Publications

role of obesity and adipose tissue-derived cytokine leptin during clostridium difficile infection.	obesity is among the most pressing health concerns in the world since it is increasingly common even in the developing world, and is clearly associated with increased risk for chronic debilitating diseases and death. furthermore, obesity can influence the pathogenesis of infectious diseases by affecting the balance of pathogen clearance and pathological inflammation. the mechanisms that result in enhanced inflammation in obese individuals are poorly understood. clostridium difficile is a major c ...	2015	25638400
how to eradicate clostridium difficile from the environment.	during the last decade, clostridium difficile has emerged as a major cause of healthcare-associated diarrhoea and death. transmission of this spore-forming bacterium is thought to occur via the hands of healthcare providers or via the contaminated environment. therefore, enhanced environmental cleaning/disinfection of the rooms housing c. difficile-infected patients is warranted. guidelines from various scientific bodies have been published. they recommend performing environmental decontaminatio ...	2015	25638358
[acute diarrhea after kidney or kidney-pancreas transplantation].	diarrhea is a frequent and potentially severe complication of kidney transplantation. we describe here, in a cross-sectional study, the epidemiological and microbiological characteristics of acute and persistent diarrhea in 52 inpatients with kidney and kidney-pancreas transplant in a hospital in buenos aires, 42 (80.8%) of whom had received a kidney and 10 (19.2%) a kidney-pancreas transplant. diarrhea was the reason of admission of 34 cases (65.4%). the etiology could be studied in 50 patients ...	2015	25637897
comparing the economic and health benefits of different approaches to diagnosing clostridium difficile infection.	accurate diagnosis of clostridium difficile infection (cdi) is essential to effectively managing patients and preventing transmission. despite the availability of several diagnostic tests, the optimal strategy is debatable and their economic values are unknown. we modified our previously existing c. difficile simulation model to determine the economic value of different cdi diagnostic approaches from the hospital perspective. we evaluated four diagnostic methods for a patient suspected of having ...	2015	25636938
rectal bacteriotherapy for recurrent clostridium difficile-associated diarrhoea: results from a case series of 55 patients in denmark 2000-2012.	clostridium difficile infection is one of the most common nosocomial infections. among other alternatives to standard treatment with vancomycin for recurrent infection are faecal microbiota transplantation and rectal bacteriotherapy with a fixed mixture of intestinal bacterial strains isolated from faeces of healthy persons to mimic a theoretical normal microflora. developed by dr. tvede and dr. rask-madsen, the latter method has been in use for selected patients during the last 25 years in denm ...	2015	25636927
complete genome sequence of the clostridium difficile laboratory strain 630δerm reveals differences from strain 630, including translocation of the mobile element ctn5.	clostridium difficile strain 630δerm is a spontaneous erythromycin sensitive derivative of the reference strain 630 obtained by serial passaging in antibiotic-free media. it is widely used as a defined and tractable c. difficile strain. though largely similar to the ancestral strain, it demonstrates phenotypic differences that might be the result of underlying genetic changes. here, we performed a de novo assembly based on single-molecule real-time sequencing and an analysis of major methylation ...	2015	25636331
gut check: clostridium difficile testing and treatment in the molecular testing era.	we evaluated the impact of nursing education and stewardship interventions on clostridium difficile testing and treatment appropriateness. diarrhea documentation increased for those with positive tests (45% to 70%); pretreatment laxative use decreased (50% to 19%). appropriate treatment increased for severe infection (57% to 93%), but all asymptomatically colonized patients were treated.	2015	25633006
evaluation of a pulsed xenon ultraviolet disinfection system for reduction of healthcare-associated pathogens in hospital rooms.	objective to determine the effectiveness of a pulsed xenon ultraviolet (px-uv) disinfection device for reduction in recovery of healthcare-associated pathogens. setting two acute-care hospitals. methods we examined the effectiveness of px-uv for killing of clostridium difficile spores, methicillin-resistant staphylococcus aureus (mrsa), and vancomycin-resistant enterococcus (vre) on glass carriers and evaluated the impact of pathogen concentration, distance from the device, organic load, and sha ...	2015	25633002
comorbidities, exposure to medications, and the risk of community-acquired clostridium difficile infection: a systematic review and meta-analysis.	clostridium difficile infection (cdi) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (ca) cdi remain uncertain. this study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with ca-cdi.	2015	25632995
a comparison between national healthcare safety network laboratory-identified event reporting versus traditional surveillance for clostridium difficile infection.	objective hospitals in the national healthcare safety network began reporting laboratory-identified (labid) clostridium difficile infection (cdi) events in january 2013. our study quantified the differences between the labid and traditional surveillance methods. design cohort study. setting a cohort of 29 community hospitals in the southeastern united states. methods a period of 6 months (january 1, 2013, to june 30, 2013) of prospectively collected data using both labid and traditional surveill ...	2015	25632994
evaluation of portability and cost of a fluorescent pcr ribotyping protocol for clostridium difficile epidemiology.	clostridium difficile is the most commonly identified pathogen among health care-associated infections in the united states. there is a need for accurate and low-cost typing tools that produce comparable data across studies (i.e., portable data) to help characterize isolates during epidemiologic investigations of c. difficile outbreaks and sporadic cases of disease. the most popular c. difficile-typing technique is pcr ribotyping, and we previously developed methods using fluorescent pcr primers ...	2015	25631804
pediatric severe pseudomembranous enteritis treated with fecal microbiota transplantation in a 13-month-old infant.	fecal microbiota transplantation (fmt) is a procedure used to restore the intestinal microbiota of a diseased individual using indigenous intestinal microorganisms from a healthy donor. the current case report presents the first case of a 13-month-old male with severe pseudomembranous enteritis (pme) treated with fmt. the infant was admitted to shanghai children's hospital with a 2-month history of diarrhea, and a 1.5-month history of retractable edema, hypoalbuminemia, electrolyte disturbance a ...	2015	25798243
the preventive antibiotics in stroke study (pass): a pragmatic randomised open-label masked endpoint clinical trial.	in adults with acute stroke, infections occur commonly and are associated with an unfavourable functional outcome. in the preventive antibiotics in stroke study (pass) we aimed to establish whether or not preventive antimicrobial therapy with a third-generation cephalosporin, ceftriaxone, improves functional outcome in patients with acute stroke.	2015	25612858
clostridium difficile ileitis in pediatric inflammatory bowel disease: a case report and literature review.		2015	25611030
supervised self-administration of outpatient parenteral antibiotic therapy: a report from a large tertiary hospital in australia.	outpatient parenteral antibiotic therapy (opat) has become established as a standard of care in most australian hospitals to treat a variety of infections. since 1998, the alternate site infusion service (asis) has provided an opat service to five hospitals in southern brisbane, queensland, using predominantly a patient or carer administration model (self-administered, s-opat). the aim of this study was to evaluate outcomes of our s-opat programme.	2015	25603999
risk factors for clostridium difficile diarrhea in patients with inflammatory bowel disease.	despite the growing incidence of clostridium difficile diarrhea (ccd) in patients with inflammatory bowel disease (ibd), little is known about the associated risk factors.	2015	25603325
clostridium difficile infection in inflammatory bowel disease.		2015	25603324
chlorhexidine bathing and health care-associated infections: a randomized clinical trial.	daily bathing of critically ill patients with the broad-spectrum, topical antimicrobial agent chlorhexidine is widely performed and may reduce health care-associated infections.	2015	25602496
faecal microbiota transplantation in clostridium difficile infections.		2015	25623242
risk of clostridium difficile infection in intensive care unit patients with sepsis exposed to metronidazole.	antimicrobial agents used to treat clostridium difficile infection (cdi), such as metronidazole and vancomycin, have been used during antibiotic treatment of other infections to try to prevent the development of cdi. we evaluated the hypothesis that intensive care unit (icu) patients who receive metronidazole as part of an antibiotic treatment regimen for sepsis have a lower risk of subsequently developing cdi.	2015	25622943
novel multiplex format of an extended multilocus variable-number-tandem-repeat analysis of clostridium difficile correlates with tandem repeat sequence typing.	subtyping of clostridium difficile is crucial for outbreak investigations. an extended multilocus variable-number tandem-repeat analysis (emlva) of 14 variable number tandem repeat (vntr) loci was validated in multiplex format compatible with a routine typing laboratory and showed excellent concordance with tandem repeat sequence typing (trst) and high discriminatory power.	2015	25620018
small molecule inhibitors of clostridium difficile toxin b-induced cellular damage.	clostridium difficile causes life-threatening diarrhea through the actions of its homologous toxins tcda and tcdb on human colonocytes. therapeutic agents that block toxin-induced damage are urgently needed to prevent the harmful consequences of toxin action that are not addressed with current antibiotic-based treatments. here, we developed an imaging-based phenotypic screen to identify small molecules that protected human cells from tcdb-induced cell rounding. a series of structurally diverse c ...	2015	25619932
in vivo bacterial imaging without engineering; a novel probe-based strategy facilitated by endogenous nitroreductase enzymes.	the feasibility of utilising bacteria as vectors for gene therapy is becoming increasingly recognised. this is primarily due to a number of intrinsic properties of bacteria such as their tumour targeting capabilities, their ability to carry large genetic or protein loads and the availability of well-established genetic engineering tools for a range of common lab strains. however, a number of issues relating to the use of bacteria as vectors for gene therapy need to be addressed in order for the ...	2015	25619884
adverse drug reactions in special populations - the elderly.	the international conference on harmonization considers older people a 'special population', as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions (adrs). medical practice is often based on single disease guidelines derived from clinical trials that have not included frail older people or those with multiple morbidities. this presents a challenge caring for older people, as drug doses in trials may not be ac ...	2015	25619317
use of tigecycline in elderly patients for clostridium difficile infection.		2015	25619268
comparison of antibiotic prophylaxis with cotrimoxazole/colistin (cot/col) versus ciprofloxacin (cip) in patients with acute myeloid leukemia.	recent meta-analyses showed that antibiotic prophylaxis in patients with neutropenia after chemotherapy reduced the incidence of fever and mortality rate. fluoroquinolones appear to be most effective and well tolerated. thus, in april 2008, we changed our antibiotic prophylaxis regimen from cotrimoxazole/colistin (cot/col) to the fluoroquinolone ciprofloxacin (cip) in patients with acute myeloid leukemia (aml). the aim of this retrospective study was to compare efficacy and development of bacter ...	2015	25617073
comparison of bd max cdiff and genomera c. difficile molecular assays for detection of toxigenic clostridium difficile from stools in conventional sample containers and in fecalswabs.	in this study, the usability and performance of genomera™ c. difficile and bd max™ cdiff nucleic acid amplification tests (naats) for the detection of toxigenic clostridium difficile were investigated in comparison with toxigenic culture and c. difficile toxin a- and toxin b-detecting immunochromatographic antigen (ia) test, the tox a/b quikchek®. in total, 302 faecal specimens were collected, 113 of which were in parallel to conventional sample containers and fecalswab liquid-based microbiology ...	2015	25616552
exposure of neutralizing epitopes in the carboxyl-terminal domain of tcdb is altered by a proximal hypervariable region.	the sequence, activity, and antigenicity of tcdb varies between different strains of clostridium difficile. as a result, ribotype-specific forms of tcdb exhibit different toxicities and are not strongly cross-neutralized. using a combination of biochemical and immunological approaches, we compared two important variants of tcdb (tcdb012 and tcdb027) to identify the mechanisms through which sequence differences alter epitopes and activity of the toxin. these analyses led to the discovery of a cri ...	2015	25614625
preface: clostridium difficile infection.		2015	25677709
the prospect for vaccines to prevent clostridium difficile infection.	clostridium difficile is a spore-forming anaerobic gram-positive organism that is the leading cause of antibiotic-associated nosocomial infectious diarrhea in the western world. this article describes the evolving epidemiology of c difficile infection (cdi) in the twenty-first century, evaluates the importance of vaccines against the disease, and defines the roles of both innate and adaptive host immune responses in cdi. the effects of passive immunotherapy and active vaccination against cdi in ...	2015	25677708
the potential of probiotics to prevent clostridium difficile infection.	exposure to antibiotics is the major risk factor for clostridium difficile diarrhea (cdd), suggesting that impairment of colonization resistance due to depletion of the gut flora is a significant underlying disease susceptibility factor. many properties of probiotic organisms indicate that they may be able to replenish the depleted gut flora and restore colonization resistance. however, despite numerous clinical trials, the evidence base for probiotics in the prevention of cdd remains weak. a re ...	2015	25677707
the morbidity, mortality, and costs associated with clostridium difficile infection.	clostridium difficile infection (cdi) is the most common cause of infectious health care-associated diarrhea and is a major burden to patients and the health care system. the incidence and severity of cdi remain at historically high levels. this article reviews the morbidity, mortality, and costs associated with cdi.	2015	25677706
fecal microbiota transplantation for the management of clostridium difficile infection.	this article discusses the use of fecal microbiota transplantation (fmt) for the treatment of recurrent clostridium difficile infection (cdi). the disruption of the normal gut microbiota is central to the pathogenesis of cdi, and disruption persists in recurrent disease. the use of fmt for recurrent cdi is characterized by a high response rate and short term safety is excellent, although the long-term effects of fmt are as yet unknown.	2015	25677705
is the prevalence of antibiotic-resistant organisms changing in canadian hospitals? comparison of point-prevalence survey results in 2010 and 2012.	a national point-prevalence survey for infection or colonization with methicillin-resistant staphylococcus aureus (mrsa) and vancomycin-resistant enterococcus (vre), and for clostridium difficile infection (cdi) was done in canadian hospitals in 2010. a follow-up survey was done in november 2012 to determine whether there were any changes in the prevalence of these organisms; we also determined the prevalence of extended-spectrum β-lactamase (esbl)-producing enterobacteriaceae, and carbapenem-re ...	2015	25677630
faecal microbiota transplantation for clostridium difficile infection in the united kingdom.	faecal microbiota transplantation (fmt) has been shown to be highly effective in treating recurrent clostridium difficile infection, but to date there have been no data from the united kingdom. an electronic survey was developed at portsmouth hospitals' national health service (nhs) trust and sent out to uk hospital specialists utilizing the contact databases of the british infection association and the royal college of gastroenterologists. a total of 162 responses were received, representing ne ...	2015	25677629
potential role of post-transplant hypogammaglobulinemia in the risk of clostridium difficile infection after kidney transplantation: a case-control study.	to identify reversible risk factors for clostridium difficile infection (cdi) after kidney transplantation (kt) that could lead to a reduction in its incidence and associated complications.	2015	25676130
clostridium difficile pcr ribotype 027 emerges in taiwan.	clostridium difficile pcr ribotype 027 is a hypervirulent strain that has caused significant nosocomial diarrhea in many countries but has not yet been reported or isolated in taiwan previously. here, we present the characteristics of a case of c. difficile pcr ribotype 027 identified in taiwan. taiwan is located in a key transportation center of asia. this report is important for alerting hospitals and public health departments in asia about the emergence of this hypervirulent strain so that cl ...	2015	25672348
low colonization rates of clostridium difficile among patients and healthcare workers at örebro university hospital in sweden.	the aim of this study was to investigate the rate of asymptomatic colonization rate of clostridium difficile among both healthcare workers (hcws) and patients in a hospital ward in sweden. in a prospective observational study, asymptomatic hcws (n = 22) (22/60; 37%) attending patients in an infectious disease ward in sweden participated and were screened once for c. difficile. at the same time, 58 consecutive patients (58/227; 26%) admitted to the same ward were screened for c. difficile, first ...	2015	25627981
low incidence of clostridium difficile infection (cdi) in patients treated with outpatient parenteral antimicrobial therapy (opat).		2015	25627769
postoperative burden of hospital-acquired clostridium difficile infection.	objective clostridium difficile infection (cdi) is a common hospital-acquired infection. previous reports on the incidence, risk factors, and impact of cdi on resources in the surgical population are limited. in this context, we study cdi across diverse surgical settings. methods we prospectively identified patients with laboratory-confirmed postoperative cdi after 40 different general, vascular, or gynecologic surgeries at 52 academic and community hospitals between july 2012 and september 2013 ...	2015	25627760
clostridium difficile the hospital plague.	clostridium difficile infection (cdi) has become one of the major public health threats in the last two decades. an increase has been observed not only in the rate of cdi, but also in its severity and mortality. symptoms caused by this pathogen are accompanied by intense local and systemic inflammation. we confirmed that raman microspectroscopy can help us in understanding cdi pathogenesis. a single erythrocyte of patients with cdi shows a difference, approximately 10 times, in the intensity of ...	2015	25627751
non-inferiority of pulsed xenon uv light versus bleach for reducing environmental clostridium difficile contamination on high-touch surfaces in clostridium difficile infection isolation rooms.	the standard for clostridium difficile surface decontamination is bleach solution at a concentration of 10 % of sodium hypochlorite. pulsed xenon uv light (px-uv) is a means of quickly producing germicidal uv that has been shown to be effective in reducing environmental contamination by c. difficile spores. the purpose of this study was to investigate whether px-uv was equivalent to bleach for decontamination of surfaces in c. difficile infection isolation rooms. high-touch surfaces in rooms pre ...	2015	25627208
acute gastroenteritis due to co-infection by salmonella and clostridium difficile.		2015	25626957
inflammasome activation contributes to interleukin-23 production in response to clostridium difficile.	clostridium difficile is the most common hospital-acquired pathogen, causing antibiotic-associated diarrhea in over 250,000 patients annually in the united states. disease is primarily mediated by toxins a and b, which induce potent proinflammatory signaling in host cells and can activate an asc-containing inflammasome. recent findings suggest that the intensity of the host response to infection correlates with disease severity. our lab has identified the proinflammatory cytokine interleukin-23 ...	2015	25626905
risk factors for recurrent clostridium difficile infection: a systematic review and meta-analysis.	an estimated 20-30% of patients with primary clostridium difficile infection (cdi) develop recurrent cdi (rcdi) within 2 weeks of completion of therapy. while the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. the aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rcdi.	2015	25626326
diagnosis and treatment of clostridium difficile in adults: a systematic review.	since 2000, the incidence and severity of clostridium difficile infection (cdi) have increased.	2015	25626036
tigecycline exhibits inhibitory activity against clostridium difficile in the intestinal tract of hospitalised patients.	no new acquisition of clostridium difficile occurred among 12 hospitalised patients receiving tigecycline, and pre-existing colonisation was reduced to undetectable levels in 2 patients. moreover, 91% of stool suspensions obtained during tigecycline therapy exhibited inhibitory activity against c. difficile. these results suggest that tigecycline achieves sufficient concentrations to inhibit intestinal colonisation by c. difficile.	2015	25623897
meropenem versus piperacillin-tazobactam for definitive treatment of bloodstream infections due to ceftriaxone non-susceptible escherichia coli and klebsiella spp (the merino trial): study protocol for a randomised controlled trial.	gram-negative bacteria such as escherichia coli or klebsiella spp. frequently cause bloodstream infections. there has been a worldwide increase in resistance in these species to antibiotics such as third generation cephalosporins, largely driven by the acquisition of extended-spectrum beta-lactamase or plasmid-mediated ampc enzymes. carbapenems have been considered the most effective therapy for serious infections caused by such resistant bacteria; however, increased use creates selection pressu ...	2015	25623485
emergence of toxin a-negative, toxin b-positive clostridium difficile strains: epidemiological and clinical considerations.		2015	25598331
selection of nanobodies that block the enzymatic and cytotoxic activities of the binary clostridium difficile toxin cdt.	the spore-forming gut bacterium clostridium difficile is the leading cause of antibiotic-associated diarrhea in hospitalized patients. the major virulence factors are two large glucosylating cytotoxins. hypervirulent strains (e.g. ribotype 027) with higher morbidity and mortality additionally produce the binary cdt toxin (clostridium difficile transferase) that adp-ribosylates actin and induces microtubule-based cell protrusions. nanobodies are robust single domain antibodies derived from cameli ...	2015	25597743
metronidazole-induced encephalopathy after prolonged metronidazole course for treatment of c. difficile colitis.	a 65-year-old woman with a diagnosis of clostridium difficile colitis undergoing prolonged treatment with metronidazole was admitted to hospital for altered mentation, slurred speech and weakness. she was diagnosed with metronidazole-induced encephalopathy, confirmed with brain mri and improved when the offending agent was removed. this case report highlights encephalopathy as a complication of prolonged metronidazole treatment, which has become more common in clinical practice for the treatment ...	2015	25596288
risk factors, outcomes and epidemiology associated with clostridium difficile infection in patients with haematological malignancies in a tertiary care hospital in china.	the purpose of this study was to evaluate the risk factors, outcomes and epidemiology associated with clostridium difficile infection (cdi) in patients with haematological malignancies in a tertiary care hospital in china. c. difficile screening was performed on patients admitted for chemotherapy or haematopoietic stem cell transplantation between 2009 and 2013. c. difficile isolates were analysed by multilocus sequence typing, and a retrospective chart review was performed on all patients with ...	2015	25596117
management of severe ulcerative colitis.	acute severe steroid-refractory ulcerative colitis (asuc) provides challenges for physicians and surgeons who manage these patients. when a patient is diagnosed with asuc, they should be admitted for inpatient management including intravenous corticosteroids, venous thromboembolism prophylaxis, oral or enteral feeding if tolerated, and exclusion of infection including clostridium difficile. failure to improve by day 3 of corticosteroids requires escalation to medical rescue therapies such as inf ...	2015	25595929
colonization versus carriage of clostridium difficile.	asymptomatic carriage of toxigenic strains of clostridium difficile is common in health care facilities and the community. however, infection control efforts have traditionally focused almost entirely on symptomatic patients. there is now growing concern that asymptomatic carriers may be an underappreciated source of transmission. this article provides an overview of the pathogenesis and epidemiology of c difficile colonization, reviews the evidence that asymptomatic carriers shed spores and con ...	2015	25595843
diagnostic pitfalls in clostridium difficile infection.	accurate diagnosis of clostridium difficile infection (cdi) is important not only for patient care but also for epidemiology and disease research. as it is not possible clinically to reliably differentiate cdi from other causes of health care-associated diarrhea, the laboratory confirmation of cdi is essential. rapid commercial assays, including nucleic acid amplification tests and immunoassays for c difficile toxin and glutamate dehydrogenase, have largely superseded the use of older assays. al ...	2015	25595842
phosphatidylcholine and the intestinal mucus layer: in vitro efficacy against clostridium difficile-associated polymorphonuclear neutrophil activation.	phosphatidylcholine (pc), an important component of intestinal mucus, protects against clostridium difficile toxin-induced intestinal barrier injury in vitro. polymorphonuclear neutrophil (pmn) activation may contribute to intestinal injury and systemic toxicity in patients with c. difficile-associated disease. we therefore hypothesized that the intestinal barrier function against c. difficile toxin by exogenous pc would ameliorate pmn activation.	2015	25595713
media discourse on the social acceptability of fecal transplants.	advances in human microbiome research have generated considerable interest in elucidating the role of bacteria in health and the application of microbial ecosystem therapies and probiotics. fecal transplants involve the introduction of gut microbes from a healthy donor's stool to the patient and have been documented as effective for treating clostridium difficile infections (cdis) and some other gastrointestinal disorders. however, the treatment has encountered regulatory hurdles preventing wide ...	2015	25595150
trend, risk factors, and costs of clostridium difficile infections in vascular surgery.	starting in december 2013, the hospital inpatient quality reporting program included clostridium difficile infection (cdi) rates as a new publically reported quality measure. our goal was to review the trend, hospital variability in cdi rates, and associated risk factors and costs in vascular surgery.	2015	25595110
appendectomy: a risk factor for colectomy in patients with clostridium difficile.	the appendix, considered an intestinal microbiota reservoir, may be protective against the risk of fulminant clostridium difficile infection.	2015	25588621
treatment of recurrent and severe clostridium difficile infection.	clostridium difficile infection (cdi) is a serious complication of hospitalization and antibiotic use with a high mortality and very high costs. despite appropriate treatment, a subset of patients develop chronic recurrent cdi. some other patients develop severe and life-threatening colitis. the risk factors, pathogenesis, and treatment of recurrent cdi and severe cdi are discussed in this review. in particular, fecal microbiota transplantation (fmt) as a treatment strategy is outlined and a tre ...	2015	25587656
clostridium difficile infection, a descriptive analysis of solid organ transplant recipients at a single center.	clostridium difficile is a bacterial enteric pathogen, which causes clinical disease among solid organ transplant (sot) recipients. this large, single-center, retrospective study describes incidence, demographics, and impact of c. difficile infection (cdi) among adult sot recipients, cardiac (n=5), lung (n=14), liver (n=9), renal (n=26), and multiorgan (n=9) patients transplanted and diagnosed with cdi (geneb pcr) between 9/2009 and 12/2012. the overall incidence of cdi in our population during ...	2015	25586932
government introduces action plan to reduce deaths from sepsis.	tackling sepsis - the potentially fatal over-reaction of the immune system to infection - must be given the same priority as reducing clostridium difficile and mrsa infections, the government has said.	2015	25585729
the epidemiology of clostridium difficile infection inside and outside health care institutions.	this article describes the global changes in clostridium difficile epidemiology since the late twentieth century and into the twenty-first century when the new epidemic strain bi/nap1/027 emerged. the article provides an overview of how understanding of c difficile epidemiology has rapidly evolved since its initial association with colitis in 1974. it also discusses how c difficile has spread across the globe, the role of asymptomatic carriers in disease transmission, the increased recognition o ...	2015	25582647
potential sources of clostridium difficile in human infection.	the view of clostridium difficile infection as a hospital-acquired infection transmitted only by symptomatic patients is changing. although c difficile is present in food for human consumption, food-borne infection caused by c difficile has never been confirmed. more information on the infective dose and the level of contamination is needed to determine the risk for food-borne exposure to c difficile in humans. the emergence of c difficile polymerase chain reaction (pcr) ribotype 078 in humans i ...	2015	25582646
the contribution of strains and hosts to outcomes in clostridium difficile infection.	acquisition of clostridium difficile spores can be followed by a spectrum of clinical outcomes ranging from asymptomatic transit through the bowel to severe colitis and death. this clinical variability is a product of bacterial virulence and host susceptibility to the pathogen. it is important to identify patients at high risk of poor outcome so that increased monitoring and optimal treatment strategies can be instigated. this article discusses the evidence linking strain type to clinical outcom ...	2015	25582645
predictive values of models of clostridium difficile infection.	in vivo and in vitro models are widely used to simulate clostridium difficile infection (cdi). they have made considerable contributions in the study of c difficile pathogenesis, antibiotic predisposition to cdi, and population dynamics as well as the evaluation of new antimicrobial and immunologic therapeutics. although cdi models have greatly increased understanding of this complicated pathogen, all have limitations in reproducing human disease, notably their inability to generate a truly refl ...	2015	25582644
testing for clostridium difficile in patients newly diagnosed with inflammatory bowel disease in a community setting.	the incidence of clostridium difficile infection (cdi) in inflammatory bowel disease (ibd) is increasing, and cdi has a negative impact on ibd outcomes with both increased morbidity and mortality. data are lacking regarding the rate of appropriate testing for cdi at the time of diagnosis.	2015	25581825
[fecal microbiota transplantation: review].	fecal microbiota transplantation (fmt) has gained an increasing medical interest, since the recognition of the role of disturbed microbiota in the development of various diseases. to date, fmt is an established treatment modality for multiple recurrent clostridium difficile infection (rcdi), despite lack of standardization of the procedure. persisting normalization of the disturbed colonic microbiota associated with rcdi seems to be responsible for the therapeutic effect of fmt. for other diseas ...	2015	25577013
mobile genetic elements in clostridium difficile and their role in genome function.	approximately 11% the clostridium difficile genome is made up of mobile genetic elements which have a profound effect on the biology of the organism. this includes transfer of antibiotic resistance and other factors that allow the organism to survive challenging environments, modulation of toxin gene expression, transfer of the toxin genes themselves and the conversion of non-toxigenic strains to toxin producers. mobile genetic elements have also been adapted by investigators to probe the biolog ...	2015	25576774
an alkaline phosphatase reporter for use in clostridium difficile.	clostridium difficile is an anaerobic, gram-positive pathogen that causes severe gastrointestinal disease in humans and other mammals. c. difficile is notoriously difficult to work with and, until recently, few tools were available for genetic manipulation and molecular analyses. despite the recent advances in the field, there is no simple or cost-effective technique for measuring gene transcription in c. difficile other than direct transcriptional analyses (e.g., quantitative real-time pcr and ...	2015	25576237
clostridium difficile infection targets.		2015	25575770
fidaxomicin use and clinical outcomes for clostridium difficile-associated diarrhea.	fidaxomicin has been scrutinized because of its high acquisition cost. real-world experience is needed to determine whether fidaxomicin has value in patients with clostridium difficile-associated diarrhea (cdad) and certain risk factors.	2015	25574116
fecal microbiota transplantation broadening its application beyond intestinal disorders.	intestinal dysbiosis is now known to be a complication in a myriad of diseases. fecal microbiota transplantation (fmt), as a microbiota-target therapy, is arguably very effective for curing clostridium difficile infection and has good outcomes in other intestinal diseases. new insights have raised an interest in fmt for the management of extra-intestinal disorders associated with gut microbiota. this review shows that it is an exciting time in the burgeoning science of fmt application in previou ...	2015	25574083
fecal transplant policy and legislation.	fecal microbiota transplantation (fmt) has garnered significant attention in recent years in the face of a reemerging clostridium difficile (c. difficile) epidemic. positive results from the first randomized control trial evaluating fmt have encouraged the medical community to explore the process further and expand its application beyond c. difficile infections and even the gastrointestinal domain. however promising and numerous the prospects of fmt appear, the method remains limited in scope to ...	2015	25574076
treatment of clostridium difficile infections.	vancomycin and metronidazole were historically considered equivalent therapies for the management of clostridium difficile infections (cdi); however, recent data confirm more favorable outcomes with vancomycin. fidaxomicin is a narrow spectrum antibiotic that has an advantage in reducing recurrence rates compared with vancomycin, possibly owing to its sparing effect on normal colonic microbiota. data are limited for guiding management of cdi recurrences, particularly multiple recurrences. severa ...	2015	25573676
environmental interventions to control clostridium difficile.	the control of clostridium difficile infection is paramount. c difficile spores are difficult to eradicate and can survive on surfaces for prolonged periods of time. hand washing with either plain or antimicrobial soap is effective in removing c difficile spores from hands. patients should be placed in private rooms and under contact precautions to prevent transmission to other patients. regular hospital germicides are not sporicidal and hypochlorite solutions are required for surface disinfecti ...	2015	25573675
new perspectives in clostridium difficile disease pathogenesis.	clostridium difficile is associated with a spectrum of clinical manifestations ranging from asymptomatic carriage to severe life-threatening pseudomembranous colitis. current perspectives indicate that c difficile pathogenesis is a multifactorial disease process dictated by pathogenic toxin production, gut microbial dysbiosis, and altered host inflammatory responses. this article summarizes recent findings underpinning the cellular and molecular mechanisms regulating bacterial virulence and shed ...	2015	25573674
costs associated with health care-associated infections in cardiac surgery.	health care-associated infections (hais) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. current information about their economic burden is limited.	2015	25572505
clostridium difficile from food and surface samples in a belgian nursing home: an unlikely source of contamination.	this study investigates the contamination of foods and surfaces with clostridium difficile in a single nursing home. c. difficile pcr-ribotype 078 was found in one food sample and in none of the tested surfaces. these results indicate that food and surfaces are an unlikely source of c. difficile infection in this setting.	2015	25571851
clostridium difficile infection: risk factors, diagnosis and management.	clostridium difficile infection (cdi) is the leading cause of death due to gastrointestinal infections in the us and is the most common cause of nosocomial diarrhea. the emergence of a hypervirulent strain in the early 2000s has been associated with a dramatic increase in the number and severity of cases in the us, canada, and several other countries. most cases are related to antibiotic use, but sporadic cases occur in otherwise healthy individuals with no risk factors. morbidity and mortality ...	2015	25567105
the gut microbiota and inflammatory noncommunicable diseases: associations and potentials for gut microbiota therapies.	rapid environmental transition and modern lifestyles are likely driving changes in the biodiversity of the human gut microbiota. with clear effects on physiologic, immunologic, and metabolic processes in human health, aberrations in the gut microbiome and intestinal homeostasis have the capacity for multisystem effects. changes in microbial composition are implicated in the increasing propensity for a broad range of inflammatory diseases, such as allergic disease, asthma, inflammatory bowel dise ...	2015	25567038
dysfunctional families: clostridium scindens and secondary bile acids inhibit the growth of clostridium difficile.	c. difficile infection is a deadly disease that is influenced by the microbiome. in a recent article in nature, buffie et al. (2014) demonstrate that the ability of c. scindens to synthesize secondary bile acids is crucial to providing resistance to c. difficile infection.	2015	25565200
the intestinal microbiota: its role in health and disease.	the intestinal microbiota (previously referred to as "intestinal flora") has entered the focus of research interest not only in microbiology but also in medicine. huge progress has been made with respect to the analysis of composition and functions of the human microbiota. an "imbalance" of the microbiota, frequently also called a "dysbiosis," has been associated with different diseases in recent years. crohn's disease and ulcerative colitis as two major forms of inflammatory bowel disease, irri ...	2015	25563215
seek and you shall find: prevalence of clostridium difficile in wuhan, china.	clostridium difficile infection (cdi) is one of the leading health care acquired-infections in the united states, but much of the epidemiology and burden of disease is unknown in china. the aim of this study was to determine the prevalence and possible risk factors of cdi among hospitalized patients with diarrhea in wuhan, china. the overall prevalence of cdi was 28% (31/111). the findings of this study suggest the prevalence of cdi in hospitalized patients with diarrhea is higher then what has ...	2015	25557771
clostridium difficile infection among kidney transplant recipients: frequency, clinical presentation, and outcome.	the objective of this study was to evaluate the frequency of clostridium difficile infection (cdi) among kidney transplant recipients and describe the clinical picture in correlation with the presence of certain risk factors. we included kidney transplant recipients with a functioning graft, who were admitted during the period 1/2012-12/2013, and patients with esrd who were admitted to undergo kidney transplantation (ktx) from a deceased or a living donor in the same period. patients were screen ...	2015	25556694
long-term effects of an antimicrobial stewardship programme at a tertiary-care teaching hospital.	antimicrobial stewardship has been shown to reduce unnecessary antibiotic use, but there are few data on the long-term benefits of such a programme. antimicrobial use over a 13-year period since implementing an antimicrobial stewardship programme (asp) at our institution was examined. nosocomial rates of clostridium difficile infection (cdi) and antimicrobial susceptibility patterns of common nosocomial micro-organisms over the same period were also reviewed. total antimicrobial use decreased by ...	2015	25554468
evaluation of the bd max cdiff assay for the detection of toxigenic clostridium difficile in human stool specimens.	the becton dickinson (bd) pcr-based geneohm cdiff assay has demonstrated a high sensitivity and specificity for detecting clostridium difficile. recently, the bd max platform, using the same principles as bd geneohm, has become available in australia. this study aimed to investigate the sensitivity and specificity of bd max cdiff assay for the detection of toxigenic c. difficile in an australian setting. between december 2013 and january 2014, 406 stool specimens from 349 patients were analysed ...	2015	25551308
overview of management of acute renal failure and its evaluation; a case analysis.	the annual incidence is about 150 per million in the uk, but this figure is six times greater in the >80 years old group. prerenal azotemia is considered as the most serious reason in community or hospital acquired acute renal failure (arf). a 67-year-old middle age male was admitted to the hospital with a chief complaint of generalized weakness, volume depletion and dysuria. he has treated with metronidazole for diarrhoea caused by clostridium difficile considered as the precipitating factor fo ...	2015	28197469
novel receptors for bacterial protein toxins.	while bacterial effectors are often directly introduced into eukaryotic target cells by various types of injection machines, toxins enter the cytosol of host cells from endosomal compartments or after retrograde transport via golgi from the er. a first crucial step of toxin-host interaction is receptor binding. using optimized protocols and new methods novel toxin receptors have been identified, including metalloprotease adam 10 for staphylococcus aureus α-toxin, laminin receptor lu/bcam for esc ...	2015	25461573
single domain antibody coated gold nanoparticles as enhancer for clostridium difficile toxin detection by electrochemical impedance immunosensors.	this work presents a sandwich-type electrochemical impedance immunosensor for detecting clostridium difficile toxin a (tcda) and toxin b (tcdb). single domain antibody conjugated gold nanoparticles were applied to amplify the detection signal. gold nanoparticles (au nps) were characterized by transmission electron microscopy and uv–vis spectra. the electron transfer resistance (ret) of the working electrode surface was used as a parameter in the measurement of the biosensor. with the increase of ...	2015	25460611
development of fecal microbiota transplantation suitable for mainstream medicine.	fecal microbiota transplantation has emerged as an increasingly common treatment for patients with refractory clostridium difficile infection. although it can be relatively simple to perform, a number of challenges need to be overcome before this procedure is widely accepted in mainstream clinical practice. most of the solutions to these challenges already exist, but some need further optimization and testing. standardized fecal microbiota is being developed as a therapeutic agent, although it c ...	2015	25460566
faecal shedding of antimicrobial-resistant clostridium difficile strains by dogs.	to longitudinally assess the shedding of antimicrobial resistant clostridium difficile strains by clinically healthy dogs raised at breeding facilities.	2015	25483272
influence of sequence mismatches on the specificity of recombinase polymerase amplification technology.	recombinase polymerase amplification (rpa) technology relies on three major proteins, recombinase proteins, single-strand binding proteins, and polymerases, to specifically amplify nucleic acid sequences in an isothermal format. the performance of rpa with respect to sequence mismatches of closely-related non-target molecules is not well documented and the influence of the number and distribution of mismatches in dna sequences on rpa amplification reaction is not well understood. we investigated ...	2015	25481659
detection of clostridium difficile toxin genes by pcr: sequence variation may cause false-negative results.		2015	25480881
analysis of interventions to reduce the incidence of clostridium difficile infection at a london teaching hospital trust, 2003-2011.	since 2008 there has been a substantial fall in the incidence of clostridium difficile infection (cdi) in the uk, though it is unclear what contribution local and governmental interventions have made to this reduction.	2015	25480022
low vitamin d level and impact on severity and recurrence of clostridium difficile infections.	clostridium difficile infection (cdi) has recently markedly increased, incurring greater health care-associated costs and hospitalizations especially in vitamin d deficient patients. accordingly, the aim of this study was to evaluate the relationship between low vitamin d levels and the severity and recurrence of cdi.	2015	25479065
the importance of considering different healthcare settings when estimating the burden of clostridium difficile.	traditional surveillance methods may underestimate the true burden of clostridium difficile infection (cdi) because they fail to capture cases brought to medical attention in outpatient settings or diagnosed during non-face-to-face patient-provider interactions.	2015	25477426
development of a sporicidal test method for clostridium difficile.	disinfectants with claimed activity against clostridium difficile must be evaluated to ensure efficacy against the spores that comprise an environmental source of patient infection. unfortunately there is, at present, no generally accepted method for evaluating these disinfectants. in the absence of such a method, laboratories have to adapt protocols that were not designed for products used in medical environments and consequently may use inappropriate test organisms, exposure times, and pass cr ...	2015	25477061
survival of clostridium difficile spores at low temperatures.	clostridium difficile's presence has been reported in meat products stored typically at low temperatures. this study evaluated the viability in phosphate buffer saline (pbs) of spores from epidemic c. difficile strain r20291 (4.6 log cfu/ml) and m120 (7.8 log cfu/ml). viability was assessed during 4 months at -80 °c, -20 °c, 4 °c (refrigeration), and 23 °c (room temperature), and after 10 freeze (-20 °c)/thaw (+23 °c) cycles. although spore viability decreased, significant viability was still ob ...	2015	25475288
a possible route for foodborne transmission of clostridium difficile?	spores of toxigenic clostridium difficile and spores of food-poisoning strains of clostridium perfringens show a similar prevalence in meats. spores of both species are heat resistant and can survive cooking of foods. c. perfringens is a major cause of foodborne illness; studies are needed to determine whether c. difficile transmission by a similar route is a cause of infection.	2015	25599421