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pseudomembranous colitis secondary to methicillin-resistant staphylococcus aureus (mrsa).a 37-year-old woman with a history of type ii diabetes and crohn's disease, status postcholecystectomy, presented with a >2-week history of cramping abdominal pain, nausea, non-bloody/non-bilious emesis and, later, diarrhoea. a flexible sigmoidoscopy was performed, revealing that 'a segmental pseudomembrane was found from rectum to sigmoid colon'. clostridium difficile pcr on the stool was repeated twice and resulted negative both times. a food history prior to onset of symptoms was consistent w ...201627165998
predominance and high antibiotic resistance of the emerging clostridium difficile genotypes napcr1 and nap9 in a costa rican hospital over a 2-year period without outbreaks.clostridium difficile is the major causative agent of nosocomial antibiotic-associated diarrhea. in a 2009 outbreak of c. difficile-associated diarrhea that was recorded in a major costa rican hospital, the hypervirulent nap1 strain (45%) predominated together with a local genotype variant (napcr1, 31%). both strains were fluoroquinolone-resistant and the napcr1 genotype, in addition, was resistant to clindamycin and rifampicin. we now report on the genotypes and antibiotic susceptibilities of 6 ...201627165560
infection: targeting asymptomatic carriers of clostridium difficile infection. 201627165512
impact of microbial derived secondary bile acids on colonization resistance against clostridium difficile in the gastrointestinal tract.clostridium difficile is an anaerobic, gram positive, spore-forming bacillus that is the leading cause of nosocomial gastroenteritis. clostridium difficile infection (cdi) is associated with increasing morbidity and mortality, consequently posing an urgent threat to public health. recurrence of cdi after successful treatment with antibiotics is high, thus necessitating discovery of novel therapeutics against this pathogen. susceptibility to cdi is associated with alterations in the gut microbiot ...201627163871
how to manipulate the microbiota: fecal microbiota transplantation.fecal microbiota transplantation (fmt) is a rather straightforward therapy that manipulates the human gastrointestinal (gi) microbiota, by which a healthy donor microbiota is transferred into an existing but disturbed microbial ecosystem. this is a natural process that occurs already at birth; infants are rapidly colonized by a specific microbial community, the composition of which strongly depends on the mode of delivery and which therefore most likely originates from the mother (palmer et al. ...201627161356
clostridium difficile infection.infection of the colon with the gram-positive bacterium clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. c. difficile is the leading cause of health-care-associated infective diarrhoea. the life cycle of c. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. the primary mediators of inflamma ...201627158839
clostridium difficile associated diarrhea.clostridium difficile associated diarrhea (cdad) is increasingly important in primary care, and associated with high cost, significant morbidity and mortality. as the preferred treatment for different groups of patients varies considerably, it is important to stratify cdad patients into mild versus severe and uncomplicated versus complicated. while treatment with either metronidazole or oral vancomycin cures a majority of patients, and despite improvement in early diagnosis and therapy, recurren ...201627156262
clostridium difficile ribotype 176 - a predictor for high mortality and risk of nosocomial spread?the objective of this survey was to determine the incidence of clostridium difficile infections (cdi) at the department of infectious diseases, bulovka hospital, and to evaluate clinical and epidemiological data on cdi patients together with a detailed molecular characterisation of c. difficile isolates. the patient outcomes were correlated to causative c. difficile pcr-ribotype.201627155489
the challenge of clostridium difficile infection.clostridium difficile infection is a major problem in the united states, resulting in significant morbidity, mortality, and financial costs to the health care system. this commentary provides an update regarding the epidemiology, diagnosis, current recommended management, and challenges surrounding c. difficile infection.201627154892
clostridium difficile toxins a and b: insights into pathogenic properties and extraintestinal effects.clostridium difficile infection (cdi) has significant clinical impact especially on the elderly and/or immunocompromised patients. the pathogenicity of clostridium difficile is mainly mediated by two exotoxins: toxin a (tcda) and toxin b (tcdb). these toxins primarily disrupt the cytoskeletal structure and the tight junctions of target cells causing cell rounding and ultimately cell death. detectable c. difficile toxemia is strongly associated with fulminant disease. however, besides the well-kn ...201627153087
fecal transplantation: any real hope for inflammatory bowel disease?fecal microbiota transplant (fmt) has emerged as an important treatment for antibiotic resistant or recurrent clostridium difficile infection. there has been a great deal of media coverage of the efficacy of fmt, and patients with inflammatory bowel disease (ibd) understandably wonder if this approach would also work for them. there are also instructions on 'do it yourself' fmt therapy on the web. it is important to understand whether there is evidence that this approach is effective in ibd so t ...201627152872
high mobility group box1 protein is involved in acute inflammation induced by clostridium difficile toxin a.high mobility group box1 (hmgb1), as a damage-associated inflammatory factor, contributes to the pathogenesis of numerous chronic inflammatory and autoimmune diseases. in this study, we explored the role of hmgb1 in cdi (clostridium difficile infection) by in vivo and in vitro experiments. our results showed that hmgb1 might play an important role in the acute inflammatory responses to c. difficile toxin a (tcda), affect early inflammatory factors, and induce inflammation via the hmgb1-tlr4 path ...201627151296
production of the ramoplanin activity analogue by double gene inactivation.glycopeptides such as vancomycin and telavancin are essential for treating infections caused by gram-positive bacteria. but the dwindling availability of new antibiotics and the emergence of resistant bacteria are making effective antibiotic treatment increasingly difficult. ramoplanin, an inhibitor of bacterial cell wall biosynthesis, is a highly effective antibiotic against a wide range of gram-positive bacteria, including methicillin-resistant staphylococcus aureus, vancomycin-intermediate re ...201627149627
rifaximin for the treatment of irritable bowel syndrome - a drug safety evaluation.irritable bowel syndrome is a functional gastrointestinal disorder with a multifactorial etiology. alterations of intestinal motility and immunity, gut-brain interactions, as well as gut microbiota dysbiosis contribute to the development of irritable bowel syndrome. therefore, gut microbiota modulation by non-absorbable antibiotics is a therapeutic option in patients with ibs.201627149541
extended perioperative antibiotic coverage in conjunction with intraoperative bile cultures decreases infectious complications after pancreaticoduodenectomy.background. bile contamination from the digestive tract is a well-known risk factor for postoperative complications. despite the literature concerning prevalence of bacterobilia and fungobilia in patients with biliary pathologies, there are no specific recommendations for perioperative antimicrobial coverage for biliary/pancreatic procedures. we evaluated the effect of at least 72 hours of perioperative broad spectrum antibiotic coverage on outcomes of pancreaticoduodenectomy (pd). materials and ...201627147813
detection of 23 gastrointestinal pathogens among children who present with diarrhea.in the era of widespread rotavirus vaccine use, toxigenic clostridium difficile, diarrheagenic escherichia coli, and viruses (particularly norovirus) are commonly detected among children with infectious gastroenteritis in the united states by using a multipathogen molecular panel.201627147712
risk factors for recurrent clostridium difficile infection in pediatric inpatients.the purpose of this study was to identify the risk factors during the incident clostridium difficile infection (cdi) episode, associated with developing recurrent cdi within 60 days, among hospitalized children that may be amenable to intervention.201627146969
transplanting a microbial organ: the good, the bad, and the unknown.fecal microbiota transplantation (fmt) has received increased attention as a therapy for correcting intestinal dysbiosis and restoring a state of health in patients suffering from either recalcitrant infection by clostridium difficile or more complex disease states, such as inflammatory bowel disease (ibd). the "gut microbial organ" from the donor that is used in these transplants may serve to transfer genetic material between donor and recipient via virus-like particles, specifically bacterioph ...201627143392
efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials.the relative efficacy and safety of proton pump inhibitors (ppis) compared to histamine-2-receptor antagonists (h2ras) should guide their use in reducing bleeding risk in the critically ill.201627142116
effect of passive immunotherapy against clostridium difficile infection: a systematic review and meta-analysis.this systematic review aimed to determine the effect of antibody therapy against clostridium difficile infection (cdi) using meta-analysis. in total, 28 studies (animals - 12; human - 17) were identified from the database on the basis of inclusion criteria; then selected studies were systematically reviewed and statistically analyzed. in animal experiments, the pooled relative risk of eight potential studies suggested that the antibody treatment could reduce the risk of cdi. however, the methodo ...201627140414
clostridium difficile infection in patients with inflammatory bowel disease.clostridium difficile infection (cdi) is now the leading cause of nosocomial infection. there has been an upsurge of cdi in patients with inflammatory bowel disease (ibd). ibd patients with cdi have increased morbidity and mortality. the establishment, proliferation, and recurrence of cdi in ibd patients form a complex interplay of microbial, environmental, and host-susceptibility factors. different risk factors have been found predisposing ibd patients to cdi. vancomycin performs better than me ...201627137789
fecal microbiota transplant for clostridium difficile infection in older adults.the objective of this study was to describe the safety of fecal microbiota transplant (fmt) for clostridium difficile infection (cdi) among older adults.201627134658
occupational health risks associated with the use of germicides in health care.environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities, including methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococcus, clostridium difficile, norovirus, and multidrug-resistant gram-negative bacilli. for this reason, routine disinfection of environmental surfaces in patient rooms is recommended. in addition, decontamination of shared medical devices between use by different patients is also recommended. environmental ...201627131141
effectiveness of ultraviolet devices and hydrogen peroxide systems for terminal room decontamination: focus on clinical trials.over the last decade, substantial scientific evidence has accumulated that indicates contamination of environmental surfaces in hospital rooms plays an important role in the transmission of key health care-associated pathogens (eg, methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, clostridium difficile, acinetobacter spp). for example, a patient admitted to a room previously occupied by a patient colonized or infected with one of these pathogens has a higher risk for ...201627131140
reducing health care-associated infections by implementing a novel all hands on deck approach for hand hygiene compliance.hand hygiene is a key intervention for preventing health care-associated infections; however, maintaining high compliance is a challenge, and accurate measurement of compliance can be difficult. a novel program that engaged all health care personnel to measure compliance and provide real-time interventions overcame many barriers for compliance measurement and proved effective for sustaining high compliance and reducing health care-associated infections.201627131129
clostridium difficile clade 5 in australia: antimicrobial susceptibility profiling of pcr ribotypes of human and animal origin.increasing reports of genetic overlap between animal and human sources of clostridium difficile necessitate an understanding of antimicrobial susceptibility and resistance in these populations. in this study, we sought to investigate the in vitro activities of 13 antimicrobials against a unique collection of clade 5 c. difficile isolates of australian animal and human origin.201627130808
impact of microbiology cascade reporting on antibiotic de-escalation in cefazolin-susceptible gram-negative bacteremia.cascade reporting (cr) involves reporting the susceptibilities of broad-spectrum agents only when the organism is resistant to more narrow-spectrum agents. the purpose of this study is to evaluate the impact of cr on antibiotic de-escalation practices and to characterize the impact of cr on clinical outcomes. cr rules were implemented in the microbiology laboratory at atlantic health system (ahs) in june 2013. a retrospective chart review was conducted at two community teaching hospitals in adul ...201627130036
fecal microbiota transplantation using upper gastrointestinal tract for the treatment of refractory or severe complicated clostridium difficile infection in elderly patients in poor medical condition: the first study in an asian country.background and aims. fecal microbiota transplantation (fmt) is a highly effective treatment option for refractory clostridium difficile infection (cdi). fmt may be challenging in patients with a low performance status, because of their poor medical condition. the aims of this study were to describe our experience treating patients in poor medical condition with refractory or severe complicated cdi using fmt via the upper gi tract route. methods. this study was a retrospective review of seven eld ...201627127501
getting to a man's heart through his colon.a 69-year-old man presented with a progressively enlarging pulsatile mass in the left side of his chest. because of a history of an ischemic cardiomyopathy, he had been randomized in 2003 to undergo coronary artery bypass grafting with a dor procedure, as part of the surgical treatment for ischemic heart failure (stich) trial. our patient's imaging studies, including a thoracic computed tomogram and transthoracic echocardiogram, were now of concern for left ventricular pseudoaneurysm. he was tak ...201627127437
durable coexistence of donor and recipient strains after fecal microbiota transplantation.fecal microbiota transplantation (fmt) has shown efficacy in treating recurrent clostridium difficile infection and is increasingly being applied to other gastrointestinal disorders, yet the fate of native and introduced microbial strains remains largely unknown. to quantify the extent of donor microbiota colonization, we monitored strain populations in fecal samples from a recent fmt study on metabolic syndrome patients using single-nucleotide variants in metagenomes. we found extensive coexist ...201627126044
[chronic salmonella typhimurium diarrhea in an immunocompetent patient].chronic diarrhea caused by infection in immunocompetent patients is an infrequent condition in developed countries, although certain pathogens,generally parasites (giardia lamblia, isospora belli,cryptosporidium, cyclospora, strongyloides, ameba,trichuris and schistosoma) and some bacteria (aeromonas,plesiomonas, campylobacter, clostridium difficile, salmonella or mycobacterium tuberculosis)can cause persistent diarrhea.we present the case of a patient who showed salmonella typhimurium in his st ...201627125610
repeat clostridium difficile pcr testing after a negative result. 201627124907
developing a clinical prediction rule for first hospital-onset clostridium difficile infections: a retrospective observational study.background the healthcare burden of hospital-acquired clostridium difficile infection (cdi) demands attention and calls for a solution. identifying patients' risk of developing a primary nosocomial cdi is a critical first step in reducing the development of new cases of cdi. objective to derive a clinical prediction rule that can predict a patient's risk of acquiring a primary cdi. design retrospective cohort study. setting large tertiary healthcare center. patients total of 61,482 subjects aged ...201627123975
dynamics of the fecal microbiome in patients with recurrent and nonrecurrent clostridium difficile infection.recurrent clostridium difficile infection (cdi) remains problematic, with up to 30 % of individuals diagnosed with primary cdi experiencing at least one episode of recurrence. the success of microbial-based therapeutics, such as fecal microbiota transplantation, for the treatment of recurrent cdi underscores the importance of restoring the microbiota. however, few studies have looked at the microbial factors that contribute to the development of recurrent disease. here we compare microbial chang ...201627121861
epidemiology, diagnosis, and management of clostridium difficile infection in patients with inflammatory bowel disease.clostridium difficile infection (cdi) is a major source of morbidity and mortality for the u.s. health care system and frequently complicates the course of inflammatory bowel disease (ibd). patients with ibd are more likely to be colonized with c. difficile and develop active infection than the general population. they are also more likely to have severe cdi and develop subsequent complications such as ibd flare, colectomy, or death. even after successful initial treatment and recovery, recurren ...201627120571
nqo1-knockout mice are highly sensitive to clostridium difficile toxin a-induced enteritis.clostridium difficile toxin a causes acute gut inflammation in animals and humans. it is known to downregulate the tight junctions between colonic epithelial cells, allowing luminal contents to access body tissues and trigger acute immune responses. however, it is not yet known whether this loss of the barrier function is a critical factor in the progression of toxin a-induced pseudomembranous colitis. we previously showed that nadh:quinone oxidoreductase 1 (nqo1) ko (knockout) mice spontaneousl ...201627116994
uk renal registry 18th annual report: chapter 12 epidemiology of reported infections amongst patients receiving dialysis for established renal failure in england 2013 to 2014: a joint report from public health england and the uk renal registry.from 1st may 2013 to 30th april 2014 there were 35 episodes of methicillin resistant staphylococcus aureus (mrsa) bacteraemia in established renal failure patients on dialysis. this is now fairly stable year-on-year equating to a rate of 0.15 episodes per 100 dialysis patient years, following an initial decline in rates from 4.0 episodes per 100 dialysis patient years in 2005 when reporting began. methicillin sensitive staphylococcus aureus (mssa) bacteraemia rates were slightly higher this year ...201627116291
effect of detecting and isolating clostridium difficile carriers at hospital admission on the incidence of c difficile infections: a quasi-experimental controlled study.clostridium difficile infection (cdi) is a major cause of health care-associated infection worldwide, and new preventive strategies are urgently needed. current control measures do not target asymptomatic carriers, despite evidence that they can contaminate the hospital environment and health care workers' hands and potentially transmit c difficile to other patients.201627111806
active surveillance and isolation of asymptomatic carriers of clostridium difficile at hospital admission: containing what lies under the waterline. 201627111468
efficacy and mechanisms of action of fecal microbiota transplantation in ulcerative colitis: pitfalls and promises from a first meta-analysis.inflammatory bowel disease (ibd) is the results of a chronic inflammatory process deriving from disequilibrium between self-microbiota composition and immune response.201627109966
determination of the extent of clostridium difficile colonisation and toxin accumulation in sows and neonatal piglets.clostridium difficile is an important spore-forming, opportunistic pathogen in animal husbandry and health care. in pig farming, only neonatal piglets are affected, and diarrhoea and necrotising lesions are common symptoms leading to dehydration and in some cases death. this study aimed at the assessment of the quantitative development of c. difficile colonisation in neonatal piglets by determining the shedding of spores and c. difficile toxins a (tcda) and b (tcdb) concentrations in sow (n = 5- ...201627108595
a novel method for imaging the pharmacological effects of antibiotic treatment on clostridium difficile.clostridium difficile is a significant cause of nosocomial-acquired infection that results in severe diarrhea and can lead to mortality. treatment options for c. difficile infection (cdi) are limited, however, new antibiotics are being developed. current methods for determining efficacy of experimental antibiotics on c. difficile involve antibiotic killing rates and do not give insight into the drug's pharmacologic effects. considering this, we hypothesized that by using scanning electron micros ...201627108094
immune responses induced by clostridium difficile.the spectrum of clostridium difficile infections is highly variable, ranging from asymptomatic carriage to fatal colitis depending on the strain virulence and on the host, its gut microbiota and its immune response. after disruption of the gut microbiota, c. difficile pathogenesis can be divided into three steps: 1) contamination by spores and their germination; 2) multiplication of vegetative cells and intestinal colonization using colonization factors; 3) production of the toxins tcda and tcdb ...201627108093
the role of clostridium difficile in the paediatric and neonatal gut - a narrative review.clostridium difficile is an important nosocomial pathogen in adults. its significance in children is less well defined, but cases of c. difficile infection (cdi) appear to be increasingly prevalent in paediatric patients. this review aims to summarize reported clostridium difficile carriage rates across children of different age groups, appraise the relationship between cdi and factors such as method of delivery, type of infant feed, antibiotic use, and co-morbidities, and review factors affecti ...201627107991
epidemiology of clostridium difficile infections in australia: enhanced surveillance to evaluate time trends and severity of illness in victoria, 2010-2014.with epidemic strains of clostridium difficile posing a substantial healthcare burden internationally, there is a need for longitudinal evaluation of clostridium difficile infection (cdi) events in australia.201627107622
corrigendum to "length of stay and mortality due to clostridium difficile infection acquired in the intensive care unit" journal of critical care (2013) 28, 335-340. 201627107495
risk factors for clostridium difficile infection in hospitalized patients with community-acquired pneumonia.clostridium difficile infection (cdi) is strongly associated with anti-biotic treatment, and community-acquired pneumonia (cap) is the leading indication for anti-biotic prescription in hospitals. this study assessed the incidence of and risk factors for cdi in a cohort of patients hospitalized with cap.201627105657
bacterial intestinal superinfections in inflammatory bowel diseases beyond clostridum difficile.besides genetics and environmental factors, intestinal microbiota seem to play a major role in the pathogenesis of inflammatory bowel diseases. for many decades, it has been said that some enteropathogens may even trigger both inflammatory bowel disease development and disease flares. for this reason, stool testing had been performed in inflammatory bowel disease flares but current guidelines only recommend to rule out clostridium difficile infection and there is no clear advice for other entero ...201627104824
recurrence and death after clostridium difficile infection: gender-dependant influence of proton pump inhibitor therapy.to determine whether patients with a pre-existing ppi treatment had a higher risk of poor evolution (recurrence or death) when diagnosed with a toxicogenic clostridium difficile digestive infection.201627104118
fecal transplantation using a nasoenteric tube during an initial episode of severe clostridium difficile infection.the incidence of clostridium difficile infection is increasing worldwide, and its severity and resulting mortality are also on the rise. metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains. furthermore, antibiotic therapy results in recurrence rates of at least 20%. fecal transplantation may be a feasible treatment option for recurrent c. difficile infection; moreover, it may be an early treatme ...201627104013
the burden of clostridium difficile infection: estimates of the incidence of cdi from u.s. administrative databases.many administrative data sources are available to study the epidemiology of infectious diseases, including clostridium difficile infection (cdi), but few publications have compared cdi event rates across databases using similar methodology. we used comparable methods with multiple administrative databases to compare the incidence of cdi in older and younger persons in the united states.201627102582
sporulation properties and antimicrobial susceptibility in endemic and rare clostridium difficile pcr ribotypes.increased sporulation and antibiotic resistance have been proposed to be associated with certain clostridium difficile epidemic strains such as pcr ribotype 027. in this study we examined these properties in another widespread pcr ribotype, 014/020, in comparison to prevalent pcr ribotype 002 and a group of rarely represented pcr ribotypes. highest sporulation was observed in 014/020 strains at 24 h, while after 72 h pcr ribotype 002 and rare pcr ribotypes formed higher total number of spores. p ...201627095618
diarrhoea in the critically ill is common, associated with poor outcome, and rarely due to clostridium difficile.diarrhoea is common in intensive care unit (icu) patients, with a reported prevalence of 15-38%. many factors may cause diarrhoea, including clostridium difficile, drugs (e.g. laxatives, antibiotics) and enteral feeds. diarrhoea impacts on patient dignity, increases nursing workload and healthcare costs, and exacerbates morbidity through dermal injury, impaired enteral uptake and subsequent fluid imbalance. we analysed a cohort of 9331 consecutive patients admitted to a mixed general intensive c ...201627094447
stress ulcer prophylaxis with a proton pump inhibitor versus placebo in critically ill patients (sup-icu trial): study protocol for a randomised controlled trial.critically ill patients in the intensive care unit (icu) are at risk of clinically important gastrointestinal bleeding, and acid suppressants are frequently used prophylactically. however, stress ulcer prophylaxis may increase the risk of serious adverse events and, additionally, the quantity and quality of evidence supporting the use of stress ulcer prophylaxis is low. the aim of the sup-icu trial is to assess the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in ad ...201627093939
clinical outcomes of acid suppressive therapy use in hematology/oncology patients at an academic medical center.acid suppressive therapy (ast)-namely, proton pump inhibitors (ppis) and histamine-2 receptor antagonists (h2ras)-is routinely prescribed to hospitalized patients for stress ulcer prophylaxis (sup).201627091869
ulcerative colitis patients with clostridium difficile are at increased risk of death, colectomy, and postoperative complications: a population-based inception cohort study.clostridium difficile (c. difficile) may worsen the prognosis of ulcerative colitis (uc). the objectives of this study were to: (i) validate the international classification of diseases-10 (icd-10) code for c. difficile; (ii) determine the risk of c. difficile infection after diagnosis of uc; (iii) evaluate the effect of c. difficile infection on the risk of colectomy; and (iv) assess the association between c. difficile and postoperative complications.201627091322
do piperacillin/tazobactam and other antibiotics with inhibitory activity against clostridium difficile reduce the risk for acquisition of c. difficile colonization?systemic antibiotics vary widely in in vitro activity against clostridium difficile. some agents with activity against c. difficile (e.g., piperacillin/tazobactam) inhibit establishment of colonization in mice. we tested the hypothesis that piperacillin/tazobactam and other agents with activity against c. difficile achieve sufficient concentrations in the intestinal tract to inhibit colonization in patients.201627091232
postoperative antimicrobials after lung transplantation and the development of multidrug-resistant bacterial and clostridium difficile infections: an analysis of 500 non-cystic fibrosis lung transplant patients.broad-spectrum antimicrobials are given prophylactically post-transplant, although these agents are a risk factor for multidrug-resistant (mdr) infections and clostridium difficile infection (cdi). this study aimed to determine whether an association exists between the duration of antimicrobials given early post-transplant and the development of mdr infections or cdi.201627091109
molecular and epidemiologic study of clostridium difficile reveals unusual heterogeneity in clinical strains circulating in different regions in portugal.clostridium difficile infection (cdi) represents a great healthcare burden in developed countries. the emergence of the epidemic pcr ribotype (rt) 027 and its acquired fluoroquinolones resistance have accentuated the need for an active surveillance of cdi. here we report the first countrywide study of cdi in portugal with the characterization of 498 c. difficile clinical isolates from 20 hospitals in four regions in portugal regarding rt, virulence factors and antimicrobial susceptibility. we id ...201627091093
microbiome mediation of infections in the cancer setting.infections encountered in the cancer setting may arise from intensive cancer treatments or may result from the cancer itself, leading to risk of infections through immune compromise, disruption of anatomic barriers, and exposure to nosocomial (hospital-acquired) pathogens. consequently, cancer-related infections are unique and epidemiologically distinct from those in other patient populations and may be particularly challenging for clinicians to treat. there is increasing evidence that the micro ...201627090860
effect of fidaxomicin versus vancomycin on susceptibility to intestinal colonization with vancomycin-resistant enterococci and klebsiella pneumoniae in mice.the use of oral vancomycin or metronidazole for treatment of clostridium difficile infection (cdi) may promote colonization by health care-associated pathogens due to disruption of the intestinal microbiota. because the macrocyclic antibiotic fidaxomicin causes less alteration of the intestinal microbiota than vancomycin, we hypothesized that it would not lead to a loss of colonization resistance to vancomycin-resistant enterococci (vre) and extended-spectrum-β-lactamase-producing klebsiella pne ...201627090175
metal ion activation of clostridium sordellii lethal toxin and clostridium difficile toxin b.lethal toxin from clostridium sordellii (tcsl) and toxin b from clostridium difficile (tcdb) belong to the family of the "large clostridial glycosylating toxins." these toxins mono-o-glucosylate low molecular weight gtpases of the rho and ras families by exploiting udp-glucose as a hexose donor. tcsl is casually involved in the toxic shock syndrome and the gas gangrene. tcdb-together with toxin a (tcda)-is causative for the pseudomembranous colitis (pmc). here, we present evidence for the in vit ...201627089365
national variability and appropriateness of surgical antibiotic prophylaxis in us children's hospitals.appropriate use of surgical antibiotic prophylaxis (ap) reduces surgical site infection rates, but prior data suggest variability in use patterns.201627088649
importation, antibiotics, and clostridium difficile infection in veteran long-term care: a multilevel case-control study.although clinical factors affecting a person's susceptibility to clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings.201627088642
should asymptomatic bacteriuria be systematically treated in kidney transplant recipients? results from a randomized controlled trial.the indication of antimicrobial treatment for asymptomatic bacteriuria (ab) after kidney transplantation (kt) remains controversial. between january 2011 and december 2013 112 kt recipients that developed ≥1 episode of ab beyond the second month post-transplantation were included in this open-label trial. participants were randomized (1:1 ratio) to the treatment group (systematic antimicrobial therapy for all episodes of ab occurring up to 24 months post-transplantation [53 patients]) or control ...201627088545
successful fecal microbiota transplantation as an initial therapy for clostridium difficile infection on an outpatient basis.a 64-year-old woman developed diarrhea after taking clindamycin for a dental infection. we diagnosed her with clostridium difficile infection (cdi) and performed fecal microbiota transplantation (fmt) as the initial therapy using colonoscopy on an outpatient basis. the frequency of her bowel movements decreased from 10 times per day to two times per day three days after the procedure. the key component of fmt is to restructure the protective microbiome of the natural intestinal flora. we conside ...201627086820
recurrent clostridium difficile infection associates with distinct bile acid and microbiome profiles.the healthy microbiome protects against the development of clostridium difficile infection (cdi), which typically develops following antibiotics. the microbiome metabolises primary to secondary bile acids, a process if disrupted by antibiotics, may be critical for the initiation of cdi.201627086647
outcomes in children with clostridium difficile infection: results from a nationwide survey.hospital- and population-based studies demonstrate an increasing incidence of clostridium difficile infection (cdi) in adults and children; although pediatric cdi outcomes are incompletely understood. we analysed united states national hospital discharge survey (nhds) data to study cdi in hospitalized children.201627081152
"clostridium difficile associated pseudomembranous colitis: an under-recognized threat" - scenario from a tertiary care hospital. 201627080803
evaluation of a new molecular method illumigene for detection of clostridium difficile associated diarrhoea. 201627080791
safety, immunogenicity and dose response of vla84, a new vaccine candidate against clostridium difficile, in healthy volunteers.clostridium difficile infection (cdi) is the leading cause of antibiotic-associated diarrhoea and colitis and the most common pathogen of health care-associated infections. in the us, cdi causes approximately half a million infections and close to 30,000 deaths. despite antibiotic treatment of c. difficile associated diarrhoea, the disease is complicated by its recurrence in up to 30% of patients.201627079932
a novel fic (filamentation induced by camp) protein from clostridium difficile reveals an inhibitory motif-independent adenylylation/ampylation mechanism.filamentation induced by camp (fic) domain proteins have been shown to catalyze the transfer of the amp moiety from atp onto a protein target. this type of post-translational modification was recently shown to play a crucial role in pathogenicity mediated by two bacterial virulence factors. herein we characterize a novel fic domain protein that we identified from the human pathogen clostridium difficile the crystal structure shows that the protein adopts a classical all-helical fic fold, which b ...201627076635
the design of a clostridium difficile carbohydrate-based vaccine.clostridium difficile vaccines composed of surface polysaccharides (pss) have the potential to simultaneously control infection and colonization levels in humans. hot water-phenol treatment of c. difficile biomass can extricate water-soluble ps-i and ps-ii; and water- and phenol-soluble ps-iii. c. difficile vaccines based on ps-ii have attracted the most attention due its facile purification and ubiquitous expression by c. difficile ribotypes. anti ps-ii antibodies recognize both c. difficile ve ...201627076143
design and purification of subunit vaccines for prevention of clostridium difficile infection.clostridium difficile is a gram-positive bacterium responsible for a large proportion of nosocomial infections in the developed world. c. difficile secretes toxins a and b (tcda and tcdb) and both toxins act synergistically to induce a spectrum of pathological responses in infected individuals ranging from pseudomembranous colitis to c. difficile-associated diarrhea. toxins a and b have been actively investigated as components of prophylactic vaccine as well as targets for therapeutic interventi ...201627076142
possible interplay between hospital and community transmission of a novel clostridium difficile sequence type 295 recognized by next-generation sequencing.objective to use next-generation sequencing (ngs) analysis to enhance epidemiological information to identify and resolve a clostridium difficile outbreak and to evaluate its effectiveness beyond the capacity of current standard pcr ribotyping. methods ngs analysis was performed as part of prospective surveillance of all detected c. difficile isolates at a university hospital. an outbreak of a novel c. difficile sequence type (st)-295 was identified in a hospital and a community hostel for homel ...201627074865
the effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation.the widespread use of antibiotics in the past 80 years has saved millions of human lives, facilitated technological progress and killed incalculable numbers of microbes, both pathogenic and commensal. human-associated microbes perform an array of important functions, and we are now just beginning to understand the ways in which antibiotics have reshaped their ecology and the functional consequences of these changes. mounting evidence shows that antibiotics influence the function of the immune sy ...201627074706
a pilot study to assess bacterial and toxin reduction in patients with clostridium difficile infection given fidaxomicin or vancomycin.to assess the effect of fidaxomicin and vancomycin on clostridium difficile toxins and correlation with clinical and microbiologic outcomes.201627071986
'no touch' technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems.this article reviews 'no touch' methods for disinfection of the contaminated surface environment of hospitalized patients' rooms. the focus is on studies that assessed the effectiveness of ultraviolet (uv) light devices, hydrogen peroxide systems, and self-disinfecting surfaces to reduce healthcare-associated infections (hais).201627257798
severe complicated clostridium difficile infection: can the upmc proposed scoring system predict the need for surgery?clostridium difficile infection (cdi) is one of the most common health care-associated infections, and it continues to have significant morbidity and mortality. the onset of fulminant colitis often requires total abdominal colectomy with ileostomy, which has a mortality rate of 35% to 57%. university of pittsburgh medical center (upmc) developed a scoring system for severity and recommended surgical consultation for severe complicated disease. the aim of this study was to evaluate if the upmc-pr ...201627257702
the efficacy of thuricin cd, tigecycline, vancomycin, teicoplanin, rifampicin and nitazoxanide, independently and in paired combinations against clostridium difficile biofilms and planktonic cells.thuricin cd is a two-component antimicrobial, belonging to the recently designated sactibiotic subclass of bacteriocins. the aim of this study was to investigate the effects of thuricin cd, as well as the antibiotics, tigecycline, vancomycin, teicoplanin, rifampicin and nitazoxanide when used independently and when combined at low concentrations on the viability of clostridium difficile 20291 r027, tl178 r002, liv022 r106, dpc6350 and vpi10463 biofilms and planktonic cells.201627257437
estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable.health care-associated infections (hais) pose a significant health care and cost burden. this study estimates annual hai hospital costs in the us avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations).201627257390
management of candidemia in patients with clostridium difficile infection.patients with c. difficile infection (cdi) experience intestinal microflora changes that can promote the overgrowth and subsequent translocation of gut resident pathogens into the blood. consistently, cdi due to pcr-ribotype 027 strain, severe or relapsing cdi, and treatment with high-dosage vancomycin are independent risk factors for candidemia.201627254270
bacterial and fungal microbiota changes distinguish c. difficile infection from other forms of diarrhea: results of a prospective inpatient study.this study sought to characterize the bacterial and fungal microbiota changes associated with clostridium difficile infection (cdi) among inpatients with diarrhea, in order to further explain the pathogenesis of this infection as well as to potentially guide new cdi therapies. twenty-four inpatients with diarrhea were enrolled, 12 of whom had cdi. each patient underwent stool testing for cdi prior to being treated with difficile-directed antibiotics, when appropriate. clinical data was obtained ...201627252696
best practices in caring for patients infected with clostridium difficile. 201627252104
rising vancomycin-resistant enterococcus infections in hospitalized children in the united states.vancomycin-resistant enterococcus (vre) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. few data are available on the epidemiology and impact of vre infections in children. we hypothesized a significant increase in vre infections among hospitalized children. additionally, we predicted that vre infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization.201627250774
blastocystis sp. infection mimicking clostridium difficile colitis.we report an unusual case of severe diarrhea related to blastocystis sp. infection in a patient with end stage renal disease on hemodialysis. the patient was admitted due to profuse diarrhea associated with fever and leukocytosis. pertinent stool work-up such as leukocytes in stool, stool culture, clostridium difficile toxin b pcr, and serology for hepatitis a, hepatitis b, and hepatitis c and cytomegalovirus screening were all negative. ova and parasite stool examination revealed blastocystis s ...201627247810
high morbidity and mortality of clostridium difficile infection and its associations with ribotype 002 in hong kong.we aim to study the disease burden, risk factors and severity of clostridium difficile infection (cdi) in hong kong.201627246801
[antibiotic treatment of clostridial colitis].the advantages and disadvantages of various antibiotics used in the treatment of clostridium difficile infection (cdi) are compared with respect to their pharmacokinetic and pharmacodynamic properties. recommendations are made for their optimal use in clinical practice. metronidazole is suitable for the treatment of mild forms of cdi which are essentially self-limiting. vancomycin kills clostridia reliably but the treatment is encumbered with considerable risk of recurrence. this can be decrease ...201627246640
cody-dependent regulation of sporulation in clostridium difficile.clostridium difficile must form a spore to survive outside the gastrointestinal tract. the factors that trigger sporulation in c. difficile remain poorly understood. previous studies have suggested that a link exists between nutritional status and sporulation initiation in c. difficile in this study, we investigated the impact of the global nutritional regulator cody on sporulation in c. difficile strains from the historical 012 ribotype and the current epidemic 027 ribotype. sporulation frequen ...201627246573
[rational use of antibiotics].international and national campaigns draw attention worldwide to the rational use of the available antibiotics. this has been stimulated by the high prevalence rates of drug-resistant pathogens, such as methicillin-resistant staphylococcus aureus (mrsa) and vancomycin-resistant enterococci (vre), a threatening spread of development of resistance in gram-negative rod-shaped bacteria and the selection of clostridium difficile with a simultaneous clear reduction in the development of new antibiotic ...201627246321
rifaximin improves clostridium difficile toxin a-induced toxicity in caco-2 cells by the pxr-dependent tlr4/myd88/nf-κb pathway.clostridium difficile infections (cdis) caused by clostridium difficile toxin a (tcda) lead to severe ulceration, inflammation and bleeding of the colon, and are difficult to treat.201627242527
bile acid sensitivity and in vivo virulence of clinical clostridium difficile isolates.clostridium difficile is an anaerobic bacterium that causes diarrheal illnesses. disease onset is linked with exposure to oral antibiotics and consequent depletion of secondary bile acids. here we investigate the relationship between in vitro secondary bile acid tolerance and in vivo disease scores of diverse c. difficile strains in mice.201627241781
evaluation of the vidas glutamate dehydrogenase assay for the detection of clostridium difficile.we evaluated the performance of the vidas gdh assay for the detection of clostridium difficile. in total, 350 fecal specimens collected from patients clinically suspected of having cdi were analyzed by c. difficile culture and enzyme-linked fluorescent immunoassay (vidas gdh); the results were compared with those of toxigenic c. difficile culture (tc), pcr (xpert c. difficile assay), and toxin ab eia (vidas cdab). the numbers of culture-positive and culture-negative samples were 108 and 242, res ...201627282799
clostridium difficile infection in a french university hospital: eight years of prospective surveillance study.the epidemiology of clostridium difficile infection (cdi) has changed with an increase in incidence and severity. prospective surveillance was therefore implemented in a french university hospital to monitor the characteristics of patients at risk and to recognize local trends. between 2007 and 2014, all hospitalized patients (≥18 years) with cdi were included. during the survey, the mean incidence rate of cdi was 2.9 per 10,000 hospital-days. in all, 590 patients were included. most of the epis ...201627281101
amelioration of clostridium difficile infection in mice by dietary supplementation with indole-3-carbinol.to determine the therapeutic effects of dietary supplementation on clostridium difficile infection (cdi).201627280500
low frequency of asymptomatic carriage of toxigenic clostridium difficile in an acute care geriatric hospital: prospective cohort study in switzerland.the role of asymptomatic carriers of toxigenic clostridium difficile (tcd) in nosocomial cross-transmission remains debatable. moreover, its relevance in the elderly has been sparsely studied.201627280019
universality of human microbial dynamics.human-associated microbial communities have a crucial role in determining our health and well-being, and this has led to the continuing development of microbiome-based therapies such as faecal microbiota transplantation. these microbial communities are very complex, dynamic and highly personalized ecosystems, exhibiting a high degree of inter-individual variability in both species assemblages and abundance profiles. it is not known whether the underlying ecological dynamics of these communities, ...201627279224
lectin binding studies on a glycopolymer brush flow-through biosensor by localized surface plasmon resonance.a localized surface plasmon resonance biosensor in a flow-through configuration was applied for investigating kinetics of lectin binding to surface-grafted glycopolymer brushes. polycarbonate filter membranes with pore sizes of 400 nm were coated with a 114-nm thick gold layer and used as substrate for surface-initiated atom-transfer radical polymerization of a glycomonomer. these grafted from glycopolymer brushes were further modified with two subsequent enzymatic reactions on the surface to yi ...201627277814
crispr/cas9-based efficient genome editing in clostridium ljungdahlii, an autotrophic gas-fermenting bacterium.acetogenic bacteria have the potential to convert single carbon gases (co and co2) into a range of bulk chemicals and fuels. realization of their full potential is being impeded by the absence of effective genetic tools for high throughput genome modification. here we report the development of a highly efficient crispr/cas9 system for rapid genome editing of clostridium ljungdahlii, a paradigm for the commercial production of ethanol from synthesis gas. following the experimental selection of tw ...201627276212
glucosylation drives the innate inflammatory response to clostridium difficile toxin a.clostridium difficile is a major, life-threatening hospital-acquired pathogen that causes mild to severe colitis in infected individuals. the tissue destruction and inflammation which characterize c. difficile infection (cdi) are primarily due to the rho-glucosylating toxins a and b. these toxins cause epithelial cell death and induce robust inflammatory signaling by activating the transcription factor nf-κb, leading to chemokine and cytokine secretion. the toxins also activate the inflammasome ...201627271747
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