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genome analysis of clostridium difficile pcr ribotype 014 lineage in australian pigs and humans reveals a diverse genetic repertoire and signatures of long-range interspecies transmission.clostridium difficile pcr ribotype (rt) 014 is well-established in both human and porcine populations in australia, raising the possibility that c. difficile infection (cdi) may have a zoonotic or foodborne etiology. here, whole genome sequencing and high-resolution core genome phylogenetics were performed on a contemporaneous collection of 40 australian rt014 isolates of human and porcine origin. phylogenies based on mlst (7 loci, sts 2, 13, and 49) and core orthologous genes (1260 loci) showed ...201628123380
blowhole colostomy for clostridium difficile-associated toxic megacolon.we present the case of a 58-year-old man who underwent urgent blowhole colostomy for toxic megacolon (tm) secondary to clostridium difficile infection (cdi). this infection occurred under antibiotic coverage with amoxicillin-clavulanic acid, four days after laparoscopic sigmoidectomy in our hospital. although prospective clinical research regarding the surgical management of tm is lacking, decompressive procedures like blowhole colostomy are reported to carry a high risk of postoperative morbidi ...201628097034
[a case of advanced rectal cancer resulting in a pathologically complete response after neoadjuvant chemotherapy].a 61-years-old man was admitted to our hospital because of abdominal pain. colonoscopy revealed a type 2 tumor in the rectum, which was diagnosed as low differentiated adenocarcinoma. at least 8 abdominal lymph adenopathies were enhanced on contrast-enhanced ct. we diagnosed stage ct3n2h0m0p0, cstage iii b. because of the risk of a poor prognosis, we tried neoadjuvant chemotherapy for the purpose of down staging. a crt was prevented by clostridium difficile enteritis, but we completed 80% of the ...201628133313
detection of clostridium difficile in fecal specimens: a comparative evaluation of nucleic acid amplification test and toxigenic culture.the available data regarding clostridium difficile infections (cdis) in developing countries are scarce. this may be related in part to the complexity of anaerobic bacterial culture and/or cytotoxicity assays of c. difficile. here, we evaluated the diagnostic efficacy of pcr in comparison with toxigenic culture for direct detection of conserved genes as well as toxin genes of c. difficile in fecal specimens of patients with clinical symptoms of cdi.201628164522
successful therapy of clostridium difficile infection with fecal microbiota transplantation.clostridium difficile infection (cdi) is the most common cause of infectious diarrhea and represents an important burden for healthcare worldwide. symptoms of severe cdi include watery, foul-smelling diarrhea, peripheral leucocytosis, increased c-reactive protein (crp), acute renal failure, hypotension and pseudomembranous colitis. recent studies indicate that the main cause of cdi is dysbiosis, an imbalance in the normal gut microbiota. the restoration of a healthy gut microbiota composition vi ...201628195066
thermal resistance of clostridium difficile spores in peptone water and pork meat.the thermal resistance of four strains of clostridium difficile spores (three hypervirulent and one nonhypervirulent) in peptone water (pw) and pork meat was evaluated individually at 70, 75, 80, 85, and 90°c using two recovery methods (taurocholate and lysozyme). pw or meat was inoculated with c. difficile spores and mixed to obtain ca. 5.0 log cfu/ml or 4.0 log cfu/g, respectively. the d-values of c. difficile spores in pw ranged from 7.07 to 22.14 h, 1.42 to 3.82 h, 0.35 to 0.59 h, 4.93 to 5. ...201628221931
isolation of clostridium difficile and molecular detection of binary and a/b toxins in faeces of dogs.the aim of this study was to isolate clostridium difficile from dogs' faeces, and to study the frequency of its virulence genes. a total of 151 samples of dogs' faeces were collected. the isolation of c. difficile was performed by using the bacterial culture methods followed by dna extraction using boiling method. multiplex pcr method was performed for identification of tcda, tcdb, cdta and cdtb genes and single method was carried out for detection of tcdc. twelve samples (7.9%) were positive in ...201628224013
enteropathogen infections in canine puppies: (co-)occurrence, clinical relevance and risk factors.laboratory confirmation of the causative agent(s) of diarrhoea in puppies may allow for appropriate treatment. the presence of potential pathogens however, does not prove a causal relationship with diarrhoea. the aim of this study was to identify specific enteropathogens in ≤12 month old puppies with and without acute diarrhoea and to assess their associations with clinical signs, putative risk factors and pathogen co-occurrence. faecal samples from puppies with (n=113) and without (n=56) acute ...201627771056
[liver disease, gastrointestinal complications, nutritional management and feeding disorders in pediatric cystic fibrosis].in cystic fibrosis (cf), approximately 5-8% of the patients develop multilobular cirrhosis during the first decade of life. annual screening (clinical examination, liver biochemistry, ultrasonography) is recommended in order to identify early signs of liver involvement, initiate ursodeoxycholic acid therapy and detect complications (portal hypertension and liver failure). management should focus on nutrition and prevention of variceal bleeding. the gut may also be involved in children with cf. g ...201628231889
periodontal-disease-associated biofilm: a reservoir for pathogens of medical importance.the ecological diversity of the periodontal microenvironment may provide suitable conditions for the colonization of species not usually considered members of the oral microbiota. in this investigation, we aimed to determine the prevalence and levels of pathogenic species of medical relevance in the microbiota of individuals with distinct periodontal clinical status. subgingival biofilm was obtained from patients with periodontal health (h, n = 81), gingivitis (g, n = 55), generalized aggressive ...201626416306
medical versus surgical patients with clostridium difficile infection: is there any difference?severity of clostridium difficile infection (cdi) varies from one patient to another. we aimed to test the hypothesis that surgical patients would suffer more severe cdis than medical patients. patients receiving in-hospital medical or surgical treatment for any underlying disease from 2007 to 2012, who developed cdi, were divided into two groups: "medical group" and "surgical group." demographics, disease characteristics, and outcomes including mortality and recurrence were compared. of 3231 pa ...201628234177
a cost-effective anaerobic culture method & its comparison with a standard method.twenty six anaerobes were recovered from 150 deep-seated abscess samples cultured by the proposed two-step combustion-modified candle-jar system and anoxomat. the degree of growth and colony size were similar in both systems, except for clostridium difficile. the modified candle-jar system was found to be a sensitive and cost-effective alternative that might be used in resource-limited settings.201628256472
molecular detection of clostridium difficile on inert surfaces from a costa rican hospital during and after an outbreak.hospital transmission of clostridium difficile is fostered by contamination of surfaces and medical equipment with spores highly resistant to disinfectants and regular cleaning procedures. despite the outbreaks and fatalities that c difficile causes, its epidemiology has not been studied in hospitals from middle- and low-income countries. to tackle this knowledge gap, the detection frequency of c difficile dna on inert surfaces of a major costa rican hospital during and after an outbreak was com ...201628340959
microbial ecosystem analysis in root canal infections refractory to endodontic treatment.the purpose of this study was to combine multiple displacement amplification and checkerboard dna-dna hybridization to qualitatively and quantitatively evaluate the microbiota present in infections refractory to endodontic treatment.201627377440
effect of united states buckwheat honey on antibiotic-resistant hospital acquired pathogens.due to an upsurge in antibiotic-resistant infections and lack of therapeutic options, new approaches are needed for treatment. honey may be one such potential therapeutic option. we investigated the susceptibility of hospital acquired pathogens to four honeys from wisconsin, united states, and then determined if the antibacterial effect of each honey against these pathogens is primarily due to the high sugar content.201628292167
human clostridium difficile infection caused by a livestock-associated pcr ribotype 237 strain in western australia.clostridium difficile infection (cdi) is a significant gastrointestinal disease in the developed world and increasingly recognised as a zoonotic infection. in north america and europe, the pcr ribotype (rt) 078 strain of c. difficile is commonly found in production animals and as a cause of disease in humans although proof of transmission from animals is lacking. this strain is absent in australian livestock. we report a case of human cdi caused by a strain of c. difficile belonging to known aus ...201628348781
rhodococcus fascians infection after haematopoietic cell transplantation: not just a plant pathogen?rhodococcus spp. have been implicated in a variety of infections in immunocompromised and immunocompetent hosts. rhodococcus equi is responsible for the majority of reported cases, but rhodococcus erythropolis, rhodococcusgordoniae and rhodococcusruber infections have been described. there are no prior reports of human infection with rhodococcus fascians.201628348752
risk factors for clostridium difficile infection in hiv-infected patients.clostridium difficile infection is a healthcare-associated infection resulting in significant morbidity. although immunosuppression is associated with clostridium difficile infection acquisition and adverse outcomes, the epidemiology of clostridium difficile infection in hiv-infected patients has been little studied in the era of antiretroviral therapy. this study identifies the risk factors for acquisition of clostridium difficile infection in hiv-infected patients.201628348742
molecular appraisal of intestinal parasitic infection in transplant recipients.diarrhoea is the main clinical manifestation caused by intestinal parasitic infections in patients, with special reference to transplant recipients who require careful consideration to reduce morbidity and mortality. further, molecular characterization of some important parasites is necessary to delineate the different modes of transmission to consider appropriate management strategies. we undertook this study to investigate the intestinal parasitic infections in transplant recipients with or wi ...201627934806
bacteria-mediated hypoxia-specific delivery of nanoparticles for tumors imaging and therapy.the hypoxia region in a solid tumor has been recognized as a complex microenvironment revealing very low oxygen concentration and deficient nutrients. the hypoxic environment reduces the susceptibility of the cancer cells to anticancer drugs, low response of free radicals, and less proliferation of cancer cells in the center of the solid tumors. however, the reduced oxygen surroundings provide an appreciable habitat for anaerobic bacteria to colonize. here, we present the bacteria-mediated targe ...201627148804
intestinal microbiota in pediatric surgical cases administered bifidobacterium breve: a randomized controlled trial.the efficacy of perioperative probiotic administration has been reported in adults. we examined the effects of orally administered bifidobacterium breve strain yakult (bbg-01) on outcomes in pediatric surgical cases by assessing intestinal and blood microbiota. bbg-01 was well tolerated without adverse effects, and postoperative infectious complications were significantly decreased. fecal analysis showed increased bifidobacterium and decreased enterobacteriaceae, clostridium difficile, and pseud ...201626859092
screening of bifidobacteria and lactobacilli able to antagonize the cytotoxic effect of clostridium difficile upon intestinal epithelial ht29 monolayer.clostridium difficile is an opportunistic pathogen inhabiting the human gut, often being the aetiological agent of infections after a microbiota dysbiosis following, for example, an antibiotic treatment. c. difficile infections (cdi) constitute a growing health problem with increasing rates of morbidity and mortality at groups of risk, such as elderly and hospitalized patients, but also in populations traditionally considered low-risk. this could be related to the occurrence of virulent strains ...201627148250
intestinal microbiota and allergic diseases: a systematic review.evidence suggests that possible imbalances in intestinal microbiota composition may be implicated in the occurrence of allergic diseases. although several studies published until 2006 indicated a correlation between microbiota composition and allergic symptoms, it has not been possible to distinguish protective microorganisms from those associated with increased risk of allergic diseases. therefore, the objective of this study was to review the studies published since 2007 that address the intes ...201625985709
effect of bifidobacterium upon clostridium difficile growth and toxicity when co-cultured in different prebiotic substrates.the intestinal overgrowth of clostridium difficile, often after disturbance of the gut microbiota by antibiotic treatment, leads to c. difficile infection (cdi) which manifestation ranges from mild diarrhea to life-threatening conditions. the increasing cdi incidence, not only in compromised subjects but also in traditionally considered low-risk populations, together with the frequent relapses of the disease, has attracted the interest for prevention/therapeutic options. among these, probiotics, ...201627242753
use of a collagen membrane to enhance the survival of primary intestinal epithelial cells.intestinal epithelial cell culture is important for biological, functional and immunological studies. since enterocytes have a short in vivo life span due to anoikis, we aimed to establish a novel and reproducible method to prolong the survival of mouse and human cells. cells were isolated following a standard procedure, and cultured on ordered-cow's collagen membranes. a prolonged cell life span was achieved; cells covered the complete surface of bio-membranes and showed a classical enterocyte ...201627626762
[design of artificial foetor flatus based on bacterial volatile compounds].excessive flatulence can be a huge social problem. the purpose of this study was to design artificial flatus from bacterial volatile compounds to stimulate research into neutralizing measures.201627966414
effect of oligosaccharides on the adhesion of gut bacteria to human ht-29 cells.the influence of five oligosaccharides (cellobiose, stachyose, raffinose, lactulose and chito-oligosaccharides) on the adhesion of eight gut bacteria (bifidobacterium bifidum atcc 29521, bacteroides thetaiotaomicron atcc 29148d-5, clostridium leptum atcc 29065, blautia coccoides atcc 29236, faecalibacterium prausnitzii atcc 27766, bacteroides fragilis atcc 23745, clostridium difficile atcc 43255 and lactobacillus casei atcc 393) to mucous secreting and non-mucous secreting ht-29 human epithelial ...201627018325
alterations in the mucosa-associated bacterial composition in crohn's disease: a pilot study.changes in the intestinal bacterial composition seem to play a major role in the pathogenesis and in the clinical course of inflammatory bowel diseases (ibd), which consist of crohn's disease (cd), and ulcerative colitis (uc). mutations in the nod2 gene are the most important genetic risk factors for the development of cd. in this study, the association between mucosal biopsies and the mucosa-associated bacterial composition from cd and uc patients regarding their genetic risk factors (mutations ...201626951181
efficacy of vancomycin extended-dosing regimens for treatment of simulated clostridium difficile infection within an in vitro human gut model.effects of two vancomycin extended-dosing regimens on microbiota populations within an in vitro gut model of simulated clostridium difficile infection (cdi) were evaluated.201626755495
high occurrence of fusobacterium nucleatum and clostridium difficile in the intestinal microbiota of colorectal carcinoma patients.colorectal carcinoma is considered the fourth leading cause of cancer deaths worldwide. several microorganisms have been associated with carcinogenesis, including enterococcus spp., helicobacter pylori, enterotoxigenic bacteroides fragilis, pathogenic e. coli strains and oral fusobacterium. here we qualitatively and quantitatively evaluated the presence of oral and intestinal microorganisms in the fecal microbiota of colorectal cancer patients and healthy controls. seventeen patients (between 49 ...201626691472
a recombination directionality factor controls the cell type-specific activation of σk and the fidelity of spore development in clostridium difficile.the strict anaerobe clostridium difficile is the most common cause of nosocomial diarrhea, and the oxygen-resistant spores that it forms have a central role in the infectious cycle. the late stages of sporulation require the mother cell regulatory protein σk. in bacillus subtilis, the onset of σk activity requires both excision of a prophage-like element (skinbs) inserted in the sigk gene and proteolytical removal of an inhibitory pro-sequence. importantly, the rearrangement is restricted to the ...201627631621
germinants and their receptors in clostridia.many anaerobic spore-forming clostridial species are pathogenic, and some are industrially useful. although many are strict anaerobes, the bacteria persist under aerobic and growth-limiting conditions as multilayered metabolically dormant spores. for many pathogens, the spore form is what most commonly transmits the organism between hosts. after the spores are introduced into the host, certain proteins (germinant receptors) recognize specific signals (germinants), inducing spores to germinate an ...201627432831
detecting cortex fragments during bacterial spore germination.the process of endospore germination in clostridium difficile, and other clostridia, increasingly is being found to differ from the model spore-forming bacterium, bacillus subtilis. germination is triggered by small molecule germinants and occurs without the need for macromolecular synthesis. though differences exist between the mechanisms of spore germination in species of bacillus and clostridium, a common requirement is the hydrolysis of the peptidoglycan-like cortex which allows the spore co ...201627403726
impact of standard test protocols on sporicidal efficacy.there has been an increase in the availability of commercial sporicidal formulations. any comparison of sporicidal data from the literature is hampered by the number of different standard tests available and the use of diverse test conditions including bacterial strains and endospore preparation.201627133281
characterization of clostridium difficile spores lacking either spovac or dipicolinic acid synthetase.the spore-forming obligate anaerobe clostridium difficile is a leading cause of antibiotic-associated diarrhea around the world. in order for c. difficile to cause infection, its metabolically dormant spores must germinate in the gastrointestinal tract. during germination, spores degrade their protective cortex peptidoglycan layers, release dipicolinic acid (dpa), and hydrate their cores. in c. difficile, cortex hydrolysis is necessary for dpa release, whereas in bacillus subtilis, dpa release i ...201627044622
the spoiiq-spoiiiah complex of clostridium difficile controls forespore engulfment and late stages of gene expression and spore morphogenesis.engulfment of the forespore by the mother cell is a universal feature of endosporulation. in bacillus subtilis, the forespore protein spoiiq and the mother cell protein spoiiiah form a channel, essential for endosporulation, through which the developing spore is nurtured. the two proteins also form a backup system for engulfment. unlike in b. subtilis, spoiiq of clostridium difficile has intact lytm zinc-binding motifs. we show that spoiiq or spoiiiah deletion mutants of c. difficile result in a ...201626690930
regulation of clostridium difficile spore formation by the spoiiq and spoiiia proteins.sporulation is an ancient developmental process that involves the formation of a highly resistant endospore within a larger mother cell. in the model organism bacillus subtilis, sporulation-specific sigma factors activate compartment-specific transcriptional programs that drive spore morphogenesis. σg activity in the forespore depends on the formation of a secretion complex, known as the "feeding tube," that bridges the mother cell and forespore and maintains forespore integrity. even though the ...201526465937
spore cortex hydrolysis precedes dipicolinic acid release during clostridium difficile spore germination.bacterial spore germination is a process whereby a dormant spore returns to active, vegetative growth, and this process has largely been studied in the model organism bacillus subtilis. in b. subtilis, the initiation of germinant receptor-mediated spore germination is divided into two genetically separable stages. stage i is characterized by the release of dipicolinic acid (dpa) from the spore core. stage ii is characterized by cortex degradation, and stage ii is activated by the dpa released du ...201525917906
morphological and genetic characterization of group i clostridium botulinum type b strain 111 and the transcriptional regulator spoiiid gene knockout mutant in sporulation.clostridium botulinum is a heat-resistant spore-forming bacterium that causes the serious paralytic illness botulism. heat-resistant spores may cause food sanitation hazards and sporulation plays a central role in the survival of c. botulinum. we observed morphological changes and investigated the role of the transcriptional regulator spoiiid in the sporulation of c. botulinum type b strain 111 in order to elucidate the molecular mechanism in c. botulinum. c. botulinum type b formed heat-resista ...201525652599
diverse mechanisms regulate sporulation sigma factor activity in the firmicutes.sporulation allows bacteria to survive adverse conditions and is essential to the lifecycle of some obligate anaerobes. in bacillus subtilis, the sporulation-specific sigma factors, σ(f), σ(e), σ(g), and σ(k), activate compartment-specific transcriptional programs that drive sporulation through its morphological stages. the regulation of these sigma factors was predicted to be conserved across the firmicutes, since the regulatory proteins controlling their activation are largely conserved. howev ...201525646759
spoiiid-mediated regulation of σk function during clostridium difficile sporulation.the spore-forming bacterial pathogen clostridium difficile is a leading cause of health-care-associated diarrhea worldwide. although c. difficile spore formation is essential for disease transmission, the regulatory pathways that control this developmental process have only been partially characterized. in the well-studied spore-former bacillus subtilis, the highly conserved σ(e) , spoiiid and σ(k) regulatory proteins control gene expression in the mother cell to ensure proper spore formation. t ...201525393584
prevalence of gastrointestinal pathogenic bacteria in patients with diarrhoea attending groote schuur hospital, cape town, south africa.diarrhoea due to gastrointestinal infections is a significant problem facing the south african (sa) healthcare system. infections can be acquired both from the community and from the hospital environment itself, the latter acting as a reservoir for potential pathogenic bacteria.201526242530
conventional and molecular methods in the diagnosis of community-acquired diarrhoea in children under 5 years of age from the north-eastern region of poland.the purpose of this study was to determine the main causative agents of community-acquired acute diarrhoea in children using conventional methods and pcr.201526159845
predictors of monomicrobial necrotizing soft tissue infections.broad-spectrum antibiotic therapy is critical in the management of necrotizing soft tissue infections (nsti) in the emergency setting. clindamycin often is included empirically to cover monomicrobial gram-positive pathogens but probably is of little value for polymicrobial infections and is associated with significant side effects, including the induction of clostridium difficile colitis. however, there have been no studies predicting monomicrobial infections prior to obtaining cultures. the pur ...201526110633
the intestinal microbiota composition and weight development in children: the koala birth cohort study.to investigate whether the intestinal microbiota composition in early infancy is associated with subsequent weight development in children.201525298274
probiotics for the primary and secondary prevention of c. difficile infections: a meta-analysis and systematic review.clostridium difficile infections are a global clinical concern and are one of the leading causes of nosocomial outbreaks. preventing these infections has benefited from multidisciplinary infection control strategies and new antibiotics, but the problem persists. probiotics are effective in preventing antibiotic-associated diarrhea and may also be a beneficial strategy for c. difficile infections, but randomized controlled trials are scarce. this meta-analysis pools 21 randomized, controlled tria ...201527025619
prebiotic preferences of human lactobacilli strains in co-culture with bifidobacteria and antimicrobial activity against clostridium difficile.to evaluate robustness, prebiotic utilization of lactobacillus paracasei f8 and lactobacillus plantarum f44 in mono- and co-cultures with bifidobacterium breve 46 and bifidobacterium animalis sub sp. lactis 8 : 8 and antimicrobial activity of co-culture against clostridium difficile.201526381324
production of biologically active scfv and vhh antibody fragments in bifidobacterium longum.bifidobacteria constitute a significant part of healthy intestinal microbiota in adults and infants and present a promising platform for construction of genetically modified probiotic agents for treatment of gastrointestinal disorders. in this study, three strains of bifidobacterium longum were constructed that express and secrete biologically active single-chain antibodies against human tnf-α and clostridium difficile exotoxin a. anti-tnf-α scfv antibody d2e7 was produced at the level of 25 μg  ...201525994292
donor recruitment for fecal microbiota transplantation.increasing demand for fecal microbiota transplantation (fmt) has created a need for stool banks sourced from long-term healthy donors. here, we describe our experience in recruiting and screening fecal donors.201526070003
profiling humoral immune responses to clostridium difficile-specific antigens by protein microarray analysis.clostridium difficile is an anaerobic, gram-positive, and spore-forming bacterium that is the leading worldwide infective cause of hospital-acquired and antibiotic-associated diarrhea. several studies have reported associations between humoral immunity and the clinical course of c. difficile infection (cdi). host humoral immune responses are determined using conventional enzyme-linked immunosorbent assay (elisa) techniques. herein, we report the first use of a novel protein microarray assay to d ...201526178385
the potential role of nemonoxacin for treatment of common infections.nemonoxacin , a novel non-fluorinated quinolone, exhibits potent activity against gram-positive bacteria, including mrsa and fluoroquinolone-resistant mrsa, gram-negative and atypical pathogens. this agent also has a reduced propensity for resistance development in many kinds of pathogens.201525529577
mortality, hospital costs, payments, and readmissions associated with clostridium difficile infection among medicare beneficiaries.the management of clostridium difficile infection (cdi) among hospitalized patients is costly, and ongoing payment reform is compelling hospitals to reduce its burden. to assess the impact of cdi on mortality, hospital costs, healthcare use, and medicare payments for beneficiaries who were discharged with cdi listed as a secondary international classification of diseases, ninth revision, clinical modification claim diagnosis.201527885315
identification of a novel mutation at the primary dimer interface of gyra conferring fluoroquinolone resistance in clostridium difficile.the aim of this study was to determine whether alternative resistance mechanisms, other than mutation in the quinolone resistance-determining region (qrdr) of dna gyrase, could confer fluoroquinolone resistance in clostridium difficile. an in vitro-generated c. difficile mutant exhibiting increased fluoroquinolone resistance was isolated through antibiotic selection on ciprofloxacin. the qrdr of this mutant was investigated by chain-termination sequencing and was found to be devoid of mutation. ...201527842877
risk factors for recurrent clostridium difficile infections and strategies to decrease readmissions in a community hospital.currently there are no universally accepted approaches for the prevention of recurrent clostridium difficile infections (cdi) following the initial infection. several studies have identified common risk factors for the emergence of recurrent cdi. identifying patients at high risk for recurrent cdi through the assessment of risk factors at initial diagnosis could enable health care providers to optimize available treatment options. a vancomycin hydrochloride-tapered regimen may be an effective tr ...201527621508
evaluating the effectiveness of an antimicrobial stewardship intervention on reducing the incidence rate of healthcare-associated clostridium difficile infection. 201527437421
[recent epidemiology of clostridium difficile infection in japan].clostridium difficile (c. difficile) is a major pathogen for diarrhea in hospitalized patients and because of outbreak of highly virulent strain in eu and us, increased length of hospital stay and increased numbers of severe patients and deaths have become major challenges. in recent years, transmissions through community-acquired or food-borne infections are reported. national surveillance has been already performed overseas. guidelines for preventing c. difficile infection (cdi) is available, ...201527004398
microbiome regulation of autoimmune, gut and liver associated diseases.extensive analysis of the complexity and diversity of microbiota using metagenomics in the gut and other body sites has provided evidence that dysbiosis occurs in many disease states. with the application of next generation sequencing technology this research is starting to uncover the impact of microbiota on metabolic, physiological and immunological pathways and elucidate the cellular and molecular mechanisms involved. to highlight these advances we have focused on autoimmunity and gut and liv ...201526817477
hospital acquired diarrhea in a burn center of tehran.incidence of hospital-acquired diarrhea has increased rapidly and burn patients are at high risk of getting it. infection with c. difficile is the most common cause of antibiotic associated diarrhea. the aim of this study was to determine the baseline characteristics and clinical presentation of hospital-acquired diarrhea and compare c. difficile and non-c. difficile diarrhea in burn patients treated at a burn center.201526885330
[clostridium difficile are on the rise]. 201526953476
the discovery of a novel antibiotic for the treatment of clostridium difficile infections: a story of an effective academic-industrial partnership.academic drug discovery is playing an increasingly important role in the identification of new therapies for a wide range of diseases. there is no one model that guarantees success. we describe here a drug discovery story where chance, the ability to capitalise on chance, and the assembling of a range of expertise, have all played important roles in the discovery and subsequent development of an antibiotic chemotype based on the bis-benzimidazole scaffold, with potency against a number of curren ...201526949507
persisting variation in testing and reporting clostridium difficile cases.previous evidence suggested a significant variation in the testing algorithms used across the united kingdom for the diagnosis of clostridium difficile infection (cdi) and new national guidelines were issued in 2012. the main aim of this paper was to explore if such variation in testing and reporting is still present, to compare the management of cdi cases, and to investigate if there is any significant variation in the antibiotic policies among different hospitals. using london hospitals as a s ...201526877769
prophylactic use of gentamicin/flucloxacillin versus cefuroxime in surgery: a meta analysis of clinical studies.to conduct meta-analyses of all available studies comparing efficacies of prophylactic cefuroxime and prophylactic gentamicin/flucloxacillin (gen/flu) in preventing post-operative wound infections and their association with risks of clostridium difficile infections and post-operative renal impairment.201526770380
prospective evaluation of a novel two-step protocol for screening of clostridium difficile infection in hospitalized adult patients.abstract. clostridium difficile infection (cdi) is one of the most common nosocomial infections in thailand and worldwide. the clinical spectrum ranges from annoy- ing diarrhea to severe life-threatening disease. enzyme-linked immunofluorescent assay for cytotoxins a/b (cytotoxins a/b elfa), which has been widely used in our institute, generally is considered as having low sensitivity for diagnosis of cdi. the study was a prospective evaluation of a novel two-step diagnostic algorithm, in which ...201526867362
[fecal bacteriotherapy for the treatment of recurrent clostridium difficile colitis used in the clinic of infectious diseases of the university hospital brno in 2010-2014 - a prospective study].the aim of the study is to assess the efficacy of fecal bacteriotherapy in the treatment of clostridium difficile colitis.201526795227
the sos response master regulator lexa is associated with sporulation, motility and biofilm formation in clostridium difficile.the lexa regulated sos network is a bacterial response to dna damage of metabolic or environmental origin. in clostridium difficile, a nosocomial pathogen causing a range of intestinal diseases, the in-silico deduced lexa network included the core sos genes involved in the dna repair and genes involved in various other biological functions that vary among different ribotypes. here we describe the construction and characterization of a lexa clostron mutant in c. difficile r20291 strain. the mutat ...201526682547
two patients with fulminant clostridium difficile enteritis who had not undergone total colectomy: a case series and review of the literature.introduction. clostridium difficile is the most common cause of healthcare associated infectious diarrhea, and its most common clinical manifestation is pseudomembranous colitis. small bowel enteritis is reported infrequently in the literature and typically occurs only in patients who have undergone ileal pouch anastomosis due to inflammatory bowel disease or total abdominal colectomy for other reasons. presentation of cases. we report here two cases in which patients developed small bowel c. di ...201526682082
time-resolved amino acid uptake of clostridium difficile 630δerm and concomitant fermentation product and toxin formation.clostridium difficile is one of the major nosocomial threats causing severe gastrointestinal infections. compared to the well documented clinical symptoms, little is known about the processes in the bacterial cell like the regulation and activity of metabolic pathways. in this study, we present time-resolved and global data of extracellular substrates and products. in a second part, we focus on the correlation of fermentation products and substrate uptake with toxin production.201526680234
clinical features and characteristics of clostridium difficile pcr-ribotype 176 infection: results from a 1-year university hospital internal ward study.clostridium difficile infection (cdi) is a major cause of antibiotic-associated diarrhoea. given an increasing cdi incidence and global spread of epidemic ribotypes, a 1-year study was performed to analyse the molecular characteristics of c. difficile isolates and associated clinical outcomes from patients diagnosed with cdi in the internal medicine department at university hospital motol, prague from february 2013 to february 2014.201526698842
molecular characteristics of clostridium difficile strains from patients with a first recurrence more than 8 weeks after the primary infection.nearly all published studies of recurrent clostridium difficile infections (cdi) report recurrent cdi within 8 weeks after the primary infection. this study explored the molecular characteristics of c. difficile isolates from the first recurrent cdi more than 8 weeks after the primary infection.201526698688
self-administered home series fecal "minitransplants" for recurrent clostridium difficile infection on a rectal remnant.a fecal microbiota transplant has proved to be an extremely effective method for patients with recurrent infections with clostridium difficile. we present the case of a 65-year-old female patient with multiple clostridium difficile infection (cdi) relapses on the rectal remnant, post-colectomy for a cdi-related toxic megacolon. the patient also evidenced associated symptomatic clostridium difficile vaginal infection. she was successfully treated with serial fecal "minitransplants" (self-administ ...201526697583
clostridium difficile infection in hospitalized cirrhotic patients with hepatic encephalopathy.patients with liver cirrhosis are at-risk population for clostridium difficile infection (cdi). there is a paucity of data on the incidence of cdi in cirrhotics with hepatic encephalopathy (he). the aim of the study was to evaluate the incidence and risk factors for cdi in cirrhotics hospitalized with he.201526697567
nutritional keys for intestinal barrier modulation.the intestinal tract represents the largest interface between the external environment and the human body. nutrient uptake mostly happens in the intestinal tract, where the epithelial surface is constantly exposed to dietary antigens. since inflammatory response toward these antigens may be deleterious for the host, a plethora of protective mechanisms take place to avoid or attenuate local damage. for instance, the intestinal barrier is able to elicit a dynamic response that either promotes or i ...201526697008
comparison of a novel chemiluminescent based algorithm to three algorithmic approaches for the laboratory diagnosis of clostridium difficile infection.rapid commercial assays, including nucleic acid amplification tests and immunoassays for clostridium. difficile toxins, have replaced the use of older assays. they are included in a two-step algorithm diagnosis, including first the detection of the glutamate dehydrogenase (gdh) as a screening method and second the detection of toxins as a confirmatory method. although assays that detect the presence of free toxins in feces are known to lack sensitivity, they are preferable to confirm infection. ...201526705425
quality outcomes in the surgical intensive care unit after electronic health record implementation.the electronic health record (ehr) is increasingly viewed as a means to provide more coordinated, patient-centered care. few studies consider the impact of ehrs on quality of care in the intensive care unit (icu) setting.201526767058
top ten facts you need to know about clostridium difficile. 201526863828
the use of an iv to po clinical intervention form to improve antibiotic administration in a community based hospital.antimicrobials are among the most commonly prescribed medications in acute care settings, with 50% of antimicrobial use deemed inappropriate. antimicrobial stewardship programs (asp) aim to optimize antibiotic use in order to improve patient clinical outcomes while minimizing unwanted effects of therapy including clostridium difficile infection (cdi) and the emergence of resistant organisms. antimicrobial stewardship involves a coordinated set of interventions that ensure patients who require an ...201526734367
an intervention to reduce health care personnel hand contamination during care of patients with clostridium difficile infection.in a quasi-experimental study, an educational intervention to improve the technique for personal protective equipment (ppe) removal in conjunction with disinfection of gloves before removal of ppe reduced acquisition of clostridium difficile spores on the hands of health care personnel caring for patients with c difficile infection.201526654239
hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce clostridium difficile infection, methicillin-resistant staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase.we report a statistically significant reduction in clostridium difficile infection (from 1.38 to 0.90 cases per 1,000 patient days), vancomycin-resistant enterococci (from 0.21 to 0.01 cases per 1,000 patient days), and extended-spectrum β-lactamase-producing gram-negative bacteria (from 0.16 to 0.01 cases per 1,000 patient days) associated with the introduction of hydrogen peroxide vapor for terminal decontamination of patient rooms and improvements in hand hygiene compliance.201526654237
association of clostridium difficile infection in hospital mortality: a systematic review and meta-analysis.the purpose of this study was to evaluate whether clostridium difficile infection (cdi) contributed to hospital mortality and whether the correlation between intensive care units (icus) and surgical wards in hospital cdi risk still remain controversial.201526654234
the role of glutamate dehydrogenase (gdh) testing assay in the diagnosis of clostridium difficile infections: a high sensitive screening test and an essential step in the proposed laboratory diagnosis workflow for developing countries like china.the incidence and severity of clostridium difficile infection (cdi) in north america and europe has increased significantly since the 2000s. however, cdi is not widely recognized in china and other developing countries due to limited laboratory diagnostic capacity and low awareness. most published studies on laboratory workflows for cdi diagnosis are from developed countries, and thus may not be suitable for most developing countries. therefore, an alternative strategy for developing countries i ...201526659011
probiotics in digestive diseases: focus on lactobacillus gg.probiotics are becoming increasingly important in basic and clinical research, but they are also a subject of considerable economic interest due to their expanding popularity. they are live micro-organisms which, when administered in adequate amounts, confer a health benefit to the host. from this very well-known definition, it is clear that, unlike drugs, probiotics might be useful in healthy subjects to reduce the risk of developing certain diseases or to optimise some physiological functions. ...201526657927
clostridium difficile ribotypes in humans and animals in brazil.clostridium difficile is an emerging enteropathogen responsible for pseudomembranous colitis in humans and diarrhoea in several domestic and wild animal species. despite its known importance, there are few studies about c. difficile polymerase chain reaction (pcr) ribotypes in brazil and the actual knowledge is restricted to studies on human isolates. the aim of the study was therefore to compare c. difficile ribotypes isolated from humans and animals in brazil. seventy-six c. difficile strains ...201526676318
optimal screening and donor management in a public stool bank.fecal microbiota transplantation is an effective treatment for recurrent clostridium difficile infection and is being investigated as a treatment for other microbiota-associated diseases. to facilitate these activities, an international public stool bank has been created, which screens donors and processes stools in a standardized manner. the goal of this research is to use mathematical modeling and analysis to optimize screening and donor management at the stool bank.201526675010
the susceptibility of celiac disease intestinal microbiota to clostridium difficile infection. 201526673511
the effect of lactobacillus plantarum 299v on the incidence of clostridium difficile infection in high risk patients treated with antibiotics.lactobacillus plantarum 299v (lp299v) has been used in order to reduce gastrointestinal symptoms during antibiotic exposure. however, it remains controversial whether or not probiotics are effective in the prevention of clostridium difficile infections (cdi) among patients receiving antibiotics. the aim of this study was to analyze the cdi among patients receiving antibiotics and hospitalized in the period before and after starting routine use of lp299v as a prevention of this infection.201526690209
25-hydroxyvitamin d concentrations and clostridium difficile infection: a meta-analysis.well-known risk factors for clostridium difficile infection (cdi) are exposure to antibiotics and gastric acid suppressants. recent studies have provided some evidence of an association between hypovitaminosis d and the risk of cdi. therefore, this meta-analysis aimed to pool all the existing evidence to investigate the association between 25-hydroxyvitamin d (25[oh]d) and cdi.201526701764
reexamining the germination phenotypes of several clostridium difficile strains suggests another role for the cspc germinant receptor.clostridium difficile spore germination is essential for colonization and disease. the signals that initiate c. difficile spore germination are a combination of taurocholic acid (a bile acid) and glycine. interestingly, the chenodeoxycholic acid class (cdca) bile acids competitively inhibit taurocholic acid-mediated germination, suggesting that compounds that inhibit spore germination could be developed into drugs that prophylactically prevent c. difficile infection or reduce recurring disease. ...201526668265
diagnostic yield of routine enteropathogenic stool tests in pediatric ulcerative colitis.it can be important to exclude infectious etiologies prior to adjusting immunosuppressive therapy in patients with ulcerative colitis (uc) exacerbation. we sought to determine the diagnostic yield of routine infectious stool studies in pediatric uc patients.201526663793
clostridium difficile infection and intestinal microbiota interactions.clostridium difficile remains the leading cause of healthcare-associated diarrhoea and outbreaks continue to occur worldwide. aside from nosocomial c. difficile infection, the bacterium is also increasingly important as a community pathogen. furthermore, asymptomatic carriage of c. difficile in neonates, adults and animals is also well recognised. the investigation of the gut's microbial communities, in both healthy subjects and patients suffering c. difficile infection (cdi), provides findings ...201526549493
[utility of a simultaneous detection kit for glutamate dehydrogenase and toxin a/b with toxigenic culture in the diagnosis and treatment of clostridium difficile infection].we examined how doctors evaluate the results of c. diff quik chek complete (complete) in the diagnosis and treatment of clostridium difficile infection (cdi). a total of 887 stool samples submitted from 2012 to 2013 were examined with complete. requested specimens among samples with discrepant results were inoculated onto ccma plates and incubated under anaerobic conditions for 48 h, then retested by complete if positive culture results were obtained. of the 887 specimens, 198 (22.3%) were gluta ...201526548233
evaluation of a clostridium difficile infection management policy with clinical pharmacy and medical microbiology involvement at a major canadian teaching hospital.clostridium difficile infection (cdi) represents a spectrum of disease and is a significant concern for healthcare institutions. our study objective was to assess whether implementation of a regional cdi management policy with clinical pharmacy and medical microbiology and infection control involvement would lead to an improvement in concordance in prescribing practices to an evidence-based cdi disease severity assessment and pharmacological treatment algorithm.201526547905
small molecules take a big step against clostridium difficile.effective treatment of clostridium difficile infections demands a shift away from antibiotics towards toxin-neutralizing agents. work by bender et al., using a drug that attenuates toxin action in vivo without affecting bacterial survival, demonstrates the exciting potential of small molecules as a new modality in the fight against c. difficile.201526547239
susceptibility of clostridium difficile isolates of varying antimicrobial resistance phenotypes to smt19969 and 11 comparators.we determined the in vitro activity of smt19969 and 11 comparators, including metronidazole, vancomycin, and fidaxomicin, against 107 c. difficile isolates of different antimicrobial resistance phenotypes. fidaxomicin and smt19969 were the most active. the fidaxomicin and smt19969 geometric mean mics were highest in ribotypes known to show multiple resistance. coresistance to linezolid and moxifloxacin was evident in ribotypes 001, 017, 027, and 356. the high-level ceftriaxone resistance in ribo ...201526552981
cost analysis of hospitalized clostridium difficile-associated diarrhea (cdad).clostridium difficile-associated diarrhea (cdad) causes heavy financial burden on healthcare systems worldwide. as with all hospital-acquired infections, prolonged hospital stays are the main cost driver. previous cost studies only include hospital billing data and compare the length of stay in contrast to non-infected patients. to date, a survey of actual cost has not yet been conducted.201526550553
correction for zhang et al., toxin-mediated paracellular transport of antitoxin antibodies facilitates protection against clostridium difficile infection. 201526556881
inhibitory effect of epigallocatechin gallate on the virulence of clostridium difficile pcr ribotype 027.clostridium difficile infection (cdi) is the most prevalent cause of health-care-associated infections. cdi-related health-care costs and deaths are both increasing annually on a global scale. c. difficile have been reported in food products in canada, europe, and the united states; however, the systematic transmission of c. difficile between humans and animals is yet to be understood. because of the limitations of current therapeutic options, there is a need for the development of new patient t ...201526556797
asymptomatic clostridium difficile colonization: epidemiology and clinical implications.the epidemiology of clostridium difficile infection (cdi) has changed over the past decades with the emergence of highly virulent strains. the role of asymptomatic c. difficile colonization as part of the clinical spectrum of cdi is complex because many risk factors are common to both disease and asymptomatic states. in this article, we review the role of asymptomatic c. difficile colonization in the progression to symptomatic cdi, describe the epidemiology of asymptomatic c. difficile colonizat ...201526573915
neutralization of clostridium difficile toxin b mediated by engineered lactobacilli that produce single-domain antibodies.clostridium difficile is the primary cause of nosocomial antibiotic-associated diarrhea in the western world. the major virulence factors of c. difficile are two exotoxins, toxin a (tcda) and toxin b (tcdb), which cause extensive colonic inflammation and epithelial damage manifested by episodes of diarrhea. in this study, we explored the basis for an oral antitoxin strategy based on engineered lactobacillus strains expressing tcdb-neutralizing antibody fragments in the gastrointestinal tract. va ...201526573738
[diagnostic workup and therapy of infectious diarrhea. current standards].infectious diarrhea is very common; its severity ranges from uncomplicated, self-limiting courses to potentially life-threatening disease. a rapid diagnostic workup providing detailed information on the suspected pathogen should be performed only in patients at risk, analyzing one single stool sample for salmonella, shigella, campylobacter, and norovirus. in the presence of risk factors, such as a history of antibiotic exposure within the last 3 months, testing for clostridium difficile should b ...201526573083
application of density gradient for the isolation of the fecal microbial stool component and the potential use thereof.the idea of considering the gut microbiota as a virtual human organ has led to the concept of fecal microbiota transplantation (fmt), which has recently been extremely successful in the treatment of cases of recurrent clostridium difficile infection. administration of safe, viable, and representative fecal microbiota is crucial for fmt. to our knowledge, suitable techniques and systematic conditions for separating the fecal microbiota from stool samples have not been thoroughly investigated. in ...201526581409
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