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clostridium difficile infection is associated with lower inpatient mortality when managed by gi surgeons.patients admitted with clostridium difficile infection are managed in a variety of settings. if their care is inadequate, these patients can rapidly deteriorate.201627505114
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
hospital acquired clostridium difficile infection in pediatric wards: a retrospective case-control study.clostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections. the aim of this study was to determine the incidence and potential risk factors for c. difficile infection (cdi) in hospitalized children who developed diarrhea. a retrospective study was performed at a university hospital in istanbul over a three-year period (2012-2014).201627563524
quantitative structure activity relationship (qsar) studies on nitazoxanide-based analogues against clostridium difficile in vitro.quantitative structure activity relationship (qsar) has been established between the various physiochemical parameters of a series of nitazoxanide-based analogues and its antibacterial activity against clostridium difficile. genetic function approximation (gfa) and comparative molecular field analysis (comfa) techniques were used to identify the descriptors that have influence on biological activity. the most influencing molecular descriptors identified in 2d-qsar include spatial, topological, a ...201627731829
efficacy of secondary prophylaxis with vancomycin for preventing recurrent clostridium difficile infections.patients with clostridium difficile infection (cdi) who are re-exposed to antibiotics have a high likelihood of recurrence. we aimed to determine whether oral vancomycin as secondary prophylaxis reduces the risk of recurrence in patients recently diagnosed with cdi who undergo subsequent antibiotic exposure (cdi-ae).201627619835
why rifampin (rifampicin) is a key component in the antibiotic treatment of hidradenitis suppurativa: a review of rifampin's effects on bacteria, bacterial biofilms, and the human immune system.combinations of rifampin and clindamycin or rifampin, metronidazole, and moxifloxcin have been reported as effective treatments for hidradenitis suppurativa (hs) hurley stage 1 and hurley stage 2.  clinical trials suggest that for stage 1 and mild stage 2 hs, clindamycin 300 mg twice daily and rifampin 300 mg twice daily for 10 weeks can substantially abate hs in ~80% of cases and remit hs in ~50% of cases.  another study notes use of rifampin-moxifloxacin-metronidazole given for 6 weeks, dosed ...201627617596
antibiotic resistance.antimicrobial resistance in bacterial pathogens is a challenge that is associated with high morbidity and mortality. multidrug resistance patterns in gram-positive and -negative bacteria are difficult to treat and may even be untreatable with conventional antibiotics. there is currently a shortage of effective therapies, lack of successful prevention measures, and only a few new antibiotics, which require development of novel treatment options and alternative antimicrobial therapies. biofilms ar ...201627616769
crispr diversity and microevolution in clostridium difficile.virulent strains of clostridium difficile have become a global health problem associated with morbidity and mortality. traditional typing methods do not provide ideal resolution to track outbreak strains, ascertain genetic diversity between isolates, or monitor the phylogeny of this species on a global basis. here, we investigate the occurrence and diversity of clustered regularly interspaced short palindromic repeats (crispr) and crispr-associated genes (cas) in c. difficile to assess the poten ...201627576538
clostridium difficile colitis: pathogenesis and host defence.clostridium difficile is a major cause of intestinal infection and diarrhoea in individuals following antibiotic treatment. recent studies have begun to elucidate the mechanisms that induce spore formation and germination and have determined the roles of c. difficile toxins in disease pathogenesis. exciting progress has also been made in defining the role of the microbiome, specific commensal bacterial species and host immunity in defence against infection with c. difficile. this review will sum ...201627573580
evaluation of gastrointestinal leakage using serum (1→3)-β-d-glucan in a clostridium difficile murine model.gastrointestinal (gi) leakage in clostridium difficile-associated diarrhea (cdad) is well known but is not routinely assessed in clinical practice. serum (1→3)-β-d-glucan (bg), a fungal cell wall component used as a biomarker for invasive fungal disease, was tested in a cdad mouse model with and without probiotics. higher serum fluorescein isothiocyanate-dextran (fitc-dextran) and spontaneous gram-negative bacteremia, gi leakage indicators, were frequently found in cdad mice, which died compared ...201627573235
the binary toxin cdt enhances clostridium difficile virulence by suppressing protective colonic eosinophilia.clostridium difficile is the most common hospital acquired pathogen in the usa, and infection is, in many cases, fatal. toxins a and b are its major virulence factors, but expression of a third toxin, known as c. difficile transferase (cdt), is increasingly common. an adenosine diphosphate (adp)-ribosyltransferase that causes actin cytoskeletal disruption, cdt is typically produced by the major, hypervirulent strains and has been associated with more severe disease. here, we show that cdt enhanc ...201627573114
role of coinfecting strains in recurrent clostridium difficile infection.the contribution of mixed infection in recurrent clostridium difficile infection (cdi) episodes is not known. among paired isolates from 52 patients, mixed infection due to >1 toxigenic strain of c. difficile was identified in 8% of first episodes. among recurrences, relapse from 1 or both co-infecting strains was uncommon; it was detected in a single case each. infect control hosp epidemiol 2016;1481-1484.201627572118
crystal structure of clostridium difficile toxin a.clostridium difficile infection is the leading cause of hospital-acquired diarrhoea and pseudomembranous colitis. disease is mediated by the actions of two toxins, tcda and tcdb, which cause the diarrhoea, as well as inflammation and necrosis within the colon. the toxins are large (308 and 270 kda, respectively), homologous (47% amino acid identity) glucosyltransferases that target small gtpases within the host. the multidomain toxins enter cells by receptor-mediated endocytosis and, upon exposu ...201627571750
clostridium difficile infection health disparities by race among hospitalized adults in the united states, 2001 to 2010.recognition of health disparities in clostridium difficile infection (cdi) is an initial step toward improved resource utilization and patient health. the purpose of this study was to identify health disparities by black vs. white race among hospitalized adults with cdi in the united states (u.s.) over 10 years.201627568176
oral, frozen fecal microbiota transplant (fmt) capsules for recurrent clostridium difficile infection.fecal microbiota transplantation (fmt) has been shown to be safe and effective in treating refractory or relapsing c. difficile infection (cdi), but its use has been limited by practical barriers. we recently reported a small preliminary feasibility study using orally administered frozen fecal capsules. following these early results, we now report our clinical experience in a large cohort with structured follow-up.201627609178
the epidemiology of clostridium difficile infection in patients with cancer.clostridium difficile infection (cdi) is a significant cause of healthcare-associated diarrhoea, and the emergence of endemic strains resulting in poorer outcomes is recognised worldwide. patients with cancer are a specific high-risk group for development of infection. areas covered: in this review, modifiable and non-modifiable risk factors for cdi in adult patients with haematological malignancy or solid tumours are evaluated. in particular, the contribution of antimicrobial exposure, hospital ...201627606976
clostridium difficile infection in production animals and avian species: a review.clostridium difficile is the leading cause of antibiotic-associated diarrhea and colitis in hospitalized humans. recently, c. difficile infection (cdi) has been increasingly recognized as a cause of neonatal enteritis in food animals such as pigs, resulting in stunted growth, delays in weaning, and mortality, as well as colitis in large birds such as ostriches. c. difficile is a strictly anaerobic spore-forming bacterium, which produces two toxins a (tcda) and b (tcdb) as its main virulence fact ...201627602596
bed utilisation and increased risk of clostridium difficile infections in acute hospitals in england in 2013/2014.the study aimed to identify thresholds for hospital bed utilisation which are independently associated with significantly higher risks for clostridium difficile infections (cdi) in acute hospitals in england.201627601687
[a scoring system for prescribing fidaxomicin in clostridium diffícile infection].recurrences of clostridium difficile infections lead to hospital readmissions and high costs, in addition to the suffering and frustration for the patients. fidaxomicin has recently been introduced as a new antibiotic that has been shown to significantly reduce the recurrence of this infection. despite this superiority, its high cost has led to very restrictive policies in its use, as such that many institutions only use it in patients with multiple recurrences. while waiting for new predictive ...201627601193
rapid detection of clostridium difficile toxins and laboratory diagnosis of clostridium difficile infections.clostridium difficile is an anaerobic, spore-forming and gram-positive bacillus. it is the major cause of antibiotic-associated diarrhea prevailing in hospital settings. the morbidity and mortality of c. difficile infection (cdi) has increased significantly due to the emergence of hypervirulent strains. because of the poor clinical different between cdi and other causes of hospital-acquired diarrhea, laboratory test for c. difficile is an important intervention for diagnosis of cdi.201627601055
use of intravenous tigecycline in patients with severe clostridium difficile infection: a retrospective observational cohort study.there are only a limited number of antimicrobials for treating severe clostridium difficile infection (scdi). tigecycline shows significant in vitro effect against c. difficile and is approved for management of complicated intra-abdominal infections. our aim was to analyse the efficacy of tigecycline compared with standard therapy (oral vancomycin plus intravenous metronidazole) in adults treated for scdi. a retrospective cohort study of such patients hospitalized at our department from january ...201627599690
growth patterns of clostridium difficile - correlations with strains, binary toxin and disease severity: a prospective cohort study.a broad spectrum of symptoms has been associated with c. difficile infection (cdi). several studies indicate that toxin-production correlates with growth rates of c. difficile. this study aimed to correlate growth rates of c. difficile with disease severity and strain characteristics. from 01/2003 to 10/2011, strains from a prospective cohort of all inpatients with cdi at the university hospital basel, switzerland were analyzed regarding binary toxin, presence of the tcdc deletion and ribotype. ...201627598309
comparison of agar dilution and broth microdilution methods for clostridium difficile antimicrobial susceptibility testing.in this study, the performance of the broth microdilution (bmd) method for testing the antimicrobial susceptibility of clostridium difficile in comparison with the agar dilution (ad) method used by the clinical and laboratory standards institute (clsi) was evaluated. in total, 70 non-duplicate c. difficile clinical isolates were used in this study. the minimum inhibitory concentrations (mics) of clindamycin, moxifloxacin, metronidazole and vancomycin were examined using ad and bmd. the results s ...201627598055
effect of an antimicrobial stewardship intervention on outcomes for patients with clostridium difficile infection.although antimicrobial stewardship programs (asps) are uniquely positioned to improve treatment of clostridium difficile infection (cdi) through targeted interventions, studies to date have not rigorously evaluated the influence of asp involvement on clinical outcomes attributed to cdi.201627592160
epidemiology of multidrug resistant bacterial organisms and clostridium difficile in german hospitals in 2014: results from a nationwide one-day point prevalence of 329 german hospitals.one important aspect in combatting resistance to antibiotics is to increase the awareness and knowledge by epidemiological studies. we therefore conducted a german-wide point-prevalence survey for multidrug resistant bacterial organisms (mdros) and clostridium difficile (cd) to assess the epidemiology and structure quality of infection control in german hospitals.201627590879
variability in testing policies and impact on reported clostridium difficile infection rates: results from the pilot longitudinal european clostridium difficile infection diagnosis surveillance study (lucid).lack of standardised clostridium difficile testing is a potential confounder when comparing infection rates. we used an observational, systematic, prospective large-scale sampling approach to investigate variability in c. difficile sampling to understand c. difficile infection (cdi) incidence rates. in-patient and institutional data were gathered from 60 european hospitals (across three countries). testing methodology, testing/cdi rates and case profiles were compared between countries and insti ...201627590621
draft genome sequence of clostridium difficile belonging to ribotype 018 and sequence type 17.clostridium difficile, belonging to ribotype 018 (rt018), is one of the most prevalent genotypes circulating in hospital settings in italy. here, we report the draft genome of c. difficile cd8-15 belonging to rt018, isolated from a patient with fatal c. difficile-associated infection.201627587821
vaccines against major icu pathogens: where do we stand?multidrug resistance of bacterial pathogens has confronted physicians around the world with the threat of inefficacy of the antibiotic regime, which is particularly important for patients with sepsis. antibiotic resistance has revived search for alternative nonantibiotic strategies. among them, prophylaxis by vaccination is an appealing concept.201627583587
a quantitative analysis of fda adverse event reports with oral bisphosphonates and clostridium difficile.studies have shown associations between clostridium difficile infection (cdi) and non-antimicrobial medications including proton pump inhibitors, osteoporosis medications, and antidepressants.201627582058
fecal microbiota transplantation is safe and efficacious for recurrent or refractory clostridium difficile infection in patients with inflammatory bowel disease.new treatments are needed as clostridium difficile infection (cdi) is becoming increasingly formidable. fecal microbiota transplantation (fmt) has a 90% success rate in the treatment of recurrent cdi. however, evidence regarding its safety, efficacy, and effect on disease activity in patients with inflammatory bowel disease (ibd) is lacking.201627580384
cost-effectiveness analysis of the use of probiotics for the prevention of clostridium difficile-associated diarrhea in a provincial healthcare system - erratum. 201627580173
high mobility group box1 protein is involved in endoplasmic reticulum stress induced by clostridium difficile toxin a.high mobility group box1 (hmgb1), a damage-associated inflammatory factor, plays an important role in the pathogenesis of numerous chronic inflammatory and autoimmune diseases. in this study, the role of the hmgb1 in tcda-induced er stress was identified. clostridium difficile toxin a is one of the major virulence factors of c. difficile infection (cdi) and has been proved to induce apoptotic cell death through er stress. our results showed that hmgb1 might play an important role in the tcda-ind ...201627579314
epidemiology of diarrheal illness in pediatric oncology patients.diarrhea is common in children with cancer, but this has not been systematically studied to date.201627578209
disparate prevalence of toxigenic and nontoxigenic clostridium difficile among distinct adult patient populations in a single institution.clostridium difficile (cd) disease remains a costly and important hospital-associated infection. although nontoxigenic cd is detected by some cd testing methods, can interfere with some detection algorithms and has been suggested as a treatment for cd disease, little is known about the relative occurrence of toxigenic and nontoxigenic cd in a single institution.we used both chromogenic and selective agar media to recover cd isolates and a molecular method to detect the toxin b gene from over 240 ...201627624898
compared lethality rates of clostridium difficile infections at the local, regional and national levels in france. 201627621820
modulation of microbiota as treatment for intestinal inflammatory disorders: an uptodate.alterations of intestinal microflora may significantly contribute to the pathogenesis of different inflammatory and autoimmune disorders. there is emerging interest on the role of selective modulation of microflora in inducing benefits in inflammatory intestinal disorders, by as probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (fmt). to summarize recent evidences on microflora modulation in main intestinal inflammatory disorders, pubmed was searched using ter ...201627621567
clearance of vancomycin-resistant enterococcus concomitant with administration of a microbiota-based drug targeted at recurrent clostridium difficile infection.background.  vancomycin-resistant enterococcus (vre) is a major healthcare-associated pathogen and a well known complication among transplant and immunocompromised patients. we report on stool vre clearance in a post hoc analysis of the phase 2 punch cd study assessing a microbiota-based drug for recurrent clostridium difficile infection (cdi). methods.  a total of 34 patients enrolled in the punch cd study received 1 or 2 doses of rbx2660 (microbiota suspension). patients were requested to volu ...201627703995
nodular colitis: endoscopic image an unusual finding.an 82-year-old male with a history of high blood pressure, copd, chronic myeloid leukemia, and stage-4 chronic renal failure. admitted to hospital for lower-limb cellulitis and severe copd exacerbation, he received antibiotic therapy and bronchodilators. during his hospital stay he developed severe anemia and had an hematochezia event with no diarrhea. a complete colonoscopy found small (4-7 mm) nacreous elevated lesions, circumferential in shape, in the cecum and ascending colon with some bleed ...201627701886
norovirus infection in solid organ transplant recipients: a single-center retrospective study.norovirus (nov) is gaining recognition as an important cause of diarrhea among solid organ transplant (sot) recipients, but existing studies have been limited by a small sample size.201627699965
henoch schonlein purpura and clostridium difficile infection: a hematologist's point of view. 201627689213
serendipity in refractory celiac disease: full recovery of duodenal villi and clinical symptoms after fecal microbiota transfer.treatment of refractory celiac disease type ii (rcd ii) and preventing the development of an enteropathy associated t-cell lymphoma in these patients is still difficult. in this case report, we describe a patient with rcd ii who received fecal microbiota transfer as treatment for a recurrent clostridium difficile infection, and remarkably showed a full recovery of duodenal villi and disappearance of celiac symptoms. this case suggests that altering the gut microbiota may hold promise in improvin ...201627689204
chemokine cxcl13 expression was up-regulated in clostridium difficile infection.clostridium difficile infection (cdi) is the leading cause of antibiotic- and healthcare-associated diarrhea. cxcl13 is a well-known cxc chemokine involved in inflammation, but its role in cdi remains unknown. in this study, serum and fecal samplings were collected from 51 cdi patients, 50 diarrhea patients without cdi and 50 healthy control subjects to determine the cxcl13 levels by enzyme-linked immunosorbent assay (elisa). besides, a mouse model of c. difficile infection was established, and ...201627685937
measuring appropriate antimicrobial use: attempts at opening the black box.indiscriminate antimicrobial use has plagued medicine since antibiotics were first introduced into clinical practice >70 years ago. infectious diseases physicians and public health officials have advocated for preservation of these life-saving drugs for many years. with rising burden of antimicrobial-resistant organisms and clostridium difficile infections, halting unnecessary antimicrobial use has become one of the largest public health concerns of our time. inappropriate antimicrobial use has ...201627682070
eccmid 2016: addressing the burden of recurrent clostridium difficile infections.26th european congress of clinical microbiology and infectious diseases (eccmid), 9-12th april 2016, amsterdam, the netherlands the european congress of clinical microbiology and infectious diseases (eccmid) is the annual scientific meeting of the european society of clinical microbiology. eccmid 2016, held in amsterdam, the netherlands, was attended by over 11,600 clinical microbiologists and infectious disease physicians from more than 120 countries. the congress offered an essential opportuni ...201627679929
assessing the risk of hospital-acquired clostridium difficile infection with proton pump inhibitor use: a meta-analysis.background clostridium difficile is the principal infectious cause of antibiotic-associated diarrhea and accounts for 12% of hospital-acquired infections. recent literature has shown an increased risk of c. difficile infection (cdi) with proton pump inhibitor (ppi) use. objective to conduct a systematic assessment of the risk of hospital-acquired cdi following exposure to ppi. methods we searched multiple databases for studies examining the relationship between ppi and hospital-acquired cdi. poo ...201627677811
the housefly musca domestica as a mechanical vector of clostridium difficile.clostridium difficile is a bacterial healthcare-associated infection that may be transferred by houseflies (musca domestica) due to their close ecological association with humans and cosmopolitan nature.201627671221
patients with risk factors for complications do not require longer antimicrobial therapy for complicated intra-abdominal infection.a prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. we hypothesized that patients with specific risk factors for complications also had similar outcomes. short-course patients with obesity, diabetes, or acute physiology and chronic health evaluation ii ≥15 from the stop-it trial were compared with longer duration patients. outcomes ...201627670577
inappropriate clostridium difficile testing and consequent overtreatment and inaccurate publicly reported metrics.background the nationally reported metric for clostridium difficile infection (cdi) relies solely on laboratory testing, which can result in overreporting due to asymptomatic c. difficile colonization. objective to review the clinical scenarios of cases of healthcare facility-onset cdi (ho-cdi) and to determine the appropriateness of c. difficile testing on the basis of presence of symptomatic diarrhea in order to identify areas for improvement. design retrospective cohort study. setting northwe ...201627666285
faecal microbiota transplantation for recurring clostridium difficile infection in a patient with crohn's disease and ileorectal anastomosis.faecal microbiota transplantation (fmt) is increasingly being used to treat refractory and recurring clostridium difficile infection (cdi). although fmt appears to be safe and highly effective in patients with a preserved colon and immunocompetence, its use in patients with inflammatory bowel disease (ibd) who are on immunomodulating therapies is controversial. in particular, patients who have undergone colectomy may have different treatment responses to fmt. in this case report, we describe the ...201627664230
vaccinology gets help from chemistry.a recent report on the immunological activity of protein conjugates of synthetic lipoteicoic fragments from clostridium difficile underpins the use of these molecules for the development of a vaccine. in a recent issue of cell chemical biology, broecker et al. (2016) illustrate the utility of glycoarray-based selection of bacterial carbohydrates with the potential to become vaccine candidates.201627662251
prevention of infection due to clostridium difficile.clostridium difficile is one of the foremost nosocomial pathogens. preventing infection is particularly challenging. effective prevention efforts typically require a multifaceted bundled approach. a variety of infection control procedures may be advantageous, including strict hand decontamination with soap and water, contact precautions, and using chlorine-containing decontamination agents. additionally, risk factor reduction can help reduce the burden of disease. the risk factor modification is ...201627660089
fecal microbiota transplant in patients with recurrent clostridium difficile infection.the clinical effectiveness of fecal microbiota transplant (fmt) for the treatment of recurrent clostridium difficile infections (rcdi) has been demonstrated in randomized controlled trials. to assess the current status of fmt in germany with respect to active centers, local standards, clinical effectiveness and safety, the microtrans registry (nct02681068) was established.201627658471
overwhelming recurrent clostridium difficile infection after reversal of diverting loop ileostomy created for prior fulminant c. difficile colitis. 201627657564
advances in the microbiome: applications to clostridium difficile infection.clostridium difficile is a major cause of morbidity and mortality worldwide, causing over 400,000 infections and approximately 29,000 deaths in the united states alone each year. c. difficile is the most common cause of nosocomial diarrhoea in the developed world, and, in recent years, the emergence of hyper-virulent (mainly ribotypes 027 and 078, sometimes characterised by increased toxin production), epidemic strains and an increase in the number of community-acquired infections has caused fur ...201627657145
2016 update on medical overuse: a systematic review.overuse of medical care is an increasingly recognized problem in clinical medicine.201627654002
what's a snp between friends: the influence of single nucleotide polymorphisms on virulence and phenotypes of clostridium difficile strain 630 and derivatives.clostridium difficile is a major cause of antibiotic induced diarrhea worldwide, responsible for significant annual mortalities and represents a considerable economic burden on healthcare systems. the two main c. difficile virulence factors are toxins a and b. isogenic toxin b mutants of 2 independently isolated erythromycin-sensitive derivatives (630e and 630δerm) of strain 630 were previously shown to exhibit substantively different phenotypes. compared to 630, strain 630e and its progeny grow ...201627652799
tea and recurrent clostridium difficile infection.background and aims. studies have shown effects of diet on gut microbiota. we aimed to identify foods associated with recurrent clostridium difficile infection (cdi). methods. in this cross-sectional survey, consecutive patients diagnosed with cdi were identified by electronic medical records. colitis symptoms and positive clostridium difficile assay were confirmed. health-care onset-health-care facility associated cdi was excluded. food surveys were mailed to 411 patients. survey responses serv ...201627651790
clostridium difficile infection diagnostics - evaluation of the c. diff quik chek complete assay, a rapid enzyme immunoassay for detection of toxigenic c. difficile in clinical stool samples.diagnostic testing for clostridium difficile infection (cdi) has, in recent years, seen the introduction of rapid dual-eia (enzyme immunoassay) tests combining species-specific glutamate dehydrogenase (gdh) with toxin a/b. in a prospective study, we compared the c. diff quik chek complete test to a combination of selective culture (sc) and loop-mediated isothermal amplification (lamp) of the toxin a gene. of 419 specimens, 68 were positive in sc including 62 positive in lamp (14.7%). the combine ...201627651167
a comparison of histamine receptor antagonists versus proton pump inhibitor gastrointestinal ulcer prophylaxis in kidney transplant recipients.there are several different agents that can be used for gastrointestinal (gi) ulcer prophylaxis in posttransplant recipients, such as histamine-2 receptor antagonists (h2ra) or proton pump inhibitors (ppis).201627650918
community- and healthcare-associated clostridium difficile infections, finland, 2008-2013(1).we evaluated incidence, case-fatality rate, and trends of community-associated (ca) and healthcare-associated (ha) clostridium difficile infections (cdis) in finland during 2008-2013. cdis were identified in the national infectious disease register, deaths in the national population information system, hospitalizations to classify infections as ca or ha in the national hospital discharge register, and genotypes in a reference laboratory. a total of 32,991 cdis were identified: 10,643 (32.3%) wer ...201627648884
fecal microbiota transplant in patients with clostridium difficile infection: a systematic review.fecal microbiota transplantation (fmt) restores a diverse bacterial profile to the gastrointestinal tract and may effectively treat patients with clostridium difficile infection (cdi). the objective of this systematic review was to evaluate the effectiveness of fmt in the treatment of cdi.201627648772
the phosphotransfer protein cd1492 represses sporulation initiation in clostridium difficile.the formation of spores is critical for the survival of clostridium difficile outside the host gastrointestinal tract. persistence of c. difficile spores greatly contributes to the spread of c. difficile infection (cdi), and the resistance of spores to antimicrobials facilitates the relapse of infection. despite the importance of sporulation to c. difficile pathogenesis, the molecular mechanisms controlling spore formation are not well understood. the initiation of sporulation is known to be reg ...201627647869
risk factors for short- and long-term mortality in very old patients with clostridium difficile infection: a retrospective study.most cases of clostridium difficile infections (cdi) occur in patients aged 65 years and older. older age is associated with increased mortality. risk factors for mortality in patients aged 80 years and older are not well recognized.201627647625
taking advantage of public reporting: an infection composite score to assist evaluating hospital performance for infection prevention efforts.the standardized infection ratio (sir) evaluates individual publicly reported health care-associated infections, but it may not assess overall performance.201627645403
proton pump inhibitors and risk of clostridium difficile infection: a multi-country study using sequence symmetry analysis.to determine the association between incident proton pump inhibitor (ppi) use and clostridium difficile infections across multiple countries method: national data covering the total population in australia and korea, the canadian population over 65 years and a 3 million person random sample data set from taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in japan. sequence symmetry analysis was used to assess the association with ...201627645304
non-invasive fecal microbiota transplantation for recurrent clostridium difficile infection in a patient presenting with hypertensive disorder post interventionem.fecal microbiota transplantation has gathered much attention due to its high efficacy in resolving recurrent clostridium difficile infection. until today, it is recognized as a safe procedure without any severe side effects. patients with impaired conscious states suffering from recurrent episodes of aspiration are at increased risk by endoscopic interventions needed during standard approaches for fecal microbiota transplantation application.here, we illustrate the case of a tetraplegic patient ...201627644000
[fecal microbiota transplantation, a novel therapy for recurrent clostridium difficile infection].clostridium difficile infection is caused by a disturbance of the gut microbiota, often resulting from the use of antibiotics. among a sub group of patients with this disorder, treatment with antibiotics is not effective. they develop a chronic, recurrent infection. such patients can be treated with a fecal microbiota transplantation (fmt), or fecal transplantation. the crucial steps for safe application of fecal transplantation are central donor selection and screening. to optimise safety and t ...201627643493
pantoprazole or placebo for stress ulcer prophylaxis (pop-up): randomized double-blind exploratory study.pantoprazole is frequently administered to critically ill patients for prophylaxis against gastrointestinal bleeding. however, comparison to placebo has been inadequately evaluated, and pantoprazole has the potential to cause harm. our objective was to evaluate benefit or harm associated with pantoprazole administration.201627635481
endoscopic delivery of fecal biotherapy in inflammatory bowel disease.the intestinal microbiome plays an important role in the pathogenesis of inflammatory bowel disease (ibd). we are able to use the microbiome as a therapeutic target with use of fecal microbiota transplantation (fmt) for cure of recurrent clostridium difficile infection. given our ability to target the dysbiotic state with fmt, its use as therapy in ibd has tremendous potential. this overview discusses the practical considerations of fmt therapy with respect to our current understanding of safety ...201627633598
reprofiled anthelmintics abate hypervirulent stationary-phase clostridium difficile.prolonged use of broad-spectrum antibiotics disrupts the indigenous gut microbiota, which consequently enables toxigenic clostridium difficile species to proliferate and cause infection. the burden of c. difficile infections was exacerbated with the outbreak of hypervirulent strains that produce copious amounts of enterotoxins and spores. in recent past, membrane-active agents have generated a surge of interest due to their bactericidal property with a low propensity for resistance. in this stud ...201627633064
hypersensitivity reaction following administration of low-dose oral vancomycin for the treatment of clostridium difficile in a patient with normal renal function.systemic absorption of oral vancomycin for the treatment of clostridium difficile is thought to be trivial in patients without risk factors for increased systemic absorption and is often overlooked in clinical practice. a 51-year-old male elicits a suspected immunoglobulin e-mediated hypersensitivity following administration of low-dose oral vancomycin for the treatment of severe c difficile the patient had normal renal function and was administered low doses of the medication, however, had a me ...201627630210
modulation of the surface-layer protein of clostridium difficile through cwp84 inhibition.cysteine protease cwp84 is responsible for surface-layer processing in clostridium difficile and was also shown to cleave several human extracellular matrix components in vitro. to enable the facile identification and characterization of cwp84 inhibitors, we developed a fluorogenic 10-mer peptide based on the enzyme's natural substrate slpa that is amenable for use in fret-based high-throughput screening. the design of substrate-mimetic inhibitors led to epoxysuccinate 8c, which displayed an ina ...201627626098
effect of detecting and isolating asymptomatic clostridium difficile carriers-reply. 201627695841
effect of detecting and isolating asymptomatic clostridium difficile carriers. 201627695834
influence of saccharomyces boulardii cncm i-745on the gut-associated immune system.the probiotic saccharomyces boulardii cncm i-745 (also known as saccharomyces cerevisiae hansen cbs 5926; in the following s. boulardii) has proven its effectiveness in preventive and therapeutic treatment of many gastrointestinal diseases, especially diseases associated with acute diarrhea. in particular, antibiotic-associated diarrhea, clostridium difficile-associated diarrhea, traveller's diarrhea, as well as acute diarrhea due to common viral and bacterial infections in children and adults.201627695355
host response to clostridium difficile infection: diagnostics and detection.clostridium difficile infection (cdi) is a significant healthcare concern worldwide, and c. difficile is recognised as the most frequent aetiological agent of infectious healthcare-associated diarrhoea in hospitalised adult patients. the clinical manifestation of cdi varies from self-limited diarrhoea to life-threatening colitis. such a broad disease spectrum can be explained by the impact of host factors. currently, a complex cdi aetiology is widely accepted, acknowledging the interaction betwe ...201627693863
high prevalence of nontoxigenic clostridium difficile isolated from hospitalized and non-hospitalized individuals in rural ghana.since data about clostridium difficile infection in sub-saharan africa are scarce, we determined its epidemiology and risk factors in a cross-sectional study in eikwe, a rural community in ghana. we tested stool samples from 176 hospitalized patients with diarrhoea and from 131 asymptomatic non-hospitalized individuals for c. difficile and some other enteric pathogens. the overall prevalence rate of c. difficile was 4.9% with ribotype 084 being predominant. with 75% of the isolates, a high rate ...201627693000
reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens.the purpose of this study was to determine the effectiveness of copper-impregnated composite hard surfaces and linens in an acute care hospital to reduce health care-associated infections (hais).201627692785
an evaluation of food as a potential source for clostridium difficile acquisition in hospitalized patients.objective to determine whether clostridium difficile is present in the food of hospitalized patients and to estimate the risk of subsequent colonization associated with c. difficile in food. methods this was a prospective cohort study of inpatients at a university-affiliated tertiary care center, may 9, 2011-july 12, 2012. enrolled patients submitted a portion of food from each meal. patient stool specimens and/or rectal swabs were collected at enrollment, every 3 days thereafter, and at dischar ...201627691986
rapid change of fecal microbiome and disappearance of clostridium difficile in a colonized infant after transition from breast milk to cow milk.clostridium difficile is the most common known cause of antibiotic-associated diarrhea. upon the disturbance of gut microbiota by antibiotics, c. difficile establishes growth and releases toxins a and b, which cause tissue damage in the host. the symptoms of c. difficile infection disease range from mild diarrhea to pseudomembranous colitis and toxic megacolon. interestingly, 10-50 % of infants are asymptomatic carriers of c. difficile. this longitudinal study of the c. difficile colonization in ...201627717398
longitudinal survey of clostridium difficile presence and gut microbiota composition in a belgian nursing home.increasing age, several co-morbidities, environmental contamination, antibiotic exposure and other intestinal perturbations appear to be the greatest risk factors for c. difficile infection (cdi). therefore, elderly care home residents are considered particularly vulnerable to the infection. the main objective of this study was to evaluate and follow the prevalence of c. difficile in 23 elderly care home residents weekly during a 4-month period. a c. difficile microbiological detection scheme wa ...201627716140
crystal structure and dna binding activity of a padr family transcription regulator from hypervirulent clostridium difficile r20291.clostridium difficile is a spore-forming obligate anaerobe that can remain viable for extended periods, even in the presence of antibiotics, which contributes to the persistence of this bacterium as a human pathogen during host-to-host transmission and in hospital environments. we examined the structure and function of a gene product with the locus tag cdr20291_0991 (cdpadr1) as part of our broader goal aimed at elucidating transcription regulatory mechanisms involved in virulence and antibiotic ...201627716049
characterization of the adherence of clostridium difficile spores: the integrity of the outermost layer affects adherence properties of spores of the epidemic strain r20291 to components of the intestinal mucosa.clostridium difficile is the causative agent of the most frequently reported nosocomial diarrhea worldwide. the high incidence of recurrent infection is the main clinical challenge of c. difficile infections (cdi). formation of c. difficile spores of the epidemic strain r20291 has been shown to be essential for recurrent infection and transmission of the disease in a mouse model. however, the underlying mechanisms of how these spores persist in the colonic environment remains unclear. in this wo ...201627713865
selected topics in anaerobic bacteriology.alteration in the host microbiome at skin and mucosal surfaces plays a role in the function of the immune system, and may predispose immunocompromised patients to infection. because obligate anaerobes are the predominant type of bacteria present in humans at skin and mucosal surfaces, immunocompromised patients are at increased risk for serious invasive infection due to anaerobes. laboratory approaches to the diagnosis of anaerobe infections that occur due to pyogenic, polymicrobial, or toxin-pr ...201627726792
receipt of antibiotics in hospitalized patients and risk for clostridium difficile infection in subsequent patients who occupy the same bed.to assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for cdi in subsequent patients who occupy the same bed.201627723860
more than 50% of clostridium difficile isolates from pet dogs in flagstaff, usa, carry toxigenic genotypes.nosocomial acquisition of clostridium difficile is well documented, yet recent studies have highlighted the importance of community acquired infections and identified community associated reservoirs for this pathogen. multiple studies have implicated companion pets and farm animals as possible sources of community acquired c. difficile infections in humans. to explore the potential role of pet dogs in human c. difficile infections we systematically collected canine fecal samples (n = 197) in fla ...201627723795
fecal microbiota-based therapeutics for recurrent clostridium difficile infection, ulcerative colitis and obesity.the human gut microbiome is a complex ecosystem of fundamental importance to human health. our increased understanding of gut microbial composition and functional interactions in health and disease states has spurred research efforts examining the gut microbiome as a valuable target for therapeutic intervention. this review provides updated insight into the state of the gut microbiome in recurrent clostridium difficile infection (cdi), ulcerative colitis (uc), and obesity while addressing the ra ...201627720396
clostridium difficile environmental contamination within a clinical laundry facility in the usa.clostridium difficile is both a hospital and community acquired pathogen. the current study determined if c. difficile could be cultured from clinical laundry facility surfaces. a total of 240 surface samples were collected from dirty areas (n = 120), which handle soiled clinical linens, and from clean areas (n = 120), which process and fold the clean linens, within the university of washington consolidated laundry facility in 2015. sampling was done four times over the course of one year. the d ...201627744367
the tipping point: patients predisposed to clostridium difficile infection and a hospital antimicrobial stewardship programme.the incidence and severity of clostridium difficile infection (cdi) have increased in recent years. predictive models may help to identify at-risk patients before the onset of infection. early identification of high-risk patients could help antimicrobial stewardship (ams) programmes and other initiatives to better prevent c. difficile in these patients.201627742079
a clostridium difficile cell wall glycopolymer locus influences bacterial shape, polysaccharide production and virulence.clostridium difficile is a diarrheagenic pathogen associated with significant mortality and morbidity. while its glucosylating toxins are primary virulence determinants, there is increasing appreciation of important roles for non-toxin factors in c. difficile pathogenesis. cell wall glycopolymers (cwgs) influence the virulence of various pathogens. five c. difficile cwgs, including psii, have been structurally characterized, but their biosynthesis and significance in c. difficile infection is un ...201627741317
probiotics and liver disease: where are we now and where are we going?probiotics are live, nonpathogenic bacteria capable of colonizing the colonic mucosa. the most common probiotics include strains of lactobacillus or bifidobacteria, which are part of the normal gastrointestinal microbiota. initial studies of selected probiotic species have suggested potential efficacy in several gastrointestinal diseases including inflammatory bowel diseases (particularly pouchitis), antibiotic-related diarrhea, clostridium difficile toxin-induced colitis, infectious diarrhea, i ...201627741172
probiotics history.gut microbiota promotes healthy effects on the host and prevents diseases. probiotic (probios, for life) are defined as "live microorganisms which when administered in adequate amounts confer a health benefit on the host." at the beginning of 1900s louis pasteur identified the microorganisms responsible for the process of fermentation, whereas e. metchnikoff associated the enhanced longevity of bulgarian rural people to the regular consumption of fermented dairy products such as yogurt. he sugge ...201627741152
laboratory experience with the liaison analyzer in the diagnosis of clostridium difficile-associated diarrhea.chemiluminescent or enzyme-linked fluorescent immunoassays are commonly used to diagnose clostridium difficile-associated diarrhea.201627766170
healthcare personnel attire and devices as fomites: a systematic review.background transmission of pathogens within the hospital environment remains a hazard for hospitalized patients. healthcare personnel clothing and devices carried by them may harbor pathogens and contribute to the risk of pathogen transmission. objective to examine bacterial contamination of healthcare personnel attire and commonly used devices. methods systematic review. results of 1,175 studies screened, 72 individual studies assessed contamination of a variety of items, including white coats, ...201627609491
mortality and costs in clostridium difficile infection among the elderly in the united states.objective to examine attributable mortality and costs of clostridium difficile infection (cdi) in the medicare population. design a population-based cohort study among us adults aged at least 65 years in the 2008-2010 medicare 5% sample, with follow-up of 12 months. patients incident cdi episode was defined by the international classification of diseases, ninth revision, clinical modification code of 008.45 and no other occurrences within the preceding 12 months. to quantify the adjusted mortali ...201627572289
a regional outbreak of clostridium difficile pcr-ribotype 027 infections in southeastern france from a single long-term care facility.objective to describe and analyze a large outbreak of clostridium difficile 027 (cd-027) infections. methods confirmed cd-027 cases were defined as cd infection plus real-time polymerase chain reaction assay (pcr) positive for cd-027. clinical and microbiological data on patients with cd-027 infection were collected from january 2013 to december 2015 in the provence-alpes-côte-d'azur region (southeastern france). results in total, 19 healthcare facilities reported 144 cd-027 infections (112 conf ...201627484769
gut microbiota differences in children from distinct socioeconomic levels living in the same urban area in brazil.to compare gut microbiota in impoverished children versus children of high socioeconomic status living in the same urban area in brazil.201626982745
wall teichoic acids are involved in the medium-induced loss of function of the autolysin cd11 against clostridium difficile.bacterial lysins are potent antibacterial enzymes with potential applications in the treatment of bacterial infections. some lysins lose activity in the growth media of target bacteria, and the underlying mechanism remains unclear. here we use cd11, an autolysin of clostridium difficile, as a model lysin to demonstrate that the inability of this enzyme to kill c. difficile in growth medium is not associated with inhibition of the enzyme activity by medium, or the modification of the cell wall pe ...201627759081
the monoclonal antitoxin antibodies (actoxumab-bezlotoxumab) treatment facilitates normalization of the gut microbiota of mice with clostridium difficile infection.antibiotics have significant and long-lasting impacts on the intestinal microbiota and consequently reduce colonization resistance against clostridium difficile infection (cdi). standard therapy using antibiotics is associated with a high rate of disease recurrence, highlighting the need for novel treatment strategies that target toxins, the major virulence factors, rather than the organism itself. human monoclonal antibodies mk-3415a (actoxumab-bezlotoxumab) to c. difficile toxin a and toxin b, ...201627757389
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