cases had positive cultures, but the organisms were no ...	1990	2363281
prevention of further recurrences of clostridium difficile colitis with saccharomyces boulardii.	a patient with six documented episodes of recurrent clostridium difficile colitis over an eight-month period is described. relapses of colitis occurred despite treatment with vancomycin, metronidazole, bacitracin, and cholestyramine. each recurrence appeared to begin successively closer to the end of the previous course of treatment. four episodes were sufficiently severe to require hospitalization for rehydration. saccharomyces boulardii, a nonpathogenic yeast, was begun prior to discontinuing ...	1990	2364845
degradation of 2-phosphoglycerate by cytotoxin b of clostridium difficile.	cytotoxin b of c. difficile was highly purified by selective ammonium sulfate precipitation, biogel a5m chromatography, phenyl boronate hydrophobic interaction chromatography and ultracentrifugation. the final cytotoxic product had a specific activity of 7.8 x 10(8) units/mg protein and showed a single protein band with an estimated molecular weight of 163,000 when subjected to sds-page. immunoelectrophoresis of the final product showed a single precipitin arc. the addition of cytotoxin b to imi ...	1990	2365093
use of standardized screening procedures to identify adverse drug reactions.	the development of an adverse drug reaction (adr)-monitoring program using standardized screening procedures in a 650-bed hospital is described. a concurrent adr-reporting system that relied on health-care professionals to report observed adrs to the pharmacy had generated just two adr reports during the previous year. the pharmacy developed a program that used standardized procedures to screen for adrs. the technicon computer was programmed to screen the previous day's orders for antidotes or " ...	1990	2368724
surface blebbing and cytoskeletal changes induced in vitro by toxin b from clostridium difficile: an immunochemical and ultrastructural study.	clostridium difficile toxin b is a powerful cytopathic agent without enterotoxic activity which is believed to be involved in the pathogenesis of pseudomembranous colitis. up until today, the mechanisms of toxin b cytotoxicity have not been elucidated. the results of in vitro studies performed on different cell lines by means of immunocytochemical and ultrastructural methods are reported here. low doses (0.15 ng/ml) of toxin b cause cell rounding and arborization. higher doses (up to 15 microgra ...	1990	2369937
clostridium difficile colitis in the hospital setting: a potentially explosive problem.		1990	2373849
risk factors for clostridium difficile toxin-associated diarrhea.	the hospital-wide attack rate for clostridium difficile-associated diarrhea at our tertiary-care university hospital was 0.02 per 100 patient discharges (0.02%) in 1982, but 0.41% and 1.47% in 1986 and 1987, respectively, with a peak incidence of 2.25% in the fourth quarter of 1987. hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole. thirty-seven cases selected for study were older than 37 control pa ...	1990	2373850
nucleotide sequence of clostridium difficile toxin b gene.		1990	2374729
clostridium difficile infection in orthopaedic patients.	in a review of the results of toxin assays, twenty-five orthopaedic patients who had a clostridium difficile infection and associated diarrhea were identified. the infection was due to the use of antibiotics in all but one patient. seventeen patients had received the antibiotics prophylactically. the two most commonly implicated antibiotics were cefazolin and clindamycin, because those drugs had been commonly used for prophylaxis at the study institutions. however, other antibiotics were implica ...	1990	2384505
primary infection of ascitic fluid with clostridium difficile.	a case of a primary infection of ascitic fluid with a toxigenic strain of clostridium difficile is described. the strain belonged to the serogroup h which is often implicated in pseudomembranous colitis. nevertheless, our patient did not have any sign of colitis or diarrhoea before the ascitic infection. she was successfully treated by the intravenous administration of metronidazole but relapsed a few weeks later. a similar strain of serogroup h was again isolated.	1990	2384684
quantitative study of antibiotic-induced susceptibility to clostridium difficile enterocecitis in hamsters.	commonly used antibiotics were compared for their ability to induce clostridium difficile enterocecitis and death in hamsters. susceptibility to infection with c. difficile was measured by calculating 50% lethal doses (in cfu) for hamsters for various intervals after antibiotic treatment. infection occurred after very small doses of c. difficile were given to hamsters treated with clindamycin, ampicillin, flucloxacillin, and cefuroxime; there was little difference between the antibiotics in the ...	1990	2386366
risk factors for clostridium difficile carriage and c. difficile-associated diarrhea in a cohort of hospitalized patients.	a prospective cohort study of 399 consecutive patients in a single ward over an 11-month period was conducted to identify risk factors for nosocomial c. difficile colonization and diarrhea. the incidence of asymptomatic carriage was 13.0/100 patient admissions and the incidence of c. difficile-associated diarrhea was 7.8/100 patient admissions. increased age and more severe underlying illness were associated with increased risk of c. difficile carriage and diarrhea. multivariate models adjusting ...	1990	2387993
presumptive identification of clostridium difficile by detection of p-cresol in prepared peptone yeast glucose broth supplemented with p-hydroxyphenylacetic acid.	prereduced, anaerobically sterilized peptone yeast glucose broth was supplemented with p-hydroxyphenylacetic acid and used for the presumptive identification of clostridium difficile. two hundred eighty-two organisms were grown in this medium for 18 h and tested for p-cresol production by gas-liquid chromatography. all 49 stock and reference strains of c. difficile and 19 organisms confirmed as c. difficile produced p-cresol. p-cresol was not produced by 53 negative control or 161 test organisms ...	1990	2394806
short-chain fatty acid and organic acid concentrations in feces of healthy human volunteers and their correlations with anaerobe cultural counts during systemic ceftriaxone administration.	short-chain fatty acid (scfa) and organic acid concentrations and (an)aerobe cultural counts were determined simultaneously in fresh feces from 10 human volunteers before, during, and after 5 days of single-dose ceftriaxone administration. the changes and the correlation coefficients between these variables were tested to be significant (p less than 0.05). to investigate whether significant changes in the intestinal microflora could be predicted by significant changes in scfa/organic acid concen ...	1990	2396083
rapid diagnosis of clostridium difficile-associated diarrhoea using a latex agglutination test.	a rapid latex agglutination test, culturette brand cdt from marion laboratories, was evaluated and compared to a tissue culture assay (tca) and isolation of clostridium difficile in 380 faecal specimens from 226 patients with clinically suspected clostridium difficile-associated diarrhoea. the sensitivity and specificity of the latex test compared with the tca were 83% and 80% respectively, and the positive and negative predictive values were 55% and 94% respectively. in patients with repeated s ...	1990	2397115
the colonic pathology of escherichia coli o157:h7 infection.	we report the colonic pathology of two surgical excisions and two autopsies from patients acutely infected by e. coli o157:h7. the right colon was most severely affected. extreme edema, fibrin deposition, and hemorrhage in the submucosa was the most distinctive finding. all cases showed patchy mucosal ulceration, mucosal hemorrhage, neutrophil infiltration, and microvascular thrombi. pseudomembranous lesions similar to those described in pseudomembranous colitis caused by clostridium difficile w ...	1990	2403759
diarrhea in developed and developing countries: magnitude, special settings, and etiologies.	diarrheal diseases are major causes of morbidity, with attack rates ranging from two to 12 or more illnesses per person per year in developed and developing countries. in addition, diarrheal illnesses account for an estimated 12,600 deaths each day in children in asia, africa, and latin america. the causes of diarrhea include a wide array of viruses, bacteria, and parasites, many of which have been recognized only in the last decade or two. while enterotoxigenic escherichia coli and rotaviruses ...	1990	2406855
virulence factors of clostridium difficile.	in addition to the two major toxins of clostridium difficile--toxins a and b, which represent the major virulence factors--a number of other putative virulence factors have been described. these factors include fimbriae and the ability to associate with gut cells/mucus, the production of a capsule, the secretion of a range of hydrolytic enzymes, the production of other toxins (such as an actin-specific adp-ribosyltransferase by some strains), and the controversial possibility of the production o ...	1990	2406871
clostridium difficile: clinical considerations.	clostridium difficile was originally reported as an agent of enteric disease in 1977. subsequent work has shown this organism to be what many consider the most important bacterial pathogen of the gut in developed countries in terms of severity of disease and prevalence. a review of the literature indicates that almost all of the clinically relevant data for this organism were reported by 1981, including data on the spectrum of disease, clinical settings in which it is suspect, epidemiology, path ...	1990	2406876
in-vitro activity of vancomycin, teicoplanin, daptomycin, ramoplanin, mdl 62873 and other agents against staphylococci, enterococci and clostridium difficile.	the minimum inhibitory concentrations (mics) of different antibiotics were determined by a broth microdilution method for staphylococci, enterococci and clostridium difficile. the antimicrobial agents tested were vancomycin, teicoplanin, daptomycin, ramoplanin, mdl 62873, rifampicin and piperacillin, the latter limited to enterococci. in terms of mic90s, daptomycin (0.89 mg/l). mdl 62873 (0.99 mg/l), and teicoplanin (1.50 mg/l) were found to be highly active against methicillin-resistant staphyl ...	1990	1688341
epidemiologic markers of clostridium difficile.	a wide range of epidemiologic markers have been identified for clostridium difficile. these markers are based on phenotypic characteristics of the organism, such as antibiotic resistance, bacteriocin or bacteriophage susceptibility, electrophoretic protein patterns, and immunologic markers. methods for determining genetic markers include plasmid and dna restriction endonuclease analysis and ribosomal rna restriction patterns. these methods have been applied to various degrees in epidemiologic st ...	1990	1689505
clostridium difficile invasion and toxin circulation in fatal pediatric pseudomembranous colitis.	the direct involvement of clostridium difficile in the lesional tissue of pseudomembranous colitis has not been demonstrated; the organism's effects have been assumed to be strictly toxin mediated. because c. difficile cytotoxin may be found incidentally in the intestinal lumina of asymptomatic infants, the role of the organism in a variety of pediatric intestinal diseases is uncertain. the authors studied seven cases of fatal pediatric pseudomembranous colitis in which the presence of c. diffic ...	1990	1699407
an extracellular material observed in clostridium difficile strains.	some extracellular material-- "capsule" has been observed among clostridium difficile strains. c. difficile strains (44 examined) contain different proportions of cells with "capsule" and without "capsules". toxigenic strains contained fewer capsulated cells than non-toxigenic strains.	1990	1715642
bacteriotherapy for clostridium difficile diarrhoea.		1990	1967389
rapid identification of toxigenic clostridium difficile by polymerase chain reaction.		1990	1968161
clostridium difficile carriage after infection.		1990	1968608
false-positive clostridium difficile latex agglutination tests.		1990	1972242
nosocomial clostridium difficile colonisation and disease.	to assess the risk of acquiring clostridium difficile diarrhoea or colitis in patients colonised with c difficile, rectal swabs taken weekly for 9 weeks from patients with long-term (at least 7 days) hospital stays on three wards were cultured for c difficile. 60 (21%) of 282 patients were culture-positive for c difficile during their hospital stay, of whom 51 were symptom-free faecal excretors. c difficile diarrhoea developed in the other 9 patients; 2 were culture-positive for c difficile and ...	1990	1975332
pseudomembranous colitis associated with ciprofloxacin.		1990	1976960
ciprofloxacin and clostridium difficile infection.		1990	1978050
ciprofloxacin and pseudomembranous colitis.		1990	1979116
[laboratory methods of diagnosing pseudomembranous colitis and diarrhea caused by clostridium difficile (review of the literature)].		1989	2469839
clostridium difficile toxin b: characterization and sequence of three peptides.	the cytotoxin, also named toxin b, was isolated from a toxigenic strain of clostridium difficile, purified to homogeneity and partially characterized. the purification procedure included ultrafiltration followed by anion-exchange chromatography. we noticed that a non-specific nucleic material eluted with the protein during the purification. the presence of these nucleic acids appeared to be important for the toxic activity of the protein. some characteristics of the cytotoxin were examined, espe ...	1989	2474559
diagnostic procedures for isolation and characterization of clostridium difficile associated with enterocolitis in foals.		1989	2488656
[enumeration and identification of clostridium from stools treated with the thioglycollate-lysozyme method].	we have used spore isolation by the sodium thioglycolate-lysozyme technique on collected stools. of the 51 stools studied, we found 41% of clostridium perfringens with an average ratio of 10(4) germs/gr. 15 strains were typical double hemolysis and trehalose positive-5 presented only one hemolysis and were trehalose negative. we only found a single strain of clostridium difficile with a rate of 10(4) germs/gr in the stools of a 10 months infant.	1989	2489405
[2 cases of arthralgia associated with infection by clostridium difficile].	the clostridium difficile is the etiologic agent most often isolated in patients with antibiotic-associated colitis. rarely this symptomatology is complicated by postinfection arthritis. the following describes 2 cases of acute colitis by clostridium difficile associated with acute polyarthritis.	1989	2491298
clostridium difficile settles in a nursing home.		1989	2493005
prevention of antibiotic-associated diarrhea by saccharomyces boulardii: a prospective study.	saccharomyces boulardii, a nonpathogenic yeast, has been widely used in europe to prevent antibiotic-associated diarrhea (aad). we performed a prospective double-blind controlled study to investigate aad in hospitalized patients and to evaluate the effect of s. boulardii, a living yeast, given in capsule form concurrently with antibiotics. over 23 mo, 180 patients completed the study. of the patients receiving placebo, 22% experienced diarrhea compared with 9.5% of patients receiving s. boulardi ...	1989	2494098
occurrence and significance of clostridium difficile in faecal specimens of hospitalized children.	stool specimens from 766 hospitalized children, 418 with diarrhoea and 348 controls, were investigated for c. difficile. in both groups the rate of isolation was highest (about 30%) during the first year of life, dropping to nearly 5% in older children. there was no significant difference in the frequency of c. difficile in children with diarrhoea and the controls nor was there a significant influence of previous antibiotic therapy on the rate of isolation. 111/135 strains (82.2%) produced toxin ...	1989	2494813
effect of purified clostridium difficile toxins on intestinal smooth muscle. i. toxin a.	in these studies we determined the effects of purified clostridium difficile toxin a, an enterotoxin, on the electrophysiological and contractile properties of rabbit intestinal circular smooth muscle and correlated these effects with changes of smooth muscle morphology. simultaneous measurements of intracellular membrane potential and contractility were determined in excised ileal muscle strips after administration of toxin a in vivo (60 micrograms/ml) into an isolated rabbit ileal loop or dire ...	1989	2495733
effect of purified clostridium difficile toxins on intestinal smooth muscle. ii. toxin b.	in the companion paper [am. j. physiol. 256 (gastrointest. liver physiol. 19): g759-g766, 1989] we showed that highly purified clostridium difficile toxin a had a profound effect on intestinal smooth muscle after in vivo but not in vitro exposure. in this study we assessed the effects of in vivo and in vitro exposure to c. difficile toxin b on simultaneous measurements of intracellular membrane potential and contractility in rabbit ileal smooth muscle. direct exposure of ileal smooth muscle to t ...	1989	2495734
focal ulcerative ileocolitis with terminal thrombocytopenic purpura in juvenile cotton top tamarins (saguinus oedipus).	a newly recognized syndrome characterized by an acute focal ulcerative ileocolitis, anemia and thrombocytopenic purpura in five juvenile cotton-top tamarins is described. the presentation and morphology of this syndrome is distinct from any other reported gastrointestinal disease reported in tamarins. traditional etiologies such as viruses, ingested toxins, campylobacter, salmonella and yersinia and clostridium difficile are not considered likely etiologic agents. nontraditional etiologies such ...	1989	2496272
multiple relapses of clostridium difficile-associated diarrhea responding to an extended course of cholestyramine.		1989	2496393
polymicrobial septicemia with clostridium difficile in acute diverticulitis.	a case is reported of a patient without previous gastrointestinal symptoms, who presented with polymicrobial septicemia caused by escherichia coli, enterococcus faecalis, clostridium difficile and bacteroides vulgatus. septicemia occurred during acute diverticulitis. a strain of clostridium difficile, which was of the same serogroup c as the blood culture isolate and also produced toxin, was recovered from the stools, but the pathogenic role of this organism in the gastrointestinal symptomatolog ...	1989	2497002
relationship between levels of clostridium difficile toxin a and toxin b and cecal lesions in gnotobiotic mice.	various clostridium difficile strains were studied with respect to their pathogenicity in monoassociated mice in relation to levels of toxin a and toxin b in vivo and in vitro. two strains which were the most potent toxin producers in vitro induced mortality (100%); mice monoassociated with these strains were found to have high levels of both toxins in their ceca and an intense cecal epithelial ulceration together with a severe inflammatory process. no mortality was observed with the other strai ...	1989	2499546
intestinal colonization with clostridium difficile in infants up to 18 months of age.	the faecal colonization with clostridium difficile was investigated among 343 infants during their first 18 months of life. rectal swabs were taken at the ages of 6 days, 6 weeks, 6 months, 11 months and 18 months. about 25% of the children were colonized with clostridium difficile between 6 days and 6 months of age. the colonization rate decreased to 3% at 18 months of age. the rate of strains producing cytotoxin was low in infants less than 6 months of age, but at that age about half of the st ...	1989	2502403
evolution of the caecal epithelial barrier during clostridium difficile infection in the mouse.	the most striking effect of clostridium difficile infection is its degrading of the intestinal barrier. the aim of this study is to establish whether the cellular or paracellular constituent of the barrier is the initial target of the toxins produced by c difficile. accordingly, the caecal epithelium of c3h/he mice was challenged under three experimental conditions with the c difficile strain vpi 10463: (1) by in vivo inoculation of axenic mice, (2) by adding the toxins to ligated caeca in vivo, ...	1989	2504650
cloning and characterization of overlapping dna fragments of the toxin a gene of clostridium difficile.	clostridium difficile, a human pathogen, produces two very large protein toxins, a and b (250-600 kda), which resist dissociation into subunits. to clone the toxin a gene, a genomic library of 3-8 kb chromosomal dna fragments of c. difficile strain vpi 10463 established in puc12 was screened with a rabbit polyclonal toxin a antiserum. thirty-five clones were isolated which carried 2.5-7.0 kb inserts representing a 10 kb region of the c. difficile genome. all the inserts were oriented in the same ...	1989	2506313
production, purification and characterization of clostridium difficile toxic proteins different from toxin a and from toxin b.	the purification and characterization of three new proteins called c1, c2, and c3 from clostridium difficile are described. their estimated molecular mass were about 350 (c1), 270 (c2) and 140 (c3) kda, consisting of subunits of 39 (c1), 43 (c2) and 41 (c3) kda, respectively. immunodiffusion revealed that the three proteins contained similar but not identical antigenic determinants to toxin a. each protein induced a cytotonic effect on hamster ovaric cells; the combined proteins, had a specific ...	1989	2506935
clostridium difficile toxin a. interactions with mucus and early sequential histopathologic effects in rabbit small intestine.	clostridium difficile produces two toxins, a (enterotoxic) and b (cytopathic), that are implicated in the pathogenesis of pseudomembranous colitis. however, the relationship of the secretory effect and the early histopathologic events is still unclear. we examined the early histopathologic effect of purified c. difficile toxin a in rabbit ileal loops and correlated the mucosal damage with the secretory response. as early as 2 hours after inoculation, toxin a at 1.0 micrograms caused cytolysis of ...	1989	2507823
comparative in vitro activity of the new oral penem alp-201 against aerobic and anaerobic bacteria.	the in vitro activity of the new penem derivative alp-201 against 226 aerobic and 350 anaerobic clinical bacterial isolates was determined using agar dilution techniques. for comparison amoxicillin, cefaclor, ceftazidime, doxycycline, erythromycin, imipenem and trimethoprim/sulfamethoxazole were also tested with aerobic bacteria, and cefoxitin, chloramphenicol, clindamycin, imipenem, metronidazole and piperacillin with anaerobic bacteria. alp-201 was found to be highly active against escherichia ...	1989	2512142
polymicrobial septicaemia and clostridium difficile.		1989	2512153
molecular studies on the epidemiology and pathogenicity of clostridium difficile.		1989	2514126
effects of clostridium difficile toxins a and b on cytoskeleton organization in hep-2 cells: a comparative morphological study.	a comparative study on the effects of toxin a and toxin b from clostridium difficile on hep-2 cells was carried out. both toxins caused cell retraction and rounding and seemed to exert their effect on cell morphology via a rearrangement of actin and alpha-actinin microfilaments. such a rearrangement occurred at an early stage, when no change in microtubular and cytokeratin systems was detectable. nevertheless, several structural modifications accompanying the cytopathological process induced by ...	1989	2515619
teicoplanin in the treatment of infections by staphylococci, clostridium difficile and other gram-positive bacteria.	eighty-three episodes of gram-positive infection in 82 patients were treated with teicoplanin in an open study. infectious episodes included endocarditis (6 cases), bacteraemia (7), osteomyelitis (8), pseudomembranous colitis (13), cellulitis (11), urinary tract infection (5), pneumonia (1), wound and post-surgical infections (9) and erysipelas (23). four patients affected by an overwhelming gram-positive infection as well as eight cases of gram-positive-gram-negative mixed infections received t ...	1989	2526109