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development and validation of a risk score for clostridium difficile infection in medicare beneficiaries: a population-based cohort study.to create a risk stratification score for clostridium difficile infection (cdi) in elderly adults.201627295521
zoonotic potential of the clostridium difficile rt078 family in taiwan.clostridium difficile is the major cause of nosocomial diarrhea. we have previously demonstrated that in southern taiwan, severe c. difficile-associated diarrhea (cdad) cases were due to the c. difficile rt 126 strain infection, indicating the arrival of an epidemic c. difficile clone in southern taiwan. rt126 has a close genetic relationship with rt078. however, the rt078 family is the predominant strain of c. difficile in animals worldwide, particularly in swine. in this study, we surveyed c. ...201627292030
the economic burden of hospital-acquired clostridium difficile infection: a population-based matched cohort study.background high-quality cost estimates for hospital-acquired clostridium difficile infection (cdi) are vital evidence for healthcare policy and decision-making. objective to evaluate the costs attributable to hospital-acquired cdi from the healthcare payer perspective. methods we conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with cdi (those with the international statistical classification of diseases and related health problems, 1 ...201627322606
long-term microbiota and virome in a zürich patient after fecal transplantation against clostridium difficile infection.fecal microbiota transplantation (fmt) is an emerging therapeutic option for clostridium difficile infections that are refractory to conventional treatment. fmt introduces fecal microbes into the patient's intestine that prevent the recurrence of c. difficile, leading to rapid expansion of bacteria characteristic of healthy microbiota. however, the long-term effects of fmt remain largely unknown. the c. difficile patient described in this paper revealed protracted microbiota adaptation processes ...201627286042
clostridium difficile ribotype 033 colitis in a patient following broad-spectrum antibiotic treatment for kpcproducing klebsiella pneumoniae infection, italy.this report describes a case of clostridium difficile ribotype 033 colitis in a patient treated with multiple antibiotics for kpc-producing klebsiella pneumoniae pancreatitis. diagnostic, clinical and therapeutic features are discussed. to the best of our knowledge, this is the first case of c. difficile ribotype 033 clinical infection reported from italy.201627284989
tolerability and pharmacokinetics of syn-004, an orally administered β-lactamase for the prevention of clostridium difficile-associated disease and antibiotic-associated diarrhea, in two phase 1 studies.syn-004 is an orally administered β-lactamase enzyme, designed to be given concurrently with certain intravenous β-lactam antibiotics like cephalosporins. syn-004 is intended to degrade residual antibiotics excreted into the intestine as a result of hepatobiliary excretion and to prevent the disruption of the gut microbiome by these excess antibiotics. preserving the gut microbiome is expected to prevent secondary infections by pathogens like clostridium difficile and protect against other antib ...201627283946
clostridium difficile infection in patients hospitalized with type 2 diabetes mellitus and its impact on morbidity, mortality, and the costs of inpatient care.type 2 diabetes mellitus (t2dm) is often complicated by infections leading to hospitalization, increased morbidity, and mortality. not much is known about the impact of clostridium difficile infection (cdi) on health outcomes in hospitalized patients with t2dm. we estimated the prevalence and temporal trends of cdi; evaluated the associations between cdi and in-hospital mortality, length of stay (los), and the costs of inpatient care; and compared the impact of cdi with that of other infections ...201627321318
[changes in the epidemiology of clostridium difficile infection during 2005-2014 in salamanca, spain].to know the most relevant epidemiological features of clostridium difficile infection (cdi) between 2005- 2014 in the province of salamanca (spain).201627318459
efficacy of oral vancomycin in preventing recurrent clostridium difficile infection in patients treated with systemic antimicrobial agents.we compared rates of recurrent clostridium difficile infection in patients receiving or not receiving oral vancomycin prophylaxis with systemic antimicrobial therapy. the incidence of c. difficile infection was significantly lower in patients receiving prophylaxis (4.2% vs 26.6% in those without prophylaxis; odds ratio, 0.12; 95% confidence interval, .04-.4; p < .001).201627318333
reduction of antibiotic resistance genes in intestinal microbiota of patients with recurrent clostridium difficile infection after fecal microbiota transplantation. 201627317794
the cellular lipids of romboutsia.we have examined the lipids of three isolates, romboutsia lituseburensis, romboutsia ilealis, and romboutsia sp. strain frifi, of the newly described genus romboutsia by two-dimensional thin-layer chromatography (2d-tlc) and by liquid chromatography/mass spectrometry (lc/ms). we have found three phospholipids, phosphatidylglycerol (pg), cardiolipin and phosphatidic acid in all three species. a fourth phospholipid, lysyl-pg, was found in r. lituseburensis and strain frifi. polyprenyl-phosphates w ...201627317428
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
evaluating the effectiveness of an antimicrobial stewardship program on reducing the incidence rate of healthcare-associated clostridium difficile infection: a non-randomized, stepped wedge, single-site, observational study.the incidence rate of healthcare-associated clostridium difficile infection (ha-cdi) is estimated at 1 in 100 patients. antibiotic exposure is the most consistently reported risk factor for ha-cdi. strategies to reduce the risk of ha-cdi have focused on reducing antibiotic utilization. prospective audit and feedback is a commonly used antimicrobial stewardship intervention (asi). the impact of this asi on risk of ha-cdi is equivocal. this study examines the effectiveness of a prospective audit a ...201627309536
immunoglobulin a vasculitis complicated with clostridium difficile infection: a rare case report and brief review of the literature.immunoglobulin a (iga) vasculitis, formerly called henoch-schönlein purpura, is a leukocytoclastic type of vasculitis affecting small vessels with a deposition of immune iga complexes, clinically characterized by the classic tetrad of nonthrombocytopenic palpable purpura, arthralgia (or arthritis), and gastrointestinal and renal involvement. although the cause of the disease remains unknown, immune complexes of iga and unidentified antigens seem to play a central pathogenic role. the diagnosis i ...201627308656
[infection control and safety culture in german hospitals].healthcare-associated infections (hai) are the most frequent adverse events in the healthcare setting and their prevention is an important contribution to patient safety in hospitals.201627306879
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
fecal microbiota therapy as rescue therapy for life-threatening clostridium difficile infection in the critically ill: a small case series. 201627452730
candidemia in patients with body temperature below 37°c and admitted to internal medicine wards: assessment of risk factors.an increasing number of candidemia episodes has been reported in patients cared for in internal medicine wards. these usually older and frail patients may not be suspected as having candidemia because they lack fever at the onset of the episode. to identify the risk factors associated with the lack of fever at the onset of candidemia (ie, the collection of the first positive blood culture for candida spp.) in patients cared for in internal medicine wards, we compared 2 group of patients with or ...201627452680
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
longitudinal investigation of carriage rates, counts, and genotypes of toxigenic clostridium difficile in early infancy.asymptomatic infant carriers of toxigenic clostridium difficile are suggested to play a role in the transmission of c. difficile infection (cdi) in adults. however, the mode of c. difficile carriage in infants remains to be fully elucidated. we investigated longitudinal changes in carriage rates, counts, and strain types of toxigenic c. difficile in infants. stools collected from 111 healthy infants in belgium periodically from birth until the age of 6 months were examined by quantitative pcr ta ...201627451451
using expert process to combat clostridium difficile infections.in 2008, clostridium difficile rates were increasing in ontario, canada, and in response, hospitals were mandated by the ontario ministry of health to publicly report their c difficile infection (cdi) rates. in order to assist hospitals which had ongoing cdi outbreaks, a process of an external infection control resource team (icrt) was introduced. this article describes the function and process of the icrt, managed by public health ontario, and reviews the lessons learned over the first 5 years ...201627451312
association between nsaids and clostridium difficile-associated diarrhea: a systematic review and meta-analysis.objective. clostridium difficile infection is a leading cause of nosocomial diarrhea in developed countries. studies evaluating the associations of increased risk of community-acquired cdad and the use of nonsteroidal anti-inflammatory drugs (nsaids) have yielded inconclusive results. we conducted a systematic review and meta-analysis to compare the odds of nsaid exposure in patients with cdad versus patients without cdad in both community-based and healthcare-associated settings. methods. relev ...201627446866
draft genome sequence of clostridium difficile strain it1118, an epidemic isolate belonging to the emerging pcr ribotype 018.clostridium difficile pcr ribotype 018 has emerged in italy, south korea, and japan, causing severe infections and outbreaks. in this study, we sequenced the genome of it1118, an italian clinical isolate, to clarify the molecular features contributing to the success of this epidemic type.201627445391
high risk of post-infectious irritable bowel syndrome in patients with clostridium difficile infection.infectious enteritis is a commonly identified risk factor for irritable bowel syndrome (ibs). the incidence of clostridium difficile infection (cdi) is on the rise. however, there is limited information on post-infectious ibs (pi-ibs) development following cdi and the host- and infection-related risk factors are not known.201627444134
community-associated clostridium difficile diarrhoea. 201627439642
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
effects of high-pressure treatment on spores of clostridium species.this work analyzes the high-pressure (hp) germination of spores of the food-borne pathogen clostridium perfringens (with inner membrane [im] germinant receptors [grs]) and the opportunistic pathogen clostridium difficile (with no im grs), which has growing implications as an emerging food safety threat. in contrast to those of spores of bacillus species, mechanisms of hp germination of clostridial spores have not been well studied. hp treatments trigger bacillus spore germination through spores' ...201627316969
epidemiological and economic burden of clostridium difficile in the united states: estimates from a modeling approach.despite a large increase in clostridium difficile infection (cdi) severity, morbidity and mortality in the us since the early 2000s, cdi burden estimates have had limited generalizability and comparability due to widely varying clinical settings, populations, or study designs.201627316794
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
editorial commentary: where to place the new treatments for clostridium difficile infection? 201627365386
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
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
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
formicin - a novel broad-spectrum two-component lantibiotic produced by bacillus paralicheniformis apc 1576.bacteriocins represent a rather underutilized class of antimicrobials despite often displaying activity against many drug-resistant pathogens. lantibiotics are a post-translationally modified class of bacteriocins, characterized by the presence of lanthionine and methyllanthionine bridges. in this study, a novel two-peptide lantibiotic was isolated and characterized. formicin was isolated from bacillus paralicheniformis apc 1576, an antimicrobial-producing strain originally isolated from the int ...201627450592
reducing co-administration of proton pump inhibitors and antibiotics using a computerized order entry alert and prospective audit and feedback.antibiotics and proton pump inhibitors (ppis) are associated with clostridium difficile infection (cdi). both a computer order entry alert to highlight this association as well as antimicrobial stewardship directed prospective audit and feedback represent novel interventions to reduce the co-administration of antibiotics and ppis among hospitalized patients.201627449956
progress in our understanding of the gut microbiome: implications for the clinician.the investigation of the role of the microbial communities of our gastrointestinal tract (microbiota) has accelerated dramatically in recent years thanks to rapid developments in the technologies that allow us to fully enumerate and evaluate the full complement of bacterial species and strains that normally inhabit the gut. laboratory studies in a range of inventive animal models continue to provide insights into the role of the microbiota in health and to generate plausible hypotheses relating ...201627448618
fecal microbiota transplantation for recurrent clostridium difficile infection in the elderly: long-term outcomes and microbiota changes.fecal microbiota transplantation (fmt) has become the cornerstone in management of recurrent clostridium difficile infection (rcdi) in adults. however, data on efficacy, safety, long-term outcomes, and microbiota alterations are limited in elderly patients (>65 years).201627447476
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
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
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
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