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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
safety of high-dose doripenem in adult patients with cystic fibrosis.high doses of β-lactam antibiotics have been advocated for acute pulmonary exacerbations caused by pseudomonas aeruginosa in patients with cystic fibrosis (cf) secondary to high minimum inhibitory concentrations (mic) of the infecting organisms. some β-lactam antibiotics have increased elimination in cf patients. this case series examines the safety of high-dose doripenem (hdd), 2 g intravenously every 8 hours, which is 4 times the labeled dose, in cf patients.201627298719
inflammatory bowel disease: a descriptive study of 716 local chilean patients.to demographically and clinically characterize inflammatory bowel disease (ibd) from the local registry and update data previously published by our group.201627298570
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
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
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
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
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
surotomycin versus vancomycin for clostridium difficile infection: phase 2, randomized, controlled, double-blind, non-inferiority, multicentre trial.clostridium difficile infection (cdi) is a major public health concern. treatment with commonly prescribed antibiotics is associated with high rates of recurrence after initial cure. here, we present the efficacy and safety of surotomycin, an orally administered, minimally absorbed, selective bactericidal cyclic lipopeptide, compared with vancomycin, in patients with cdi.201627432604
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
clinical characterization of clostridium difficile infection in elderly patients. 201627340722
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
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
clostridium difficile pcr ribotypes 001 and 176 - the common denominator of c. difficile infection epidemiology in the czech republic, 2014.in 2014, 18 hospitals in the czech republic participated in a survey of the incidence of clostridium difficile infections (cdi) in the country. the mean cdi incidence was 6.1 (standard deviation (sd):7.2) cases per 10,000 patient bed-days and 37.8 cases (sd: 41.4) per 10,000 admissions. the mean cdi testing frequency was 39.5 tests (sd: 25.4) per 10,000 patient bed-days and 255.8 tests (sd: 164.0) per 10,000 admissions. a total of 774 c. difficile isolates were investigated, of which 225 (29%) b ...201627484171
cost of hospital management of clostridium difficile infection in united states-a meta-analysis and modelling study.clostridium difficile infection (cdi) is the leading cause of infectious nosocomial diarrhoea but the economic costs of cdi on healthcare systems in the us remain uncertain.201627562241
coinfection and emergence of rifamycin resistance during a recurrent clostridium difficile infection.clostridium difficile (peptoclostridium difficile) is a common health care-associated infection with a disproportionately high incidence in elderly patients. disease symptoms range from mild diarrhea to life-threatening pseudomembranous colitis. around 20% of patients may suffer recurrent disease, which often requires rehospitalization of patients. c. difficile was isolated from stool samples from a patient with two recurrent c. difficile infections. pcr ribotyping, whole-genome sequencing, and ...201627558181
prevalence of nosocominal toxigenic clostridium difficile in children under 5 years in hajar hospital, shahrekord, iran. 201627504373
intravenous adenovirus expressing a multi-specific, single-domain antibody neutralizing tcda and tcdb protects mice from clostridium difficile infection.clostridium difficile infection (cdi) is the most common cause of antibiotic-associated diarrhea and colitis in developed countries. the disease is mainly mediated via two major exotoxins tcda and tcdb secreted by the bacterium. we have previously developed a novel, potently neutralizing, tetravalent and bispecific heavy-chain-only single domain (vhh) antibody to both tcda and tcdb (designated as aba) that reverses fulminant cdi in mice. since aba has a short serum half-life, in this study a rep ...201627502696
can we improve the therapy of clostridium difficile infection in elderly patients?clostridium difficile infection (cdi) is becoming a serious problem predominantly in geriatric patients, who are a significant risk group. the goal of this study was to evaluate the risk factors for mortality in cdi patients and to construct a binary logistic regression model that describes the probability of mortality in geriatric patients suffering from cdi.201627501856
effect of metronidazole use on tacrolimus concentrations in transplant patients treated for clostridium difficile.two case reports suggest that metronidazole treatment for clostridium difficile infections (cdi) increases tacrolimus (tac) trough levels. the primary objective of this study was to determine the clinical significance of this potential interaction in transplant patients receiving cdi treatment. currently, no robust literature exists to estimate a magnitude of pharmacokinetic interaction between metronidazole and tac.201627501504
clostridium difficile infection and inflammatory bowel disease. 201627499718
prevalence and impact of clostridium difficile infection in elderly residents of long-term care facilities, 2011: a nationwide study.the elderly population is particularly vulnerable to clostridium difficile infection (cdi), but the epidemiology of cdi in long-term care facilities (ltcfs) is unknown.we performed a retrospective cohort study and used us 2011 ltcf resident data from the minimum data set 3.0 linked to medicare claims. we extracted cdi cases based on international classification of diseases-9 coding, and compared residents with the diagnosis of cdi to those who did not have a cdi diagnosis during their ltcf stay. ...201627495022
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
authors' correction for euro surveill. 2016;21(29). 201627494203
interview with professor mark wilcox.mark wilcox speaks to georgia patey, commissioning editor: professor mark wilcox is a consultant microbiologist and head of microbiology at the leeds teaching hospitals (leeds, uk), the professor of medical microbiology at the university of leeds (leeds, uk), and is the lead on clostridium difficile and the head of the uk c. difficile reference laboratory for public health england (phe). he was the director of infection prevention (4 years), infection control doctor (8 years) and clinical direct ...201627494150
fecal microbiota transplantation for inflammatory bowel disease.the gut bacterial microbiome, particularly its role in disease and inflammation, has gained international attention with the successful use of fecal microbiota transplantation (fmt) in the treatment of clostridium difficile infection. this success has led to studies exploring the role of fmt in other conditions, including inflammatory bowel disease (ibd). both crohn's disease and ulcerative colitis are chronic inflammatory conditions of the gastrointestinal system that have multifactorial etiolo ...201627493597
frequency and risks associated with clostridium difficile-associated diarrhea after pediatric solid organ transplantation: a single-center retrospective review.morbidity and mortality related to clostridium difficile infection (cdi) has increased, but epidemiology and risk factors within pediatric solid organ transplant (sot) recipients are uncertain.201627492796
fecal microbiota transplantation and its usage in neuropsychiatric disorders.fecal microbiota transplantation has a 1700-year history. this forgotten treatment method has been put into use again during the last 50 years. the interest in microbiota-gut-brain axis and fecal microbiota transplantation is rapidly increasing. new evidence is obtained in the etiopathogenesis of neuropsychiatric disorders. there is a large number of experimental and clinical researches in the field of gut-brain axis. there is limited information on fecal microbiota transplantation. despite this ...201627489376
enhanced surveillance of clostridium difficile infection occurring outside hospital, england, 2011 to 2013.there are limited national epidemiological data for community-associated (ca)-clostridium difficile infections (cdis). between march 2011 and march 2013, laboratories in england submitted to the clostridium difficile ribotyping network (cdrn) up to 10 diarrhoeal faecal samples from successive patients with ca-cdi, defined here as c. difficile toxin-positive diarrhoea commencing outside hospital (or less than 48 hours after hospital admission), including those cases associated with community-base ...201627487436
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
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
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
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