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gastrointestinal organoids: understanding the molecular basis of the host-microbe interface.in recent years, increasing attention has been devoted to the concept that microorganisms play an integral role in human physiology and pathophysiology. despite this, the molecular basis of host-pathogen and host-symbiont interactions in the human intestine remains poorly understood owing to the limited availability of human tissue, and the biological complexity of host-microbe interactions. over the past decade, technological advances have enabled long-term culture of organotypic intestinal tis ...201728275681
strategies for optimizing the diagnostic predictive value of clostridium difficile molecular diagnostics.because nucleic acid amplification tests (naats) do not distinguish clostridium difficile infection (cdi) and asymptomatic c. difficile carriage, the diagnostic predictive value of naats is limited when used in patients with low probability of cdi. in this issue of the journal of clinical microbiology, truong et al. report significant reductions in hospital-onset cdi and oral vancomycin utilization at their institution following implementation of a novel intervention that leveraged their clinica ...201728275072
role of postgraduate year 2 pharmacy residents in providing weekend antimicrobial stewardship coverage in an academic medical center.the integration of pharmacy residents into an antimicrobial stewardship program (asp) is described, and data on the residents' asp interventions and outcomes are reported.201728274985
emerging monoclonal antibodies against clostridium difficile infection.clostridium difficile infections are characterized by a high recurrence rate despite antibiotic treatments and there is an urgent need to develop new treatments such as fecal transplantation and immonotherapy. besides active immunotherapy with vaccines, passive immunotherapy has shown promise, especially with monoclonal antibodies. areas covered: herein, the authors review the different assays performed with monoclonal antibodies against c. difficile toxins and surface proteins to treat or preve ...201728274145
[selection of laboratory procedures to detect toxigenic by the 2-step method].the 2-step method is an algorithm to detect toxigenic clostridium difficile. we herein compared the sensitivities and specificities of an enzyme immunoassay (toxin a/b-eia), toxigenic culture (tc-eia), loop-mediated isothermal amplification assay (lamp), and xpert c. difficile (xpert) with the detection of the toxin b gene by a polymerase chain reaction (pcr). the results obtained showed that the sensitivities and specificities of toxin a/b-eia, xpert, tc-eia, and lamp were 30 and 100%, 87.2 and ...201728274126
recurrent clostridium difficile infection among medicare patients in nursing homes: a population-based cohort study.we explored the epidemiology and outcomes of clostridium difficile infection (cdi) recurrence among medicare patients in a nursing home (nh) whose cdi originated in acute care hospitals.we conducted a retrospective, population-based matched cohort combining medicare claims with minimum data set 3.0, including all hospitalized patients age ≥65 years transferred to an nh after hospitalization with cdi 1/2011-11/2012. incident cdi was defined as icd-9-cm code 008.45 with no others in prior 60 days. ...201728272217
a rare case of raoultella planticola urinary tract infection in an immunocompromised patient with multiple myeloma.raoultella planticola is a gram-negative rod associated with soil and aquatic environments that has rarely been associated with human infections.201728271042
clostridium difficile disease: diagnosis, pathogenesis, and treatment update.clostridium difficile infections are the leading cause of health care-associated infectious diarrhea, posing a significant risk for both medical and surgical patients. because of the significant morbidity and mortality associated with c difficile infections, knowledge of the epidemiology of c difficile in combination with a high index of suspicion and susceptible patient populations (including surgical, postcolectomy, and inflammatory bowel disease patients) is warranted. c difficile infections ...201728267992
the challenge of detecting indels in bacterial genomes from short-read sequencing data.we tested the capabilities of four different software tools to detect insertions and deletions (indels) in a bacterial genome on the basis of short sequencing reads. we included tools applying the gapped-alignment (varscan, freebayes) or split-read (pindel) methods, respectively, and a combinatorial approach with local de-novo assembly (scanindel). tests were performed with 151-basepair, paired-end sequencing reads simulated from a bacterial (clostridioides difficile r20291) genome sequence with ...201728267569
microbiome: fecal transplant in clostridium difficile and ulcerative colitis. dr. paul moayyedi in an interview with dr. roman jaeschke: part 2. 201728267142
whole genome sequences of three clade 3 clostridium difficile strains carrying binary toxin genes in china.clostridium difficile consists of six clades but studies on clade 3 are limited. here, we report genome sequences of three clade 3 c. difficile strains carrying genes encoding toxin a and b and the binary toxin. isolates 103 and 133 (both of st5) and isolate 106 (st285) were recovered from three icu patients. whole genome sequencing using hiseq 2500 revealed 4.1-mb genomes with 28-29% gc content. there were ≥1,104 snp between the isolates, suggesting they were not of a single clone. the toxin a ...201728262711
inhibition of mrsa and of clostridium difficile by durancin 61a: synergy with bacteriocins and antibiotics.the aim of this study was to evaluate the efficacy of durancin 61a alone or in combination with nisin, pediocin pa-1, reuterin, microcin j25, vancomycin or tetracycline as an inhibitor of resistant clinical pathogens and to shed light on its mode of action.201728262046
hospital impact after a chemical spill that compromised the potable water supply: west virginia, january 2014.in january 2014, a chemical spill of 4-methylcyclohexanemethanol and propylene glycol phenyl ethers contaminated the potable water supply of approximately 300,000 west virginia residents. to understand the spill's impact on hospital operations, we surveyed representatives from 10 hospitals in the affected area during january 2014. we found that the spill-related loss of potable water affected many aspects of hospital patient care (eg, surgery, endoscopy, hemodialysis, and infection control of cl ...201728260560
impact of clostridium difficile infection in patients hospitalized with acute pancreatitis- a population based cohort study. 201728258934
the effect of omeprazole treatment on the gut microflora and neutrophil function.proton pump inhibitors (ppis) may increase the risk of clostridium difficile infections. there are interactions between gut microbiota and innate immune cells including neutrophils. we evaluated the effect of treatment with omeprazole on the gut microflora and neutrophil function.201728258834
insights into drug resistance mechanisms in clostridium difficile.the incidence of clostridium difficile infection has been elevated and becoming common in hospitals worldwide. although antibiotics usually serve as the primary treatment for bacterial infection including c. difficile infection, limitations and failures have been evident due to drug resistance. antibiotic resistance in c. difficile has been recognized as one of the most important factors to promote the infection and increase the level of severity and the recurrence rate. several outbreaks in man ...201728258232
successful treatment of persistent clostridium difficile infection with manuka honey. 201728257905
antibiotic treatment for clostridium difficile-associated diarrhoea in adults.clostridium difficile (c. difficile) is recognized as a frequent cause of antibiotic-associated diarrhoea and colitis. this review is an update of a previously published cochrane review.201728257555
risk factors for outpatient use of antibiotics in children with acute respiratory illnesses.antibiotics for acute respiratory illness (ari) constitute most pediatric medication use and contribute to the emergence of antimicrobial resistance. we investigated antibiotic prescription risk factors for ari in pediatric clinics and clinical follow-up in individuals prescribed and not prescribed antibiotics.201728257541
a population-based matched cohort study examining the mortality and costs of patients with community-onset clostridium difficile infection identified using emergency department visits and hospital admissions.few studies have evaluated the mortality or quantified the economic burden of community-onset clostridium difficile infection (cdi). we estimated the attributable mortality and costs of community-onset cdi. we conducted a population-based matched cohort study. we identified incident subjects with community-onset cdi using health administrative data (emergency department visits and hospital admissions) in ontario, canada between january 1, 2003 and december 31, 2010. we propensity-score matched e ...201728257438
updates on clostridium difficile spore biology.clostridium difficile is a gram-positive, anaerobic spore former, and an important nosocomial pathogenic bacterium. c. difficile spores are the morphotype of transmission and recurrence of the disease. the formation of c. difficile spores and their subsequent germination are essential processes during the infection. recent in vitro and in vivo work has shed light on how spores are formed and the timing of in vivo sporulation in a mouse model. advances have also been made in our understanding of ...201728254263
are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?in a survey of 5 hospitals, we found that floors in patient rooms were frequently contaminated with pathogens and high-touch objects such as blood pressure cuffs and call buttons were often in contact with the floor. contact with objects on floors frequently resulted in transfer of pathogens to hands.201728254251
quantification of small gtpase glucosylation by clostridial glucosylating toxins using multiplexed mrm analysis.large clostridial toxins (lct) mono-o-glucosylate small gtpases of the rho and ras subfamily. as a result of the glucosylation the gtpases are inhibited and thereby corresponding downstream signaling pathways are disturbed. current methods for quantifying the extent of glucosylation include sequential [(14) c]glucosylation, sequential [(32) p]adp-ribosylation and western blot detection of non-glucosylated gtpases, with neither method allowing the quantification of the extent of glucosylation of ...201728252257
risk factors and clinical outcome of clostridium difficile infection in patients with ibd:a chinese single-center retrospective study of 260 cases.clostridium difficile infection(cdi) may lead to poor outcome in inflammatory bowel disease(ibd) patients. this study was designed to investigate the cumulative incidence, risk factors, and outcome of cdi in patients with ibd in one chinese single center.201728251812
real-time electronic tracking of diarrheal episodes and laxative therapy enables verification of clostridium difficile clinical testing criteria and reduction of clostridium difficile infection rates.background. health care-onset healthcare facility associated clostridium difficile infection (ho-cdi) is overdiagnosed for several reasons including the high prevalence of c. difficile colonization and the inability of hospitals to limit testing to patients with clinically-significant diarrhea.methods. we conducted a quasi-experimental study from june 22, 2015, to june 30, 2016, on consecutive inpatients with c. difficile orders at an academic hospital. real-time electronic patient data tracking ...201728250001
disease-associated changes in bile acid profiles and links to altered gut microbiota.the gastrointestinal microbiota plays a central role in the host metabolism of bile acids through deconjugation and dehydroxylation reactions, which generate unconjugated free bile acids and secondary bile acids respectively. these microbially generated bile acids are particularly potent signalling molecules that interact with host bile acid receptors (including the farnesoid x receptor, vitamin d receptor and tgr5 receptor) to trigger cellular responses that play essential roles in host lipid m ...201728249284
predictors of hospital readmissions for ulcerative colitis in the united states: a national database study.early readmissions are important indicators of quality of care. limited data exist describing hospital readmissions in ulcerative colitis (uc). the aim of this study was to describe unplanned, 30-day readmissions among adult uc patients and to assess readmission predictors.201728248734
the antibiotic resistance crisis, with a focus on the united states.beginning with the discovery of penicillin by alexander fleming in the late 1920s, antibiotics have revolutionized the field of medicine. they have saved millions of lives each year, alleviated pain and suffering, and have even been used prophylactically for the prevention of infectious diseases. however, we have now reached a crisis where many antibiotics are no longer effective against even the simplest infections. such infections often result in an increased number of hospitalizations, more t ...201728246379
fradiamine a, a new siderophore from the deep-sea actinomycete streptomyces fradiae mm456m-mf7.new bioactive substances were identified from several marine actinomycetes strains by lc-hresi-ms based non-targeted metabolomics. a new siderophore and its derivative, named fradiamines a and b, were isolated from the extract of the deep-sea actinomycetes streptomyces fradiae mm456m-mf7 by diaion chp-20p, sephadex lh-20 column chromatography and hplc. fradiamine a was a new compound, but fradiamine b was previously patented as a sweetness enhancer. their structures were determined by nmr and lc ...201728246378
clostridium difficile infection among us emergency department patients with diarrhea and no vomiting.the incidence of clostridium difficile infection has increased and has been observed among persons from the community who have not been exposed to antibiotics or health care settings. our aims are to determine prevalence of c difficile infection among emergency department (ed) patients with diarrhea and the prevalence among patients without traditional risk factors.201728242058
management of a cluster of clostridium difficile infections among patients with osteoarticular infections.here we describe a cluster of hospital-acquired clostridium difficile infections (cdi) among 26 patients with osteoarticular infections. the aim of the study was to define the source of c. difficile and to evaluate the impact of general infection control measures and antibiotic stewardship on the incidence of cdi.201728239451
rapid diagnosis of gastrointestinal tract infections due to parasites, viruses, and bacteria.rapid diagnostic techniques are valuable tools in the diagnosis of gastrointestinal infections, especially for the detection of some microorganisms and in certain groups of patients. while antigen detection techniques are widely used in clinical microbiology laboratories, for the diagnosis of viruses, some parasites and some bacteria, molecular techniques are routinely used only for some pathogens (such as clostridium difficile). however, molecular techniques are constantly evolving, and they al ...201728238506
development of a non-radiolabeled glucosyltransferase activity assay for c. difficile toxin a and b using ultra performance liquid chromatography.clostridium difficile infection (cdi) is the leading cause of gastroenteritis-associated death in the united states. the major virulent factors of c. difficile are toxin a (tcda) and toxin b (tcdb). toxicity is mediated by the glucosyltransferase domains on tcda and tcdb wherein a glucose is transferred from udp-glucose to ras homolog family member a (rhoa) receptor. this modification results in disruption of critical cell signaling events. vaccination against these toxins is considered the best ...201728238427
laboratory-based surveillance of clostridium difficile strains circulating in the australian healthcare setting in 2012.clostridium difficile infection (cdi) has risen in prominence in australia recently. we conducted laboratory-based surveillance of cdi to examine c. difficile circulating in australia in october/november 2012. we collected 542 isolates from all states and territories of australia except the northern territory. the most common ribotypes (rts) were rts 014/020 (25.5%), 002 (10.5%), 056 (5.9%) and 070 (4.2%). the survey results were compared with results from a similar australian survey conducted i ...201728237369
[fecal microbiota transplantation].the human intestinal microbiome has important metabolic and immunological functions for the host and is part of the defense against pathogens in the gastrointestinal tract. antibiotics, probiotics, dietary measures, such as prebiotics, and the relatively newly established method of fecal microbiota transplantation (fmt, also known as fecal microbiome transfer) all influence the intestinal microbiome. the fmt procedure comprises the transmission of fecal microorganisms from a healthy donor into t ...201728235986
proteome mining for the identification and in-silico characterization of putative drug targets of multi-drug resistant clostridium difficile strain 630.clostridium difficile is an enteric pathogen that causes approximately 20% to 30% of antibiotic-associated diarrhea. in recent years, there has been a substantial rise in the rate of c. difficile infections as well as the emergence of virulent and antibiotic resistant c. difficile strains. so, there is an urgent need for the identification of therapeutic potential targets and development of new drugs for the treatment and prevention of c. difficile infections. in the current study, we used a hyb ...201728235560
[microbiome and gut inflammation].in the past decade the gut microbiome has received scientific attention like few other topics. it has become increasingly apparent that the commensal microbiota plays an important role in maintaining the health of the host. changes of the microbiota composition or function coincide with different disorders such as infectious (i. e. clostridium difficile infection) or inflammatory bowel diseases like crohn's disease or ulcerative colitis. although the significance of this observation has not yet ...201728235226
predictors of hospital readmissions for ulcerative colitis in the united states: a national database study.early readmissions are important indicators of quality of care. limited data exist describing hospital readmissions in ulcerative colitis (uc). the aim of this study was to describe unplanned, 30-day readmissions among adult uc patients and to assess readmission predictors.201728221246
toxin-positive clostridium difficile latently infect mouse colonies and protect against highly pathogenic c. difficile.clostridium difficile is a toxin-producing bacterium and a leading cause of antibiotic-associated disease. the ability of c. difficile to form spores and infect antibiotic-treated persons at low multiplicity of infection (moi) underlies its large disease burden. however, c. difficile-induced disease might also result from long-harboured c. difficile that blooms in individuals administered antibiotics.201728219893
the use of a computerized provider order entry alert to decrease rates of clostridium difficile testing in young pediatric patients.background infants and young children are frequently colonized with c. difficile but rarely have symptomatic disease. however, c. difficile testing remains prevalent in this age group. objective to design a computerized provider order entry (cpoe) alert to decrease testing for c. difficile in young children and infants. design an interventional age-targeted before-after trial with comparison group setting monroe carell jr. children's hospital at vanderbilt university, nashville, tennessee. patie ...201728219462
novel insight from computational virtual screening depict the binding potential of selected phytotherapeutics against probable drug targets of clostridium difficile.this study explores computational screening and molecular docking approaches to screen novel herbal therapeutics against probable drug targets of clostridium difficile. the essential genes were predicted by comparative genome analysis of c. difficile and best homologous organisms using blast search at database of essential genes (deg). the functions of these genes in various metabolic pathways were predicted and some of these genes were considered as potential targets. three major proteins were ...201728217823
impact of tigecycline versus other antibiotics on the fecal metabolome and on colonization resistance to clostridium difficile in mice.the glycylcycline antibiotic tigecycline may have a relatively low propensity to promote clostridium difficile infection in part because it causes less disruption of the indigenous intestinal microbiota than other broad-spectrum antibiotics. we used a mouse model to compare the effects of tigecycline versus other commonly used antibiotics on colonization resistance to c. difficile and on the metabolic functions of the intestinal microbiota.201728217763
effect of tcdr mutation on sporulation in the epidemic clostridium difficile strain r20291.clostridium difficile is an important nosocomial pathogen and the leading cause of hospital-acquired diarrhea. antibiotic use is the primary risk factor for the development of c. difficile-associated disease because it disrupts normally protective gut flora and enables c. difficile to colonize the colon. c. difficile damages host tissue by secreting toxins and disseminates by forming spores. the toxin-encoding genes, tcda and tcdb, are part of a pathogenicity locus, which also includes the tcdr ...201728217744
a clostridioides difficile bacteriophage genome encodes functional binary toxin-associated genes.pathogenic clostridia typically produce toxins as virulence factors which cause severe diseases in both humans and animals. whereas many clostridia like e.g., clostridium perfringens, clostridium botulinum or clostridium tetani were shown to contain toxin-encoding plasmids, only toxin genes located on the chromosome were detected in clostridioides difficile so far. in this study, we determined, annotated, and analyzed the complete genome of the bacteriophage phisemix9p1 using single-molecule rea ...201728216103
occurrence of clostridium difficile ribotype 027 in hospitals of silesia, poland.clostridium difficile is an important healthcare-associated pathogen, responsible for a broad spectrum of diarrheal diseases. the aim of this prospective study was to determine the occurrence of c. difficile infection (cdi), to characterize cultured c. difficile strains and to investigate the association of fecal lactoferrin with cdi. between january 2013 and june 2014, 148 stool samples were obtained from adult diarrheal patients (c. difficile as a suspected pathogen) hospitalized in different ...201728216085
a ten-year review of total hospital onset intensive care unit bloodstream infections at an academic medical center.the rates of central line-associated bloodstream infections (clabsis) in united states intensive care units (icu) have decreased significantly, and a parallel reduction in the rates of total hospital onset bacteremias in these units should also be expected. we report 10-year trends for total hospital onset icu-associated bacteremias at a tertiary care academic medical center.201728215789
clostridium difficile infection in acute flares of inflammatory bowel disease: a prospective study.clostridium difficile infection (cdi) is a common complication in inflammatory bowel disease (ibd) and has been associated with poor ibd outcome. the aims of our study were to look for predictive factors of cdi in patients hospitalized for ibd flare and to evaluate a rapid testing strategy in this population.201728215602
identification of highly specific diversity-oriented synthesis-derived inhibitors of clostridium difficile.in 2013, the centers for disease control highlighted clostridium difficile as an urgent threat for antibiotic-resistant infections, in part due to the emergence of highly virulent fluoroquinolone-resistant strains. limited therapeutic options currently exist, many of which result in disease relapse. we sought to identify molecules specifically targeting c. difficile in high-throughput screens of our diversity-oriented synthesis compound collection. we identified two scaffolds with apparently nov ...201728215073
structural and functional insights into corrinoid iron-sulfur protein from human pathogen clostridium difficile.the human pathogen clostridium difficile infection (cdi) is one of the most important healthcare-associated infections. the wood-ljungdahl pathway, which is responsible for acetyl-coa biosynthesis, is essential for the survival of the pathogen and is absent in humans. the key proteins and enzymes involved in the pathway are attractive targets for the treatment of cdi. corrinoid iron-sulfur protein (cofesp) is a key protein and acts as a methyl transformer in the wood-ljungdahl pathway. in this s ...201728214753
rna-based control mechanisms of clostridium difficile.clostridium difficile (cd)-associated diarrhoea is currently the most prevalent nosocomial diarrhoea worldwide. many characteristics of cd pathogenicity remain poorly understood. recent data strongly indicate the importance of an rna network for the control of gene expression in cd. more than 200 regulatory rnas have been identified by deep sequencing and targeted approaches, including hfq-dependent trans riboregulators, cis-antisense rnas, crispr rnas, and c-di-gmp-responsive riboswitches. thes ...201728214735
[adult immunisation: general points, hot topics and perspectives].vaccination in immunocompetent adult mainly concerns booster vaccination against diphtheria, tetanus, polio and pertussis. some chronic diseases may also require the achievement of pneumococcal and influenza vaccines. in addition, from the age of 65, annual influenza vaccination as well as one dose of a live attenuated shingles vaccine between 64 and 75 years are recommended. immunocompromised adults, due to the increased risk of serious infections responsible of significant morbidity and mortal ...201728214181
protective antibodies against clostridium difficile are present in intravenous immunoglobulin and are retained in humans following its administration.the prevalence of serum antibodies against clostridium difficile (cd) toxins a and b in healthy populations have prompted interest in evaluating the therapeutic activity of intravenous immunoglobulin (ivig) in individuals experiencing severe or recurrent c. difficile infection (cdi). despite some promising case reports, a definitive clinical role for ivig in cdi remains unclear. contradictory results may be attributed to a lack of consensus regarding optimal dose, timing of administration and pa ...201728213939
clostridium difficile infection in inflammatory bowel disease: challenges in diagnosis and treatment.the problem of clostridium difficile infection (cdi) has reached epidemic proportions, particularly in industrialized nations. the pathophysiology, disease course and the potential complications are well appreciated in the general hospitalized patient. however, when cdi occurs in the setting of inflammatory bowel disease (ibd), a number of distinct differences in the diagnosis and clinical management of the infection in this population should be appreciated by gastroenterologists, hospitalists a ...201728210836
the daniel k. inouye college of pharmacy scripts: updates on clostridium difficile infection: advances in laboratory testing to aid diagnosis and treatment.clostridium difficile remains a major source of nosocomial infections and associated diarrhea. more recently, community-acquired cases are on the rise creating a concern for a serious public health threat. appropriate infection control precautions as well as prevention and optimal management may help to avoid detrimental outbreaks. a key step is utilizing laboratory testing for quick and accurate diagnosis of potential cases. this overview article describes clostridium difficile infection contro ...201728210531
community-acquired clostridium difficile infection. 201728209679
making life difficult for clostridium difficile: augmenting the pathogen's metabolic model with transcriptomic and codon usage data for better therapeutic target characterization.clostridium difficile is a bacterium which can infect various animal species, including humans. infection with this bacterium is a leading healthcare-associated illness. a better understanding of this organism and the relationship between its genotype and phenotype is essential to the search for an effective treatment. genome-scale metabolic models contain all known biochemical reactions of a microorganism and can be used to investigate this relationship.201728209199
the wide spectrum high biocidal potency of bioxy formulation when dissolved in water at different concentrations.traditional surface disinfectants that have long been applied in medicine, animal husbandry, manufacturing and institutions are inconvenient at best and dangerous at worst. moreover, some of these substances have adverse environmental impacts: for example, quaternary ammonium compounds ("quats") are reproductive toxicants in both fish and mammals. halogens are corrosive both to metals and living tissues, are highly reactive, can be readily neutralized by metals, and react with organic matter to ...201728207828
systematic review with meta-analysis: the impact of clostridium difficile infection on the short- and long-term risks of colectomy in inflammatory bowel disease.clostridium difficile infection (cdi) is associated with increased mortality in inflammatory bowel disease (ibd), but the risk of colectomy is variable and has not been adequately studied.201728206678
the risk for clostridium difficile colitis during hospitalization in asymptomatic carriers. 201728202190
hospital discharge abstracts have limited accuracy in identifying occurrence of clostridium difficile infections among hospitalized individuals with inflammatory bowel disease: a population-based study.hospital discharge databases are used to study the epidemiology of clostridium difficile infections (cdi) among hospitalized patients with inflammatory bowel disease (ibd). cdi in ibd is increasingly important and accurately estimating its occurrence is critical in understanding its comorbidity. there are limited data on the reliability of the international classification of diseases 10th revision (icd-10) (now widely used in north america) cdi code in determining occurrence of cdi among hospita ...201728199401
the alternative sigma factor σ(b) plays a crucial role in adaptive strategies of clostridium difficile during gut infection.clostridium difficile is a major cause of diarrhoea associated with antibiotherapy. exposed to stresses in the gut, c. difficile can survive by inducing protection, detoxification and repair systems. in several firmicutes, most of these systems are controlled by the general stress response involving σ(b) . in this work, we studied the role of σ(b) in the physiopathology of c. difficile. we showed that the survival of the sigb mutant during the stationary phase was reduced. using a transcriptome ...201728198085
fecal microbiota transplantation: is there a role in the eradication of carbapenem-resistant klebsiella pneumoniae intestinal carriage?the authors present the case of a 66-year-old woman with four hospitalizations due to recurrent clostridium difficile infection (cdi) non responsive to vancomycin and fidaxomicin. furthermore, intestinal colonization with carbapenem-resistant klebsiella pneumoniae (crkp) was identified after a positive stool culture in a screening routinely performed in our center in patients recently hospitalized.201728196423
successful resolution of recurrent clostridium difficile infection using freeze-dried, encapsulated fecal microbiota; pragmatic cohort study.fecal microbiota transplantation (fmt) is increasingly being used for treatment of recurrent clostridium difficile infection (r-cdi) that cannot be cured with antibiotics alone. in addition, fmt is being investigated for a variety of indications where restoration or restructuring of the gut microbial community is hypothesized to be beneficial. we sought to develop a stable, freeze-dried encapsulated preparation of standardized fecal microbiota that can be used for fmt with ease and convenience i ...201728195180
cloning, expression, and biochemical characterization of a novel nadp(+)-dependent 7α-hydroxysteroid dehydrogenase from clostridium difficile and its application for the oxidation of bile acids.a gene encoding a novel 7α-specific nadp(+)-dependent hydroxysteroid dehydrogenase from clostridium difficile was cloned and heterologously expressed in escherichia coli. the enzyme was purified using an n-terminal hexa-his-tag and biochemically characterized. the optimum temperature is at 60°c, but the enzyme is inactivated at this temperature with a half-life time of 5min. contrary to other known 7α-hsdhs, for example from clostridium sardiniense or e. coli, the enzyme from c. difficile does n ...201728193327
evaluation of two novel chemiluminescence immunoassays for the detection of clostridium difficile glutamate dehydrogenase and toxin a&b.a novel immunoassay for clostridium difficile glutamate dehydrogenase (gdh) and toxin a&b (liaison, diasorin) was compared to another gdh assay (alere), pcr and toxigenic culture. the gdh-diasorin is slightly more sensitive than the gdh-alere. sensitivity of the toxin-diasorin test is in accordance to the sensitivity of other immunoassays in literature.201728192156
timely use of probiotics in hospitalized adults prevents clostridium difficile infection: a systematic review with meta-regression analysis.systematic reviews have provided evidence for the efficacy of probiotics in preventing clostridium difficile infection (cdi), but guidelines do not recommend probiotic use for prevention of cdi. we performed an updated systematic review to help guide clinical practice.201728192108
improvement of infection control management by routine molecular evaluation of pathogen clusters.undetected pathogen clusters can often be a source of spreading in-hospital infections. unfortunately, detection of clusters can be problematic because epidemiological connection is not always easily established. infection prevention and control (ipc) measures, however, are most effective when applied at the earliest possible stage.201728189284
comparison of clostridium difficile minimum inhibitory concentrations obtained using agar dilution vs broth microdilution methods.due to increasing antibiotic resistance among anaerobic bacteria, routine antimicrobial susceptibility testing is recommended by the clinical and laboratory standards institute (clsi). this study compared the minimum inhibitory concentrations (mics) from 920 clostridium difficile isolates tested against seven antimicrobial agents using the two current clsi reference methodologies, agar dilution method, vs broth microdilution method. a subset of isolate testing was performed independently by two ...201728188880
a mathematical model of clostridium difficile transmission in medical wards and a cost-effectiveness analysis comparing different strategies for laboratory diagnosis and patient isolation.clostridium difficile infection (cdi) is a common and potentially fatal healthcare-associated infection. improving diagnostic tests and infection control measures may prevent transmission. we aimed to determine, in resource-limited settings, whether it is more effective and cost-effective to allocate resources to isolation or to diagnostics.201728187144
risk factors and impact of clostridium difficile recurrence on haematology patients. 201728186243
review of the role of probiotics in gastrointestinal diseases in adults.probiotics may act as biological agents that modify the intestinal microbiota and certain cytokine profiles, which can lead to an improvement in certain gastrointestinal diseases.201728185664
evaluation of nested polymerase chain reaction and immunoassay for rapid diagnosis of clostridium difficile in children with community acquired diarrhea.clostridium difficile (c. difficile) is a known pathogen associated with diarrhea especially in hospital acquired diarrhea. yet, it is being recognized as a probable etiology for community acquired diarrhea. the aim of the present study was to detect the presence of c. difficile as a pathogen causing community acquired diarrhea in children and to verify the value of different laboratory methods for diagnosis, namely specific culture, immunoassay for toxin detection, and nested polymerase chain r ...201728182338
effect of aging on the composition of fecal microbiota in donors for fmt and its impact on clinical outcomes.fecal microbiota transplantation (fmt) is emerging as an effective therapy for the treatment of recurrent clostridium difficile infection (rcdi). selecting an appropriate donor is vital to the success of fmt. however, the relationship between age of donors and the efficacy of fmt has not been examined to date. the aim of this study was to examine the effect of age of healthy donors on their fecal microbiota and assess the impact of these changes on the clinical efficacy of fmt.201728181098
comprehensive evaluation of chemiluminescent immunoassays for the laboratory diagnosis of clostridium difficile infection.for the microbiological diagnosis of a clostridium (c.) difficile infection (cdi), a two-test algorithm consisting of a c. difficile glutamate dehydrogenase (gdh)-immunoassay followed by a toxin-immunoassay in positive cases is widely used. in this study, two chemiluminescent immunoassays (clias), one for gdh and the other for the toxins a and b, have been evaluated systematically using appropriate reference methods. three-hundred diarrhoeal stool specimens submitted for cdi diagnosis were analy ...201728181032
designing fecal microbiota transplant trials that account for differences in donor stool efficacy.fecal microbiota transplantation is a highly effective intervention for patients suffering from recurrent clostridium difficile, a common hospital-acquired infection. fecal microbiota transplantation's success as a therapy for c. difficile has inspired interest in performing clinical trials that experiment with fecal microbiota transplantation as a therapy for other conditions like inflammatory bowel disease, obesity, diabetes, and parkinson's disease. results from clinical trials that use fecal ...201728178876
interventions to improve antibiotic prescribing practices for hospital inpatients.antibiotic resistance is a major public health problem. infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. we updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients.201728178770
fecal microbiota transplant for clostridium difficile infection in a pregnant patient.clostridium difficile infection has been associated with negative outcomes in the general population and in pregnant patients. fecal microbiota transplant has become the standard for treatment of recurrent as well as refractory c difficile infection.201728178052
laboratory diagnosis of clostridium difficile infection: comparison of techlab c. diff quik chek complete, xpert c. difficile, and multistep algorithmic approach.clostridium difficile is a major pathogen responsible for nosocomial infectious diarrhea. we explored optimal laboratory strategies for diagnosis of c. difficile infection (cdi) in our clinical settings, a 1400-bed tertiary care hospital.201728177534
"infectious supercarelessness" in discussing antibiotic-resistant bacteria.many bacterial pathogens are exhibiting resistance to increasing numbers of antibiotics making it much more challenging to treat the infections caused by these microbes. in many reports in the media and perhaps even in discussions among physicians and biomedical scientists, these bacteria are frequently referred to as "bugs" with the prefix "super" appended. this terminology has a high potential to elicit unjustified inferences and fails to highlight the broader evolutionary context. understandi ...201728174759
infection: modifying recurrence of clostridium difficile infection. 201728174419
cost analysis of nonoperative management of acute appendicitis in children.the purpose of this study was to determine if nonoperative management of acute appendicitis in children is more cost effective than appendectomy.201728173947
the american cockroach peptide periplanetasin-2 blocks clostridium difficile toxin a-induced cell damage and inflammation in the gut.clostridium difficile, which causes pseudomembranous colitis, releases toxin a and toxin b. these toxins are considered to be the main causative agents for the disease pathogenesis, and their expression is associated with a marked increase of apoptosis in mucosal epithelial cells. colonic epithelial cells are believed to form a physical barrier between the lumen and the submucosa, and abnormally increased mucosal epithelial cell apoptosis is considered to be an initial step in gut inflammation r ...201728173695
transmissibility of clostridium difficile without contact isolation: results from a prospective observational study with 451 patients. 201728172613
optimal strategies for the diagnosis of community-onset diarrhea in solid organ transplant recipients: less is more.diarrhea, a common complication after solid organ transplant (sot), is associated with allograft failure and death. no evidence-based guidelines exist for the evaluation of diarrhea in sot recipients. we performed a cost analysis to derive a testing algorithm for the diagnosis of community-onset diarrhea that minimizes costs without compromising diagnostic yields.201728170133
bile acid disease: the emerging epidemic.our objective was to review advances in bile acids in health and disease published in the last 2 years. bile acid diarrhea (bad) is recognized as a common cause of chronic diarrhea, and its recognition has been facilitated by development of new screening tests.201728169840
cost analysis of an outbreak of clostridium difficile infection ribotype 027 in a dutch tertiary care centre.the economic impact of clostridium difficile infection (cdi) on the healthcare system is significant. from may 2013 to may 2014, an outbreak of c. difficile ribotype 027 occurred in a dutch tertiary care hospital, involving 72 patients. the primary aim of this study was to provide insight into the financial burden that this cdi outbreak brought upon this hospital.201728169013
food indwelling clostridium difficile in naturally contaminated household meals: data for expanded risk mathematical predictions. 201728166846
comparative effectiveness of vancomycin and metronidazole for the prevention of recurrence and death in patients with clostridium difficile infection.metronidazole hydrochloride has historically been considered first-line therapy for patients with mild to moderate clostridium difficile infection (cdi) but is inferior to vancomycin hydrochloride for clinical cure. the choice of therapy may likewise have substantial consequences on other downstream outcomes, such as recurrence and mortality, although these secondary outcomes have been less studied.201728166328
impact of antibiotics on necrotizing enterocolitis and antibiotic-associated diarrhea.antibiotic treatment alters the composition and metabolic function of the intestinal microbiota. these alterations may contribute to the pathogenesis of necrotizing enterocolitis (nec) and antibiotic-associated diarrhea (aad). recent studies are beginning to unravel the contribution of specific groups of microbes and their metabolic pathways to these diseases. probiotics or other microbiota-targeted therapies may provide effect strategies to prevent and treat nec and aad.201728164853
fecal microbiota transplantation.fecal microbiota transplantation (fmt) is the transfer of stool from a healthy donor into the colon of a patient whose disease is a result of an altered microbiome, with the goal of restoring the normal microbiota and thus curing the disease. the most effective and well-studied indication for fmt is recurrent clostridium difficile infection. at this time, there is insufficient evidence to recommend fmt for other gastrointestinal diseases, but studies are under way. there is also insufficient evi ...201728164849
effect of antibiotics on bacterial populations: a multi-hierachical selection process.antibiotics have been widely used for a number of decades for human therapy and farming production. since a high percentage of antibiotics are discharged from the human or animal body without degradation, this means that different habitats, from the human body to river water or soils, are polluted with antibiotics. in this situation, it is expected that the variable concentration of this type of microbial inhibitor present in different ecosystems may affect the structure and the productivity of ...201728163908
lack of benefit with combination therapy for clostridium difficile infection.limited data exist regarding combination therapy for clostridium difficile infection (cdi). after adjusting for confounders in a cohort of patients with cdi and≥1 year old, combination therapy was not associated with significant differences in clinical outcomes, but it was associated with prolonged duration of therapy (1.22 days; 95% confidence interval, 1.03-1.44 days; p=.02). infect control hosp epidemiol 2017;1-4.201728162100
cecal perforation associated with clostridium difficile infection: a case report.various complications are reported with clostridium difficile infection (cdi), including fulminant cdi. fulminant cdi is an underappreciated life-threatening condition associated with complications such as toxic megacolon and bowel perforation.201728161256
contribution to clostridium difficile transmission of symptomatic patients with toxigenic strains who are fecal toxin negative. 201728158441
evolutionary clade affects resistance of clostridium difficile spores to cold atmospheric plasma.clostridium difficile is a spore forming bacterium and the leading cause of colitis and antibiotic associated diarrhoea in the developed world. spores produced by c. difficile are robust and can remain viable for months, leading to prolonged healthcare-associated outbreaks with high mortality. exposure of c. difficile spores to a novel, non-thermal atmospheric pressure gas plasma was assessed. factors affecting sporicidal efficacy, including percentage of oxygen in the helium carrier gas admixtu ...201728155914
risks factors and outcomes of clostridium difficile infection in patients with cancer: a matched case-control study.clostridium difficile infection (cdi) is the leading cause of diarrhoea in hospitalised patients. cancer populations are at high-risk for infection, but comprehensive evaluation in the current era of cancer care has not been performed. the objective of this study was to describe characteristics, risk factors, and outcomes of cdi in cancer patients.201728155020
chylous peritoneal dialysate related to the use of nutritional supplements in a patient with clostridium difficile diarrhea. 201728153974
clinical and laboratory features of the most common clostridium difficile ribotypes isolated in belgium.previous studies comparing clostridium difficile infection (cdi) due to different ribotypes have been conflicting, and many have only compared small numbers of cases or few ribotypes.201728153559
use of tigecycline for the management of clostridium difficile colitis in oncology patients and case series of breakthrough infections.clostridium difficile infection (cdi) is the most frequent cause of nosocomial diarrhoea in adults. cancer patients, in particular, are at a higher risk for cdi. limited clinical data exist regarding the use of tigecycline for the treatment of cdi, especially in patients with oncologic and haematologic malignancies.201728153556
case report: acute flair of ulcerative colitis during pregnancy is still a major problem.although severe flare of ulcerative colitis (uc) is uncommon, it significantly increases the risk of preterm delivery, low birth weight and other adverse fetal outcomes. it is critical to optimize aggressive medical treatment with both mother and fetal health. here, we present a case of a 30-year-old woman with a severe flare of uc at the 16th gestational week. the diagnosis of extensive uc was established 8 years ago. from the time she was diagnosed, she had 5 moderate flares successfully treat ...201728147377
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