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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
frizzled proteins are colonic epithelial receptors for c. difficile toxin b.clostridium difficile toxin b (tcdb) is a critical virulence factor that causes diseases associated with c. difficile infection. here we carried out crispr-cas9-mediated genome-wide screens and identified the members of the wnt receptor frizzled family (fzds) as tcdb receptors. tcdb binds to the conserved wnt-binding site known as the cysteine-rich domain (crd), with the highest affinity towards fzd1, 2 and 7. tcdb competes with wnt for binding to fzds, and its binding blocks wnt signalling. fzd ...201627680706
shoe soles as a potential vector for pathogen transmission: a systematic review.shoe soles are possible vectors for infectious diseases. although studies have been performed to assess the prevalence of infectious pathogens on shoe soles and decontamination techniques, no systematic review has ever occurred. the aim of this study was to perform a systematic review of the literature to determine the prevalence of infectious agents on shoe bottoms and possible decontamination strategies. three electronic bibliographic databases were searched using a predefined search strategy ...201627495010
nosocomial clostridium difficile-associated diarrhoea in assiut university children's hospital, egypt.there are no large epidemiological studies of clostridium difficile-associated disease (cdad) in hospitalised children.201625496416
burden of six healthcare-associated infections on european population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study.estimating the burden of healthcare-associated infections (hais) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. based on the methodology of the burden of communicable diseases in europe (bcode) project and 2011-2012 data from the european centre for disease prevention and control (ecdc) point prevalence survey (pps) of hais and antimicrobial use in european acute care hospit ...201627755545
the use and efficacy of fecal microbiota transplantation for refractory clostridium difficile in patients with inflammatory bowel disease.clostridium difficile (cd) is an anaerobic, spore-forming bacillus that is responsible for a spectrum of gastrointestinal illness ranging from asymptomatic carriage to toxic megacolon and death. the prevalence of cd infection is increasing in both hospitalized and community-based inflammatory bowel disease populations. standard antibiotic therapy fails to cure or prevent recurrence in more than 50% of patients, thus increasing the need for alternative therapies. recently, fecal microbiota transp ...201627755271
increased rates of clostridium difficile infection and poor outcomes in patients with ibd with cytomegalovirus.clostridium difficile infection (cdi) and cytomegalovirus (cmv) reactivation are associated with disease exacerbations and poor outcomes in inflammatory bowel disease (ibd). therefore, we assessed the association between these organisms in patients with ibd and the impact on colectomy.201627755270
emergence and spread of moxifloxacin-resistant clostridium difficile ribotype 231 in sweden between 2006 and 2015.an aggregation of moxifloxacin-resistant clostridium difficile ribotype 231 (rt231) isolates was first identified in the county of stockholm in 2008, and by the end of 2015 isolates of rt231 had spread to 13 of 21 swedish counties. we investigated the epidemiology of c. difficile rt231 in sweden between 2006 and 2015 using whole genome sequencing (wgs) and evaluated whether its emergence could be associated with extended moxifloxacin use. we performed wgs and phylogenetic analysis of 51 c. diffi ...201627752322
thermal contrast amplification reader yielding 8-fold analytical improvement for disease detection with lateral flow assays.there is an increasing need for highly sensitive and quantitative diagnostics at the point-of-care. the lateral flow immunoassay (lfa) is one of the most widely used point-of-care diagnostic tests; however, lfas generally suffer from low sensitivity and lack of quantification. to overcome these limitations, thermal contrast amplification (tca) is a new method that is based on the laser excitation of gold nanoparticles (gnps), the most commonly used visual signature, to evoke a thermal signature. ...201627750420
successful colonoscopic fecal microbiota transplantation for active ulcerative colitis: first report from india.forty-four-year-old male with ulcerative colitis (uc) for 11 years reported frequent relapse despite daily sulfasalazine 4 g, azathioprine 125 mg, and rectal 5-aminosalicylic acid. repeated use of corticosteroids led to cataract. at enrollment, he was passing eight stools a day with blood with a mayo score of 9 (3+1+3+2). stool was negative for ova/cysts/acid fast bacilli and clostridium difficile toxin assay. rectal biopsy showed cryptitis, crypt abscess, and crypt distortion with no inclusion ...201627718119
[recurrences in clostridium difficile infections in cancer patients]. 201627293195
the cost-efficiency and care effectiveness of probiotic administration with antibiotics to prevent hospital-acquired clostridium difficile infection.health care facility-acquired clostridium difficile infections (hcfa-cdi) have increased over the last several decades despite facilities developing protocols for prescribing probiotics with antibiotics to prevent hcfa-cdi. the literature does not consistently support this. a retrospective medical record review evaluated the care effectiveness of this practice. care effectiveness was not found; patients receiving probiotics with antibiotics were twice as likely to develop hcfa-cdi (p = .004). ex ...201627749722
a dna vaccine targeting tcda and tcdb induces protective immunity against clostridium difficile.clostridium difficile-associated disease (cdad) constitutes a great majority of hospital diarrhea cases in industrialized countries and is induced by two types of large toxin molecules: toxin a (tcda) and toxin b (tcdb). development of immunotherapeutic approaches, either active or passive, has seen a resurgence in recent years. studies have described vaccine plasmids that express either tcda and/or tcdb receptor binding domain (rbd). however, the effectiveness of one vector encoding both toxin ...201627770789
the projected effectiveness of clostridium difficile vaccination as part of an integrated infection control strategy.early clinical trials of a clostridium difficile toxoid vaccine show efficacy in preventing c. difficile infection (cdi). the optimal patient group to target for vaccination programmes remains unexplored. this study performed a model-based evaluation of the effectiveness of different cdi vaccination strategies, within the context of existing infection prevention and control strategies such as antimicrobial stewardship.201627727031
endoscopic peroral jejunal fecal microbiota transplantation.fecal microbiota transplantation (fmt) is a valuable treatment modality for recurrent clostridium difficile (c. difficile) colitis. multiple questions including the best delivery route and volume remain unanswered. here, we report a case series of high-volume fmt using endoscopic jejunal application route.201627575658
positive predictive value of the immunoassay for clostridium difficile toxin a and b detection at a private hospital.clostridium difficile (c. difficile) is a gram-positive bacillus that is a common cause of diarrhea in the hospital environment, with a documented incidence of up to 10%. there are different methods to detect it, but a widely used test in our environment is the immunoassay for toxins a and b.201627316592
[laboratory diagnosis of clostridium difficile infection].clostridium difficile is the leading cause of nosocomial diarrhoea in developed countries, and is one of the main aetiologic agents of community diarrhea. the eruption of the hypervirulent strain bi/nap1/027 has given rise to an increase in the morbidity and mortality of c.difficile infection (cdi). this document aims to review the main clinical pictures of cdi and the laboratory diagnosis, including sampling, transport and storage of specimens, specimen processing, diagnostic procedures, antimi ...201626493356
rapid identification of the etiological factors causing diarrheal diseases.the main objective of this investigation was to develop and pilot a real-time polymerase chain reaction (rt-pcr) diagnostic system for rapid and simultaneous identification of pathogens with a particular emphasis on diarrheal disease diagnostics. the diarrheal diseases were selected as a target for the pilot because they constitute a primary public health priority in georgia and worldwide. the product developed by our research team "neo_pcr_diagnostics" represents an original system for the iden ...201627770538
epidemiology and recurrence rates of clostridium difficile infections in germany: a secondary data analysis.clostridium difficile infection (cdi) is the most common cause of health-care-associated infectious diarrhea. recurrence rates are as high as 20-30% after standard treatment with metronidazole or vancomycin, and appear to be reduced for patients treated with fidaxomicin. according to the literature, the risk of cdi recurrence increases after the second relapse to 30-65%. accurate data for germany are not yet available.201627770261
therapeutic manipulation of the microbiota: past, present, and considerations for the future.the growing appreciation of the potential role of indigenous microbiota in disease has resulted in a concomitant interest in manipulating the microbiome for therapeutic effect. the most successful example of microbiota manipulation for treatment of a disease is in recurrent infection with the bacterial pathogen clostridium difficile.201627619640
correction: importance of glutamate dehydrogenase (gdh) in clostridium difficile colonization in vivo.[this corrects the article doi: 10.1371/journal.pone.0160107.].201627768767
household transmission of clostridium difficile to family members and domestic pets.objective to determine the risk of clostridium difficile transmission from index cases with c. difficile infection (cdi) to their household contacts and domestic pets. design a prospective study from april 2011 to june 2013. setting patients with cdi from canadian tertiary care centers. participants patients with cdi, their household human contacts, and pets. methods epidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. ...201627767004
new and emerging therapies for clostridium difficile infection.clostridium difficile infection has attained high prominence given its prevalence and impacts on patients and healthcare institutions. multiple new approaches to the prevention and treatment of c. difficile infection (cdi) are undergoing clinical trials.201627753689
crystal structures of two nitroreductases from hypervirulent clostridium difficile and functionally related interactions with the antibiotic metronidazole.nitroreductases (nrs) are flavin mononucleotide (fmn)-dependent enzymes that catalyze the biotransformation of organic nitro compounds (rno2; r = alkyl, aryl) to the nitroso rn=o, hydroxylamino rnhoh, or amine rnh2 derivatives. metronidazole (mtz) is a nitro-containing antibiotic that is commonly prescribed for lower-gut infections caused by the anaerobic bacterium clostridium difficile. c. difficile infections rank number one among hospital acquired infections, and can result in diarrhea, sever ...201627623089
identification of risk factors associated with clostridium difficile infection in liver transplantation recipients: a single-center analysis.clostridium difficile remains the leading cause of health care-associated infectious diarrhea, and its incidence and severity are increasing in liver transplant recipients. several known risk factors for c difficile infection (cdi) are inherently associated with liver transplantation, such as severe underlying illness, immunosuppression, abdominal surgery, and broad-spectrum antibiotic use. we conducted a single-center retrospective case control study to characterize risk factors for cdi among p ...201627788814
colon-targeted delivery of igy against clostridium difficile toxin a and b by encapsulation in chitosan-ca pectinate microbeads.this study investigated the use of a newly developed chitosan-ca pectinate microbead formulation for the colon-targeted delivery of anti-a/b toxin immunoglobulin of egg yolk (igy) to inhibit toxin binding to colon mucosa cells. the effect of the three components (pectinate, calcium chloride, and chitosan) used for the microbead production was examined with the aim of identifying the optimal levels to improve drug encapsulation efficiency, swelling ratio, and cumulative igy release rate. the opti ...201627826799
infection: modulation of clostridium difficile infection by dietary zinc. 201627826138
molecular characteristics of clostridium difficile isolates from human and animals in the north eastern region of india.a total of 1034 samples were collected from different sources and c. difficile was isolated from 18 (9.04%) of 199 human, 9 (4.89%) of 184 cattle, 29 (12.44%) of 233 pig, and from 23 (13.94%) of 165 poultry samples. variations were observed on the rate of isolation according to age and clinical conditions (diarrhoea). none of the samples from cow, sheep, goat, local chicken, and wild animals yielded any c. difficile. out of those isolates, 8, 2, 19 and 6 isolates from human, cattle, pig and poul ...201627569848
efficacy of oral vancomycin in preventing recurrent clostridium difficile infection in patients treated with systemic antimicrobial agents. 201627567123
molecular characterisation of czech clostridium difficile isolates collected in 2013-2015.clostridium difficile is a leading nosocomial pathogen and molecular typing is a crucial part of monitoring its occurrence and spread. over a three-year period (2013-2015), clinical c. difficile isolates from 32 czech hospitals were collected for molecular characterisation. of 2201 c. difficile isolates, 177 (8%) were non-toxigenic, 2024 (92%) were toxigenic (tcda and tcdb) and of these, 677 (33.5%) carried genes for binary toxin production (cdta, cdtb). capillary-electrophoresis (ce) ribotyping ...201627519407
[clostridium difficile infections in geriatric patients].clostridium difficile is the main cause of nosocomial antibiotic-associated diarrhea in adults in europe and north america. infections with c. difficile typically occur in elderly patients with comorbidities and prior antibiotic therapy. other risk factors are proton pump inhibitors, which are taken by many elderly patients. the main virulence factors are toxins a and b. the clinical spectrum ranges from asymptomatic colonization to severe disease with abdominal complications and sepsis. the cur ...201627785569
antibiotic treatment of hospitalized patients with pneumonia complicated by clostridium difficile infection.clostridium difficile infection (cdi) is one of the most common gastrointestinal complication after antimicrobial treatment. it is estimated that cdi after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. the aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia cdi. we addressed the issue by examining retrospectively the records of 217 patients who met the diagno ...201627620311
clostridium difficile presence in spanish and belgian hospitals.clostridium difficile is recognised worldwide as the main cause of infectious bacterial antibiotic-associated diarrhoea in hospitals and other healthcare settings. the aim of this study was to first survey c. difficile prevalence during the summer of 2014 at the central university hospital of asturias (spain). by typing the isolates obtained, it was then possible to compare the ribotype distribution at the spanish hospital with results from the st luc university hospital in belgium over the same ...201627616443
newly identified bacteriolytic enzymes that target a wide range of clinical isolates of clostridium difficile.clostridium difficile has emerged as a major cause of infectious diarrhea in hospitalized patients, with increasing mortality rate and annual healthcare costs exceeding $3 billion. since c. difficile infections are associated with the use of antibiotics, there is an urgent need to develop treatments that can inactivate the bacterium selectively without affecting commensal microflora. lytic enzymes from bacteria and bacteriophages show promise as highly selective and effective antimicrobial agent ...201627260850
[clostridium difficile infection : what is currently available for treatment?]clostridium difficile (c. difficile) is an anaerobic, gram-positive, spore-forming, toxin-secreting bacillus. it is transmitted via a fecal-oral route and can be found in 1-3 % of the healthy population. symptoms caused by c. difficile range from uncomplicated diarrhea to a toxic megacolon. the incidence, frequency of recurrence, and mortality rate of c. difficile infections (cdis) have increased significantly over the past few decades. the most important risk factor is antibiotic treatment in e ...201627796474
dietary zinc alters the microbiota and decreases resistance to clostridium difficile infection.clostridium difficile is the most commonly reported nosocomial pathogen in the united states and is an urgent public health concern worldwide. over the past decade, incidence, severity and costs associated with c. difficile infection (cdi) have increased dramatically. cdi is most commonly initiated by antibiotic-mediated disruption of the gut microbiota; however, non-antibiotic-associated cdi cases are well documented and on the rise. this suggests that unexplored environmental, nutrient and hos ...201627668938
effect of fecal microbiota transplantation on recurrence in multiply recurrent clostridium difficile infection: a randomized trial.to date, evidence for the efficacy of fecal microbiota transplantation (fmt) in recurrent clostridium difficile infection (cdi) has been limited to case series and open-label clinical trials.201627547925
toxin profiles, pcr ribotypes and resistance patterns of clostridium difficile: a multicentre study in china, 2012-2013.a total of 178 clinical isolates of clostridium difficile were collected from five major teaching hospitals representing northern, eastern and southern china from august 2012 to july 2013. among the 178 isolates, 162 (91.0%) were toxigenic, including 66 (40.7%) toxin a-negative, toxin b-positive, 95 (58.6%) toxin a-positive, toxin b-positive and only 1 (0.6%) toxin a-, toxin b- and binary toxin-positive. twenty-nine different pcr ribotypes were identified, of which 017 (21.0%), 012 (17.3%) and n ...201627793509
snp-ing out the differences: investigating differences between clostridium difficile lab strains. 201627791481
drug utilization review of cephalosporins in a secondary care hospital in united arab emirates.background cephalosporins are one of the most commonly used antibiotics in united arab emirates (uae). few studies have been carried out to evaluate the antibiotic utilization pattern in uae in spite of the obvious increase in cephalosporins resistance during the past decade. objective to assess the prescriptions pattern of cephalosporins among physicians at a secondary care hospital in ras al khaimah, uae. method this observational prospective study was carried out during october 2013 to april ...201627817172
proton pump inhibitors do not increase risk for clostridium difficile infection in the intensive care unit.patients in the intensive care unit (icu) frequently receive proton pump inhibitors (ppis) and have high rates of clostridium difficile infection (cdi). ppis have been associated with cdi in hospitalized patients, but icu patients differ fundamentally from non-icu patients and few studies have focused on ppi use exclusively in the critical care setting. we performed a retrospective cohort study to determine the associations between ppis and health-care facility-onset cdi in the icu.201627575714
identification of factors impacting recurrent clostridium difficile infection and development of a risk evaluation tool.recurrent clostridium difficile infection (rcdi) is a growing concern, yet limited data exists to clarify which patients are at highest risk.  identification of these patients may better inform decisions of those who may benefit from prophylactic intervention. the purpose of this study was to determine which factors are associated with the recurrence of clostridium difficile infection (cdi) and to develop a risk stratification tool.  methods. patients readmitted within 10 weeks of positive c. di ...201627806252
costs and consequences associated with misdiagnosed lower extremity cellulitis.inflammatory dermatoses of the lower extremity are often misdiagnosed as cellulitis (aka "pseudocellulitis") and treated with antibiotics and/or hospitalization. there is limited data on the cost and complications from misdiagnosed cellulitis.201627806170
clostridium difficile infection: associations with chemotherapy, radiation therapy, and targeting therapy treatments.although mucositis, diarrhea, and constipation as well as immunosuppression are well recognized side-effects of cancer treatment, the underlying mechanisms including changes in the composition of gut microbiota and clostridium difficile infection have not yet been thoroughly reviewed.201627804875
hydralazine-induced anca vasculitis in the setting of acute clostridium difficile infection.we report a rare case of hydralazine-induced anca associated glomerulonephritis with alveolar hemorrhage in the setting of acute clostridium difficile infection. a 71-year-old caucasian woman with hypertension, who was being treated with hydralazine 25 mg twice a day for six years, presented to the hospital with diarrhea, nausea, vomiting and anemia. she had acute kidney injury and urinalysis showed proteinuria, dysmorphic rbcs, and rare rbc cast. she was found to have clostridium difficile coli ...201627801920
molecular epidemiology and antimicrobial susceptibility of clostridium difficile isolates from a university teaching hospital in china.while the developed world has seen a significant increase in the number of scientific articles on clostridium difficile infection (cdi), the developing world still lags behind on this subject due to limited laboratory capacity, low awareness, and limited surveillance of this problem. as such, cdi is considered a neglected but potentially huge problem in developing countries. the major aim of this study was to systemically evaluate the utility of several molecular typing tools for cdi, including ...201627799923
eosinophils, probiotics, and the microbiome.there is currently substantial interest in the therapeutic properties of probiotic microorganisms as recent research suggests that oral administration of specific bacterial strains may reduce inflammation and alter the nature of endogenous microflora in the gastrointestinal tract. eosinophils are multifunctional tissue leukocytes, prominent among the resident cells of the gastrointestinal mucosa that promote local immunity. recent studies with genetically altered mice indicate that eosinophils n ...201627549754
epidemiology and outcome of clostridium difficile infections in patients hospitalized in internal medicine: findings from the nationwide fadoi-practice study.clostridium difficile (cd) is a leading cause of diarrhoea among hospitalized patients. the objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of cd infections (cdi) in internal medicine (im) wards in italy.201627825317
clostridium difficile associated diarrhoea: an increased problem.clostridium difficile associated diarrhoea is a major health problem that seems to be on the increase. in our study, we analyse the changes in the incidence of this infection over the last 11 years.201627823794
chemical and stress resistances of clostridium difficile spores and vegetative cells.clostridium difficile is a gram-positive, sporogenic and anaerobic bacterium that causes a potentially fatal colitis. c. difficile enters the body as dormant spores that germinate in the colon to form vegetative cells that secrete toxins and cause the symptoms of infection. during transit through the intestine, some vegetative cells transform into spores, which are more resistant to killing by environmental insults than the vegetative cells. understanding the inherent resistance properties of th ...201627833595
vesicoileal fistula and clostridium difficile colitis in a child with acute lymphoblastic leukemia. 201627842209
pharmacologic stress gastropathy prophylaxis may not be necessary in at-risk surgical trauma icu patients tolerating enteral nutrition.stress gastropathy is a rare complication of the intensive care unit stay with high morbidity and mortality. there are data that support the concept that patients tolerating enteral nutrition have sufficient gut blood flow to obviate the need for prophylaxis; however, no robust studies exist. this study assesses the incidence of clinically significant gastrointestinal bleeding in surgical trauma intensive care unit (sticu) patients at risk of stress gastropathy secondary to mechanical ventilatio ...201627837045
genome sequence of clostridium paraputrificum 373-a1 isolated in chile from a patient infected with clostridium difficile.clostridium paraputrificum is a gut microbiota member reported in several cases of bacteremia and coinfections. so far, only one genome sequence of a c. paraputrificum (agr2156) isolate is available. here, we present the draft genome of c. paraputrificum strain 373-a1, isolated from stools from a patient with c. difficile infection.201627811092
distribution of clostridium difficile pcr ribotypes and high proportion of 027 and 176 in some hospitals in four south eastern european countries.while clostridium difficile epidemiology is well documented in many european countries, data are largely missing for south eastern european region. here we report the pcr ribotype distribution of 249 c. difficile isolates received for typing from six hospital settings from croatia, bosnia and herzegovina, republic of macedonia and serbia in time period from 2008 to 2015. twenty-four pcr ribotypes were detected. the majority of strains from bosnia and herzegovina and serbia belonged to pcr riboty ...201627751937
characterization of clostridium difficile pcr-ribotype 018: a problematic emerging type.recent surveys indicate that the majority of toxigenic clostridium difficile strains isolated in european hospitals belonged to pcr-ribotypes (rts) different from rt 027 or rt 078. among these types, rt 018 has been reported in italy and, more recently, in korea and japan. in italy, strains rt 018 have become predominant in the early 2000s, whereas the majority of strains isolated before were rt 126, a type belonging to the same lineage as the rt 078. in this study, we have found that italian st ...201627725230
gut eradication of vim-1 producing st9 klebsiella oxytoca after fecal microbiota transplantation for diarrhea caused by a clostridium difficile hypervirulent r027 strain.we report the fecal carriage eradication of a vim-1-producing st9 klebsiella oxytoca strain in a pluripathological 84-year-old woman after fecal microbiota transplantation to control relapsing r027 hypervirulent clostridium difficile infections. the donor was her son, in which the absence of fecal carbapenemase-producing bacteria was corroborated.201627712927
clostridium difficile: a rare cause of pyogenic liver abscess.extra-intestinal infections due to clostridium difficile have been reported rarely. herein we report a case of pyogenic liver abscess from toxigenic c. difficile in an 80-year-old non-hospitalized woman with diabetes mellitus, cerebrovascular and cardiovascular diseases. the patient was admitted to the emergency department with fever and abdominal pain. there was no history of diarrhea or use of antibiotics. laboratory parameters revealed signs of inflammation and elevated ast and alt levels. ab ...201627693543
molecular types and antimicrobial susceptibility patterns of clostridium difficile isolates in different epidemiological settings in a tertiary care center in israel.the aims of this prospective study were to examine the correlation between the molecular types and the antimicrobial susceptibility patterns of clostridium difficile isolates with the source of acquisition and the occurrence of c. difficile infections (cdi) in a tertiary center in israel. all available isolates from community-acquired (ca) cdi episodes (n=43) and matching numbers of isolates from community-onset, hospital acquired (co-ha, n=67) and ha-cdi (n=56) and 32 cases of recurrent cdi wer ...201627638350
a genetic assay for gene essentiality in clostridium.essential genes of pathogens are potential therapeutic targets, but are difficult to verify. here, gene essentiality was determined by targeted knockout following engineered gene duplication. null mutants of candidate essential genes of clostridium difficile were viable only in the presence of a stable second copy of the gene.201627487328
predictors of clostridium difficile infection-related mortality among older adults.over 90% of annual deaths caused by clostridium difficile infection (cdi) occur in persons aged ≥65 years. however, no large-scale studies have been conducted to investigate predictors of cdi-related mortality among older adults.201627424303
teaching health care workers to adopt a systems perspective for improved control and prevention of health care-associated infections. 201627424302
a case of multiple recurrence of clostridium difficile infection with severe hematochezia in an immunocompromised host.clostridium difficile infection (cdi) is increasing in incidence and severity. clinically, diarrhea frequently occurs, but severe hematochezia is rarely seen with cdi. we describe here a hematopoietic stem cell transplantation (hsct) recipient who experienced life-threatening gastrointestinal bleeding due to severe cdi. subsequent stool surveillance and molecular typing observed the patient who had two episodes of recurrence with a new strain of c. difficile distinct from the initial infection. ...201627377777
clostridium difficile infection epidemiology and management: comparison of results of a prospective study with a retrospective one in a reference teaching and research hospital in northern italy.clostridium difficile-associated disease (cdad) is the most common infectious antibiotic-associated diarrhea and is a growing health care problem. prevention of clostridium difficile infection focuses on clinical and epidemiologic infection control measures.201627372227
hospitalized patients with heart failure and common bacterial infections: a nationwide analysis of concomitant clostridium difficile infection rates and in-hospital mortality.patients with heart failure (hf) are frequently hospitalized with common bacterial infections. it is unknown whether they experience concomitant clostridium difficile infection (cdi) more frequently than patients without hf, and whether cdi affects their mortality.201627317844
health care worker hand contamination at critical moments in outpatient care settings.the delivery of health care in outpatient settings has steadily increased over the past 40 years. the risk of infection in these settings is considered to be low. however, the increasing severity of illness and complexity of care in outpatient settings creates a need to reexamine the transmission of pathogens in this setting.201627287735
epidemiology of clostridium difficile infection in hospitalized oncology patients.the epidemiology of clostridium difficile infection (cdi) among oncology inpatients is poorly understood. in multivariate analysis we identified age, history of cdi, and prior receipt of cephalosporins, β-lactam/β-lactamase inhibitors, metronidazole, and blood transfusion as risk factors associated with cdi. reducing broad-spectrum antibiotic use, particularly among older patients and those with a cdi history and recent blood transfusions, may decrease cdi risk in this population.201627287733
a pilot study to assess the effectiveness and cost of routine universal use of peracetic acid sporicidal wipes in a real clinical environment.peracetic acid sporicidal wipes have been shown to be an effective disinfectant, but in controlled test environments. their high cost may restrict use.201627238941
asymptomatic and yet c. difficile-toxin positive? prevalence and risk factors of carriers of toxigenic clostridium difficile among geriatric in-patients.clostridium difficile infections (cdi) are the most frequent cause of diarrhoea in hospitals. geriatric patients are more often affected by the condition, by a relapse and complications. therefore, a crucial question is how often colonization with toxigenic clostridium difficile strains occurs in elderly patients without diarrhoea and whether there is a "risk pattern" of colonized patients that can be defined by geriatric assessment. furthermore, the probability for those asymptomatic carriers t ...201627846818
rates of microbiologically diagnosed infection and pathogen detection in hematopoietic stem cell transplant patients.infections remain a significant cause of mortality in hematopoietic stem cell transplant patients. evaluations of causes of infection are often unrevealing, and at some sites, increasing rates of antimicrobial resistance have been noticed. we performed a retrospective analysis of infection rates and microbiologic testing yield, or percent of tests ordered to diagnose an infection, in the first 100 days of 30 allogeneic and 56 autologous stem cell transplants performed at san antonio military med ...201627849508
national age group trends in clostridium difficile infection incidence and health outcomes in united states community hospitals.prior studies have demonstrated an increase in clostridium difficile infection (cdi) incidence in the united states (u.s.) in recent years, but trends among different age groups have not been evaluated. this study describes national cdi incidence by age group over a 10-year period and mortality and hospital length of stay (los) among patients with cdi.201627855653
characterization of the clostridium difficile volatile metabolome using comprehensive two-dimensional gas chromatography time-of-flight mass spectrometry.clostridium difficile is a bacterial pathogen capable of causing life-threatening infections of the gastrointestinal tract characterized by severe diarrhea. exposure to certain classes of antibiotics, advanced age, and prolonged hospitalizations are known risk factors for infection by this organism. anecdotally, healthcare providers have reported that they can smell c. difficile infections in their patients, and several studies have suggested that there may indeed be an olfactory signal associat ...201627855313
two novel myoviruses from the north of iraq reveal insights into clostridium difficile phage diversity and biology.bacteriophages (phages) are increasingly being explored as therapeutic agents to combat bacterial diseases, including clostridium difficile infections. therapeutic phages need to be able to efficiently target and kill a wide range of clinically relevant strains. while many phage groups have yet to be investigated in detail, those with new and useful properties can potentially be identified when phages from newly studied geographies are characterised. here, we report the isolation of c. difficile ...201627854339
draft genome sequence of robinsoniella peoriensis 6600698, a confounder of clostridium difficile diagnosis.robinsoniella peoriensis is a gram-positive, strictly anaerobic, spore-forming, rod-shaped organism. here, we report the draft genome of r. peoriensis 6600698, initially classified as clostridium difficile due to growth on selective agar, a fecal gdh pcr-positive result, and clinical symptoms. r. peoriensis is a potential confounder of c. difficile diagnosis.201627856584
chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis.health care-associated infections (hai) have been shown to increase length of stay, the cost of care, and rates of hospital deaths (kaye and marchaim, j am geriatr soc 62(2):306-11, 2014; roberts and scott, med care 48(11):1026-35, 2010; warren and quadir, crit care med 34(8):2084-9, 2006; zimlichman and henderson, jama intern med 173(22):2039-46, 2013). importantly, infections acquired during a hospital stay have been shown to be preventable (loveday and wilson, j hosp infect 86:s1-70, 2014). i ...201627876075
the role of single-shot metronidazole in the prevention of clostridium difficile infection following ileostomy reversal surgery.symptomatic infection with clostridium difficile is strongly linked to antibiotic use and rates are higher for colorectal surgery. in february 2015, trust policy for antibiotic prophylaxis of ileostomy reversal surgery was changed from three doses of metronidazole plus cefuroxime to single-dose metronidazole, in a bid to reduce rates of clostridium difficile infection.201627878620
burden of clostridium difficile-associated disease among patients residing in nursing homes: a population-based cohort study.clostridium difficile (c. difficile) infection (cdi) is the leading cause of nosocomial diarrhea in the united states. this study aimed to examine the incidence of cdi and evaluate mortality and economic burden of cdi in an elderly population who reside in nursing homes (nhs).201627884118
[adalimumab as induction therapy for crohn's disease - one center study].adalimumab is a subcutaneously administered recombinant fully human monoclonal antibody targeting tumor necrosis factor alpha. it has been approved for use in poland to treat patients with crohn's disease under the program of polish national health found since 2010.201627883347
highly divergent clostridium difficile strains isolated from the environment.clostridium difficile is one of the most important human and animal pathogens. however, the bacterium is ubiquitous and can be isolated from various sources. here we report the prevalence and characterization of c. difficile in less studied environmental samples, puddle water (n = 104) and soil (n = 79). c. difficile was detected in 14.4% of puddle water and in 36.7% of soil samples. environmental strains displayed antimicrobial resistance patterns comparable to already published data of human a ...201627880843
bezlotoxumab approved to prevent clostridium difficile recurrence. 201627864194
liver abscess and bacteremia caused by lactobacillus: role of probiotics? case report and review of the literature.lactobacilli are non-spore forming, lactic acid producing, gram-positive rods. they are a part of the normal gastrointestinal and genitourinary microbiota and have rarely been reported to be the cause of infections. lactobacilli species are considered non-pathogenic organisms and have been used as probiotics to prevent antibiotic associated diarrhea. there are sporadic reported cases of infections related to lactobacilli containing probiotics.201627863462
rethinking strategies to select antibiotic therapy in clostridium difficile infection.in recent years, clostridium difficile infection (cdi) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective components not well delineated across treatment algorithms and clinical trials. furthermore, there is little evidence linking severity at onset to ou ...201627862113
evidence for dual receptor-binding sites in clostridium difficile toxin a.tcda (308 kda) and tcdb (270 kda) disrupt the integrity of the intestinal epithelial barrier and provide an environment favorable for clostridium difficile colonization. recent evidence suggests that entry of tcda into cells is mediated by at least two domains. here, we report the characterization of a second receptor-binding domain (rbd2) for tcda. while both the isolated combined repetitive oligopeptides (crops) and rbd2 fragments are rapidly internalized into cells under physiologic condition ...201627861794
predominance of clostridium difficile ribotypes 017 and 078 among toxigenic clinical isolates in southern taiwan.ribotypes and toxin genotypes of clinical c. difficile isolates in taiwan are rarely reported. a prospective surveillance study from january 2011 to january 2013 was conducted at the medical wards of a district hospital in southern taiwan. of the first toxigenic isolates from 120 patients, 68 (56.7%) of 120 isolates possessed both tcda and tcdb. of 52 (43.3%) with tcdb and truncated tcda (tcda-/tcdb+), all were ribotype 017 and none had binary toxin or tcdc deletion. eighteen (15%) toxigenic iso ...201627861606
two clusters of fluoroquinolone and clindamycin-resistant clostridium difficile pcr ribotype 001 strain recognized by capillary electrophoresis ribotyping and multilocus variable tandem repeat analysis.to perform a retrospective analysis of the high occurrence of clostridium difficile infection in the surgical department of a czech tertiary care hospital and to identify weaknesses in c. difficile infection (cdi) prevention and control policies.201627860531
asymptomatic colitis induced by low-dose methotrexate.a woman aged 77 years with a history of rheumatoid arthritis (ra) presented with inflammatory colitis confined to her rectum, which was incidentally found by a screening colonoscopy. histopathological examination of colonic biopsies showed non-specific inflammatory infiltrates of lymphocytes, the cause of which was unknown. she had been diagnosed with ra 5 years before, and she was receiving methotrexate 6 mg weekly, to which tocilizumab had been added 4 years earlier, which achieved stable cont ...201627888222
detection of a cfr(b) variant in german enterococcus faecium clinical isolates and the impact on linezolid resistance in enterococcus spp.the national reference centre for staphylococci and enterococci in germany has received an increasing number of clinical linezolid-resistant e. faecium isolates in recent years. five isolates harbored a cfr(b) variant gene locus the product of which is capable of conferring linezolid resistance. the cfr(b)-like methyltransferase gene was also detected in clostridium difficile. antimicrobial susceptibility was determined for cfr(b)-positive and linezolid-resistant e. faecium isolates and two isog ...201627893790
antimicrobial stewardship programs that target only high-cost, broad-spectrum antimicrobials miss opportunities to reduce clostridium difficile infections.antimicrobial stewardship programs are promoted as a strategy to reduce clostridium difficile infections. we implemented an antimicrobial stewardship program comprised of formulary restriction plus prospective audit with feedback for high-cost and broad-spectrum antimicrobials. subsequently, we reviewed all heath care facility-onset, health care facility-associated c difficile infections. we found that most of these infections were associated with the antecedent receipt of nonaudited, and often ...201627908435
bezlotoxumab: first global approval.bezlotoxumab (zinplava™) is a human monoclonal antibody against clostridium difficile toxin b developed by merck & co. in october 2016 it was approved in the usa for reducing the recurrence of c. difficile infection. this article summarizes the milestones in the development of bezlotoxumab leading to this first approval for use in patients receiving antibacterial drug treatment for c. difficile infection who are at high risk for recurrence of c. difficile infection.201627905086
the incidence and drug resistance of clostridium difficile infection in mainland china: a systematic review and meta-analysis.it has been widely reported that the incidence and severity of clostridium difficile infection (cdi) have increased dramatically in north america and europe. however, little is known about cdi in mainland china. in this study, we aimed to investigate the incidence of cdi and the main epidemic and drug-resistant strains of c. difficile in mainland china through meta-analysis of related studies published after the year 2010. a total of 51 eligible studies were included. the pooled incidence of tox ...201627897206
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