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fecal microbiota transplantation via fluoroscopy-guided nasojejunal catheter placement: indications, technique, and the role of radiology.clostridium difficile is a well-established cause of nosocomial gastrointestinal disease. although antibiotics remain an effective first-line treatment for c. difficile colitis (cdc), relapse and recurrence are common. fmt has emerged as one of the safest and most effective known therapies available for recurrent or refractory cdc, which is likely due to restoration of the protective microbiotic barrier of the gastrointestinal tract. fmt varies greatly across institutions by route of delivery, d ...201627315076
clostridium difficile infections amongst patients with haematological malignancies: a data linkage study.identify risk factors for clostridium difficile infection (cdi) and assess cdi outcomes among australian patients with a haematological malignancy.201627314498
diagnosing clostridium difficile-associated diarrhea using enzyme immunoassay: the clinical significance of toxin negativity in glutamate dehydrogenase-positive patients.the enzyme immunoassay (eia) has lower sensitivity for clostridium difficile toxins a and b than the polymerase chain reaction in the diagnosis of c. difficile-associated diarrhea (cdad). furthermore, toxin positivity with eia performed on c. difficile isolates from stool cultures may be observed even in patients with eia glutamate dehydrogenase (gdh)-positive and toxin-negative stool specimens. it is unclear whether such patients should be treated as having cdad.201627313472
evolution of an audit and monitoring tool into an infection prevention and control process.in 2010, an infection prevention and control team in an acute hospital trust integrated an audit and monitoring tool (amt) into the management regime for patients with clostridium difficile infection (cdi).201627313140
role of binary toxin in the outcome of clostridium difficile infection in a non-027 ribotype setting - corrigendum. 201627312805
comparison of the vidas c. difficile and quik chek-60 glutamate dehydrogenase assays for the detection of clostridium difficile in faecal samples. 201627311869
a mlst clade 2 clostridium difficile strain with a variant tcdb induces severe inflammatory and oxidative response associated with mucosal disruption.the epidemiology of clostridium difficile infections is highly dynamic as new strains continue to emerge worldwide. here we present a detailed analysis of a new c. difficile strain (icc-45) recovered from a cancer patient in brazil that died from severe diarrhea. a polyphasic approach assigned a new pcr-ribotype and pfge macrorestriction pattern to strain icc-45, which is toxigenic (tcda(+), tcdb(+) and ctdb(+)) and classified as st41 from mlst clade 2 and toxinotype ixb. strain icc-45 encodes f ...201627311833
gut microbiome predictors of treatment response and recurrence in primary clostridium difficile infection.clostridium difficile infection (cdi) may not respond to initial therapy and frequently recurs, but predictors of response and recurrence are inconsistent. the impact of specific alterations in the gut microbiota determining treatment response and recurrence in patients with cdi is unknown.201627481036
ultrastructure variability of the exosporium layer of clostridium difficile spores from sporulating cultures and biofilms.the anaerobic sporeformer clostridium difficile is the leading cause of nosocomial antibiotic-associated diarrhea in developed and developing countries. the metabolically dormant spore form is considered the morphotype responsible for transmission, infection, and persistence, and the outermost exosporium layer is likely to play a major role in spore-host interactions during recurrent infections, contributing to the persistence of the spore in the host. a recent study (m. pizarro-guajardo, p. cal ...201627474709
normal, regular and standard: scaling the body through fecal microbial transplants.in 1987, nancy scheper-hughes and margaret lock proposed "three bodies" to think through biomedicine and the kinds of subjects it produces. in the current article, i revise their theory of three bodies in two ways: first, i suggest that the three bodies are a scaling process, which allows medical governance to manage bodies across scales, from the individual to the group; second, i add two new levels of scalar analysis, the molecular and the microbial, in an attempt to flesh out the three bodies ...201627474685
applications of an automated and quantitative ce-based size and charge western blot for therapeutic proteins and vaccines.capillary electrophoresis (ce) is a versatile and indispensable analytical tool that can be applied to characterize proteins. in recent years, labor-intensive sds-page and ief slab gels have been replaced with ce-sds (cge) and ce-ief methods, respectively, in the biopharmaceutical industry. these two ce-based methods are now an industry standard and are an expectation of the regulatory agencies for biologics characterization. another important and traditional slab gel technique is the western bl ...201627473492
standardised surveillance of clostridium difficile infection in european acute care hospitals: a pilot study, 2013.clostridium difficile infection (cdi) remains poorly controlled in many european countries, of which several have not yet implemented national cdi surveillance. in 2013, experts from the european cdi surveillance network project and from the european centre for disease prevention and control developed a protocol with three options of cdi surveillance for acute care hospitals: a 'minimal' option (aggregated hospital data), a 'light' option (including patient data for cdi cases) and an 'enhanced' ...201627472820
partly fermented infant formulae with specific oligosaccharides support adequate infant growth and are well-tolerated.fermented formulae (ferm) and a specific mixture of 90% short-chain galacto-oligosaccharides and 10% long-chain fructo-oligosaccharides (scgos/lcfos; 9:1) have a potential beneficial effect on gastrointestinal function and microbiota development in infants. the present study assessed the safety and tolerance of the combination of partly fermented infant milk formulae and scgos/lcfos compared with either 1 feature, in healthy term infants.201627472478
a comparison of current guidelines of five international societies on clostridium difficile infection management.clostridium difficile infection (cdi) is increasingly recognized as an emerging healthcare problem of elevated importance. prevention and treatment strategies are constantly evolving along with the apperance of new scientific evidence and novel treatment methods, which is well-reflected in the differences among consecutive international guidelines. in this article, we summarize and compare current guidelines of five international medical societies on cdi management, and discuss some of the contr ...201627470257
diversity of clostridium difficile pcr ribotypes in europe: results from the european, multicentre, prospective, biannual, point-prevalence study of clostridium difficile infection in hospitalised patients with diarrhoea (euclid), 2012 and 2013.clostridium difficile infection (cdi) is the major cause of infective diarrhoea in healthcare environments. as part of the european, multicentre, prospective, biannual, point-prevalence study of clostridium difficile infection in hospitalised patients with diarrhoea (euclid), the largest c. difficile epidemiological study of its type, pcr ribotype distribution of c. difficile isolates in europe was investigated. pcr ribotyping was performed on 1,196 c. difficile isolates from diarrhoeal samples ...201627470194
survey of diagnostic and typing capacity for clostridium difficile infection in europe, 2011 and 2014.suboptimal laboratory diagnostics for clostridium difficile infection (cdi) impedes its surveillance and control across europe. we evaluated changes in local laboratory cdi diagnostics and changes in national diagnostic and typing capacity for cdi during the european c. difficile infection surveillance network (ecdis-net) project, through cross-sectional surveys in 33 european countries in 2011 and 2014. in 2011, 126 (61%) of a convenience sample of 206 laboratories in 31 countries completed a s ...201627469624
survey of clostridium difficile infection surveillance systems in europe, 2011.to develop a european surveillance protocol for clostridium difficile infection (cdi), existing national cdi surveillance systems were assessed in 2011. a web-based electronic form was provided for all national coordinators of the european cdi surveillance network (ecdis-net). of 35 national coordinators approached, 33 from 31 european countries replied. surveillance of cdi was in place in 14 of the 31 countries, comprising 18 different nationwide systems. three of 14 countries with cdi surveill ...201627469420
difficile indeed. 201627469287
successful treatments with polymyxin b hemoperfusion and recombinant human thrombomodulin for fulminant clostridium difficile-associated colitis with septic shock and disseminated intravascular coagulation: a case report.clostridium difficile (cd)-associated colitis (cdac) is endemic and a common nosocomial enteric disease encountered by surgeons in modern hospitals due to prophylactic or therapeutic antibiotic therapies. currently, the incidence of fulminant cdac, which readily causes septic shock followed by multiple organ dysfunction syndromes, is increasing. fulminant cdac requires surgeons to perform a prompt surgery, such as subtotal colectomy, to remove the septic source. it is known that fulminant cdac i ...201627468959
importance of glutamate dehydrogenase (gdh) in clostridium difficile colonization in vivo.clostridium difficile is the principal cause of antibiotic-associated diarrhea. major metabolic requirements for colonization and expansion of c. difficile after microbiota disturbance have not been fully determined. in this study, we show that glutamate utilization is important for c. difficile to establish itself in the animal gut. when the glud gene, which codes for glutamate dehydrogenase (gdh), was disrupted, the mutant c. difficile was unable to colonize and cause disease in a hamster mode ...201627467167
characterisation of clostridium difficile strains isolated from groote schuur hospital, cape town, south africa.the c. difficile infection rate in south africa is concerning. many strains previously isolated from diarrhetic patients at groote schuur hospital were ribotype 017. this study further characterised these strains with respect to their clonal relationships, antibiotic susceptibility, toxin production and various attributes impacting on pathogen colonisation. multilocus variable-number tandem-repeat analysis (mlva) was used to characterise all c. difficile isolates. antibiotic susceptibility was d ...201627465145
optimizing the diagnostic testing of clostridium difficile infection.clostridium difficile infection (cdi) is the leading cause of hospital-acquired diarrhea and is associated with a considerable health and cost burden. however, there is still not a clear consensus on the best laboratory diagnosis approach and a wide variation of testing methods and strategies can be encountered.201627462827
polonium-210 poisoning: a first-hand account.polonium-210 ((210)po) gained widespread notoriety after the poisoning and subsequent death of mr alexander litvinenko in london, uk, in 2006. exposure to (210)po resulted initially in a clinical course that was indistinguishable from infection or exposure to chemical toxins, such as thallium.201627461439
impact of malignancy on clostridium difficile infection.the purpose of this study was to investigate the impact of malignancy and chemotherapy on the clinical and microbiological characteristics of clostridium difficile infections (cdi).201627461221
european society of clinical microbiology and infectious diseases: update of the diagnostic guidance document for clostridium difficile infection.in 2009 the first european society of clinical microbiology and infectious diseases (escmid) guideline for diagnosing clostridium difficile infection (cdi) was launched. since then newer tests for diagnosing cdi have become available, especially nucleic acid amplification tests. the main objectives of this update of the guidance document are to summarize the currently available evidence concerning laboratory diagnosis of cdi and to formulate and revise recommendations to optimize cdi testing. th ...201627460910
rapid detection of clostridium difficile via magnetic bead aggregation in cost-effective polyester microdevices with cell phone image analysis.pathogen detection has traditionally been accomplished by utilizing methods such as cell culture, immunoassays, and nucleic acid amplification tests; however, these methods are not easily implemented in resource-limited settings because special equipment for detection and thermal cycling is often required. in this study, we present a magnetic bead aggregation assay coupled to an inexpensive microfluidic fabrication technique that allows for cell phone detection and analysis of a notable pathogen ...201627460478
correction for alcalá et al., comparison of genomera c. difficile and xpert c. difficile as confirmatory tests in a multistep algorithm for diagnosis of clostridium difficile infection. 201627458271
adult intussusception caused by ileocecal clostridium difficile pseudomembranous colitis. 201627457842
clostridium difficile toxins tcda and tcdb cause colonic tissue damage by distinct mechanisms.as the major cause of antibiotic-associated diarrhea, clostridium difficile is a serious problem in health care facilities worldwide. c. difficile produces two large toxins, tcda and tcdb, which are the primary virulence factors in disease. the respective functions of these toxins have been difficult to discern, in part because the cytotoxicity profiles for these toxins differ with concentration and cell type. the goal of this study was to develop a cell culture model that would allow a side-by- ...201627456833
recombinant mucin-type fusion proteins with a galα1,3gal substitution as clostridium difficile toxin a inhibitors.the capability of a recombinant mucin-like fusion protein, p-selectin glycoprotein ligand-1/mouse igg2b (psgl-1/migg2b), carrying galα1,3galβ1,4glcnac determinants to bind and inhibit clostridium difficile toxin a (tcda) was investigated. the fusion protein, produced by a glyco-engineered stable cho-k1 cell line and designated c-pgc2, was purified by affinity and gel filtration chromatography from large-scale cultures. liquid chromatography-mass spectrometry was used to characterize o-glycans re ...201627456831
characterization of polymorphic forms of rifaximin.rifaximin is a gut-selective oral antimicrobial that has no systemic adverse effects compared with placebo. it is used for the treatment of hepatic encephalopathy, traveler's diarrhea, irritable bowel syndrome, clostridium difficile infection, ulcerative colitis, and acute diarrhea. the crystalline form present in rifaximin, α, has minimal systemic absorption compared to the amorphous form. the objective of this study was to obtain polymorphic forms of rifaximin using recrystallization processes ...201627455934
risk and severity of hospital-acquired clostridium difficile infection in patients taking proton pump inhibitors.to compare the rates and severity of hospital-acquired clostridium difficile infection (cdi) among patients taking proton pump inhibitors (ppis) versus those not taking ppis.201627455386
clostridium difficile-associated disease: a primary clinical evaluation of elderly patients in a geriatric hospital.the purpose of this study was to screen all cases of clostridium difficile-associated disease during a 2-year period in a geriatric hospital to determine the incidence and clinical characteristics related to this risk. twenty percent of suspected cases were diagnosed as positive and analyzed. the c difficile disease-associated clinical factors were ischemic heart disease and chronic obstructive pulmonary disease. use of acetylsalicylic acid, other nonsteroidal anti-inflammatory drugs, and steroi ...201627375063
targeting the ecology within: the role of the gut-brain axis and human microbiota in drug addiction.despite major advances in our understanding of the brain using traditional neuroscience, reliable and efficacious treatments for drug addiction have remained elusive. hence, the time has come to utilize novel approaches, particularly those drawing upon contemporary advances in fields outside of established neuroscience and psychiatry. put another way, the time has come for a paradigm shift in the addiction sciences. apropos, a revolution in the area of human health is underway, which is occurrin ...201627372861
reduction in clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection.the clinical impact of implementing hydrogen peroxide vapour (hpv) disinfection of rooms vacated by patients with clostridium difficile infection (cdi) was evaluated. breakpoint time series analysis indicated a significant reduction (p<0.001) in the cdi rate at the time when hpv disinfection was implemented, resulting in a reduction in the cdi rate from 1.0 to 0.4 cases per 1000 patient-days in the 24 months before hpv usage compared with the first 24 months of hpv usage. hpv should be considere ...201627372150
a diverse soil microbiome degrades more crude oil than specialized bacterial assemblages obtained in culture.soil microbiome modification may alter system function, which may enhance processes like bioremediation. in this study, we filled microcosms with gamma-irradiated soil that was reinoculated with the initial soil or cultivated bacterial subsets obtained on regular media (reg-m) or media containing crude oil (co-m). we allowed 8 weeks for microbiome stabilization, added crude oil and monoammonium phosphate, incubated the microcosms for another 6 weeks, and then measured the biodegradation of crude ...201627371586
epidemiology and risk factors for community-associated clostridium difficile infection: a narrative review.clostridium difficile infection (cdi) was once considered a primarily nosocomial concern. emerging evidence from the last 20 years has highlighted a drastic shift in the known epidemiology of cdi, with disease outside of hospitals apparently occurring more frequently and causing severe disease in populations that were thought to be at low risk. this narrative review summarises potential pathways for infection outside of the hospital environment and highlights likely routes of transmission. furth ...201627370914
reclassification of clostridium difficile as clostridioides difficile (hall and o'toole 1935) prévot 1938.the recent proposal by lawson and rainey (2015) to restrict the genus clostridium to clostridium butyricum and related species has ramifications for the members of the genera that fall outside this clade that should not be considered as clostridium sensu stricto. one such organism of profound medical importance is clostridioides difficile that is a major cause of hospital-acquired diarrhea and mortality in individuals. based on 16s rrna gene sequence analysis, the closest relative of clostridium ...201627370902
type iv pili promote early biofilm formation by clostridium difficile.increasing morbidity and mortality from clostridium difficile infection (cdi) present an enormous challenge to healthcare systems. clostridium difficile express type iv pili (t4p), but their function remains unclear. many chronic and recurrent bacterial infections result from biofilms, surface-associated bacterial communities embedded in an extracellular matrix. cdi may be biofilm mediated; t4p are important for biofilm formation in a number of organisms. we evaluate the role of t4p in c. diffic ...201627369898
characterization of clostridium difficile strains in british columbia, canada: a shift from nap1 majority (2008) to novel strain types (2013) in one region.background. clostridium difficile is a major cause of gastrointestinal illness. epidemic nap1 strains contain toxins a and b, a deletion in repressor tcdc, and a binary toxin. objectives. to determine the molecular epidemiology of c. difficile in british columbia and compare between two time points in one region. methods. c. difficile isolates from hospital and community laboratories (2008) and one island health hospital laboratory (2013) were characterized by pulsed-field gel electrophoresis, p ...201627366181
fidaxomicin versus vancomycin in the treatment of clostridium difficile infection: canadian outcomes.background. this analysis examined the efficacy of fidaxomicin versus vancomycin in 406 canadian patients with clostridium difficile infection (cdi), based on data from 2 randomized, clinical trials. methods. patients received fidaxomicin or vancomycin 1. patients were assessed for clinical response recurrence of infection and sustained clinical response for 28 days after treatment completion. patients at increased risk of recurrence were subjected to subgroup analyses. results. clinical respons ...201627366179
antibodies to toxin b are protective against clostridium difficile infection recurrence.although newer studies have evaluated risk factors for recurrent clostridium difficile infection (cdi), the vast majority did not measure important biomarkers such as endogenous anti-toxin a and anti-toxin b antibody levels.201627365387
editorial commentary: where to place the new treatments for clostridium difficile infection? 201627365386
[infection control from the viewpoint of medical safety by our clinical laboratory in tmdu hospital].infection control based on appropriate bacteriological examinations and information is important for medical safety. i present the activities performed by our clinical laboratory in tokyo medical and dental university (tmdu) hospital. we detected and reported the first japanese case of kpc-2 carbapenemase-producing klebsiella pneumoniae, of which infection will be a serious problem in the near future in japan. we examine the antigen and toxins of clostridium difficile with an immunochromatograph ...201627363226
[relationship between clostridium difficile its-pcr type and pathogenicity].clostridium difficile (c. difficile) causes antibiotic-associated diarrhea and nosocomial infection. the pcr of internal transcribed spacer regions (its) is easily conductible in a relatively short time. the purpose of the current study is to classify c. difficile by pcr electrophoresis pattern of its (its-pcr type) and estimate the relationship of the its-pcr type of c. difficile with its pathogenicity. we examined 77 strains which were obtained in our hospital from march 2012 to august 2013. t ...201627363217
editorial commentary: potential risks and rewards with prophylaxis for clostridium difficile infection. 201627358349
risk factors for clostridium difficile diarrhea in patients with solid organ transplantation.there is limited knowledge about specific risk factors for clostridium difficile infection (cdi).201627358344
laboratory identification of anaerobic bacteria isolated on clostridium difficile selective medium.despite increasing interest in the bacterium, the methodology for clostridium difficile recovery has not yet been standardized. cycloserine-cefoxitin fructose taurocholate (ccft) has historically been the most used medium for c. difficile isolation from human, animal, environmental, and food samples, and presumptive identification is usually based on colony morphologies. however, ccft is not totally selective. this study describes the recovery of 24 bacteria species belonging to 10 different gen ...201627352971
deciphering adaptation strategies of the epidemic clostridium difficile 027 strain during infection through in vivo transcriptional analysis.clostridium difficile is responsible for a wide spectrum of infection from asymptomatic carriage to severe, relapsing colitis. since 2003, c. difficile infections have increased with a higher morbidity and mortality due to the emergence of epidemic and hypervirulent c. difficile strains such as those of the epidemic lineage 027/bi/nap1. to decipher the hypervirulence and epidemicity of 027 strains, we analyzed gene expression profiles of the r20291 027 strain using a monoxenic mouse model during ...201627351947
(1)h(n), (13)c, and (15)n resonance assignments of the cdtb-interacting domain (cdtabid) from the clostridium difficile binary toxin catalytic component (cdta, residues 1-221).once considered a relatively harmless bacterium, clostridium difficile has become a major concern for healthcare facilities, now the most commonly reported hospital-acquired pathogen. c. difficile infection (cdi) is usually contracted when the normal gut microbiome is compromised by antibiotic therapy, allowing the opportunistic pathogen to grow and produce its toxins. the severity of infection ranges from watery diarrhea and abdominal cramping to pseudomembranous colitis, sepsis, or death. the ...201627351891
clostridium difficile in food and animals: a comprehensive review.zoonoses are infections or diseases that can be transmitted between animals and humans through direct contact, close proximity or the environment. clostridium difficile is ubiquitous in the environment, and the bacterium is able to colonise the intestinal tract of both animals and humans. since domestic and food animals frequently test positive for toxigenic c. difficile, even without showing any signs of disease, it seems plausible that c. difficile could be zoonotic. therefore, animals could p ...201627350639
impact of antimicrobial stewardship on outcomes in hospitalized veterans with pneumonia.the purpose of this study was to evaluate the impact of an antimicrobial stewardship program (asp) on outcomes for inpatients with pneumonia, including length of stay, treatment duration, and 30-day readmission rates.201627349712
vital signs: preventing antibiotic-resistant infections in hospitals - united states, 2014.healthcare-associated antibiotic-resistant (ar) infections increase patient morbidity and mortality and might be impossible to successfully treat with any antibiotic. cdc assessed healthcare-associated infections (hai), including clostridium difficile infections (cdi), and the role of six ar bacteria of highest concern nationwide in several types of healthcare facilities.201627348802
microbiota-regulated il-25 increases eosinophil number to provide protection during clostridium difficile infection.clostridium difficile infection (cdi) is the most common cause of hospital-acquired infection in the united states. host susceptibility and the severity of infection are influenced by disruption of the microbiota and the immune response. however, how the microbiota regulate immune responses to mediate cdi outcome remains unclear. here, we have investigated the role of the microbiota-linked cytokine il-25 during infection. intestinal il-25 was suppressed during cdi in humans and mice. restoration ...201627346351
clinical characterization of clostridium difficile infection in elderly patients. 201627340722
septins guide microtubule protrusions induced by actin-depolymerizing toxins like clostridium difficile transferase (cdt).hypervirulent clostridium difficile strains, which are associated with increased morbidity and mortality, produce the actin-adp ribosylating toxin clostridium difficile transferase (cdt). cdt depolymerizes actin, causes formation of microtubule-based protrusions, and increases pathogen adherence. here, we show that septins (sept) are essential for cdt-induced protrusion formation. sept2, -6, -7, and -9 accumulate at predetermined protrusion sites and form collar-like structures at the base of pr ...201627339141
clostridium difficile infection: an emerging cause of death in the twenty-first century.enterocolitis due to clostridium difficile is major emerging cause of death in the u.s. between 1999 and 2012, c. diff. deaths rose by a staggering almost ten-fold amount, to 7,739 from 793. this article has three goals. first, we present a demographic description of c. diff. mortality in the u.s. since 1999. second, we test a hypothesis that the increase in c. diff. deaths is due to population aging. we find that the emergence of this cause of death follows a proportional hazard pattern above a ...201627337554
clostridium difficile infection.clostridium difficile is an anaerobic, gram-positive, spore-forming, toxin-secreting bacillus that has long been recognized to be the most common etiologic pathogen of antibiotic-associated diarrhea. c. difficile infection (cdi) is now the most common cause of health care-associated infections in the united states and accounts for 12% of these infections (magill ss et al., n engl j med370:1198-1208, 2014). among emerging pathogens of public health importance in the united states, cdi has the hig ...201627337475
novel clostridium difficile anti-toxin (tcda and tcdb) humanized monoclonal antibodies demonstrate in vitro neutralization across a broad spectrum of clinical strains and in vivo potency in a hamster spore challenge model.clostridium difficile (c. difficile) infection (cdi) is the main cause of nosocomial antibiotic-associated colitis and increased incidence of community-associated diarrhea in industrialized countries. at present, the primary treatment of cdi is antibiotic administration, which is effective but often associated with recurrence, especially in the elderly. pathogenic strains produce enterotoxin, toxin a (tcda), and cytotoxin, toxin b (tcdb), which are necessary for c. difficile induced diarrhea and ...201627336843
correlation between fecal calprotectin levels, disease severity and the hypervirulent ribotype 027 strain in patients with clostridium difficile infection.clostridium difficile is the most common infectious etiology of nosocomial diarrhea. fecal calprotectin (fc) is a sensitive marker of intestinal inflammation, found to be associated with enteric bacterial infections and inflammatory bowel disease.201627334992
the signal sequence of the abundant extracellular metalloprotease ppep-1 can be used to secrete synthetic reporter proteins in clostridium difficile.clostridium difficile is an opportunistic pathogen and the main cause of antibiotic-associated diarrhea. adherence of c. difficile to host cells is modulated by proteins present on the bacterial cell surface or secreted into the environment. cleavage of collagen-binding proteins is mediated by the zinc metalloprotease ppep-1, which was identified as one of the most abundant secreted proteins of c. difficile. here, we exploit the ppep-1 signal sequence to produce novel secreted enzymes. we have c ...201627333161
understanding the mechanisms of faecal microbiota transplantation.this review summarizes mechanistic investigations in faecal microbiota transplantation (fmt), which has increasingly been adapted into clinical practice as treatment for clostridium difficile infection (cdi) that cannot be eliminated with antibiotics alone. administration of healthy donor faecal microbiota in this clinical situation results in its engraftment and restoration of normal gut microbial community structure and functionality. in this review, we consider several main mechanisms for fmt ...201627329806
using multiplex molecular testing to determine the etiology of acute gastroenteritis in children.to detect the etiologic agents of acute gastroenteritis (age) in children using broad molecular-based techniques, and compare clinical presentations among etiologies.201627329497
role of the microbiome, probiotics, and 'dysbiosis therapy' in critical illness.loss of 'health-promoting' microbes and overgrowth of pathogenic bacteria (dysbiosis) in icu is believed to contribute to nosocomial infections, sepsis, and organ failure (multiple organ dysfunction syndrome). this review discusses new understanding of icu dysbiosis, new data for probiotics and fecal transplantation in icu, and new data characterizing the icu microbiome.201627327243
erratum for marín et al., clostridium difficile isolates with high linezolid mics harbor the multiresistance gene cfr. 201627325817
antibiotic-associated diarrhoea in emergency department observation unit patients.clostridium difficile diarrhoea is an urgent threat to patients, but little is known about the role of antibiotic administration that starts in emergency department observation units (edous). we studied risk factors for antibiotic-associated diarrhoea (aad) and c. difficile infection (cdi) in edou patients. this prospective cohort study enrolled adult patients discharged after edou antibiotic treatment between january 2013 and 2014. we obtained medical histories, edou treatment and occurrence of ...201627324463
outcomes associated with observation stays versus inpatient admissions for pulmonary embolism.changes in reimbursement policies have led to an increased use of observation stays in the united states (us). we sought to compare outcomes among pulmonary embolism (pe) patients managed through observation stays or inpatient admissions.the premier perspective comparative hospital database was used to identify patients with a primary international classification of diseases, ninth-edition diagnosis of pe (415.1×) from 11/2012-3/2015. patients were required to have claims for ≥1 diagnostic tests ...201627324143
comparison of enzyme immunoassays and rapid diagnostic tests for clostridium difficile glutamate dehydrogenase and toxin a + b to toxinogenic culture on a highly selective chromogenic medium.to compare clostridium. (c.) difficile toxin a/b and glutamate dehydrogenase (gdh) enzyme immunoassays or rapid diagnostic tests to toxinogenic culture on recently described highly selective agar plates. five hundred consecutive samples sent in for c. difficile diagnostics were tested by toxin a/b enzyme immunoassay (eia) and rapid diagnostic test (rdt), gdh eia and rdt, and culture on chromid c. difficile plates for 48 hrs, with toxin testing from culture if the toxin eia from feces was negativ ...201627323765
natural gum modified emulsion gel as single carrier for the oral delivery of probiotic-drug combination.single formulation based delivery of probiotic-drug combination is envisioned as a superior therapeutic delivery modality for the diseases like crohn's diseases, ulceritive colitis and recurrent clostridium difficile-associated diarrhoea (rcdad). keeping this perspective in mind, here we have developed natural gum [using a combination of aqueous solution of xantham gum (x) and guar gum (g)] modified sunflower oil based emulsion gels for the delivery of probiotics-drugs combination. ft-ir analysi ...201627431793
induction of antitoxin responses in clostridium-difficile-infected patients compared to healthy blood donors.according to the literature clostridium difficile antitoxins are present in up to 66% of humans. in a survey of ∼400 plasma samples from healthy blood donors we found that less than 6% were positive for anti-tcda or anti-tcdb antitoxins. using the same standard immunoassay protocol, we looked for igg and iga antitoxins in the blood and stool samples from 25 patients with c. difficile infection (cdi). some patients with cdi had no antitoxin detected at all, while others had high levels of specifi ...201627427464
burden of clostridium difficile infections in québec by levy et al. 201627419192
intravenous tigecycline facilitates cure of severe clostridium difficile infection (cdi) after failure of standard therapy: a case report and literature review of tigecycline use in cdi.standard treatment for severe clostridium difficile infection (cdi) is oral vancomycin with metronidazole. after failure of this standard regimen, treatment becomes challenging. a young woman treated for septic shock developed cdi. standard treatment failed and she was ineligible for fecal transplant. addition of tigecycline to her regimen resulted in cure.201627419166
prevalence of human norovirus and clostridium difficile coinfections in adult hospitalized patients.human norovirus (hunov) and clostridium difficile are common causes of infectious gastroenteritis in adults in the us. however, limited information is available regarding hunov and c. difficile coinfections. our study was designed to evaluate the prevalence of hunov and c. difficile coinfections among adult patients in a hospital setting and disease symptomatology.201627418856
diagnostic test accuracy of glutamate dehydrogenase for clostridium difficile: systematic review and meta-analysis.we performed this systematic review and meta-analysis to assess the diagnostic accuracy of detecting glutamate dehydrogenase (gdh) for clostridium difficile infection (cdi) based on the hierarchical model. two investigators electrically searched four databases. reference tests were stool cell cytotoxicity neutralization assay (ccna) and stool toxigenic culture (tc). to assess the overall accuracy, we calculated the diagnostic odds ratio (dor) using a dersimonian-laird random-model and area the u ...201627418431
clostridium difficile infection worsen outcome of hospitalized patients with inflammatory bowel disease.the prevalence of clostridium difficile infection (cdi) in patients suffering from inflammatory bowel disease (ibd) has increased rapidly over the past several decades in north america and europe. however, the exact global epidemiology remains unclear because of insufficient data from developing countries. a total of 646 hospitalized adult ibd patients were enrolled; and their fresh stool specimens were obtained and used for clostridium difficile detection. the incidence of cdi in crohn's diseas ...201627417996
cdtr regulates tcda and tcdb production in clostridium difficile.clostridium difficile is a global health burden and the leading cause of antibiotic-associated diarrhoea worldwide, causing severe gastrointestinal disease and death. three well characterised toxins are encoded by this bacterium in two genetic loci, specifically, tcdb (toxin b) and tcda (toxin a) in the pathogenicity locus (paloc) and binary toxin (cdt) in the genomically distinct cdt locus (cdtloc). toxin production is controlled by regulators specific to each locus. the orphan response regulat ...201627414650
a tetraspecific vhh-based neutralizing antibody modifies disease outcome in three animal models of clostridium difficile infection.clostridium difficile infection (cdi), a leading cause of nosocomial infection, is a serious disease in north america, europe, and asia. cdi varies greatly from asymptomatic carriage to life-threatening diarrhea, toxic megacolon, and toxemia. the incidence of community-acquired infection has increased due to the emergence of hypervirulent antibiotic-resistant strains. these new strains contribute to the frequent occurrence of disease relapse, complicating treatment, increasing hospital stays, an ...201627413067
outpatient antibiotic prescription.in view of the rise in antibiotic resistance and clostridium difficile superinfection, close monitoring of antibiotic prescribing practices is essential so that targeted quality assurance measures can be taken.201627412990
protocol for a randomised control trial of methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients (motion).gastrointestinal dysmotility and constipation are common problems in intensive care patients. the majority of critical care patients are sedated with opioids to facilitate tolerance of endotracheal tubes and mechanical ventilation, which inhibit gastrointestinal motility and lead to adverse outcomes. methylnaltrexone is a peripheral opioid antagonist that does not cross the blood-brain barrier and can reverse the peripheral side effects of opioids without affecting the desired central properties ...201627412108
nosocomial transmission of clostridium difficile ribotype 027 in a chinese hospital, 2012-2014, traced by whole genome sequencing.the rapid spread of clostridium difficile nap1/bi/027 (c. difficile 027) has become one of the leading threats of healthcare-associated infections worldwide. however, c. difficile 027 infections have been rarely reported in asia, particularly in china.201627411304
new antibiotics in clinical trials for clostridium difficile.there are limited number of approved therapies for c. difficile infections (cdis) and new treatments are needed to decrease recurrence rates. over the past 5 years, four novel antibiotics have been evaluated in clinical trials that offer distinct advantages over existing therapies for the treatment of cdi.201627410763
digestive disease week and american society of clinical oncology.we report on key digestive disease week sessions that focused on hepatitis c virus and clostridium difficile infection, colonoscopy preparation, irritable bowel syndrome, and crohn's disease. we also review major american society of clinical oncology sessions on breast, pancreatic, ovarian, skin, and brain cancers and multiple myeloma.201627408522
intestinal microbiota transplant - current state of knowledge.faecal microbiota transplantation (fmt) has induced a lot scientific interest and hopes for the last couple of years. fmt has been approved as a treatment of recurrent clostridium difficile colitis. highly sophisticated molecular dna identification methods have been used to assess the healthy human microbiome as well as its disturbances in several diseases. the metabolic and immunologic functions of the microbiome have become more clear and understandable. a lot of pathological changes, such as ...201627407273
fecal transplants: what is being transferred?fecal transplants are increasingly utilized for treatment of recurrent infections (i.e., clostridium difficile) in the human gut and as a general research tool for gain-of-function experiments (i.e., gavage of fecal pellets) in animal models. changes observed in the recipient's biology are routinely attributed to bacterial cells in the donor feces (~1011 per gram of human wet stool). here, we examine the literature and summarize findings on the composition of fecal matter in order to raise cauti ...201627404502
tropheryma whipplei associated with diarrhoea in young children.tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in europe but also in africa. in this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. from december 2009 to january 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in marseille, france, were analysed: 555 children (245 femal ...201627404363
impact of reported beta-lactam allergy on inpatient outcomes: a multicenter prospective cohort study.reported allergy to beta-lactam antibiotics is common and often leads to unnecessary avoidance in patients who could tolerate these antibiotics. we prospectively evaluated the impact of these reported allergies on clinical outcomes.201627402820
in vitro activity of surotomycin against contemporary clinical isolates of toxigenic clostridium difficile strains obtained in spain. 201627402007
cost-effectiveness of a model infection control program for preventing multi-drug-resistant organism infections in critically ill surgical patients.interventions to contain two multi-drug-resistant acinetobacter (mdra) outbreaks reduced the incidence of multi-drug-resistant (mdr) organisms, specifically methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococcus, and clostridium difficile in the general surgery intensive care unit (icu) of our hospital. we therefore conducted a cost-effective analysis of a proactive model infection-control program to reduce transmission of mdr organisms based on the practices used to cont ...201627399263
cleaning the grey zones of hospitals: a prospective, crossover, interventional study.environmental cleaning is a fundamental principle of infection prevention in hospitals, but its role in reducing transmission of health care-acquired pathogens has been difficult to prove experimentally. in this study we analyze the influence of cleaning previously uncleaned patient care items, grey zones (gz), on health care-acquired transmission rates.201627397907
[oncologic aspects of clostridium difficile].clostridium difficile infection is one of the most frequent among cancer patients. its diagnosis is complicated by the fact that the symptoms of the infection and the side effects of the anticancer treatments could be similar. chemotherapy itself might facilitate clostridium difficile infection. several risk factors are known but clostridium difficile infection can develop in the absence of these. neutreopenia is a risk factor for fatal clostridium difficile infection and also the side effect of ...201627397423
infectious diarrhea: norovirus and clostridium difficile in older adults.norovirus infection usually results in acute gastroenteritis, often with incapacitating nausea, vomiting, and diarrhea. it is highly contagious and resistant to eradication with alcohol-based hand sanitizer. appropriate preventative and infection control measures can mitigate the morbidity and mortality associated with norovirus infection. clostridium difficile infection is the leading cause of health care-associated diarrhea in the united states. antibiotic use is by far the most common risk fa ...201627394020
binary toxin and its clinical importance in clostridium difficile infection, belgium.binary toxin-producing clostridium difficile strains such as ribotypes 027 and 078 have been associated with increased clostridium difficile infection (cdi) severity. our objective was to investigate the association between presence of the binary toxin gene and cdi severity and recurrence. we performed a laboratory-based retrospective study including patients between january 2013 and march 2015 whose fecal samples were analyzed by polymerase chain reaction (pcr) for the presence of the genes for ...201627393490
utility of prophylactic antibiotics in nonoperative facial fractures.facial fractures are commonly managed nonoperatively. patients with facial fractures involving sinus cavities commonly receive 7 to 10 days of prophylactic antibiotics, yet no literature exists to support or refute this practice. the aim of this study was to compare the administration and duration of antibiotic prophylaxis on the incidence of soft tissue infection in nonoperative facial fractures. a total number of 289 patients who were admitted to our level i trauma center with nonoperative fac ...201627391655
an exploratory study to evaluate clostridium difficile polymerase chain reaction ribotypes and infection outcomes.clostridium difficile infection ranges from mild to severe prolonged diarrhea with systemic symptoms. previous studies have assessed the correlation of some disease severity parameters to c. difficile ribotypes. however, certain clinical parameters of interest have not yet been evaluated.201627390531
the efficacy of intracolonic vancomycin for severe clostridium difficile colitis: a case series.clostridium difficile infection (cdi) unresponsive to the standard treatments of metronidazole and oral vancomycin requires aggressive medical management and possible surgical intervention including colectomy. intracolonic vancomycin therapy has been reported to be particularly promising in the setting of severe cdi in the presence of ileus. this is a descriptive case series exploring the effect of adjunctive intracolonic vancomycin therapy on the morbidity and mortality in patients with moderat ...201627388627
male veterans with complicated urinary tract infections: influence of a patient-centered antimicrobial stewardship program.the influence of antimicrobial stewardship programs (asps) on outcomes in male veterans treated for complicated urinary tract infection has not been determined.201627388268
management of inflammatory bowel disease in the elderly.a substantial and growing proportion of patients with inflammatory bowel disease (ibd) are elderly, and these patients require tailored treatment strategies. however, significant challenges exist in the management of this population due to the paucity of data. establishing the initial diagnosis and assessing the etiology of future symptoms and flares can be challenging as several other prevalent diseases can masquerade as ibd, such as ischemic colitis, diverticular disease, and infectious coliti ...201627387455
active caspase-1 induces plasma membrane pores that precede pyroptotic lysis and are blocked by lanthanides.canonical inflammasome activation induces a caspase-1/gasdermin d (gsdmd)-dependent lytic cell death called pyroptosis that promotes antimicrobial host defense but may contribute to sepsis. the nature of the caspase-1-dependent change in plasma membrane (pm) permeability during pyroptotic progression remains incompletely defined. we assayed propidium(2+) (pro(2+)) influx kinetics during nlrp3 or pyrin inflammasome activation in murine bone marrow-derived macrophages (bmdms) as an indicator of th ...201627385778
fecal transplant for clostridium difficile infection relapses using "pooled" frozen feces from non-related donors. 201627382953
rifamycin resistance in clostridium difficile is generally associated with a low fitness burden.we characterized clinically occurring and novel mutations in the β subunit of rna polymerase in clostridium difficile (cdrpob), conferring rifamycin (including rifaximin) resistance. the arg505lys substitution did not impose an in vitro fitness cost, which may be one reason for its dominance among rifamycin-resistant clinical isolates. these observations were supported through the structural modeling of cdrpob. in general, most mutations lacked in vitro fitness costs, suggesting that rifamycin r ...201627381389
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