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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
total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: results of a national medication utilization evaluation.practice guidelines recommend the shortest duration of antimicrobial therapy appropriate to treat uncomplicated pneumonia be prescribed to reduce the emergence of resistant pathogens. a national evaluation was conducted to assess the duration of therapy for pneumonia.201627527659
multiorgan dysfunction syndrome from strongyloides stercoralis hyperinfection in a patient with human t-cell lymphotropic virus-1 coinfection after initiation of ivermectin treatment.strongyloides stercoralis is well known to cause hyperinfection syndrome during the period of immunosuppression; but dissemination, worsening hyperinfection, and development of multiorgan dysfunction syndrome after initiation of ivermectin has not been reported in the past. herein, we describe the case of a 62-year-old man with chronic strongyloidiasis and human t-cell lymphotropic virus-1 coinfection, who developed significant clinical worsening after 24-48 hours of initiation of treatment with ...201627527631
disease progression and resolution in rodent models of clostridium difficile infection and impact of antitoxin antibodies and vancomycin.clostridium difficile causes infections of the colon in susceptible patients. specifically, gut dysbiosis induced by treatment with broad-spectrum antibiotics facilitates germination of ingested c. difficile spores, expansion of vegetative cells, and production of symptom-causing toxins tcda and tcdb. the current standard of care for c. difficile infections (cdi) consists of administration of antibiotics such as vancomycin that target the bacterium but also perpetuate gut dysbiosis, often leadin ...201627527088
synthetic lipoteichoic acid glycans are potential vaccine candidates to protect from clostridium difficile infections.infections with clostridium difficile increasingly cause morbidity and mortality worldwide. bacterial surface glycans including lipoteichoic acid (lta) were identified as auspicious vaccine antigens to prevent colonization. here, we report on the potential of synthetic lta glycans as vaccine candidates. we identified lta-specific antibodies in the blood of c. difficile patients. therefore, we evaluated the immunogenicity of a semi-synthetic lta-crm197 glycoconjugate. the conjugate elicited lta-s ...201627524293
[characteristic of antibiotic-associated diarrhea in patients with acute cerebral circulation disorder].this full-design study included patients admitted to the regional vascular centre in 2013 and was aimed to obtain more detailed information on the need for medical aid, indications for antibacterial therapy and the spectrum of the drugs being prescribed 42 patients presented with antibiotic-associated diarrhea caused by clostridium difficile. the composition of antibiotics used for mono- and combined therapy was analysed, details of the clinical picture are described, the importance of timely di ...201627522728
restrictive antibiotic stewardship associated with reduced hospital mortality in gram-negative infection.antimicrobial stewardship has an important role in the control of clostridium difficile infection (cdi) and antibiotic resistance. an important component of uk stewardship interventions is the restriction of broad-spectrum beta-lactam antibiotics and promotion of agents associated with a lower risk of cdi such as gentamicin. while the introduction of restrictive antibiotic guidance has been associated with improvements in cdi and antimicrobial resistance, evidence of the effect on outcome follow ...201627521583
clostridium difficile bacteremia in a neonate. 201627521152
fecal microbiota therapy for clostridium difficile infection: a health technology assessment.fecal microbiota therapy is increasingly being used to treat patients with clostridium difficile infection. this health technology assessment primarily evaluated the effectiveness and cost-effectiveness of fecal microbiota therapy compared with the usual treatment (antibiotic therapy).201627516814
clostridium difficile infection in special high-risk populations.antibiotic use continues to be the most important risk factor for the development of clostridium difficile infection (cdi) through disruption of the indigenous microbiota of the colon. this factor, together with environmental contamination, makes hospital and other healthcare facilities the perfect breeding ground for the infection. several groups of patients are exposed to the hospital environment and, at the same time, affected by conditions that can make cdi more prevalent, more severe or mak ...201627515721
impact of a prevention bundle on clostridium difficile infection rates in a hospital in the southeastern united states.we sought to assess the impact of a multicomponent prevention program on hospital-acquired clostridium difficile infections in a hospital in the southeastern united states. we collected retrospective data of 140 patients from years 2009-2014 and applied the poisson regression model for analysis. we did not find any significant associations of increased risk of clostridium difficile infections for the preintervention group. further studies are needed to test multifaceted bundles in hospitals with ...201627515578
antimicrobial stewardship for the infection control practitioner.antibiotic misuse is a serious patient safety concern and a national public health priority. years of indiscriminant antibiotic use has promoted selection for antibiotic resistant bacteria and clostridium difficile this crisis has led to clinicians being faced with managing untreatable infections, often in the most vulnerable patient populations. this review summarizes the goals of antimicrobial stewardship programs, the essential members needed to initiate a program, various antimicrobial stewa ...201627515147
occupational health update: focus on preventing the acquisition of infections with pre-exposure prophylaxis and postexposure prophylaxis.health care personnel are commonly exposed to infectious agents via sharp injuries (eg, human immunodeficiency virus, hepatitis b virus, and hepatitis c virus), direct patient care (eg, pertussis and meningococcus), and the contaminated environment (eg, clostridium difficile). an effective occupational program is a key aspect of preventing acquisition of an infection by offering the following: (1) education of health care personnel regarding proper handling of sharps, early identification and is ...201627515145
probiotic saccharomyces boulardii cncm i-745 prevents outbreak-associated clostridium difficile-associated cecal inflammation in hamsters.c. difficile infection (cdi) is a common debilitating nosocomial infection associated with high mortality. several cdi outbreaks have been attributed to ribotypes 027, 017, and 078. clinical and experimental evidence indicates that the nonpathogenic yeast saccharomyces boulardii cncm i-745 (s.b) is effective for the prevention of cdi. however, there is no current evidence suggesting this probiotic can protect from cdi caused by outbreak-associated strains. we used established hamster models infe ...201627514478
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(1,2). the toxins are large (308 and 270 kda, respectively), homologous (47% amino acid identity) glucosyltransferases that target small gtpases within the host(3,4). the multidomain toxins enter cells by receptor-mediated endocytosis and, u ...201627512603
the protein inventory of clostridium difficile grown in complex and minimal medium.the intestinal pathogen clostridium difficile is causing an increasing number of infections often characterized by severity and high relapse rates. profound knowledge of the physiology of the pathogen could help to develop new treatment strategies. proteomics, a valuable tool to study bacterial physiology, was used in this work to establish a benchmark proteome of reference strain c. difficile 630δerm with ms-based details on all identified proteins. our elaborate annotation and visualization of ...201627511832
risk factors for clostridium difficile infection in hemato-oncological patients: a case control study in 144 patients.evidence on risk factors for clostridium difficile infection (cdi) in hemato-oncologic patients is conflicting. we studied risk factors for cdi in a large, well-characterized cohort of hemato-oncological patients. 144 hemato-oncological patients were identified in this retrospective, single center study with a microbiologically confirmed cdi-associated diarrhea. patients were compared with 144 age and sex matched hemato-oncologic patients with cdi negative diarrhea. risk factors such as prior an ...201627510591
[new aspects on clostridium difficile infection].clostridium difficile infection (cdi) is a frequent and complex disease which is influenced by the repertoire of bacterial virulence factors, by host immunity and by the intestinal microbiome. these complex interaction opens a number of options which may be used for treatment in the future. one example for new treatment options is fecal microbiota transplantation (fmt). driven by c. difficile related research activities the knowledge of protective microorganism is increasing and it may be assume ...201627509341
clostridium difficile infections in medical intensive care units of a medical center in southern taiwan: variable seasonality and disease severity.critical patients are susceptible to clostridium difficile infections (cdis), which cause significant morbidity and mortality in the hospital. in taiwan, the epidemiology of cdi in intensive care units (icus) is not well understood. this study was aimed to describe the incidence and the characteristics of cdi in the icus of a medical center in southern taiwan. adult patients with diarrhea but without colostomy/colectomy or laxative use were enrolled. stool samples were collected with or without ...201627509051
a size-exclusion chromatography method for analysis of clostridium difficile vaccine toxins.high-performance size-exclusion chromatography (hpsec or sec) is a method that can be applied to measure size distribution of proteins, including aggregates, monomers, and fragments. in the biopharmaceutical industry the quantitation of aggregates contained in biotherapeutics and protein-based vaccines is critical given the potential impact on safety, immunogenicity, and efficacy. hence, aggregation analysis of therapeutic proteins or protein-based vaccine products is almost always a requirement ...201627507349
ion-exchange chromatography to analyze components of a clostridium difficile vaccine.ion-exchange (iex) chromatography is one of many separation techniques that can be employed to analyze proteins. the separation mechanism is based on a reversible interaction between charged amino acids of a protein to the charged ligands attached to a column at a given ph. this interaction depends on both the pi and conformation of the protein being analyzed. the proteins are eluted by increasing the salt concentration or ph gradient. here we describe the use of this technique to characterize t ...201627507348
a practical method for preparation of fecal microbiota transplantation.clostridium difficile is a challenging infection that can be difficult to treat with antibiotic therapy. this chapter outlines the processing material for fecal microbiota transplantation (fmt), also known as stool transplant. fecal transplantations are effective in treating recurrent c. difficile infection (cdi). fmt uses a stool sample collected from a healthy, screened donor to restore healthy microbiota in the colon of a patient with cdi for symptom resolution. here, we describe a rapid meth ...201627507347
minibioreactor arrays (mbras) as a tool for studying c. difficile physiology in the presence of a complex community.the commensal microbiome plays an important role in the dynamics of clostridium difficile infection. in this chapter, we describe minibioreactor arrays (mbras), an in vitro cultivation system that we developed that allows for c. difficile physiology to be assayed in the presence of complex fecal microbial communities. the small size of the bioreactors within the mbras allows for dozens of reactors to be run simultaneously and therefore several different variables can be tested with limited time ...201627507346
an in vitro model of the human colon: studies of intestinal biofilms and clostridium difficile infection.the in vitro gut model is an invaluable research tool to study indigenous gut microbiota communities, the behavior of pathogenic organisms, and the therapeutic and adverse effect of antimicrobial administration on these communities. the model has been validated against the intestinal contents of sudden death victims to reflect the physicochemical and microbiological conditions of the proximal to distal colon, and has been extensively used to investigate the interplay between gut microbiota popul ...201627507345
investigating transfer of large chromosomal regions containing the pathogenicity locus between clostridium difficile strains.the genomes of all sequenced clostridium difficile isolates contain multiple mobile genetic elements. the chromosomally located pathogenicity locus (paloc), encoding the cytotoxins tcda and tcdb, was previously hypothesized to be a mobile genetic element; however, mobility was not demonstrated. here we describe the methods used to facilitate and detect the transfer of the paloc from a toxigenic strain into non-toxigenic strains of c. difficile. although the precise mechanism of transfer has not ...201627507344
methods for determining transfer of mobile genetic elements in clostridium difficile.horizontal gene transfer by mobile genetic elements plays an important role in the evolution of bacteria, allowing them to rapidly acquire new traits, including antibiotic resistance. mobile genetic elements such as conjugative and mobilizable transposons make up a considerable part of the c. difficile genome. while sequence analysis has identified a large number of these elements, experimental analysis is required to demonstrate mobility and function. this chapter describes the experimental met ...201627507343
transfer of clostridium difficile genetic elements conferring resistance to macrolide-lincosamide-streptogramin b (mlsb) antibiotics.molecular analysis is an important tool to investigate clostridium difficile resistance to macrolide-lincosamide-streptogramin b (mlsb). in particular, the protocols described in this chapter have been designed to investigate the genetic organization of erm(b)-containing elements and to evaluate the capability of these elements to transfer in c. difficile recipient strains using filter mating assay.201627507342
induction and purification of c. difficile phage tail-like particles.due to the inherent limitations of conventional antibiotics for the treatment of c. difficile infection (cdi), there is a growing interest in the development of alternative treatment strategies. both bacteriophages and r-type bacteriocins, also known as phage tail-like particles (ptlps), show promise as potential antibacterial alternatives for treating cdi. similar to bacteriophages, but lacking a viral capsid and genome, ptlps remain capable of killing target bacteria. here we describe our expe ...201627507340
characterization of functional prophages in clostridium difficile.bacteriophages (phages) are present in almost, if not all ecosystems. some of these bacterial viruses are present as latent "prophages," either integrated within the chromosome of their host, or as episomal dnas. since prophages are ubiquitous throughout the bacterial world, there has been a sustained interest in trying to understand their contribution to the biology of their host. clostridium difficile is no exception to that rule and with the recent release of hundreds of bacterial genome sequ ...201627507339
inducing and quantifying clostridium difficile spore formation.the gram-positive nosocomial pathogen clostridium difficile induces sporulation during growth in the gastrointestinal tract. sporulation is necessary for this obligate anaerobe to form metabolically dormant spores that can resist antibiotic treatment, survive exit from the mammalian host, and transmit c. difficile infections. in this chapter, we describe a method for inducing c. difficile sporulation in vitro. this method can be used to study sporulation and maximize spore purification yields fo ...201627507338
isolating and purifying clostridium difficile spores.the ability for the obligate anaerobe, clostridium difficile to form a metabolically dormant spore is critical for the survival of this organism outside of the host. this spore form is resistant to a myriad of environmental stresses, including heat, desiccation, and exposure to disinfectants and antimicrobials. these intrinsic properties of spores allow c. difficile to survive long-term in an oxygenated environment, to be easily transmitted from host-to-host, and to persist within the host follo ...201627507337
intestinal epithelial cell response to clostridium difficile flagella.clostridium difficile is the bacterium responsible for most antibiotic-associated diarrhea in north america and europe. this bacterium, which colonizes the gut of humans and animals, produces toxins that are known to contribute directly to damage of the gut. it is known that bacterial flagella are involved in intestinal lesions through the inflammatory host response. the c. difficile flagellin recognizes tlr5 and consequently activates the nf-κb and the mapk signaling pathways which elicit the s ...201627507336
clostridium difficile adhesins.clostridium difficile is responsible for a large spectrum of intestinal diseases ranging from mild diarrhea to fatal colitis depending on the one hand on the strain virulence and on the other on the host. the pathogenesis of c. difficile infection could be seen as a three-step process that takes place after disruption of the digestive microbiota by antibiotics: (1) contamination by and germination of spores; (2) multiplication of vegetative cells in the colonic niche using colonization factors; ...201627507335
a fluorescent reporter for single cell analysis of gene expression in clostridium difficile.genetically identical cells growing under homogeneous growth conditions often display cell-cell variation in gene expression. this variation stems from noise in gene expression and can be adaptive allowing for division of labor and bet-hedging strategies. in particular, for bacterial pathogens, the expression of phenotypes related to virulence can show cell-cell variation. therefore, understanding virulence-related gene expression requires knowledge of gene expression patterns at the single cell ...201627507334
use of mcherryopt fluorescent protein in clostridium difficile.here we describe protocols for using the red fluorescent protein mcherryopt in clostridium difficile. the protocols can be readily adapted to similar fluorescent proteins (fps), such as green fluorescent protein (gfp) and cyan fluorescent protein (cfp). there are three critical considerations for using fps in c. difficile. (1) choosing the right color: blue and (especially) red are preferred because c. difficile exhibits considerable yellow-green autofluorescence. (2) codon optimization: most fp ...201627507333
clostridium difficile genome editing using pyre alleles.precise manipulation (in-frame deletions and substitutions) of the clostridium difficile genome is possible through a two-stage process of single-crossover integration and subsequent isolation of double-crossover excision events using replication-defective plasmids that carry a counterselection marker. use of a coda (cytosine deaminase) or pyre (orotate phosphoribosyltransferase) as counter selection markers appears equally effective, but there is considerable merit in using a pyre mutant as the ...201627507332
direct pcr-ribotyping of clostridium difficile.pcr-ribotyping, a method based on heterogeneity of ribosomal intergenic spacer region, is the preferred method for genotyping of clostridium difficile. standardly used procedure for pcr-ribotyping is culturing of c. difficile from fecal samples and subsequent typing. in this chapter, we describe a modified pcr-ribotyping method for direct detection of pcr-ribotypes directly in total stool dna extract, without prior need to isolate c. difficile.201627507330
restriction endonuclease analysis typing of clostridium difficile isolates.restriction endonuclease analysis (rea) typing using hindiii enzyme is a highly discriminatory, reproducible, and consistent method of genetic typing of clostridium difficile (cd) isolates. rea typing analyzes cd whole cellular dna on two levels of discrimination: rea group designation and rea type designation, which distinguishes specific subtypes within the rea group. this methodology has enabled the tracking of epidemiologically significant cd strains over time and in some cases has allowed d ...201627507329
colonization of toxigenic clostridium difficile among icu patients: a prospective study.a prospective study was performed to investigate the prevalence of colonization among icu patients and to examine whether asymptomatic carriers were the source of subsequent c. difficile infection (cdi) and acquisition of toxigenic c. difficile.201627506470
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
a multi-center study of fidaxomicin use for clostridium difficile infection.fidaxomicin use in real-world clinical practice, especially for severe clostridium difficile infection (cdi), is mainly based on single-center observational studies. the purpose of this pharmacoepidemiology study was to assess outcomes of patients given fidaxomicin based on episode number and use of concomitant antibiotics.201627536508
an update on antibody-based immunotherapies for clostridium difficile infection.clostridium difficile continues to be one of the most prevalent hospital-acquired bacterial infections in the developed world, despite the recent introduction of a novel and effective antibiotic agent (fidaxomicin). alternative approaches under investigation to combat the anaerobic gram-positive bacteria include fecal transplantation therapy, vaccines, and antibody-based immunotherapies. in this review, we catalog the recent advances in antibody-based approaches under development and in the clin ...201627536153
bolaamphiphile-based nanocomplex delivery of phosphorothioate gapmer antisense oligonucleotides as a treatment for clostridium difficile.despite being a conceptually appealing alternative to conventional antibiotics, a major challenge toward the successful implementation of antisense treatments for bacterial infections is the development of efficient oligonucleotide delivery systems. cationic vesicles (bolasomes) composed of dequalinium chloride ("dqasomes") have been used to deliver plasmid dna across the cardiolipin-rich inner membrane of mitochondria. as cardiolipin is also a component of many bacterial membranes, we investiga ...201627536102
distribution of pcr ribotypes among recent clostridium difficile isolates collected in two districts of hungary using capillary gel electrophoresis and review of changes in the circulating ribotypes over time.following the first description of a clostridium difficile case caused by ribotype 027 in hungary in 2007, the rapid spread of c. difficile infection in different hospitals within the country was observed. the aim of this pilot study was to investigate the distribution of different pcr ribotypes among inpatient and outpatient isolates obtained in two geographically different parts of hungary. one hundred and ninety-two toxigenic c. difficile isolates collected between 1 october and 1 december 20 ...201627534855
physical pre-treatment improves efficient dna extraction and qpcr sensitivity from clostridium difficile spores in faecal swine specimens.a considerable fraction of the faecal microbiota is spore-forming. molecular quantification of bacteria may be underestimated if preceded with nucleic acid extraction without special treatment to extract recalcitrant bacterial spores. the objective of this study was to improve the dna extraction regarding the presence of clostridium difficile spores in faecal swine specimens. sow faeces were inoculated with spores of c. difficile (10(6) cfu), frozen at - 30 °c overnight and subjected to dna extr ...201627534405
infection-related hospitalizations in the first year after inflammatory bowel disease diagnosis.with the rapid increase in the incidence of inflammatory bowel disease (ibd) in asia, the natural course of the early phase of disease in these patients remains poorly defined. this study aimed to determined the incidence and characteristics of infection-related hospitalization in the first year in patients newly diagnosed with ibd in hong kong sar, china.201627533786
community-acquired clostridium difficile infection, queensland, australia. 201627533328
an outbreak of clostridium difficile ribotype 027 associated with length of stay in the intensive care unit and use of selective decontamination of the digestive tract: a case control study.an outbreak of clostridium difficile ribotype 027 infection (cdi) occurred at an university hospital, involving 19 departments. to determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study.201627533048
reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices.improving hand hygiene from high to very high compliance has not been documented to decrease healthcare-associated infections. we conducted longitudinal analyses during 2013-2015 in an 853-bed hospital and observed a significantly increased hand hygiene compliance rate (p<0.001) and a significantly decreased healthcare-associated infection rate (p = 0.0066).201627532259
comparison of diagnostic algorithms for detecting toxigenic clostridium difficile in routine practice at a tertiary referral hospital in korea.since every single test has some limitations for detecting toxigenic clostridium difficile, multistep algorithms are recommended. this study aimed to compare the current, representative diagnostic algorithms for detecting toxigenic c. difficile, using vidas c. difficile toxin a&b (toxin elfa), vidas c. difficile gdh (gdh elfa, biomérieux, marcy-l'etoile, france), and xpert c. difficile (cepheid, sunnyvale, california, usa). in 271 consecutive stool samples, toxigenic culture, toxin elfa, gdh elf ...201627532104
accessory gene regulator-1 locus is essential for virulence and pathogenesis of clostridium difficile.clostridium difficile infection (cdi) is responsible for most of the definable cases of antibiotic- and hospital-associated diarrhea worldwide and is a frequent cause of morbidity and mortality in older patients. c. difficile, a multidrug-resistant anaerobic pathogen, causes disease by producing toxins a and b, which are controlled by an accessory gene regulator (agr) quorum signaling system. some c. difficile strains encode two agr loci in their genomes, designated agr1 and agr2 the agr1 locus ...201627531912
antibiotics as deep modulators of gut microbiota: between good and evil.the recent increase in our knowledge of human gut microbiota has changed our view on antibiotics. antibiotics are, indeed, no longer considered only beneficial, but also potentially harmful drugs, as their abuse appears to play a role in the pathogenesis of several disorders associated with microbiota impairment (eg, clostridium difficile infection or metabolic disorders). both drug-related factors (such as antibiotic class, timing of exposure or route of administration) and host-related factors ...201627531828
antimicrobial stewardship in paediatrics.antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. unfortunately, a great number of these prescriptions are unnecessary or inappropriate. antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. in this paper, the principle of and stra ...201627538503
[new aspects on clostridium difficile infection]. 201627538120
identification of an essential region for translocation of clostridium difficile toxin b.clostridium difficile toxin a (tcda) and toxin b (tcdb) are the major virulence factors involved in c. difficile-associated diarrhea and pseudomembranous colitis. tcda and tcdb both contain at least four distinct domains: the glucosyltransferase domain, cysteine protease domain, receptor binding domain, and translocation domain. few studies have investigated the translocation domain and its mechanism of action. recently, it was demonstrated that a segment of 97 amino acids (aa 1756-1852, designa ...201627537911
surveillance of antibiotic resistance among hospital- and community-acquired toxigenic clostridium difficile isolates over 5-year period in kuwait.clostridium difficile infection (cdi) is a leading and an important cause of diarrhea in a healthcare setting especially in industrialized countries. community-associated cdi appears to add to the burden on healthcare setting problems. the aim of the study was to investigate the antimicrobial resistance of healthcare-associated and community-acquired c. difficile infection over 5 years (2008-2012) in kuwait. a total of 111 hospital-acquired (ha-cd) and 35 community-acquired clostridium difficile ...201627536994
tracking inhibitory alterations during interstrain clostridium difficile interactions by monitoring cell envelope capacitance.global threats arising from the increasing use of antibiotics coupled with the high recurrence rates of clostridium difficile (c. difficile) infections (cdi) after standard antibiotic treatments highlight the role of commensal probiotic microorganisms, including nontoxigenic c. difficile (ntcd) strains in preventing cdi due to highly toxigenic c. difficile (htcd) strains. however, optimization of the inhibitory permutations due to commensal interactions in the microbiota requires probes capable ...201627547818
nursing home residence is associated with spread of clostridium difficile ribotype 027 in central italy. 201627546454
acyldepsipeptide antibiotics as a potential therapeutic agent against clostridium difficile recurrent infections.alternative antimicrobial therapies based on acyldepsipeptides may hold promising results, based on the fact that they have shown to efficiently eradicate persister cells, stationary cells and cell in biofilm structures of several pathogenic bacteria from the infected host. clostridium difficile infection is considered the result of extensive hospital use of expanded-spectrum antibiotics, which cause dysbiosis of the intestinal microbiota, enhancing susceptibility to infection and persistence. c ...201627546386
impact of a pharmacist-driven protocol to decrease proton pump inhibitor use in non-intensive care hospitalized adults.results of a pharmacist-driven protocol to decrease proton pump inhibitor (ppi) use in non-intensive care unit (icu) hospitalized adults are presented.201627543598
false negative results in clostridium difficile testing.accurate diagnosis of clostridium difficile infection (cdi) is paramount for patient management. the wrong diagnosis places patients at risk, delays treatment, and/ or contributes to transmission of infection in the healthcare setting. although amplification of the toxin b gene by polymerase chain reaction (pcr) is a sensitive method for detecting toxigenic c. difficile, false negative results still occur and could impact the diagnosis and treatment of this infection.201627543102
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
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
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
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
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
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