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clarifying the management of clostridium difficile infection. 201526584845
quantitative lipoproteomics in clostridium difficile reveals a role for lipoproteins in sporulation.bacterial lipoproteins are surface exposed, anchored to the membrane by s-diacylglyceryl modification of the n-terminal cysteine thiol. they play important roles in many essential cellular processes and in bacterial pathogenesis. for example, clostridium difficile is a gram-positive anaerobe that causes severe gastrointestinal disease; however, its lipoproteome remains poorly characterized. here we describe the application of metabolic tagging with alkyne-tagged lipid analogs, in combination wit ...201526584780
[recent antibiotic use in german acute care hospitals - from benchmarking to improved prescribing and quality care].in view of increasing rates of bacterial resistance and clostridium difficile infections efforts to enhance appropriate and intelligent antibiotic prescribing have become important. a prerequisite is the availability of reliable antibiotic use data. so far antibiotic consumption data in this country had only a very limited coverage of acute care hospitals.201526583825
concomitant medical conditions and therapies preclude accurate classification of children with severe or severe complicated clostridium difficile infection.severe and severe complicated clostridium difficile infections (scdi/sccdi) were retrospectively assessed in a pediatric cohort. underlying medical conditions and concomitant medical therapy preclude accurate classification of children with scdi/sccdi, using current cdi severity definitions. revised cdi definitions in children should focus on more objective, age-appropriate, and cdi-specific markers of severity.201526582882
effectiveness of probiotic in preventing and treating antibiotic-associated diarrhoea and/or clostridium difficile-associated diarrhoea in patients with spinal cord injury: a protocol of systematic review of randomised controlled trials.probiotics may prevent antibiotic-associated and clostridium difficile-associated diarrhoea (aad/cdad). many spinal cord injury centre (scic) practitioners consider probiotics generically and may not realise that efficacy can be strain-, dose- and disease-specific. in order to confirm these effects and fully evaluate the extent of probiotic effectiveness in these patients, a systematic review and meta-analysis is indicated.201526596269
cost-effectiveness in clostridium difficile treatment decision-making.to develop a framework for the clinical and health economic assessment for management of clostridium difficile infection (cdi).201526601096
regulation of type iv pili contributes to surface behaviors of historical and epidemic strains of clostridium difficile.the intestinal pathogen clostridium difficile is an urgent public health threat that causes antibiotic-associated diarrhea and is a leading cause of fatal nosocomial infections in the united states. c. difficile rates of recurrence and mortality have increased in recent years due to the emergence of so-called "hypervirulent" epidemic strains. a great deal of the basic biology of c. difficile has not been characterized. recent findings that flagellar motility, toxin synthesis, and type iv pilus ( ...201526598364
making a case for pediatric antimicrobial stewardship programs.although antimicrobials are commonly used in children, it is important to remember that they can have a profound impact on this unique patient population. inadvertent consequences of antiinfective use in children include antimicrobial resistance, infection caused by clostridium difficile, increased risk of obesity, and adverse drug events. in addition, compared with adults, children have different dosing requirements, antimicrobial formulation needs, pharmacokinetics, and antimicrobial susceptib ...201526598095
probiotics and fecal microbiota transplant for primary and secondary prevention of clostridium difficile infection.clostridium difficile infection (cdi) is the most common cause of nosocomial diarrhea and is associated with an increased risk of mortality. the use of probiotics and fecal microbiota transplantation (fmt) has been studied to reduce the incidence and severity of this infection, but variable efficacy and safety data have been reported. probiotics are hypothesized to be effective in the management of cdi through a number of mechanisms that include maintenance of normal gastrointestinal flora, anti ...201526598094
economic burden of clostridium difficile in five hospitals of the florence health care system in italy.despite the awareness about the increasing rates of clostridium difficile infection (cdi) and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation), few studies are available in italy on the economic costs directly attributable to the cdi. the florence health care system has designed a study with the aim of describing the costs attributable to the cdi and defines the incremental economic burden associat ...201526604846
memory of germinant stimuli in bacterial spores.bacterial spores, despite being metabolically dormant, possess the remarkable capacity to detect nutrients and other molecules in their environment through a biochemical sensory apparatus that can trigger spore germination, allowing the return to vegetative growth within minutes of exposure of germinants. we demonstrate here that bacterial spores of multiple species retain memory of transient exposures to germinant stimuli that can result in altered responses to subsequent exposure. the magnitud ...201526604257
the aged gut in inflammatory bowel diseases.senescence is accompanied by various anatomical and functional alterations starting from mastication and deglutition and consequent modifications of nutrition. in addition, the widespread use of proton pump inhibitors and non-steroidal anti-inflammatory drugs in aged subjects weakens the gastric barrier, thus contributing to easier entry of microbes into the gastrointestinal tract. the microbiota of the elderly is less stable than that of younger adults, therefore, gut dysbiosis is more frequent ...201526603728
binding and entry of clostridium difficile toxin b is mediated by multiple domains.clostridium difficile is responsible for a number of serious gastrointestinal diseases caused primarily by two exotoxins, tcda and tcdb. these toxins enter host cells by binding unique receptors, at least partially via their combined repetitive oligopeptides (crops) domains. our study investigated structural determinants necessary for binding and entry of tcdb. deletion analyses identified tcdb residues 1372-1493 as essential for cytotoxicity in three cell lines. consistent with this observation ...201526602083
amoebiasis masquerading as inflammatory bowel disease.a 60-year-old japanese man presented with bloody diarrhoea. he stated that he had been diagnosed with ulcerative colitis (uc) 3 years prior, but discontinued follow-up care as treatment was ineffective. one year later, he came to our hospital with anorexia and weight loss. the abdomen was soft and flat without tenderness. laboratory tests were unremarkable; faecal culture and clostridium difficile toxin were negative. findings and biopsy from a subsequent colonoscopy reconfirmed his diagnosis of ...201526607188
the first report of a previously undescribed ebv-negative nk-cell lymphoma of the gi tract presenting as chronic diarrhoea with eosinophilia.a 74-year-old man presented with a 2-month history of watery diarrhoea. his complete blood count showed lymphopaenia and marked eosinophilia. investigations for common infectious causes including clostridium difficile toxin, stool culture, ova and parasites were negative. endoscopy revealed extensive colitis and a ct of the abdomen identified numerous large abdominal lymph nodes suspicious for lymphoma. multiple tissue samples were obtained; colon, mesenteric lymph node and bone marrow biopsy, a ...201526611482
the challenge of clostridium difficile infection: overview of clinical manifestations, diagnostic tools and therapeutic options.the most important infectious cause of antibiotic-associated diarrhoea and colitis is clostridium difficile, which is a gram-positive, anaerobic, spore-forming, toxin-producing bacillus. in this overview we will discuss the diagnostic and therapeutic management of patients presenting with suspected or proven c. difficile infection (cdi). the clinical spectrum varies from asymptomatic c. difficile carriers to fulminant colitis with multi-organ failure. the onset of symptoms is usually within 2 we ...201526612229
the or environment--hand hygiene, cleaning, and clostridium difficile. 201526616318
fecal transplantation successfully treats recurrent d-lactic acidosis in a child with short bowel syndrome.d-lactic acidosis can occur in patients with short bowel syndrome (sbs) when excessive malabsorbed carbohydrate (cho) enters the colon and is metabolized by colonic bacteria to d-lactate. d-lactate can be absorbed systemically, and increased serum levels are associated with central nervous system toxicity manifested by confusion, ataxia, and slurred speech. current therapy, usually directed toward suppressing intestinal bacterial overgrowth and limiting ingested cho, is not always successful. fe ...201526616138
mortality benefits of antibiotic computerised decision support system: modifying effects of age.antibiotic computerised decision support systems (cdsss) are shown to improve antibiotic prescribing, but evidence of beneficial patient outcomes is limited. we conducted a prospective cohort study in a 1500-bed tertiary-care hospital in singapore, to evaluate the effectiveness of the hospital's antibiotic cdss on patients' clinical outcomes, and the modification of these effects by patient factors. to account for clustering, we used multilevel logistic regression models. one-quarter of 1886 eli ...201526617195
scientific evidence for the use of current traditional systemic therapies in patients with hidradenitis suppurativa.traditional systemic therapies are frequently prescribed for the treatment of hidradenitis suppurativa (hs). clinicians consider antibiotics, retinoids, antiandrogens, immunosuppressants, and less common treatment, such as fumarates, in the management of hs. different classes of medications have been selected to treat hs based on their ability to target various pathways of the condition. concerns about infection, such as infection with clostridium difficile, necessitates switching therapy or sho ...201526470615
a gut odyssey: the impact of the microbiota on clostridium difficile spore formation and germination. 201526468647
the effect of polydextrose and probiotic lactobacilli in a clostridium difficile-infected human colonic model.clostridium difficile is a natural resident of the intestinal microbiota; however, it becomes harmful when the normal intestinal microbiota is disrupted, and overgrowth and toxin production occurs. the toxins can cause bloating and diarrhoea, which may cause severe disease and have the potential to cause outbreaks in hospitals and other healthcare settings. normally, antibiotic agents are used for treatment, although for some of the patients, these treatments provide only a temporary relief with ...201526468159
clostridium difficile screening in cirrhosis: one for all, or some for one? 201526467702
[the most common acute gastrointestinal infections].acute gastrointestinal infections and diarrhea with vomiting as its main presentation are a frequently encountered entity in an outpatient setting. due to a mostly self-limiting disease course a diagnostic work-up is often futile. viral infections caused by noro- or rotavirus are most frequent, while bacterial infections are second line due to high hygienic standards in developed countries. in an inpatient setting and after a precedent antibiotic treatment one should think of clostridium diffici ...201526463905
effects of proton pump inhibitors and histamine-2 receptor antagonists on response to fidaxomicin or vancomycin in patients with clostridium difficile-associated diarrhoea.it has been established that use of proton pump inhibitors (ppis) is associated with an increased risk of acquiring clostridium difficile-associated diarrhoea (cdad). however, it is not known whether the use of ppis or histamine-2 receptor antagonists (h2ras) concurrently with cdad-targeted antibiotic treatment affects clinical response or recurrence rates.201526462279
the non-toxigenic clostridium difficile cd37 protects mice against infection with a bi/nap1/027 type of c. difficile strain.clostridium difficile cd37, a clinical isolate from the usa, does not produce toxin a, b or binary toxin. the aim of this study was to determine whether strain cd37 can protect mice against infection from a challenge with a toxigenic c. difficile strain. three groups of mice (n = 10) were pretreated with a antibiotics cocktail for 5 days, switched to sterile water for 2 days, and given one dose of clindamycin (10 mg/kg) one day (day-1) before challenge (day 0) with a toxigenic c. difficile strai ...201526461425
preparation and preliminary application of monoclonal antibodies to the receptor binding region of clostridium difficile toxin b.a previous nationwide chinese epidemiological study revealed through isolation of a‑b+ clostridium difficile strains, which produce toxin b (tcdb), but not toxin a tcda, that the strains are widespread and more frequent in east asian countries,. the development of a process capable of detecting tcdb is required in microbiological laboratories in order to facilitate the control of the a‑b+ c. difficile strains, however, no diagnostic reagents have been developed to date. the aim of the present st ...201526459027
microbiome as mediator: do systemic infections start in the gut?the intestinal microbiome is emerging as a crucial mediator between external insults and systemic infections. new research suggests that our intestinal microorganisms contribute to critical illness and the development of non-gastrointestinal infectious diseases. common pathways include a loss of fecal intestinal bacterial diversity and a disproportionate increase in toxogenic bacterial species. therapeutic interventions targeting the microbiome - primarily probiotics - have yielded limited resul ...201526457009
a potential cellular explanation for the increased risk of clostridium difficile infection due to hypoalbuminemia: reply di bella et al. 201526456896
the protective role of albumin in clostridium difficile infection: a step toward solving the puzzle. 201526456662
complete genome sequence of the clostridium difficile type strain dsm 1296t.in this study, we sequenced the complete genome of the clostridium difficile type strain dsm 1296(t). a combination of single-molecule real-time (smrt) and illumina sequencing technology revealed the presence of one chromosome and two extrachromosomal elements, the bacteriophage phicdif1296t and a putative plasmid-like structure harboring genes of another bacteriophage.201526450746
identification of population at risk for future clostridium difficile infection following hospital discharge to be targeted for vaccine trials.efforts to develop a clostridium difficile vaccine are underway; identification of patients at risk for c. difficile infection (cdi) is critical to inform vaccine trials. we identified groups at high risk of cdi ≥ 2 8 days after hospital discharge.201526450660
[campylobacteriosis at the department of infectious diseases of the university hospital brno in 2011-2013: a retrospective study].to provide basic clinical, laboratory, and microbiological characteristics of adult patients with campylobacteriosis admitted to the department of infectious diseases university hospital brno (uhb), in 2011-2013.201526448303
the effectiveness of probiotics in reducing the incidence of clostridium difficile associated diarrhea in elderly patients: a systematic review protocol. 201526455937
evaluating risk factors for clostridium difficile infection in adult and pediatric hematopoietic cell transplant recipients.although hematopoietic cell transplant (hct) recipients are routinely exposed to classic risk factors for clostridium difficile infection (cdi), few studies have assessed cdi risk in these high-risk patients, and data are especially lacking for pediatric hct recipients. we aimed to determine incidence and risk factors for cdi in adult and pediatric allogeneic hct recipients.201526473030
fecal microbiota transplant: respice, adspice, prospice.respice, adspice, prospice, look to the past, look to the present, look to the future, is one of life's valuable axioms; for it is only if one knows where one has been can one intelligently prepare for the future. i have used this approach here to review fecal microbiota transplant (fmt). first used in fourth-century china to treat an assortment of gastrointestinal (gi) symptoms, today fmt is primarily used for recurrent clostridium difficile infection (rcdi). in the future, however, it is likel ...201526447968
clostridium difficile infection in rural ontario: a retrospective multisite population-based study.we conducted a retrospective, population-based study to assess the prevalence of clostridium difficile infections and the associated risk factors among inpatients and outpatients in our region.201526447730
longitudinal study of clostridium difficile shedding in raccoons on swine farms and conservation areas in ontario, canada.clostridium difficile is an important enteropathogen affecting humans, domestic animals, and wildlife. the objectives of this study were to 1) compare the prevalence and characteristics of c. difficile isolated from the feces of raccoons trapped on swine farms and conservation sites, and 2) investigate the role of raccoons as potential reservoirs for host-adapted strains of c. difficile using a longitudinal study. fecal swabs were collected from raccoons at 5 conservation sites and 5 swine farms ...201526446591
clostridium difficile: new insights into the evolution of the pathogenicity locus.the major virulence factors of clostridium difficile are toxins a and b. these toxins are encoded by tcda and tcdb genes, which form a pathogenicity locus (paloc) together with three additional genes that have been implicated in regulation (tcdr and tcdc) and secretion (tcde). to date, the paloc has always been found in the same location and is replaced in non-toxigenic strains by a highly conserved 75/115 bp non-coding region. here, we show new types of c. difficile pathogenicity loci through t ...201526446480
tracing the spread of clostridium difficile ribotype 027 in germany based on bacterial genome sequences.we applied whole-genome sequencing to reconstruct the spatial and temporal dynamics underpinning the expansion of clostridium difficile ribotype 027 in germany. based on re-sequencing of genomes from 57 clinical c. difficile isolates, which had been collected from hospitalized patients at 36 locations throughout germany between 1990 and 2012, we demonstrate that c. difficile genomes have accumulated sequence variation sufficiently fast to document the pathogen's spread at a regional scale. we de ...201526444881
efficacy and safety of metronidazole monotherapy versus vancomycin monotherapy or combination therapy in patients with clostridium difficile infection: a systematic review and meta-analysis.clostridium difficile infection (cdi) has become a global epidemiological problem for both hospitalized patients and outpatients. the most commonly used drugs to treat cdi are metronidazole and vancomycin. the aim of this study was to compare the efficacy and safety of metronidazole monotherapy with vancomycin monotherapy and combination therapy in cdi patients.201526444424
bacterial glycosyltransferase toxins.mono-glycosylation of host proteins is a common mechanism by which bacterial protein toxins manipulate cellular functions of eukaryotic target host cells. prototypic for this group of glycosyltransferase toxins are clostridium difficile toxins a and b, which modify guanine nucleotide-binding proteins of the rho family. however, toxin-induced glycosylation is not restricted to the clostridia. various types of bacterial pathogens including escherichia coli, yersinia, photorhabdus and legionella sp ...201526445410
monitoring in real time the cytotoxic effect of clostridium difficile upon the intestinal epithelial cell line ht29.the incidence and severity of clostridium difficile infections (cdi) has been increased not only among hospitalized patients, but also in healthy individuals traditionally considered as low risk population. current treatment of cdi involves the use of antibiotics to eliminate the pathogen, although recurrent relapses have also been reported. for this reason, the search of new antimicrobials is a very active area of research. the strategy to use inhibitors of toxin's activity has however been les ...201526436983
erratum for boudry et al., function of the crispr-cas system of the human pathogen clostridium difficile. 201526443462
scientific evidence for health effects attributed to the consumption of probiotics and prebiotics: an update for current perspectives and future challenges.probiotics and prebiotics, mainly commercialised as food ingredients and also as supplements, are considered highly profitable niche markets. however, in recent years, the food industry has suffered from a series of health claim restrictions on probiotics and prebiotics in many parts of the world, including those made by the european food safety authority. therefore, we reviewed the core benefits of probiotic and prebiotic consumption on health. a number of studies have examined the prevention a ...201526443321
on lactococcus lactis ul719 competitivity and nisin (nisaplin(®)) capacity to inhibit clostridium difficile in a model of human colon.clostridium difficile is the most frequently identified enteric pathogen in patients with nosocomially acquired, antibiotic-associated diarrhea and pseudomembranous colitis. although metronidazole and vancomycin were effective, an increasing number of treatment failures and recurrence of c. difficile infection are being reported. use of probiotics, particularly metabolically active lactic acid bacteria, was recently proposed as an alternative for the medical community. the aim of this study was ...201526441942
isolation and characterization of clostridium difficile in farm animals from slaughterhouse to retail stage in isfahan, iran.to determine the prevalence of clostridium difficile in farm animals from slaughterhouse through to retail stage, a total of 750 samples of feces, posteviscerated and washed carcass were collected from cattle, camels, goats, and sheep in isfahan, iran. the overall prevalence of c. difficile in feces, posteviscerated and washed carcass were 20 (13.3%), 23 (15.3%), and 11 (7.3%), respectively; while c. difficile was isolated from 79 (26.3%) retail samples. twenty-nine (3.8%) isolates were toxigeni ...201526440207
clostridium difficile infection in patients with liver disease: a review.over the past two decades, there has been a dramatic worldwide increase in both the incidence and severity of clostridium difficile infection (cdi). paralleling the increased incidence of cdi in the general population, there has been increased interest in cdi among patients with liver disease, particularly in those with liver cirrhosis and post liver transplantation. medline and several other electronic databases from january 1995 to december 2014 were searched in order to identify potentially r ...201526440041
clostridium difficile recurrent infection: possible implication of ta systems.clostridium difficile is an important nosocomial pathogen associated with antibiotic treatments. c. difficile's ability to survive antimicrobial therapy and transition from inert colonization to active infection is one of the most perplexing aspects of c. difficile infections and suggests that additional mechanisms are involved in persistence. in this regard, novel mechanisms linked with pathogenesis and persistence of c. difficile such as toxin-antitoxin systems might significantly contribute t ...201526439907
case report of gastric outlet obstruction from metastatic lobular breast carcinoma.the most common malignancy to cause gastric outlet obstruction is primary gastric adenocarcinoma and it is followed by carcinoma of the pancreas and gallbladder. herein, we report a case of gastric outlet obstruction secondary to metastatic lobular breast carcinoma.201526408025
economic assessment of fidaxomicin for the treatment of clostridium difficile infection (cdi) in special populations (patients with cancer, concomitant antibiotic treatment or renal impairment) in spain.the objective of this paper was to assess the cost-utility of fidaxomicin versus vancomycin in the treatment of clostridium difficile infection (cdi) in three specific cdi patient subgroups: those with cancer, treated with concomitant antibiotic therapy or with renal impairment. a markov model with six health states was developed to assess the cost-utility of fidaxomicin versus vancomycin in the patient subgroups over a period of 1 year from initial infection. cost and outcome data used to param ...201526407619
effect of geographic region and seasonality on clostridium difficile incidence and hospital mortality. 201526416527
necrotizing fasciitis and the diabetic foot.necrotizing fasciitis (nf) represents a rapidly progressive, life-threatening infection involving skin, soft tissue, and deep fascia. an early diagnosis is crucial to treat nf effectively. the disease is generally due to an external trauma that occurs in predisposed patients: the most important risk factor is represented by diabetes mellitus. nf is classified into 3 different subtypes according to bacterial strains responsible: type 1 associated to polymicrobial infection, type 2 nf, generally a ...201526415868
fecal microbiota transplantation in gastrointestinal disease: 2015 update and the road ahead.at its height, the clostridium difficile infection epidemic caused approximately 7000 infections and 300 deaths per day in the usa. fecal microbiota transplantation (fmt) has demonstrated extraordinary clinical resolution, c. difficile infection cure rates of over 90%, and low recurrence. in tandem with the rise of fmt, the gastrointestinal microbiome has emerged as a 'vital' organ armed with a wealth of microbe 'soldiers' more powerful than known antibiotics. fmts' reputation has diffused into ...201526414076
recombinant bacterial lipoproteins as vaccine candidates.recombinant bacterial lipoproteins (rlp) with built-in immuno-stimulating properties for novel subunit vaccine development are reviewed. this platform technology offers the following advantages: easily converts antigens into highly immunogenic rlp using a fusion sequence containing lipobox; the lipid moiety of rlp is recognized as the danger signals in the immune system through the toll-like receptor 2, so both innate and adaptive immune responses can be induced by rlp; serves as an efficient an ...201526420467
minimal systemic and high faecal exposure to cadazolid in patients with severe clostridium difficile infection.cadazolid is under development as an oral treatment for clostridium difficile infection (cdi), which is the most common infectious cause of antibiotic-associated diarrhoea. low systemic cadazolid exposures were previously reported in healthy subjects following both single and multiple oral dosing. the main objective of this study was to investigate systemic cadazolid exposure in patients with severe cdi with potential disrupted lining of the gastrointestinal tract. a single 3000 mg oral dose of ...201526419191
hand hygiene: knowledge and attitudes of fourth-year clerkship medical students at alfaisal university, college of medicine, riyadh, saudi arabia.little is known about the clerkship (clinical) medical students' knowledge of hand hygiene as the single most important precautionary measure to reduce nosocomial healthcare-associated infections. the aim of this study is to explore the knowledge of, and attitudes towards, hand hygiene practices among fourth-year clerkship medical students at alfaisal university, college of medicine, riyadh, saudi arabia.201526430584
healthcare-associated clostridium difficile infections and strain diversity in pediatric hospitals in the canadian nosocomial infection surveillance program, 2007-2011.children with healthcare-associated clostridium difficile infection were identified. the incidence increased from 3.2/10,000 patient days in 2007 to 5.2/10,000 patient days in 2011 (p < 0.001). of 169 isolates, the most common north american pulsed-field (nap) types were nap4 (n = 43; (25.4%), and nap1 (n = 25;14.8%) while 55 (32.6%) were non-assigned nap types.201526407250
dentists, antibiotics and clostridium difficile-associated disease.dentists prescribe significant volumes of antimicrobial drugs within primary care settings. there is good evidence that many of the prescriptions are not justified by current clinical guidance and that that there is considerable misuse of these drugs in dentistry. one of the risks associated with antibiotic administration is clostridium difficile-associated disease (cdad), an entity of which many healthcare workers, including dentists, have little knowledge or understanding. this review seeks to ...201526404991
clostridium difficile infection in the pediatric transplant patient.cdis are on the rise in both hospital and community settings in adults and children. children with cancer or a history of hsct or sot appear to be at higher risk for primary disease, recurrent disease, and severe outcomes when compared to children with other comorbidities. the reasons for this are not clear and no studies to date have analyzed risk factors for cdi in pediatric transplant patients. colonization rates in children with cancer and a transplant history are also high. determining whic ...201526403484
outcome of relapsing clostridium difficile infections do not correlate with virulence-, spore- and vegetative cell-associated phenotypes.one of the main clinical challenges of clostridium difficile infections (cdi) is the high rate of relapse episodes. the main determinants involved in relapse of cdi include the presence of antibiotic-resistant c. difficile spores in the colonic environment and a permanent state of dysbiosis of the microbiota caused by antibiotic therapy. a possible scenario is that phenotypes related to the persistence of c. difficile spores might contribute to relapsing infections. in this study, 8 c. difficile ...201526403333
gastro-hepatic fistula with liver abscess: a rare complication of a common procedure.percutaneous endoscopic gastrostomy (peg) is a procedure used most commonly for enteral access for nutrition and continuation of treatment in patients when oral nutrition is not possible. it is a safe, cost-effective procedure; however, has its own complications and adverse effects that can be life threatening.201526402902
a small-molecule antivirulence agent for treating clostridium difficile infection.clostridium difficile infection (cdi) is a worldwide health threat that is typically triggered by the use of broad-spectrum antibiotics, which disrupt the natural gut microbiota and allow this gram-positive anaerobic pathogen to thrive. the increased incidence and severity of disease coupled with decreased response, high recurrence rates, and emergence of multiple antibiotic-resistant strains have created an urgent need for new therapies. we describe pharmacological targeting of the cysteine pro ...201526400909
a bedside test for clostridium difficile infection: an emergency department use. preliminary results.clostridium difficile (cd) infection is a severe cause of diarrhea in patients with prolonged hospitalization and/or previously treated with antibiotics. cd's a and b toxins are responsible for either diarrhea or septical status as well as other complications including toxic megacolon. toxins isolation, usually performed by a central microbiological laboratory (cml), is mandatory for the final diagnosis of the disease. the clinical suspect of cd infection (cdi) results in the isolation of the pa ...201526400518
using a novel lysin to help control clostridium difficile infections.as a consequence of excessive antibiotic therapies in hospitalized patients, clostridium difficile, a gram-positive anaerobic spore-forming intestinal pathogen, is the leading cause of hospital-acquired diarrhea and colitis. drug treatments for these diseases are often complicated by antibiotic-resistant strains and a high frequency of treatment failures and relapse; therefore, novel nonantibiotic approaches may prove to be more effective. in this study, we recombinantly expressed a prophage lys ...201526392484
bilateral cellulitis.we present a case of bilateral lesions in a 50-year-old man, which were on first impression mistaken for and initially treated as bilateral cellulitis. we propose that bilateral cellulitis, as opposed to unilateral, is rare and that other aetiologies should be considered in evaluating a patient with bilateral lesions. the differential diagnosis includes stasis-dermatitis, lipodermatosclerosis, lymphoedema and vascular lesions such as kaposi sarcoma, as was identified in this case. early consulta ...201526392449
[multidrug-resistant organisms and c. difficile in munich acute-care clinics: results from a point prevalence study of clinical routine data].to combat multidrug resistant organisms (mrdos), networks have been established all over germany. here we show here how those networks can survey the prevalence of mrdos and c. difficile (cd), as well as structure data (e.g. staffing with hygiene control personnel), with reasonable efforts. we conducted a questionnaire-based point prevalence survey in may 2012. the prevalence (colonisation or infection) of inpatient cases with methicillin-resistant s. aureus (mrsa), vancomycin resistant s. aureu ...201526391097
a comprehensive assessment across the healthcare continuum: risk of hospital-associated clostridium difficile infection due to outpatient and inpatient antibiotic exposure.limitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for clostridium difficile infection (cdi).201526387888
quantifying the exposure to antibiotic-resistant pathogens among patients discharged from a single hospital across all california healthcare facilities.to assess the time-dependent exposure of california healthcare facilities to patients harboring methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), extended-spectrum β-lactamase (esbl)-producing escherichia coli and klebsiella pneumoniae, and clostridium difficile infection (cdi) upon discharge from 1 hospital.201526387690
in vitro augmented photodynamic bactericidal activity of tetracycline and chitosan against clostridium difficile kctc5009 in the planktonic cultures.infection with clostridium difficile (c. difficile) causes a severe colitis with high recurrence. treatment of c. difficile infection (cdi) is based on antibiotics in spite of the increase of resistance. to interrupt the vicious cycles such as new antibiotics treatment and appearance of resistance strains, photodynamic therapy (pdt) might be a possible alternative therapy for cdi. tetracycline (tc) has been used as a broad spectrum antibiotic with low risk of cdi and a photosensitizer (ps) in pd ...201526386640
clostridium difficile infection (cdi) in children due to hypervirulent strains pcr-ribotype 027: an emblematic report of two cases.in this report, the first two cases of pediatric clostridium difficile infection (cdi) due to the hypervirulent pcr-ribotype 027 in italy are described as emblematic of the role of both the infecting c. difficile strain and patient status in the occurrence and clinical manifestation of cdi in children.201526385433
updates on clostridium difficile infection. 201526259303
cleaning hospital room surfaces to prevent health care-associated infections: a technical brief.the cleaning of hard surfaces in hospital rooms is critical for reducing health care-associated infections. this review describes the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. key informants were interviewed, and a systematic search for publications since 1990 was done with the use of several bibliographic and gray literature resources. studies examinin ...201526258903
antibiotic profiling of clostridium difficile ribotype 176--a multidrug resistant relative to c. difficile ribotype 027.antibiotic profiling of twenty czech clostridium difficile pcr-ribotype 176 isolates revealed a high level of resistance to erythromycin, ciprofloxacin and moxifloxacin (n = 20) and to rifampicin (n = 13). accumulation of resistance mechanisms to multiple antibiotics highlight that pcr-ribotype 176 belong to problematic epidemic strains.201526256807
increased risk of functional gastrointestinal sequelae after clostridium difficile infection among active duty united states military personnel (1998-2010).some acute enteric infections are associated with the development of functional gastrointestinal disorders, most commonly irritable bowel syndrome but also other functional and organic gastrointestinal sequelae. clostridium difficile infection has increased in incidence and severity, however, few studies have evaluated functional disorders after this infection.201526255560
hospital cost of clostridium difficile infection including the contribution of recurrences in french acute-care hospitals.the impact of clostridium difficile infection (cdi) on healthcare costs is significant due to the extra costs of associated inpatient care. however, the specific contribution of recurrences has rarely been studied.201526253518
racial differences in clostridium difficile infection rates are attributable to disparities in health care access.this study confirms previously reported racial differences in clostridium difficile infection (cdi) rates in the united states and explores the nature of those differences. we conducted a retrospective study using the 2010 nationwide inpatient sample, the largest all-payer database of hospital discharges in the united states. we identified hospital stays most likely to include antibiotic treatment for infections, based on hospital discharge diagnoses, and we examined how cdi rates varied, in an ...201526248363
multicenter, double-blind, randomized, phase 2 study evaluating the novel antibiotic cadazolid in patients with clostridium difficile infection.cadazolid, a novel fluoroquinolone-oxazolidinone antibiotic, exhibits potent in vitro activity against clostridium difficile, including the epidemic bi/nap1/027 strain. this multicenter, randomized, double-blind, active reference group, phase 2 study evaluated the efficacy and safety of oral cadazolid in treatment of adult patients with c. difficile infection (cdi). eligible patients with first occurrence/first recurrence of cdi were randomized 1:1:1:1 to 250, 500, or 1,000 mg cadazolid twice da ...201526248357
vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities - united states.treatments for health care-associated infections (hais) caused by antibiotic-resistant bacteria and clostridium difficile are limited, and some patients have developed untreatable infections. evidence-supported interventions are available, but coordinated approaches to interrupt the spread of hais could have a greater impact on reversing the increasing incidence of these infections than independent facility-based program efforts.201526247436
gastrointestinal localization of metronidazole by a lactobacilli-inspired tetramic acid motif improves treatment outcomes in the hamster model of clostridium difficile infection.metronidazole, a mainstay treatment for clostridium difficile infection (cdi), is often ineffective for severe cdi. whilst this is thought to arise from suboptimal levels of metronidazole in the colon due to rapid absorption, empirical validation is lacking. in contrast, reutericyclin, an antibacterial tetramic acid from lactobacillus reuteri, concentrates in the gastrointestinal tract. in this study, we modified metronidazole with reutericyclin's tetramic acid motif to obtain non-absorbed compo ...201526286574
ceftolozane-tazobactam activity against phylogenetically diverse clostridium difficile strains.ceftolozane-tazobactam (c/t) is approved for the treatment of complicated intra-abdominal and urinary tract infections and has varied activity against anaerobic bacteria. here, we evaluate the activity of c/t against a phylogenetically diverse collection of clostridium difficile isolates and report uniformly high mics (≥256 μg/ml) to c/t.201526282409
ertapenem prophylaxis associated with an increased risk of clostridium difficile infection among surgical patients.a case-control study was conducted to determine risk factors for hospital-onset clostridium difficile infection among patients admitted to 2 surgical units. ertapenem prophylaxis was significantly associated with c. difficile infection risk (odds ratio, 3.13 [95% ci, 1.13-8.68], p=.028) and may offer an antimicrobial stewardship target among surgical patients.201526278576
risk for clostridium difficile infection after radical cystectomy for bladder cancer: analysis of a contemporary series.this study seeks to evaluate the incidence and associated risk factors of clostridium difficile infection (cdi) in patients undergoing radical cystectomy (rc) for bladder cancer.201526278363
rapid detection of ermb gene in clostridium difficile by loop-mediated isothermal amplification.macrolide-lincosamide-streptogramin b resistance in clostridium difficile is mostly due to the ermb resistance determinant. here, we describe a sensitive and rapid molecular method to detect ermb in c. difficile to contribute to the wider epidemiological study. five sets of loop-mediated isothermal amplification (lamp) primers were designed and optimized for rapid detection of ermb. the specificity and sensitivity of the primers for ermb were detected, and the ermb lamp assay was compared to con ...201526272634
pathological and bacteriological characterization of neonatal porcine diarrhoea of uncertain aetiology.neonatal porcine diarrhoea of uncertain aetiology has been reported from a number of countries. this study investigated 50 diarrhoeic and 19 healthy piglets from 10 affected swedish herds. the piglets were blood-sampled for analysis of serum γ-globulin and necropsied, and the intestines were sampled for histopathology and cultured for escherichia coli, clostridium perfringens and clostridium difficile. escherichia coli isolates (n = 276) were examined by pcr for virulence genes encoding lt, sta, ...201526272503
biochemical and immunological characterization of truncated fragments of the receptor-binding domains of c. difficile toxin a.clostridium difficile is an emerging pathogen responsible for opportunistic infections in hospitals worldwide and is the main cause of antibiotic-associated pseudo-membranous colitis and diarrhea in humans. clostridial toxins a and b (tcda and tcdb) specifically bind to unknown glycoprotein(s) on the surface of epithelial cells in the host intestine, disrupting the intestinal barrier and ultimately leading to acute inflammation and diarrhea. the c-terminal receptor-binding domain (rbd) of tcda, ...201526271033
faecal microbiota transplant for recurrent clostridium difficile infection using long-term frozen stool is effective: clinical efficacy and bacterial viability data.faecal microbial transplant (fmt) for recurrent clostridium difficile infection (rcdi) is greatly facilitated by frozen stool banks. however, the effect of frozen storage of stool for greater than 2 months on the viability of stool bacteria is unknown and the efficacy of fmt is not clear.201526264455
variable alterations of the microbiota, without metabolic or immunological change, following faecal microbiota transplantation in patients with chronic pouchitis.faecal microbiota transplantation (fmt) is effective in the treatment of clostridium difficile infection, where efficacy correlates with changes in microbiota diversity and composition. the effects of fmt on recipient microbiota in inflammatory bowel diseases (ibd) remain unclear. we assessed the effects of fmt on microbiota composition and function, mucosal immune response, and clinical outcome in patients with chronic pouchitis. eight patients with chronic pouchitis (current pdai ≥7) were trea ...201526264409
[fecal microbiota transfer (fmt) in a patient with refractory irritable bowel syndrome].irritable bowel syndrome is a disorder of the gastrointestinal tract with unknown etiology. recent clinical data support a link between changes in fecal microbiota with decreased biodiversity and the development of irritable bowel syndrome. whether these changes of the microbiota are caused by the disease or whether they develop during the course of the disease remains unclear. several studies demonstrated that fecal microbiota transfer (fmt) successfully attenuates clostridium difficile infecti ...201526261935
function of the crispr-cas system of the human pathogen clostridium difficile.clostridium difficile is the cause of most frequently occurring nosocomial diarrhea worldwide. as an enteropathogen, c. difficile must be exposed to multiple exogenous genetic elements in bacteriophage-rich gut communities. crispr (clustered regularly interspaced short palindromic repeats)-cas (crispr-associated) systems allow bacteria to adapt to foreign genetic invaders. our recent data revealed active expression and processing of crispr rnas from multiple type i-b crispr arrays in c. difficil ...201526330515
clostridium difficile infection is more severe when toxin is detected in the stool than when detected only by a toxigenic culture.clostridium difficile infection (cdi) is the major cause of antibiotic-associated diarrhea in hospital inpatients. rapid testing for the toxins in stool specimens is inconclusive due to its low sensitivity. therefore, a two-step method is recommended as the most appropriate approach. the purpose of the present study was to evaluate the differences in the disease severity score between the patients who were glutamate dehydrogenase (gdh)-positive/enzyme immunoassays (eia) toxin-positive (group a) ...201526328639
burden of gastrointestinal, liver, and pancreatic diseases in the united states.gastrointestinal (gi), liver, and pancreatic diseases are a source of substantial morbidity, mortality, and cost in the united states. quantification and statistical analyses of the burden of these diseases are important for researchers, clinicians, policy makers, and public health professionals. we gathered data from national databases to estimate the burden and cost of gi and liver disease in the united states.201526327134
analysis of bacterial communities during clostridium difficile infection in the mouse.clostridium difficile infection (cdi) is a major cause of health care-associated disease. cdi initiates with ingestion of c. difficile spores, germination in the gastrointestinal (gi) tract, and then colonization of the large intestine. the interactions between c. difficile cells and other bacteria and with host mucosa during cdi remain poorly understood. here, we addressed the hypothesis that, in a mouse model of cdi, c. difficile resides in multicellular communities (biofilms) in association w ...201526324536
clinical and economic benefits of fidaxomicin compared to vancomycin for clostridium difficile infection.we studied the clinical and economic impact of a protocol encouraging the use of fidaxomicin as a first-line drug for treatment of clostridium difficile infection (cdi) in patients hospitalized during a 2-year period. this study evaluated patients who received oral vancomycin or fidaxomicin for the treatment of cdi during a 2-year period. all included patients were eligible for administration of fidaxomicin via a protocol that encouraged its use for selected patients. the primary clinical endpoi ...201526324268
comparative evaluation of broad-panel pcr assays for the detection of gastrointestinal pathogens in pediatric oncology patients.broadly multiplexed molecular amplification assays offer an unprecedented ability to diagnose gastrointestinal infection in immunocompromised patients. however, little data are available to compare the performance of such systems in this population. a total of 436 stool samples were collected from 199 predominantly immunocompromised pediatric oncology patients. remnant samples were tested in parallel with the use of the premarket (investigational use only) versions of two broadly multiplexed pcr ...201526321042
response to "effect of geographic region and seasonality on clostridium difficile incidence and hospital mortality". 201526320700
[fecal transplantation the future therapy?].intestinal bacteria play an important role in human physiology, taking part in the metabolism, absorption of nutrients and regulation of the immune system. in many illnesses the bacterial imbalance in the digestive tract occurs, and fecal transplantation is one method that allows you to restore the balance. the essence of the described method is to replace the pathogenesis, abnormal bacterial flora with the flora occurring in normal healthy individuals. so far, the main use of the method describ ...201526319378
routine disc diffusion antimicrobial susceptibility testing of clostridium difficile and association with pcr ribotype 027.reduced susceptibility to metronidazole and vancomycin in clostridium difficile has been reported, which emphasises the need for simple antimicrobial susceptibility testing methods. the aim of this study was to apply a published disc diffusion method and zone diameter breakpoint correlates to the european committee on antimicrobial susceptibility testing (eucast) epidemiological minimum inhibitory concentration (mic) cut-off values in a routine setting. metronidazole and vancomycin zone diameter ...201526319148
skin and environmental contamination in patients diagnosed with clostridium difficile infection but not meeting clinical criteria for testing.of 134 patients diagnosed with clostridium difficile infection, 30 (22%) did not meet clinical criteria for testing because they lacked significant diarrhea or had alternative explanations for diarrhea and no recent antibiotic exposure. for these patients, skin and/or environmental contamination was common only in those with prior antibiotic exposure.201526315659
medical devices; immunology and microbiology devices; classification of clostridium difficile toxin gene amplification assay. final order.the food and drug administration (fda) is classifying clostridium difficile (c. difficile) toxin gene amplification assay into class ii (special controls). the agency is classifying the device into class ii (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.201526314093
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