Publications

clostridium difficile-associated typhlitis in specific pathogen free guineapigs in the absence of antimicrobial treatment.	clostridium difficile (toxin) associated typhlitis was diagnosed in untreated barrier-maintained specific pathogen free guineapigs. it resembled the pathological lesions of antibiotic induced enterocolitis. the possible role of limited colonization resistance to c. difficile provided by mouse enteric microflora in the pathogenesis of the disease is discussed.	1989	2527322
treatment of clostridium difficile-associated disease with teicoplanin.	forty-seven patients affected by clostridium difficile-associated disease were treated orally with either vancomycin (patients hospitalized from february 1984 to february 1987) or teicoplanin (from march 1987 to december 1988). all patients given teicoplanin remained asymptomatic after discontinuation of treatment, and all but one were also cleared of c. difficile. in the vancomycin group, clinical symptoms recurred in 3 of 23 evaluable patients, and follow-up cultures were positive in another a ...	1989	2528941
observations on phage-typing of clostridium difficile: preliminary evaluation of a phage panel.	of the various methods now employed to type clostridium difficile, the performance of the phage-typing, as proposed by sell et al., was investigated on a large collection of isolates from various local epidemiological settings. because those isolates appeared in preliminary trials mostly resistant to the reference phages, the panel was enlarged by including newly isolated phages. the new set was redundant but better suited to the purpose: out of 287 phage sensitivity patterns 8.4% only were resi ...	1989	2529136
mechanism of action of clostridium difficile toxin b: role of external medium and cytoskeletal organization in intoxicated cells.	toxin b, an exotoxin produced by clostridium difficile, induces the rounding-up and arborization of cultured mammalian cells, a typical effect which resembles that provoked by cytochalasins. in this study, the effect of toxin b was examined on astroglial cells grown in primary culture. a specific antiserum to toxin b was used to investigate its mechanisms of action. we found that the toxin exerts its effects on cell morphology after its incorporation into cells. the internalization of toxin b re ...	1989	2545447
presence of fructokinase in pancreatic islets.	homogenates of rat pancreatic islets that had been heated for 5 min at 70 degrees c to inactive hexokinases, catalyzed the atp-dependent phosphorylation of d-fructose. this reaction was dependent on the presence of k+ and was inhibited by d-tagatose although not by d-glucose or d-glucose 6-phosphate. the phosphorylation product was identified as fructose 1-phosphate through its conversion to a bisphosphate ester by clostridium difficile fructose 1-phosphate kinase. these findings allowed the con ...	1989	2551726
comparative study of clostridium difficile toxin a and cholera toxin in rabbit ileum.	the purpose of this study was to compare the effects of clostridium difficile toxin a and cholera toxin on fluid secretion, intestinal permeability, and arachidonate metabolites in rabbit ileum. injection of 25 micrograms of either purified toxin into 10-cm ileal loops caused significant increases in fluid secretion and intestinal permeability to mannitol as well as release of prostaglandin e2 into the lumen. toxin a, but not cholera toxin, caused a severe inflammatory reaction of the lamina pro ...	1989	2551764
cloning and hybridization analysis of ermp, a macrolide-lincosamide-streptogramin b resistance determinant from clostridium perfringens.	the erythromycin resistance determinant from clostridium perfringens cp592 was cloned and shown to be expressed in escherichia coli. the resultant plasmid, pjir122 (7.9 kilobase pairs [kb]), was unstable since in both reca+ and reca e. coli hosts spontaneous deletion of 2.7 kb, including the erythromycin resistance determinant, was observed. subcloning, as well as deletion analysis with bal 31, localized the erythromycin resistance gene (ermp) to within a 1.0-kb region of pjir122. a 0.5-kb fragm ...	1989	2552908
enterotoxin induced diarrhoea--an update.	the pathogenic personality or the criteria required to be a successful pathogen, of enteric bacteria includes, among others, the ability to produce potent proteins which by different intracellular mechanisms elicit what we overtly see as diarrhoea. enteropathogens belonging to several genera like vibrio, escherichia, shigella, salmonella, campylobacter, aeromonas and yersinia include species capable of elaborating strikingly similar exotoxins which seem to share common mechanisms of action invol ...	1989	2554547
hybridization analysis of three chloramphenicol resistance determinants from clostridium perfringens and clostridium difficile.	the chloramphenicol resistance determinant from a nonconjugative strain of clostridium perfringens was cloned and shown to be expressed in escherichia coli. subcloning and deletion analysis localized the resistance gene, catq, to within a 1.25-kilobase (kb) partial sau3a fragment. the catq gene contained internal hindii, haeiii, and drai restriction sites and was distinct from the catp gene, which was originally cloned (l. j. abraham, a. j. wales, and j. i. rood plasmid 14:37-46, 1985) from the ...	1989	2554801
bacteriotherapy for chronic relapsing clostridium difficile diarrhoea in six patients.	six patients with chronic relapsing diarrhoea caused by clostridium difficile were treated with rectal instillation of homologous faeces (one patient) or a mixture of ten different facultatively aerobic and anaerobic bacteria diluted in sterile saline (five patients). the mixture led to a prompt loss of cl difficile and its toxin from the stools and to bowel colonisation by bacteroides sp, which had not been present in pre-treatment stool samples. strains of escherichia coli, cl bifermentans, an ...	1989	2566734
protein-losing enteropathy associated with clostridium difficile infection.	a commercially available radial immunodiffusion assay was used to measure serum alpha-1-antitrypsin levels in stool samples from subjects aged over 60 years as a marker of protein-losing enteropathy. alpha 1-antitrypsin was found in all of 12 patients with colonoscopy-confirmed pseudomembranous colitis, 6 of 14 (43%) patients with clostridium difficile diarrhoea without pseudomembranes, 6 of 12 (50%) nursing-home patients culture-positive for cl difficile but negative for its cytotoxin, and none ...	1989	2567373
outbreak of clostridium difficile diarrhoea in an orthopaedic unit: evidence by phage-typing for cross-infection.	in a three-week period five patients had diarrhoea in an orthopaedic unit. the first case was clinically diagnosed as pseudomembranous colitis but the causative agent was not sought. of the remaining cases, two were clostridium difficile positive. the outbreak then apparently ceased, but during the following several days two of seven stool samples taken at random from asymptomatic patients yielded c. difficile. phage-typing of the isolates showed that all apparently belonged to the same strain.	1989	2567761
bacteriotherapy for clostridium difficile diarrhoea.		1989	2570250
clostridium difficile infection in health-care workers.		1989	2571792
clostridium difficle infection in health-care workers.		1989	2572809
bacteriotherapy for clostridium difficile colitis.		1989	2572812
intravenous metronidazole and clostridium difficile-associated diarrhea or colitis.		1989	2584759
intravenous/oral ciprofloxacin versus ceftazidime in the treatment of serious infections.	seventy-one adult patients with 72 infections were treated, by random selection, with intravenous/oral ciprofloxacin or intravenously administered ceftazidime. twenty-seven additional patients with 29 infections who were not appropriate for random assignment were treated in an open study with intravenously administered ciprofloxacin only; the latter infections were generally more serious or were caused by ceftazidime-resistant organisms. the most common doses were ciprofloxacin, 200 mg intraveno ...	1989	2589361
[hospital epidemic of clostridium difficile diarrhea: demonstration of cross-infection using a typing technic].	two hospital outbreaks of clostridium difficile diarrhoea in two general surgery units of different hospitals are described. moreover, the results of a study on the circulation of c. difficile in a neurosurgery unit following two cases of colitis are reported. c. difficile strains isolated from patients and environment have been typed using antimicrobial susceptibility testing and electrophoretic profiles of edta-extracted proteins. the majority of strains isolated in each hospital shared the sa ...	1989	2589733
high incidence of false positives by a latex agglutination test for the diagnosis of clostridium difficile associated colitis in compromised patients.	detection of clostridium difficile cytotoxin using cell culture assays for the diagnosis of antibiotic-associated colitis has been used for over a decade. because the methodology is time consuming and cumbersome, a recently introduced commercial latex agglutination (la) kit has attracted much attention. we compared the sensitivity and specificity of this method with the cytotoxic assay (cta) using diarrheal stools from 652 patients at a referral tertiary care center. specimens from 71 (10.9%) pa ...	1989	2591165
[the occurrence of clostridium difficile in fecal samples of dogs and cats].	fecal samples of 150 dogs and 175 cats originating from different veterinary practices were investigated for assessing the occurrence of clostridium (cl.) difficile by using a selective medium for cultural isolation. from dogs without enteric symptoms 7 (9.3%) of 75 samples were positive for cl. difficile, with 2 strains being cytotoxic for bovine embryonic lung fibroblast cells, which could be neutralized by cl. difficile-antitoxin. in samples of 75 dogs with enteric symptoms cl. difficile coul ...	1989	2596198
antibiotic exposure delays intestinal colonization by clostridium difficile in the newborn.	two antibiotic regimens commonly used in neonatal intensive care were compared for the rate at which clostridium difficile appeared in the faeces. over a nine month period neonates with suspected sepsis admitted to a special care baby unit (scbu) were randomly allocated to receive either cefotaxime or penicillin and netilmicin. a contemporaneous group also admitted to scbu but without sepsis served as non-treated controls. four hundred and sixteen stool specimens from 158 neonates without diarrh ...	1989	2600001
[infectious diarrhea in the adult].	infectious diarrhoeas are usually divided into two types; toxinogenic and invasive. invasive diarrhoeas are copious and responsible for dehydration which is the principal clinical sign; mucosal lesions and bacteraemia are absent. the most typical of toxinogenic diarrhoeas is cholera, but enterotoxicogenic e. coli and aeromonas infections have similar clinical features. in invasive diarrhoeas the responsible microorganisms penetrate into the epithelial cells of the intestine, producing fever and ...	1989	2602888
clostridium difficile in elderly patients.		1989	2603844
inhibition of clostridium difficile toxin a and b by 1,2-cyclohexanedione modification of an arginine residue.	toxin a (enterotoxin) and toxin b (cytotoxin) of clostridium difficile were both inactivated by the arginine specific reagent 1,2-cyclohexanedione. molecular stability during the inactivation process was demonstrated by sds-page analysis showing the same migration rates for modified and unmodified forms of the 230 kda toxin a and of the 250 kda toxin b. cytotoxicity of both toxins as well as mouse lethality of the enterotoxin were drastically decreased as a result of the arginine modification. t ...	1989	2610698
the effect of new broad-spectrum antibiotics on faecal flora of cancer patients.	the effects of newly available broad-spectrum antibiotics, used for infection prophylaxis and therapy in cancer patients, on faecal aerobic and anaerobic bacteria were investigated. quantitative and qualitative aerobic and anaerobic cultures were performed in 34 patients before therapy and between the sixth and eleventh day of therapy. of the two prophylactic regimens norfloxacin plus amphotericin-b eliminated enterobacteriaceae and enterococci without encouraging growth of yeasts or clostridium ...	1989	2613606
effect of erythromycin acistrate and erythromycin stearate on human colonic microflora.	the effects of erythromycin acistrate (2'-acetyl erythromycin stearate), a new erythromycin derivative, and erythromycin stearate on the faecal microflora were compared in a randomized cross-over study. 12 healthy volunteers were given either drug 500 mg t.i.d. for 1 week. their faeces were studied before, immediately after, and 1 week after the drug administration period. after a wash-out period of 4 weeks, the drugs were interchanged. both erythromycin acistrate and erythromycin stearate induc ...	1989	2617212
medical implications of nosocomial infection with clostridium difficile.	88 patients above the age of 60 years who contracted clostridium difficile associated diarrhoea (cdad) between 1979 and 1986, mostly during their stay in hospital were studied retrospectively as regards nursing time and clinical outcome. these patients were compared with 176 control patients who were matched according to diagnosis on admission to hospital, sex, age and underlying disease. thromboembolic complications occurred in 14% in cdad patients (controls 4%) (p = 0.0042). the mortality rate ...	1989	2617213
[a rapid test for detecting clostridium difficile].	staphylococcus aureus cells, strain cowan 1, were coated with an anti-clostridium difficile serum, produced in rabbits. this reagents were used in the coagglutination (coa-test) for detection of clostridium difficile. a total of 275 bacterial cultures of different species were tested for detection of clostridium difficile by coa-test and bacterial culture. of 183 strains positive by isolation of the organism, 181 were positive by coa-test. the sensitivity and specificity of the coa-test relative ...	1989	2618112
[clostridium difficile enterocolitis in subjects treated with wide-spectrum antibiotics].	after a concise description the main aetiopathogenic features of clostridium difficile colitis, three clinical cases are reported. it is considered that this disease could be easily cured as long as high risk patients are determined.	1989	2622575
disease associated with clostridium difficile infection.		1989	2643913
anaerobic bacteremia in patients with acute leukemia.	we reviewed 402 hospital admissions of patients with acute leukemia to define the frequency and characteristics of anaerobic bacteremia in this patient population. six (5.2%) of the 116 septicemia episodes documented in these patients were caused by anaerobes (bacteroides species, 3; fusobacterium species, 2; and clostridium tertium, 1); two of these episodes were polymicrobial. five patients had had prior bacteremia. all six patients were receiving broad-spectrum antibiotics, including an anti- ...	1989	2647821
clostridium difficile associated reactive arthritis in an hla-b27 positive female: report and literature review.	a case of clostridium difficile associated reactive arthritis in an hla-b27 positive female is reported and compared to 9 other cases. the clinical course of c. difficile associated reactive arthritis is similar to that caused by other enteric pathogens. therefore, c. difficile should be considered in the differential diagnosis of the reactive arthritides.	1989	2654390
[antibiotic-associated diarrhea and colitis caused by clostridium difficile].		1989	2658892
clostridium difficile and its cytotoxin in diarrhoeic stools of hospitalized patients. toxigenic potential of the isolates.	cytotoxin assay and culture for clostridium difficile were performed on 303 diarrhoeic stools from 261 hospitalized patients. specimens from 42 patients were positive by at least one of the methods, and 40 of them had an antibiotic-associated diarrhoea. the cytotoxin assay was positive in 5 of 7 patients with pseudomembranous colitis. thirteen had an appropriate response to specific therapy and the remainder have resolved of diarrhoea without c. difficile directed chemotherapy. these findings sh ...	1989	2660635
[diarrhea induced by antibiotics].	the most frequent cause of antibiotic-associated colitis is clostridium difficile. this gram-positive, spore-forming anaerobic bacillus releases toxins, which produce diarrhea and damage the colonic mucosa. endoscopy shows a wide range of alterations, "unspecific colitis" with reddening or edema, ulcerations or at the worst pseudomembranous colitis. nearly all antibiotics are able to trigger clostridium difficile colitis. an enhanced risk is exerted by broad spectrum substances, which act also o ...	1989	2662616
third generation cephalosporins as a risk factor for clostridium difficile-associated disease: a four-year survey in a general hospital.	the main clinical features of patients who developed pseudomembranous colitis (pmc) or clostridium difficile-associated diarrhoea (cdad) during their stay at the s. anna general hospital, como, over the period february 1984 to may 1988, are reported. forty patients developed either cdad (ten cases) or pmc (30 cases). twenty-seven (65.7%) had undergone surgery and 32 (80.0%) had received prolonged antibiotic treatment. three patients (7.5%) were given three doses only of ceftriaxone. five patient ...	1989	2663814
rapid method to detect shiga toxin and shiga-like toxin i based on binding to globotriosyl ceramide (gb3), their natural receptor.	shiga toxin and the closely related shiga-like toxins produced by escherichia coli represent a group of very similar cytotoxins that may play an important role in diarrheal disease and hemolytic uremic syndrome. these toxins have the same biologic activities and according to recent studies also share the same binding receptor, globotriosyl ceramide (gb3). they are currently detected, on the basis of their ability to damage several cell lines, by using expensive and tedious assays that require fa ...	1989	2666433
etiology of childhood diarrhea in korea.	to assess the role of recently recognized enteropathogens in childhood diarrhea in korea, 231 children with diarrhea admitted to and 104 children without diarrhea seen at the well-baby clinic or the outpatient department of hanyang university hospital in seoul, korea, were evaluated during a 14-month period. stools were cultured for bacterial pathogens, including enterotoxigenic (heat-labile and heat-stable enterotoxin-producing) and enteroadherent organisms. only those stools obtained from pati ...	1989	2666437
intestinal infections: current aspects and new possibilities of prophylaxis and treatment.	intestinal infections of still high importance from the hygienic-epidemiological aspects and the recent results obtained in this field have been surveyed. recently recognized enteric pathogens (campylobacter, yersinia, rotavirus, clostridium difficile, etc.) as well as the newest data on the pathomechanism of intestinal infections have been discussed. these data not only have increased our knowledge of the pathology but also resulted in basic, favourable changes in therapy. detailed information ...	1989	2667192
[diseases caused by clostridium difficile].		1989	2672583
[epidemiology of colitis caused by clostridium difficile].		1989	2675504
treatment of recurrent clostridium difficile colitis with vancomycin and saccharomyces boulardii.	recurrence of clostridium difficile-associated diarrhea and pseudomembranous colitis occurs in up to 20% of patients after standard therapy. in these patients, subsequent recurrences are even more frequent. saccharomyces boulardii, a nonpathogenic yeast, was found to be effective in preventing clindamycin cecitis recurrence in an animal model. we performed an open trial of s. boulardii to evaluate its efficacy in treating recurrences of c. difficile-associated colitis in humans. thirteen patient ...	1989	2679049
the ecology of the human intestine and its consequences for overgrowth by pathogens such as clostridium difficile.		1989	2679366
interrelationships between digestive proteolytic activities and production and quantitation of toxins in pseudomembranous colitis induced by clostridium difficile in gnotobiotic mice.	clostridium difficile pathogenicity is related to in vivo production of toxins, and it is of great interest to detect toxins produced in biological samples. several reports have shown that proteases in stools interfere with immunological methods for quantitation of toxin a. the purpose of this work was to estimate the relationship between the proteases and the c. difficile toxins produced in a gnotobiotic mouse model of pseudomembranous cecitis. cecal proteolytic activities hydrolyzed toxin a, a ...	1989	2680988
portal venous gas after hepatic transplantation: sonographic detection and clinical significance.	in seven (18%) of 39 liver transplantation patients, serial doppler sonographic examinations performed in the first 2 weeks after the transplantation showed transient, highly echogenic nonshadowing particles moving within the portal vein, believed to be portal venous air. this finding was associated with sepsis in one patient, a positive stool culture for clostridium difficile in another, and postoperative ileus in a third patient. a fourth patient had primary graft failure and required a second ...	1989	2683676
identification of clostridium difficile in stool specimens by culture-enhanced gas-liquid chromatography.	we have developed a sensitive and specific method for the identification of clostridium difficile in stool specimens based on the detection of metabolic breakdown products of the organism by gas-liquid chromatography after incubation of stool samples in a selective broth medium containing cefoxitin. use of this approach to test samples from two different populations of patients at separate medical centers showed this method to be superior to plate cultures or cytotoxin testing alone for both pop ...	1989	2685021
detection of asymptomatic clostridium difficile carriage by an alcohol shock procedure.	direct inoculation to cefoxitin-cycloserine-fructose agar and broth was compared with alcohol shock-chopped meat broth inoculation for optimal detection of clostridium difficile in fecal samples. alcohol shock is significantly more sensitive than cefoxitin-cycloserine-fructose agar or broth and may be the method of choice to detect c. difficile in asymptomatic carriers.	1989	2685035
prospective, randomized comparison of sequential intravenous followed by oral ciprofloxacin with intravenous ceftazidime in the treatment of serious infections.	in a prospective, comparative trial, 47 hospitalized patients with serious infections that required parenteral antibiotic therapy were randomly assigned to receive either ciprofloxacin (200 mg every 12 hours intravenously followed by 500 mg every 12 hours orally at a time dependent on the patients' clinical and bacteriologic responses) or ceftazidime (2 g every eight to 12 hours intravenously). all evaluable subjects (39 patients) had documented infections, 23 percent of which were associated wi ...	1989	2686421
in vitro antimicrobial activity and susceptibility testing of ofloxacin. current status.	the fluoroquinolone, ofloxacin, exhibits a broad antibacterial spectrum. based on our data and a review of the literature, ofloxacin inhibited essentially 100 percent of staphylococci, including oxacillin-resistant strains, haemophilus influenzae, neisseria spp. and branhamella catarrhalis. ninety-five percent of enterobacteriaceae were susceptible to ofloxacin. pseudomonas aeruginosa and enterococci were less susceptible: 79 and 63 percent, respectively, were susceptible (minimal inhibitory con ...	1989	2690614
a randomized trial to compare amoxycillin/clavulanate with metronidazole plus gentamicin in prophylaxis in elective colorectal surgery.	a randomized controlled trial was designed to compare antibiotic prophylaxis with a standard combination of agents, metronidazole and gentamicin, with a single preparation, amoxycillin/clavulanate in 400 patients undergoing elective colorectal surgery. there were 41 patients who were excluded or withdrawn (wrong dose, inappropriate operation, established sepsis or concurrent disease). abdominal wound sepsis occurred in 14% of the assessable patients in the amoxycillin/clavulanate group and in 15 ...	1989	2691480
severe pseudomembranous enterocolitis in a child: case report and literature review.	antibiotic-associated pseudomembranous enterocolitis (pmc), an inflammatory gastrointestinal disease mediated by toxins produced by clostridium difficile, is increasingly recognized in the pediatric population. we report a case of fulminant pmc in an otherwise normal 2 1/2-year-old child after antibiotic therapy given for a routine childhood illness. the patient had debilitating colitis marked by severe diarrhea, a generalized electrolyte derangement, an extreme protein-losing enteropathy state, ...	1989	2696928
demonstration of capsules in clostridium difficile.	in four strains of clostridium difficile the formation of capsules was demonstrated by light and electron microscopy.	1989	2711788
diagnostic studies of nosocomial diarrhea in children: assessing their use and value.	during a 17-month period (01/11/85-05/31/86) 225 cases of nosocomial diarrhea were identified in a children's hospital. diarrhea was considered to be nosocomial if it began at least 72 hours after the patient's hospital admission or within 3 days after discharge. one or more routine diagnostic studies for identification of a pathogen were performed in 195 (87%) cases. the most commonly performed test was the bacterial stool culture. none of these samples yielded a bacterial pathogen. the only pa ...	1989	2729660
antibacterial activity of the new glycopeptide antibiotic skf104662.	the inhibitory activity of the new glycopeptide antibiotic skf104662 was generally equivalent (+/- 1 concentration increment) to the activities of vancomycin, teicoplanin, and daptomycin against selected gram-positive bacteria. however, skf104662 demonstrated greater activity against staphylococcus epidermidis and s. haemolyticus than did teicoplanin and was more active than the other drugs against clostridium difficile isolates. skf104662 possessed bactericidal activity quite similar to that of ...	1989	2729947
typing of clostridium difficile causing diarrhoea in an orthopaedic ward.	in an outbreak of diarrhoeal disease in an orthopaedic ward clostridium difficile was isolated from all six patients with diarrhoea. attempts were made to type these isolates by means of antibiogram, detection of pre-formed enzymes, analysis of surface proteins by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (sds-page) and immunoblotting, and plasmid profile analysis. this showed that a single strain (type e) indistinguishable by the four distinct methods of typing, was isolated fr ...	1989	2732346
[preparation of diagnostic antitoxic serum to clostridium difficile].	the results of the studies on the preparation of diagnostic antitoxic sera to c. difficile, intended for use in biological assays with the aim of the laboratory diagnosis of clostridial enteric infections, are presented. the conditions for the detoxification of c. difficile native toxin have been established, the optimum schedules for the immunization of rabbits have been selected and specific antitoxic sera to c. difficile have been obtained. the neutralizing activity of these sera has been eva ...	1989	2735166
comparison of two oral formulations of vancomycin for treatment of diarrhoea associated with clostridium difficile.		1989	2745253
evaluation of a latex agglutination test for clostridium difficile in two nursing home outbreaks.	the culturette brand clostridium difficile test (cdt; marion laboratories, inc., kansas city, mo.) is a latex agglutination test for c. difficile. the recent controversy involving the identity of antigens detected by cdt has made decisions on its use difficult. we compared the test results with those of selective culture and stool cytotoxin assays in investigations of two nursing home outbreaks of c. difficile-associated disease in order to formulate usage recommendations. selective culture for ...	1989	2745696
nosocomial clostridium difficile infections.		1989	2747751
nucleotide sequence of a chloramphenicol acetyl transferase gene from clostridium difficile.		1989	2748343
clostridium difficile in the intensive care unit: management problems and prevention issues.	several patients hospitalized in our 12-bed medical icu were found to have clostridium difficile associated colitis. stool cultures of all patients identified eight cases (three culture positive, and five culture and cytotoxin positive), seven of which were geographically and temporarily clustered within a 2-wk period. at least one patient appeared to contract the disease after hospitalization and in the absence of antibiotic therapy or other known major risk factors. the outbreak highlights the ...	1989	2752778
extended spectrum cephalosporins and clostridium difficile.	there is little information about how commonly the newer cephalosporins cause diarrhoea due to clostridium difficile. in this study of 111 patients with c. difficile-associated diarrhoea, 106 had received antimicrobial agents in the four weeks before detection of c. difficile. the relative risk for each antimicrobial agent was greatest with clindamycin, followed by cefotaxime, cephamandole and ceftriaxone. there was no statistically significant difference in risk between the cephalosporins evalu ...	1989	2759933
relapsing clostridium difficile toxin-associated colitis in ovarian cancer patients treated with chemotherapy.	symptomatic relapse of clostridium difficile toxin-associated colitis occurred in three patients with ovarian cancer. in two patients, c difficile toxin-positive diarrhea initially appeared in association with antibiotic therapy. the third patient developed diarrhea after chemotherapy, without recent antecedent antibiotic administration. patients were initially treated with oral metronidazole and became asymptomatic and toxin-negative. a symptomatic toxin-positive recurrence then developed after ...	1989	2761938
in vitro and in vivo antibacterial activities of bmy 40062, a new fluoronaphthyridone.	the in vitro and in vivo activities of a new naphthyridone, bmy 40062, were compared with those of ciprofloxacin and ofloxacin. bmy 40062 showed about threefold more activity than ciprofloxacin showed and four- to eightfold more activity than ofloxacin showed against staphylococci, streptococci, and enterococci. bmy 40062 showed generally twofold less activity than ciprofloxacin showed against most species of the family enterobacteriaceae, pseudomonas aeruginosa, and acinetobacter spp. but twofo ...	1989	2764541
characterization and reassembly of a regular array in the cell wall of clostridium difficile gai 4131.	the cell wall of clostridium difficile gai 4131 was revealed by electron microscopy to have an outer layer composed of a nearly square array and contained the two major proteins with molecular weights of 38 kda and 42 kda. the properties and reassembly of the two major proteins into the regular array were investigated. when the isolated cell walls were treated with hydrophobic bond-disrupting agents or a chelating agent specific for ca2+, the two major proteins were effectively removed and the r ...	1989	2770560
fulminant idiopathic pseudomembranous colitis.	pseudomembranous colitis is characterized by inflammatory plaques and pseudomembranes on the colonic mucosa. the disorder most commonly occurs after the use of antibiotics, which allow overgrowth of clostridium difficile, a spore-forming, gram-positive rod that produces a toxin. overgrowth of staphylococcus aureus can also produce pseudomembranous colitis. in rare cases, pseudomembranous colitis is not associated with antibiotic use. when c. difficile is present, vancomycin or metronidazole usua ...	1989	2773757
comparison of media for screening of diarrheic stools for the recovery of clostridium difficile.	recoveries of clostridium difficile from stool specimens by using three media, cycloserine-mannitol agar (m-cma), cycloserine-mannitol-blood agar (m-cmba), and cycloserine-cefoxitin agar (m-cca), were compared. of 321 clinical specimens, 37 yielded c. difficile. thirty-four were positive on m-cca, 21 were positive on m-cma, and 20 were positive on m-cmba. m-cca recovered significantly more c. difficile than did m-cmba or m-cma.	1989	2778074
purification and characterisation of clostridium difficile toxin a by bovine thyroglobulin affinity chromatography and dissociation in denaturing conditions with or without reduction.	highly purified toxin a of clostridium difficile was obtained by bovine thyroglobulin affinity chromatography followed by two sequential anion-exchange chromatography steps on q sepharose ff and mono q. after q sepharose ff chromatography of a thyroglobulin affinity-purified toxin a preparation, two major peaks of cytotoxicity representing toxins a and b were detected. the homogeneity of the final toxin a preparation obtained from mono q anion-exchange fast protein liquid chromatography was asce ...	1989	2778794
reactive oligoarthritis associated with clostridium difficile colitis.		1989	2784867
fixation of clostridium difficile toxin a and cholera toxin to intestinal brush border membranes from axenic and conventional mice.	we have tested the in vitro binding of clostridium difficile toxin a (enterotoxin) and cholera toxin to intestinal brush border membranes prepared from either conventional or axenic mice. membranes from axenic mice were shown to be saturated at a lower toxin a concentration (at least 2.5 times lower). because there were no significant differences between membranes from axenic and conventional mice in binding at low toxin a concentrations, the presence of the normal microflora seems to increase t ...	1989	2785961
origin and fate of ige-bearing lymphocytes. ii. modulation of ige isotype expression on peyer's patch cells by feeding with certain bacteria and bacterial cell wall components or by thymectomy.	mechanisms regulating the appearance of sige+ b lymphocytes appear to be lacking in adult germfree (gf) rats in that their peyer's patches (pp) contain high numbers of cells with sige (approximately 15% of total cells), one-half of which simultaneously express siga, whereas sige+ cells are absent from pp of conventional rats (less than 1%). gf rat pp also contain elevated numbers of siga+ cells and decreased numbers of sigm+ cells, with elevated numbers of sthy-1+ rt 7.1+ ig- t cells, and reduce ...	1989	2789249
comparative in vitro activity of lomefloxacin, a difluoro-quinolone.	lomefloxacin is a new difluoro-quinolone. in this study, we have determined the in vitro activity of lomefloxacin against a wide range of clinical bacterial isolates and compared it with that of other fluoro-quinolones and some unrelated antimicrobials. lomefloxacin was very active against enterobacteriaceae (mic90, 0.5 micrograms/ml) with activity comparable to that of ofloxacin (mic90, 0.25 micrograms/ml). lomefloxacin was moderately active against isolates of pseudomonas aeruginosa (mic90, 4 ...	1989	2791500
feacal carriage of cytotoxigenic strains of clostridium difficile by adult nigerians.	the isolation rate of clostridium difficile and the presence of its cytotoxin in stool were studied in adults with diarrhoea and healthy normal individuals over a period of one year. c. difficile was isolated from 23(56%) out of 41 patients with diarrhoea who gave history of antibiotic exposure prior to the development of the disease from 12(31.6%) of the 38 healthy controls with no history of antibiotic exposure. of the 23(31.6%) c. difficile isolated from the patients, 16(69.6%), and only 8(66 ...	1989	2791928
diarrhoea associated with ceftriaxone and its implications in paediatric patients.	we prospectively studied 50 paediatric patients (3 months-12 years) who received 50 mg/kg ceftriaxone, i.v. over 20 min every 12 h for 3-14 days. diarrhoea, as defined by four bowel movements/day for two consecutive days, occurred in 34% (17) of 50 patients. an additional two patients with diarrhoea were excluded due to the presence of enteroviruses. diarrhoea occurred after 2-14 (8.7 +/- 3.2) doses and persisted for 2-8 (3.1 +/- 1.7) days. the mean number of bowel movements was 1.2/days before ...	1989	2793955
treatment of clostridium difficile diarrhea.		1989	2796843
clostridium difficile colitis associated with ofloxacin therapy.		1989	2801739
effect of clostridium difficile enterotoxin a on ultrastructure of chinese hamster ovary cells.	electron microscopical immunocytochemistry and light microscopy were used to study the effect of clostridium difficile enterotoxin a (ea) on cultured chinese hamster ovary (cho) cells. at 4 degrees c, immunocytochemically detected ea was randomly distributed along the plasma membrane; when cells were subsequently transferred to 37 degrees c, the ea moved into coated pits and coated vesicles within 2 min. within 2 h of incubation at 37 degrees c with ea, the perinuclear cytoplasm of the cho cells ...	1989	2807554
comparative in-vitro activity of meropenem on clinical isolates from the united kingdom.	mics of meropenem were determined for a wide range of common bacteria of clinical importance. for enterobacteriaceae, aeromonas spp., haemophilus influenzae, branhamella catarrhalis, neisseria gonorrhoeae, gardnerella vaginalis, campylobacter coli/jejuni, beta-haemolytic streptococci and anaerobes other than clostridium difficile, mics were almost always within the range 0.002-0.5 mg/l. the activity of meropenem for these organisms was always greater than that of imipenem and piperacillin, and w ...	1989	2808214
immunoblot analysis of serum immunoglobulin g response to surface proteins of clostridium difficile in patients with antibiotic-associated diarrhea.	we examined by immunoblot analysis the serum immunoglobulin g antibody response to edta-extracted surface proteins of clostridium difficile in 16 patients with antibiotic-associated diarrhea. for each patient, paired serum samples were tested against proteins of the infecting strain and of a collection strain (c253) known to belong to the electrophoretic group 2 pattern. eight patients, all harboring group 2 c. difficile strains, exhibited responses to the proteins of the infecting strain; six p ...	1989	2808681
an outbreak of clostridium difficile associated diarrhoea in urological practice: a potential consequence of excessive antibiotic prophylaxis?	during an outbreak of clostridium difficile associated diarrhoea, 17 patients on a urological ward developed symptoms in a 17-day period. of these patients, 15 had received antibiotics during their admission. in order to eradicate the infection, it was necessary to close the unit for 1 month. antibiotic associated diarrhoea is a serious complication of the prophylactic and therapeutic use of such agents and, because of the common use of antimicrobials on urological units, there is potential for ...	1989	2810164
treatment of antibiotic-associated clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens.	high-dose (500 mg orally four times daily) vancomycin is considered by many investigators to be the most effective treatment for antibiotic-associated clostridium difficile colitis. however, a lower dosage of 125 or 150 mg given three or four times a day has become popular, has been shown to be effective, and is less expensive than the high-dose regimen. we therefore decided to compare two vancomycin dosage regimens in a randomized trial.	1989	2910090
clostridium difficile colitis secondary to intravenous vancomycin.	nearly every known antibiotic has been implicated as a cause of clostridium difficile colitis. we report the first case resulting from monotherapy with intravenous vancomycin. the patient was on chronic hemodialysis and was treated with intravenous vancomycin for presumed cervical osteomyelitis. after 29 days of therapy he developed abdominal pain and diarrhea and his stool was found to contain both c. difficile and cytotoxin. the patient responded with symptomatic and microbiological recovery t ...	1989	2910675
nosocomial acquisition of clostridium difficile infection.	we studied the acquisition and transmission of clostridium difficile infection prospectively on a general medical ward by serially culturing rectal-swab specimens from 428 patients admitted over an 11-month period. immunoblot typing was used to differentiate individual strains of c. difficile. seven percent of the patients (29) had positive cultures at admission. eighty-three (21 percent) of the 399 patients with negative cultures acquired c. difficile during their hospitalizations. of these pat ...	1989	2911306
recurrences of clostridium difficile diarrhea not caused by the original infecting organism.		1989	2915158
phenelfamycins, a novel complex of elfamycin-type antibiotics. iii. activity in vitro and in a hamster colitis model.	phenelfamycins a, b, c, e, f and unphenelfamycin make up a recently isolated group of elfamycin-type antibiotics. all of the phenelfamycins were active against gram-positive anaerobes, including clostridium difficile. phenelfamycin a was also active in vitro against neisseria gonorrhoeae and streptococci. phenelfamycin a was found to be effective in prolonging the survival of hamsters in an animal model of c. difficile enterocolitis. after oral administration of phenelfamycin a to hamsters, anti ...	1989	2921230
recovery of spores of clostridium difficile altered by heat or alkali.	the effect of heating or alkali-treatment on spore recovery in ordinary growth medium was examined for four strains of clostridium difficile. heating spores at 80 degrees c for 10 min produced 95.50-99.95% decreases in the recovery rates. treatment with 0.1 n naoh for 15 min produced 99.47 and 99.83% decreases in spore recovery rates for two of the four strains. the influence of either addition of lysozyme after treatment with sodium thioglycollate (thioglycollate-lysozyme method) or addition of ...	1989	2926793
oral fluoroquinolone therapy for clostridium difficile enterocolitis.		1989	2926941
evaluation of antibiotic-associated diarrhea with a latex agglutination test and cell culture cytotoxicity assay for clostridium difficile.	diagnosis of clostridium difficile (c. difficile) by its antigen or toxin has improved treatment for patients who have antibiotic-associated diarrhea and opportunistic colonization of the colon with c. difficile. unfortunately, results from the tissue culture cytotoxicity assay are not available for 48 h. we prospectively compared a latex agglutination test with the tissue culture cytotoxicity assay in 83 patients (15 with antibiotic-associated diarrhea, 23 with non-antibiotic-associated diarrhe ...	1989	2929558
effect of clindamycin on factor-vii activity in healthy cats.	four healthy cats were given clindamycin orally in daily doses of 25 or 50 mg/kg of body weight for 6 weeks. significant change in factor-vii activity was not found, compared with pretreatment values. in 2 cats tested, toxin produced by clostridium difficile was not detected in fecal samples obtained before treatment and at 6 weeks after treatment, suggesting that intestinal overgrowth by c difficile did not develop. results of the study seemed to indicate that orally administered clindamycin do ...	1989	2930027
efficacy of daptomycin compared to teicoplanin in the treatment of clostridium difficile colitis in hamsters.		1989	16312372
antibacterial activity of rifaximin against clostridium difficile, campylobacter jejunii and yersinia spp.		1989	16312377
prevalence of enteric pathogens in homosexual men with and without acquired immunodeficiency syndrome.	we studied 388 homosexual or bisexual men from the baltimore-washington area to define the spectrum of enteric pathogen carriage in a population at high risk for "gay bowel syndrome" in association with human immunodeficiency virus infection. seventy-seven patients with acquired immunodeficiency syndrome, 68 gay men with symptoms of acute diarrhea or proctitis, and 243 gay men without gastrointestinal symptoms and participating in a natural history study of human immunodeficiency virus infection ...	1988	2831107
serotyping of clostridium difficile.	a total of 246 live clostridium difficile cultures were serotyped by a slide agglutination technique. fifteen grouping antisera were produced which serotyped 98% of the cultures (241 of 246). our results indicated that certain serogroups may have specific pathogenicity. strains of serogroups a, g, h, k, s1, and s4 were cytotoxigenic and were isolated mainly from adult patients with pseudomembranous colitis or antibiotic-associated diarrhea. nontoxigenic strains of serogroups d and cd-5 were isol ...	1988	2833528
acquisition of clostridium difficile from the hospital environment.	an outbreak of antibiotic-associated colitis that occurred on a ward of a michigan hospital during february-april, 1984, was studied by bacteriophage-bacteriocin typing. stools from the seven involved patients yielded clostridium difficile isolates of types b1537 or cld7;b1537. c. difficile was recovered from 31.4% of environmental cultures obtained on the ward, and the majority of isolates were types b1537 or cld7;b1537. when the ward was disinfected with unbuffered hypochlorite (500 parts per ...	1988	2835900
in vivo profiles of eicosanoids in ulcerative colitis, crohn's colitis, and clostridium difficile colitis.	to compare the local release of arachidonic acid metabolites in inflammatory diarrheal disease, in vivo equilibrium dialysis of the rectum was done in consecutive untreated patients with ulcerative colitis (n = 20), crohn's colitis (n = 10), and clostridium difficile colitis (n = 7). all patients had endoscopically proven rectal inflammation. eicosanoid profiles were determined in rectal dialysates by radioimmunoassay after preliminary purification. concentrations of prostaglandin e2, prostaglan ...	1988	2836256
in vitro activity of ly146032 against gram-positive bacteria.	the activity of ly146032 (ly) was evaluated against 269 clinical isolates: 150 staphylococcus spp. (staph), 45 enterococci, 51 clostridium spp., and 23 peptostreptococci. ly was compared to penicillin, metronidazole, imipenem, clindamycin, oxacillin, ciprofloxacin, vancomycin, and ampicillin. ly and oxacillin were tested against staph by microdilution in cation-supplemented mueller-hinton broth (csmhb), and in unsupplemented mueller-hinton broth (mhb). for ly, the mic 90s in csmhb were 16-32 dil ...	1988	2838217
clostridium difficile toxin a stimulates intracellular calcium release and chemotactic response in human granulocytes.	clostridium difficile, a common enteric pathogen, mediates tissue damage and intestinal fluid secretion by release of two protein exotoxins: toxin a, an enterotoxin, and toxin b, a cytotoxin. because toxin a elicits an intense inflammatory reaction in vivo, we studied the effects of highly purified c. difficile toxins on activation of human granulocytes. toxin a at concentrations of 10(-7) to 10(-6) m, but not toxin b, elicited a significant chemotactic and chemokinetic response by granulocytes ...	1988	2838520
in vitro activities of daptomycin (ly146032) and paldimycin (u-70,138f) against anaerobic gram-positive bacteria.	the in vitro activities of daptomycin (ly146032), paldimycin (u-70,138f), vancomycin, and penicillin g against 344 clinical isolates of anaerobic gram-positive bacteria were determined by an agar dilution method in calcium-supplemented (50 micrograms/ml) wilkins-chalgren medium, using an inoculum of 10(5) cfu. daptomycin demonstrated excellent activity against a broad range of anaerobic gram-positive cocci and bacilli, including peptostreptococcus, eubacterium, bifidobacterium, actinomyces, prop ...	1988	2840019
characterization of a nosocomial clostridium difficile outbreak by using plasmid profile typing and clindamycin susceptibility testing.	the mean number of cases of clostridium difficile diarrhea at the minneapolis veterans administration medical center increased to 17.3 per month in june-august 1985, compared with 7.1 per month in the previous 17 mo. plasmid profiles and clindamycin susceptibility were used as markers to evaluate the increase in cases. ninety clindamycin-resistant and 22 clindamycin-susceptible isolates of c. difficile from 1985 were examined for plasmids. a clindamycin-resistant organism contained a cryptic pla ...	1988	2844914