Publications

fecal microbiota transplantation: effectiveness, complexities, and lingering concerns.	the mammalian colon is home to a microbial ecosystem that enhances resistance to infection, stimulates mucosal immune defenses, synthesizes essential vitamins, and promotes caloric uptake by hydrolyzing complex carbohydrates. the bacterial populations inhabiting the gut are complex and vary between different individuals. clinical and experimental studies reveal that the colonic microbiota can enhance or ameliorate intestinal and systemic inflammatory diseases. because of its potential to enhance ...	2014	24399149
characterization of clostridium perfringens in the feces of adult horses and foals with acute enterocolitis.	up to 60% of cases of equine colitis have no known cause. to improve understanding of the causes of acute colitis in horses, we hypothesized that clostridium perfringens producing enterotoxin (cpe) and/or beta2 toxin (cpb2) are common and important causes of severe colitis in horses and/or that c. perfringens producing an as-yet-undescribed cytotoxin may also cause colitis in horses. fecal samples from 55 horses (43 adults, 12 foals) with clinical evidence of colitis were evaluated by culture fo ...	2014	24396174
evaluation of the diagnostic performance of the xpert clostridium difficile assay and its comparison with the toxin a/b enzyme-linked fluorescent assay and in-house real-time pcr assay used for the detection of toxigenic c. difficile.	clostridium difficile genes or toxin can be detected using several laboratory techniques. in this study, we compared the performance of the xpert c. difficile assay with that of a toxin a/b enzyme-linked fluorescent immunoassay (elfa) and an in-house real-time pcr assay for the tcdb gene.	2014	24395702
faecal microbiota transplantation for clostridium difficile infection.	to review the current clinical literature regarding the use of fecal microbiota transplantation (fmt) for severe and recurrent clostridium difficile disease (cdad).	2014	24372725
small animal models for the study of clostridium difficile disease pathogenesis.	clostridium difficile is the leading cause of bacterial antibiotic-associated diarrhoea in hospitals in the developed world. despite this notoriety, the complex mechanisms employed by this pathogen to overcome innate host defences and induce fulminant disease are poorly understood. various animal models have been used extensively for c. difficile research to study disease pathogenesis. until recently, the most commonly used c. difficile disease model has utilised hamsters; however, mouse and pig ...	2014	24372713
controversies surrounding clostridium difficile infection in infants and young children.	clostridium difficile is a frequent cause of antibiotic-associated diarrhea in adults and older children. however, as many as 80% of infants can be asymptomatically colonized. the reasons for this have not been well established but are believed to be due to differences in toxin receptors or toxin internalization. determining which children who test positive for c. difficile warrant treatment is exceedingly difficult, especially in the setting of increased rates of detection and the rising risk o ...	2014	27417466
false-positive clostridium difficile in negative-control reactions peak and then decrease with repetitive refrigeration of immunoassay.	aberrant false-positive reactions in negative-controls during elisa testing for clostridium difficile indicated the potential for false-diagnoses. experiments with 96-well products showed a maximum peak of false-positive immunoassay reactions with the provided negative-control reagents after 5 refrigeration-to-room temperature cycles (p < 0.001), decreasing thereafter with additional refrigeration cycles. because repetitive refrigeration causes a peak of false-positives, the use of single negati ...	2014	27350964
old and new glycopeptide antibiotics: action and resistance.	glycopeptides are considered antibiotics of last resort for the treatment of life-threatening infections caused by relevant gram-positive human pathogens, such as staphylococcus aureus, enterococcus spp. and clostridium difficile. the emergence of glycopeptide-resistant clinical isolates, first among enterococci and then in staphylococci, has prompted research for second generation glycopeptides and a flurry of activity aimed at understanding resistance mechanisms and their evolution. glycopepti ...	2014	27025757
ciprofloxacin affects host cells by suppressing expression of the endogenous antimicrobial peptides cathelicidins and beta-defensin-3 in colon epithelia.	antibiotics exert several effects on host cells including regulation of immune components. antimicrobial peptides (amps), e.g., cathelicidins and defensins display multiple functions in innate immunity. in colonic mucosa, cathelicidins are induced by butyrate, a bacterial fermentation product. here, we investigated the effect of antibiotics on butyrate-induced expression of cathelicidins and beta-defensins in colon epithelial cells. real-time pcr analysis revealed that ciprofloxacin and clindamy ...	2014	27025750
improving management of constipation in an inpatient setting using a care bundle.	constipation is a common occurrence on geriatric in-patient wards. it can result in delirium and other complications including bowel obstruction. over treatment with laxatives can result in iatrogenic diahorrea, which can lead to dehydration, delirium, and the false positive labeling and unnecessary treatment of clostridium difficile carriers. this can result in increased morbidity and mortality, and a longer stay in hospital. this means that improving the assessment and treatment of constipatio ...	2014	26734278
prevention of clostridium difficile infection in rural hospitals.	prevention of clostridium difficile infection (cdi) remains challenging across the spectrum of health care. there are limited data on prevention practices for cdi in the rural health care setting.	2014	24406257
patients' experience and perception of hospital-treated clostridium difficile infections: a qualitative study.	clostridium difficile is the leading cause of antibiotic-associated diarrhea and an important source of nosocomial infection. clinical manifestations can range from mild diarrhea to lethal pseudomembranous colitis. little is known about the burden of c. difficile infections (cdi) in patients.	2014	24403096
proteomic analysis of a nap1 clostridium difficile clinical isolate resistant to metronidazole.	clostridium difficile is an anaerobic, gram-positive bacterium that has been implicated as the leading cause of antibiotic-associated diarrhea. metronidazole is currently the first-line treatment for mild to moderate c. difficile infections. our laboratory isolated a strain of c. difficile with a stable resistance phenotype to metronidazole. a shotgun proteomics approach was used to compare differences in the proteomes of metronidazole-resistant and -susceptible isolates.	2014	24400070
clostridium difficile: deleterious impact on hematopoietic stem cell transplantation.	c. difficile infection (cdi), the most common cause of hospital-acquired diarrhea, is very frequent after hematopoietic stem cell transplantation (hsct). recent publications suggest it affects between 6 % and 20 % of hsct recipients during the first year and is more common following allogeneic transplant (allo-hsct). the best diagnostic strategy remains to be defined, but molecular testing for the toxin genes by polymerase chain reaction (pcr) seems to be replacing the traditional enzyme immunoa ...	2014	24390550
a clinician's primer on the role of the microbiome in human health and disease.	the importance of the commensal microbiota that colonizes the skin, gut, and mucosal surfaces of the human body is being increasingly recognized through a rapidly expanding body of science studying the human microbiome. although, at first glance, these discoveries may seem esoteric, the clinical implications of the microbiome in human health and disease are becoming clear. as such, it will soon be important for practicing clinicians to have an understanding of the basic concepts of the human mic ...	2014	24388028
new routes towards reutericyclin analogues.	a range of n-acylpyrrolo[3,4-c]isoxazoles and derived n-acyltetramides has been prepared via a nitrile oxide dipolar cycloaddition approach, as analogues of the acyltetramic acid metabolite reutericyclin, of interest for its antibiotic potential against gram-positive bacteria including hospital-acquired infections of resistant clostridium difficile.	2014	24382380
low vitamin d level is an independent predictor of poor outcomes in clostridium difficile-associated diarrhea.	the incidence, recurrence, and all-cause mortality rate for clostridium difficile-associated diarrhea (cdad) has increased markedly over the past 10 years despite treatment. low vitamin d levels are known to impair immune responses to infection and are associated with increased mortality. we compared the role of patient comorbidity measured by the charlson comorbidity index (cci) with vitamin d levels to ascertain whether vitamin d levels were an independent variable affecting the outcome of cda ...	2014	24381644
recurrence of clostridium difficile infection among veterans with spinal cord injury and disorder.	recurrent clostridium difficile (cdi) infection is a growing concern; however, there are little data on impact of recurrent cdi on those with spinal cord injury and disorder (sci/d). therefore, the objective of this study was to identify risk factors associated with recurrence of cdi among veterans with sci/d.	2014	24485372
sequence similarity of clostridium difficile strains by analysis of conserved genes and genome content is reflected by their ribotype affiliation.	pcr-ribotyping is a broadly used method for the classification of isolates of clostridium difficile, an emerging intestinal pathogen, causing infections with increased disease severity and incidence in several european and north american countries. we have now carried out clustering analysis with selected genes of numerous c. difficile strains as well as gene content comparisons of their genomes in order to broaden our view of the relatedness of strains assigned to different ribotypes. we analyz ...	2014	24482682
lipoprotein cd0873 is a novel adhesin of clostridium difficile.	clostridium difficile is a cause of antibiotic-associated diarrhea and colitis, a healthcare-associated intestinal disease. colonization of the gut is a critical step in the course of infection. the c. difficile lipoprotein cd0873 was identified as a putative adhesin through a bioinformatics approach. surface exposure of cd0873 was confirmed and a cd0873 mutant was generated. the cd0873 mutant showed a significant reduction in adherence to caco-2 cells and wild-type bacteria preincubated with an ...	2014	24482399
clostridium difficile toxin cdt hijacks microtubule organization and reroutes vesicle traffic to increase pathogen adherence.	clostridium difficile causes antibiotic-associated diarrhea and pseudomembranous colitis by the actions of rho-glucosylating toxins a and b. recently identified hypervirulent strains, which are associated with increased morbidity and mortality, additionally produce the actin-adp-ribosylating toxin c. difficile transferase (cdt). cdt depolymerizes actin, causes formation of microtubule-based protrusions, and increases pathogen adherence. here we show that cdt-induced protrusions allow vesicle tra ...	2014	24469807
shedding of clostridium difficile pcr ribotype 078 by zoo animals, and report of an unstable metronidazole-resistant isolate from a zebra foal (equus quagga burchellii).	clostridium difficile is an emerging and potentially zoonotic pathogen, but its prevalence in most animal species, including exhibition animals, is currently unknown. in this study we assessed the prevalence of faecal shedding of c. difficile by zoo animals, and determined the ribotype, toxin profile and antimicrobial susceptibility of recovered isolates. a total of 200 samples from 40 animal species (36.5% of which came from plains zebra, equus quagga burchellii) were analysed. c. difficile was ...	2014	24467928
is there any value in measuring faecal calprotectin in clostridium difficile positive faecal samples?	markers of intestinal inflammation have been proposed for inclusion in clostridium difficile diagnostic algorithms. faecal calprotectin (f-cp), a sensitive marker of intestinal inflammation, was evaluated for utility in c. difficile diagnosis in the hospital setting. one hundred and twenty c. difficile positive and 99 c. difficile negative faecal samples of hospital-acquired diarrhoea were analysed for f-cp using a quantitative elisa. c. difficile positivity was confirmed using elisas for either ...	2014	24464697
[cloudy peritoneal effluent and diarrhoea due to clostridium difficile].		2014	24463873
fulminant clostridium difficile colitis: prospective development of a risk scoring system.	of the patients with a clostridium difficile infection, 2% to 8% will progress to fulminant c. difficile colitis (fcdc), which carries high morbidity and mortality. no system exists to rapidly identify patients at risk for developing fcdc and possibly in need of surgical intervention. our aim was to design a simple and accurate risk scoring system (rss) for daily clinical practice.	2014	24458048
faecal transplantation for clostridium difficile infection. three cases treated in italy.		2014	24457126
[successful home-made fecal transplant for an elderly woman].	recurrent clostridium difficile infection (cdi) is a challenge for infectious disease specialists. a third of first recurrences will fail antibiotic therapy. several mechanisms have been proposed to explain this, such as persistence of spores, inadequate antibody response, and altered gut microbiota. standard recommendations for cdi treatment include metronidazole and vancomycin. fecal transplant has proven to be an effective therapy for recurrent cdi. infusion of stools can be administered to t ...	2014	24481438
prospects for flavonoid and related phytochemicals as nature-inspired treatments for clostridium difficile infection.	there is a need for novel treatments for clostridium difficile infection(cdi). antibacterial flavonoids are part of a large family of polyphenol phytochemicals with a long history of use in ethnomedicine, but are unexamined against cl. difficile. we explored their anti-difficile properties.	2014	24479135
a cost-effective approach for detection of toxigenic clostridium difficile: toxigenic culture using chromid clostridium difficile agar.	we evaluated the performance and the cost of toxigenic culture using a commercial chromogenic medium (cdif) for 538 stool specimens. compared with real-time pcr, this method was found to detect an additional 9% of positive specimens and result in 61% reduction in material costs, with a trade-off increase in turnaround time of 1 day.	2014	24478510
impact of changes in clostridium difficile testing practices on stool rejection policies and c. difficile positivity rates across multiple laboratories in the united states.	we describe the adoption of nucleic acid amplification tests (naat) for clostridium difficile diagnosis and their impact on stool rejection policies and c. difficile positivity rates. of the laboratories with complete surveys, 51 (43%) reported using naat in 2011. laboratories using naat had stricter rejection policies and increased positivity rates.	2014	24478500
economic evaluation of laboratory testing strategies for hospital-associated clostridium difficile infection.	clostridium difficile infection (cdi) is the most common cause of infectious diarrhea in health care settings, and for patients presumed to have cdi, their isolation while awaiting laboratory results is costly. newer rapid tests for cdi may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. we used decision analysis from the hospital perspective to compare multiple cdi testing algorithms for adult inpatients with suspected cdi, assuming patient m ...	2014	24478478
protection from clostridium difficile infection in cd4 t cell- and polymeric immunoglobulin receptor-deficient mice.	clostridium difficile rivals methicillin-resistant staphylococcus aureus as the primary hospital-acquired infection. c. difficile infection (cdi) caused by toxins a and/or b can manifest as mild diarrhea to life-threatening pseudomembranous colitis. although most patients recover fully from cdi, ~20% undergo recurrent disease. several studies have demonstrated a correlation between anti-toxin antibody (ab) and decreased recurrence; however, the contributions of the systemic and mucosal ab respon ...	2014	24478068
colonic immunopathogenesis of clostridium difficile infections.	there are major gaps in our understanding of the immunopathogenesis of clostridium difficile infections (cdis). in this study, 36 different biomarkers were examined in the stools of cdi and non-cdi patients using the proteome profiler human cytokine array assay and quantitative enzyme-linked immunosorbent assay. diarrheal stools from patients with cdi (cdi-positive diarrheal stools) showed higher relative amounts of the following inflammatory markers than the diarrheal stools from cdi-negative p ...	2014	24477852
outcomes of clostridium difficile infection in recipients of solid abdominal organ transplants.	knowledge of outcomes of clostridium difficile infection (cdi) in solid organ transplant (sot) recipients is limited. to evaluate this population, we undertook a retrospective cohort study of all recipients of kidney and liver transplants diagnosed with cdi at a single center over 14 yr. data pertaining to all episodes of cdi were collected. multivariate analysis using logistic regression was performed to determine independent predictors of clinical cure. overall, 170 patients developed 215 epis ...	2014	24476412
transmission of clostridium difficile spores in isolation room environments and through hospital beds.	the aim of this study was to determine the dissemination of clostridium difficile (cd) spores in a hospital setting where the potassium monopersulfate-based disinfectant virkon™ was used for cleaning. in the initial part of the study, we sampled 16 areas of frequent patient contact in 10 patient rooms where a patient with cd infection (cdi) had been accommodated. in the second part of the study, we obtained samples from 10 patient beds after discharge of cdi patients, both before and after the b ...	2014	24475890
what does the talking?: quorum sensing signalling genes discovered in a bacteriophage genome.	the transfer of novel genetic material into the genomes of bacterial viruses (phages) has been widely documented in several host-phage systems. bacterial genes are incorporated into the phage genome and, if retained, subsequently evolve within them. the expression of these phage genes can subvert or bolster bacterial processes, including altering bacterial pathogenicity. the phage phicdhm1 infects clostridium difficile, a pathogenic bacterium that causes nosocomial infections and is associated w ...	2014	24475037
an interprofessional approach to reducing the overutilization of stress ulcer prophylaxis in adult medical and surgical intensive care units.	overutilization of stress ulcer prophylaxis (sup) in the intensive care unit (icu) is common. acid-suppressive therapies routinely used for sup are best reserved for patients with greatest risk of clinically important bleeding as they have been associated with nosocomial pneumonia, clostridium difficile infection and increased hospital cost.	2014	24473490
prophylactic antibiotics for hemorrhoidectomy: are they really needed?	hemorrhoidectomy is considered by many to be a contaminated operation that requires antibiotic prophylaxis to lower the incidence of surgical site infection. in reality, little evidence exists to either support or refute the use of antibiotic prophylaxis in this setting.	2014	24509461
effect of antisera from clostridium difficile-infected mice on toxin-a-induced colonic epithelial cell death signaling.	clostridium difficile causes mucosal damage and diarrhea by releasing two exotoxins: toxin a and toxin b. c. difficile colitis is associated with alterations in bowel flora and the failure to mount an effective antibody response. the aim of the current study was to investigate whether antitoxin sera prevent toxin-a-induced apoptosis, cytoskeletal disaggregation, cell detachment, and tight junction loss in cultured colonic epithelial cells. serum samples were isolated from mice that survived a c. ...	2014	24509250
prevalence and molecular characterization of clostridium difficile isolated from european barn swallows (hirundo rustica) during migration.	clostridium difficile is an important bacterial pathogen of humans and a variety of animal species. birds, especially migratory passerine species, can play a role in the spread of many pathogens, including clostridium difficile. barn swallows (hirundo rustica) nest in close proximity to human habitats and their biology is closely associated with cattle farming. therefore, we hypothesized that barn swallows can be the reservoir of clostridium difficile.	2014	24507706
acute diarrhea.	acute diarrhea in adults is a common problem encountered by family physicians. the most common etiology is viral gastroenteritis, a self-limited disease. increases in travel, comorbidities, and foodborne illness lead to more bacteria-related cases of acute diarrhea. a history and physical examination evaluating for risk factors and signs of inflammatory diarrhea and/or severe dehydration can direct any needed testing and treatment. most patients do not require laboratory workup, and routine stoo ...	2014	24506120
preoperative clostridium difficile infection is not associated with an increased risk for the infection in ileal pouch patients.	clostridium difficile infection (cdi) might contribute to a refractory course of pouchitis. however, the association between preoperative cdi and postoperative cdi in ileal pouch patients has not been investigated.	2014	24504594
epidemiological study of clostridium difficile infection in critical patients admitted to the intensive care unit.	data on the epidemiology of infections caused by clostridium difficile (cdi) in critically ill patients are scarce and center on studies with a limited time framework and/or epidemic outbreaks.	2014	24503331
role of the intestinal microbiota in resistance to colonization by clostridium difficile.	antibiotic-associated infection with the bacterial pathogen clostridium difficile is a major cause of morbidity and increased health care costs. c difficile infection follows disruption of the indigenous gut microbiota by antibiotics. antibiotics create an environment within the intestine that promotes c difficile spore germination, vegetative growth, and toxin production, leading to epithelial damage and colitis. studies of patients with c difficile infection and animal models have shown that t ...	2014	24503131
prevalence of clostridium difficile in raw beef, cow, sheep, goat, camel and buffalo meat in iran.	clostridium difficile has been shown to be a nosocomial pathogen associated with diarrhoea and pseudomembranous colitis in hospitalised patients and the infection is believed to be acquired nosocomially. recent studies have shown the occurrence of c. difficile in food animals which may act as a source of infection to humans.the aim of this study was to determine the occurrence of c. difficile in retail raw beef, cow, sheep, goat, camel and buffalo meat in iran.	2014	24499381
is clostridium difficile associated with the '4c' antibiotics? a retrospective observational study in diabetic foot ulcer patients.	clostridium difficile is an anaerobic cytotoxin-producing bacterium that can cause infectious diarrhoea, pseudomembranous colitis and toxic megacolon. the major risk factors for developing c. difficile infection include recent or current antimicrobial use, diabetes, age over 65, proton pump inhibitor use, immunosuppression and previous infection with c. difficile. most diabetic foot ulcers are polymicrobial.	2014	24499256
[insidious and widespread outbreak of clostridium difficile. changed cleaning procedures and frequent evaluations cut infection rates in half].		2014	24498716
spore formation and toxin production in clostridium difficile biofilms.	the ability to grow as a biofilm can facilitate survival of bacteria in the environment and promote infection. to better characterize biofilm formation in the pathogen clostridium difficile, we established a colony biofilm culture method for this organism on a polycarbonate filter, and analyzed the matrix and the cells in biofilms from a variety of clinical isolates over several days of biofilm culture. we found that biofilms readily formed in all strains analyzed, and that spores were abundant ...	2014	24498186
comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial.	we have already reported that, for patients undergoing elective colon cancer operations, perioperative infection can be prevented by a single intravenous dose of an antibiotic given immediately beforehand if mechanical bowel preparation and the administration of oral antibiotics are implemented. synbiotics has been reported to reduce the rate of infection in patients after pancreatic cancer operations. the effectiveness of oral antibiotics and probiotics in preventing postoperative infection in ...	2014	24524389
survey of clostridium difficile in retail seafood in college station, texas.	the incidence and severity of disease associated with toxigenic clostridium difficile have increased in hospitals in north america with the emergence of newer, more virulent strains. toxigenic c. difficile has been isolated from food animals and retail meat with potential implications of transfer to humans. the objective of the present study was to investigate the prevalence of c. difficile in retail seafood from grocery stores in college station, texas. c. difficile was found in 4.5% (3/67) of ...	2014	24524301
estimating risk of c. difficile transmission from pcr positive but cytotoxin negative cases.	the use of molecular methods to diagnose clostridium difficile infection (cdi) has improved diagnostic yield compared to conventional methods. however, pcr testing can detect colonization and has introduced several practical challenges pertaining to need for treatment and isolation of cases.	2014	24523882
a cluster of fulminant clostridium difficile colitis in an intensive care unit in italy.	we describe, for the first time, a cluster of lethal fulminant health-care associated clostridium difficile (cd) colitis in italy, observed in the intensive care unit (icu) of an italian tertiary care hospital in rome. for all cases the cause of icu admission was cd-related septic shock. three out of seven patients were residents in a long-term care facility in rome, and the others had been transferred to the icu from different medical wards of the same hospital. five patients died within 96 h o ...	2014	24523055
variability of contact precaution policies in us emergency departments.	contact precautions policies in us emergency departments have not been studied. we surveyed a structured random sample and found wide variation; for example, 45% required contact precautions for stool incontinence or diarrhea, 84% for suspected clostridium difficile, and 79% for suspected methicillin-resistant staphylococcus aureus infection. emergency medicine departments and organizations should enact policies.	2014	24521599
the simple predictors of pseudomembranous colitis in patients with hospital-acquired diarrhea: a prospective observational study.	as the incidence rate of and mortality from pseudomembranous colitis (pmc) are increasing worldwide, it is important to study the simple predictive risk factors for pmc among patients with hospital-acquired diarrhea (had). this study focused on identifying the clinical risk factors that can easily predict pmc.	2014	24516700
clostridium difficile infection: a worldwide disease.	clostridium difficile, an anaerobic toxigenic bacterium, causes a severe infectious colitis that leads to significant morbidity and mortality worldwide. both enhanced bacterial toxins and diminished host immune response contribute to symptomatic disease. c. difficile has been a well-established pathogen in north america and europe for decades, but is just emerging in asia. this article reviews the epidemiology, microbiology, pathophysiology, and clinical management of c. difficile. prompt recogn ...	2014	24516694
development and validation of a chemostat gut model to study both planktonic and biofilm modes of growth of clostridium difficile and human microbiota.	the human gastrointestinal tract harbours a complex microbial community which exist in planktonic and sessile form. the degree to which composition and function of faecal and mucosal microbiota differ remains unclear. we describe the development and characterisation of an in vitro human gut model, which can be used to facilitate the formation and longitudinal analysis of mature mixed species biofilms. this enables the investigation of the role of biofilms in clostridium difficile infection (cdi) ...	2014	24516647
kibdelomycin is a potent and selective agent against toxigenic clostridium difficile.	clostridium difficile is the causative agent of c. difficile-associated diarrhea (cdad), with increased risk in elderly populations. kibdelomycin, a novel natural-product inhibitor of type ii topoisomerase enzymes, was evaluated for activity against c. difficile and gastrointestinal anaerobic organisms. toxigenic c. difficile isolates (n=168) from u.s. hospitals and anaerobic gram-positive and gram-negative organisms (n=598) from chicago-area hospitals were tested. kibdelomycin showed potent act ...	2014	24514098
synchronous cytomegalovirus and clostridium difficile infection of the pouch: a trigger for chronic pouchitis?	pouchitis occurs in up to one half of patients after restorative proctocolectomy with ileal pouch-anal anastomosis (ipaa). cytomegalovirus (cmv) and clostridium difficile are among the commonest secondary identifiable etiologies. a 17-year-old male with ulcerative colitis underwent ipaa due to refractory disease. nine months later he experienced bloody diarrhea and fever. laboratory testing and endoscopy confirmed pouch inflammation. testing for c. difficile toxins a and b was positive. histolog ...	2014	26183628
life after colectomy for fulminant clostridium difficile colitis: a 7-year follow up study.	the long-term prognosis of patients undergoing colectomy for fulminant clostridium difficile colitis has not been well studied. the authors present 7-year survival trends in such patients.	2014	24674828
administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing clostridium difficile-associated diarrhea.	proton pump inhibitors (ppis) effectively prevent gastrointestinal bleedings in critically ill patients at the intensive care unit (icu). in non-icu hospitalized patients, ppi administration increases the risk of infectious complications, especially clostridium difficile-associated diarrhea (cdad); but no such data are available for the icu setting.	2014	24674763
a retrospective analysis of clinical characteristics, hospitalization, and functional outcomes in residents with and without clostridium difficile infection in us long-term care facilities.	patients in long-term care (ltc) are at increased risk for acquiring clostridium difficile infection (cdi). we compared the characteristics and outcomes of matched cohorts with and without cdi in the ltc setting.	2014	24552133
comparative microbiological studies of transcription inhibitors fidaxomicin and the rifamycins in clostridium difficile.	fidaxomicin (fdx) is a narrow-spectrum antibiotic for the treatment of clostridium difficile-associated diarrhea. while fdx and rifamycins share the same target (rna polymerase), fdx exhibits a unique mode of action distinct from that of rifamycins. in comparative microbiological studies with c. difficile, fdx interacted synergistically with rifamycins, demonstrated a lower propensity for the development of resistance to rifamycins, and exhibited no cross-resistance with rifamycins. these result ...	2014	24550338
histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit.	importance histamine-2 receptor antagonists (h2ras) and proton pump inhibitors (ppis) are commonly used to prevent gastrointestinal tract (gi) hemorrhage in critically ill patients. the stronger acid suppression of ppis may reduce the rate of bleeding but enhance infectious complications, specifically pneumonia and clostridium difficile infection (cdi). objective to evaluate the occurrence and risk factors for gi hemorrhage, pneumonia, and cdi in critically ill patients. design, setting, and par ...	2014	24535015
characterization of temperate phages infecting clostridium difficile isolates of human and animal origins.	clostridium difficile is a gram-positive pathogen infecting humans and animals. recent studies suggest that animals could represent potential reservoirs of c. difficile that could then transfer to humans. temperate phages contribute to the evolution of most bacteria, for example, by promoting the transduction of virulence, fitness, and antibiotic resistance genes. in c. difficile, little is known about their role, mainly because suitable propagating hosts and conditions are lacking. here we repo ...	2014	24532062
clostridium difficile is common in patients with postoperative diarrhea after hip and knee arthroplasty.	clostridium difficile is an antibiotic-associated gastrointestinal infection that has detrimental consequences. we sought to determine the incidence of c. difficile in tja patients with postoperative diarrhea, to determine risk factors for c. difficile infection, and to establish the incidence of c. difficile-related complications. our institutional protocol includes screening for c. difficile in all patients with diarrhea after tja. we identified 121 such patients over four years with twenty-ei ...	2014	24530206
microbial composition analysis of clostridium difficile infections in an ulcerative colitis patient treated with multiple fecal microbiota transplantations.	fecal microbiota transplantation (fmt) is a promising therapy for clostridium difficile infection (cdi). however, questions remain regarding efficacy and safety in inflammatory bowel disease (ibd) patients, as well as longitudinal stability of donor stool composition. this report describes an ibd patient with two cdis 18 months apart, each successfully treated with fmt with no ibd flares or complications. microbiome composition analysis of patient samples during each infection revealed low-diver ...	2014	24529606
inpatient antibiotic consumption in a regional secondary hospital in new zealand.	reporting of antibiotic consumption in hospitals is a crucial component of antibiotic stewardship, but data from australasian secondary hospitals are scarce. the hypothesis of this audit is that antibiotic consumption in secondary hospitals would be lower than in tertiary centres.	2014	24528814
[diarrhea associated with clostridium difficile in the elderly: new perspectives].	infection due to clostridium difficile is currently the main cause of hospital acquired gastrointestinal disease. its prevalence in the elderly population is higher due to there being many associated risk factors in this age group, such as comorbidity, frequent exposure to the healthcare or residential home setting, immunosenescence, greater consumption of antibiotics, and antiacids. the diagnostic techniques have notably improved in the last few years, which could also account for an increase i ...	2014	24685366
fever notions of the misinformed: a quality improvement project.	tracking temperatures graphically, recognizing their normal quotidian variations, and acknowledging that fever may be a beneficial physiological response to infection, have been lost in modern hospital care. further, injudicious use of antibiotics for "low-grade fever" contributes to the multiple drug resistant organism and clostridium difficile epidemics. this essay discusses these issues and proposes changing common misperceptions of fever as a quality improvement project.	2014	24683931
a novel multivalent, single-domain antibody targeting tcda and tcdb prevents fulminant clostridium difficile infection in mice.	the incidence of clostridium difficile infection (cdi) and associated mortality have increased rapidly worldwide in recent years. therefore, it is critical to develop new therapies for cdi. in this study, we generated a novel, potently neutralizing, tetravalent, and bispecific antibody composed of 2 heavy-chain-only vh (vhh) binding domains against both tcda and tcdb (designated "aba") that reverses fulminant cdi in mice infected with an epidemic 027 strain after a single injection of the antibo ...	2014	24683195
role of doxycycline in clostridium difficile infection acquisition.	to evaluate and review the literature surrounding the potential protective benefit of tetracyclines, particularly doxycycline, in reducing clostridium difficile infection (cdi) acquisition.	2014	24682682
utility of the clostridial site-specific recombinase tnpx to clone toxic-product-encoding genes and selectively remove genomic dna fragments.	tnpx is a site-specific recombinase responsible for the excision and insertion of the transposons tn4451 and tn4453 in clostridium perfringens and clostridium difficile, respectively. here, we exploit phenotypic features of tnpx to facilitate genetic mutagenesis and complementation studies. genetic manipulation of bacteria often relies on the use of antibiotic resistance genes; however, a limited number are available for use in the clostridia. the ability of tnpx to recognize and excise specific ...	2014	24682304
effects of clostridium difficile infection in patients with alcoholic hepatitis.	infection increases mortality in patients with alcoholic hepatitis (ah). little is known about the association between clostridium difficile infection (cdi) and ah. we examined the prevalence and effects of cdi in patients with ah, compared with those of other infections.	2014	24681081
risk of clostridium difficile infection in hospitalized patients receiving metronidazole for a non-c difficile infection.	antibiotics often are given to prevent infections but also constitute a risk factor for clostridium difficile infection (cdi). metronidazole is an effective treatment for cdi. we investigated whether prophylactic administration of metronidazole to patients before they receive other antibiotics reduces the risk of cdi.	2014	24681079
the silver lining of disposable sporicidal privacy curtains in an intensive care unit.	the environment is a well-known source of health care-acquired infection. because of the known risk of contamination, patient privacy curtains require frequent changes to decrease the risk of spread from patients to curtain and visa versa.	2014	24679561
working relationships of infection prevention and control programs and environmental services and associations with antibiotic-resistant organisms in canadian acute care hospitals.	environmental contamination in hospitals with antibiotic-resistant organisms (aros) is associated with patient contraction of aros. this study examined the working relationship of infection prevention and control (ipac) and environmental services and the impact of that relationship on aro rates.	2014	24679559
reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent clostridium difficile infection.	recurrent clostridium difficile infection (cdi) can be effectively treated by infusion of a healthy donor faeces suspension. however, it is unclear what factors determine treatment efficacy. by using a phylogenetic microarray platform, we assessed composition, diversity and dynamics of faecal microbiota before, after and during follow-up of the transplantation from a healthy donor to different patients, to elucidate the mechanism of action of faecal infusion. global composition and network analy ...	2014	24577353
antimicrobial stewardship in hospitals: does it work and can we do it?	selection of resistant pathogens by antimicrobial use is probably the most important cause of antimicrobial resistance. antimicrobial stewardship (ams) refers to a multifaceted approach to optimise prescribing. the benefits of ams programmes have been widely demonstrated in terms of reductions in antimicrobial use, mortality, clostridium difficile and other healthcare-associated infections, hospital length of stay and bacterial resistance. several kinds of interventions (i.e. restriction of drug ...	2014	27873630
diagnosis and management of clostridium difficile infection by pediatric infectious diseases physicians.	the incidence of c difficile infection (cdi) has risen among children; however, optimal management of cdi within a diverse pediatric population remains unclear. although adult guidelines recommend oral vancomycin for treatment of second recurrence or severe cdi, dedicated pediatric data to support pediatric specific management guidelines are lacking. our objective was to describe current cdi management practices by pediatric infectious diseases (id) physicians.	2014	26624906
clostridium difficile infection is on the rise.	the emergence of an epidemic strain makes prevention and early diagnosis critical.	2014	24572541
clinical outcomes associated with chronic antimicrobial suppression therapy in patients with continuous-flow left ventricular assist devices.	this retrospective cohort study evaluates the effect of chronic antimicrobial suppression (cas) therapy on clinical outcomes in patients with continuous-flow left ventricular assist devices (cf-lvads) and a history of device-related infection. patients with cf-lvad implantation between january 2008 and august 2011 who received systemic cas after index antibiotic treatment of a device-related infection were included. chronic suppression was defined as continuation of antibiotics for longer than 6 ...	2014	24571683
functional genomics reveals that clostridium difficile spo0a coordinates sporulation, virulence and metabolism.	clostridium difficile is an anaerobic, gram-positive bacterium that can reside as a commensal within the intestinal microbiota of healthy individuals or cause life-threatening antibiotic-associated diarrhea in immunocompromised hosts. c. difficile can also form highly resistant spores that are excreted facilitating host-to-host transmission. the c. difficile spo0a gene encodes a highly conserved transcriptional regulator of sporulation that is required for relapsing disease and transmission in m ...	2014	24568651
management of suspected infectious diarrhoea by english gps: are they right?	the criteria used when gps submit stool specimens for microbiological investigation are unknown.	2014	24567579
translocation domain mutations affecting cellular toxicity identify the clostridium difficile toxin b pore.	disease associated with clostridium difficile infection is caused by the actions of the homologous toxins tcda and tcdb on colonic epithelial cells. binding to target cells triggers toxin internalization into acidified vesicles, whereupon cryptic segments from within the 1,050-aa translocation domain unfurl and insert into the bounding membrane, creating a transmembrane passageway to the cytosol. our current understanding of the mechanisms underlying pore formation and the subsequent translocati ...	2014	24567384
the genome of clostridium difficile 5.3.	clostridium difficile is the leading cause of infectious diarrhea in humans and responsible for large outbreaks of enteritis in neonatal pigs in both north america and europe. disease caused by c. difficile typically occurs during antibiotic therapy and its emergence over the past 40 years is linked with the widespread use of broad-spectrum antibiotics in both human and veterinary medicine.	2014	24565059
surface layer proteins isolated from clostridium difficile induce clearance responses in macrophages.	clostridium difficile is the leading cause of hospital-acquired diarrhoea worldwide, and if the bacterium is not cleared effectively it can pose a risk of recurrent infections and complications such as colitis, sepsis and death. in this study we demonstrate that surface layer proteins from the one of the most frequently acquired strains of c. difficile, activate mechanisms in murine macrophage in vitro that are associated with clearance of bacterial infection. surface layer proteins (slps) isola ...	2014	24560642
clostridium difficile infection in brazil: a neglected problem?	the epidemiology of clostridium difficile infection is virtually unknown in brazil. in this prospective study, 8.3% of patients with nosocomial diarrhea were found to have toxigenic strains of c difficile in their feces. the relevant risk factors for clostridium difficile infection were receipt of solid organ transplantation and septic shock.	2014	24559593
premarket evaluations of the imdx c. difficile for abbott m2000 assay and the bd max cdiff assay.	clostridium difficile-associated diarrhea is a well-recognized complication of antibiotic use. historically, diagnosing c. difficile has been difficult, as antigen assays are insensitive and culture-based methods require several days to yield results. nucleic acid amplification tests (naats) are quickly becoming the standard of care. we compared the performance of two automated investigational/research use only (iuo/ruo) naats for the detection of c. difficile toxin genes, the imdx c. difficile ...	2014	24554744
faecal transplantation for the treatment of clostridium difficile infection: a review.	clostridium difficile infection (cdi) remains a major healthcare burden despite recent global falls in its prevalence. the risk of recurrence is high when using antibiotics such as vancomycin, particularly in already recurrent disease. in light of this, new therapy options are being perused, including novel antibiotics such as fidaxomicin, probiotics, intravenous immunoglobulin and faecal transplantation. faecal transplantation, referred to here as human probiotic infusion (hpi), is attracting a ...	2014	24636428
probiotics, prebiotics and the gastrointestinal tract in health and disease.	the microbiome located in the human gastrointestinal tract (git) comprises the largest community (diverse and dense) of bacteria, and in conjunction with a conducive internal milieu, promotes the development of regulated pro- and anti-inflammatory signals within the git that promotes immunological and metabolic tolerance. in addition, host-microbial interactions govern git inflammation and provide cues for upholding metabolic regulation in both the host and microbes. failure to regulate inflamma ...	2014	24633989
is the interleukin 8 promoter polymorphism rs4073/-251t >a associated with clostridium difficile infection?	the interleukin 8 gene single-nucleotide polymorphism rs4073/-251t >a predisposes to clostridium difficile infection (cdi), but this association has not been independently validated. in this study, we were unable to replicate this association in either a white cohort or by meta-analysis, suggesting that rs4073/-251t >a is unlikely to constitute a major risk factor for cdi.	2014	24633688
effect of antibiotic stewardship programmes on clostridium difficile incidence: a systematic review and meta-analysis.	despite vigorous infection control measures, clostridium difficile continues to cause significant disease burden. antibiotic stewardship programmes (asps) may prevent c. difficile infections by limiting exposure to certain antibiotics. our objective was to perform a meta-analysis of published studies to assess the effect of asps on the risk of c. difficile infection in hospitalized adult patients.	2014	24633207
validation of the 3-day rule for stool bacterial tests in japan.	stool cultures are expensive and time consuming, and the positive rate of enteric pathogens in cases of nosocomial diarrhea is low. the 3-day rule, whereby clinicians order a clostridium difficile (cd) toxin test rather than a stool culture for inpatients developing diarrhea >3 days after admission, has been well studied in western countries. the present study sought to validate the 3-day rule in an acute care hospital setting in japan.	2014	24633021
of stewardship, motherhood and apple pie.	antibiotic stewardship is universally agreed to be desirable, but optimal models for stewardship remain uncertain. uk stewardship targets the particular antibiotic families-cephalosporins and fluoroquinolones-blamed for the selection of clostridium-difficile-associated disease. to balance this there have been dramatic increases in the use of penicillin-β-lactamase inhibitor combinations. by channelling selection pressure in this way, we hazard destroying the utility of these antibiotic classes i ...	2014	24630303
clostridium difficile in paediatric populations.	an increase in clostridium difficile infection incidence has been observed among hospitalized children in the united states. the present statement, targeted at clinicians caring for infants and children in community and institutional settings, summarizes the relevant information relating to the role of c difficile in childhood diarrhea and provides recommendations for diagnosis, prevention and treatment. significant differences between adult and paediatric risk factors and disease are discussed, ...	2014	24627655
the outcome and long-term follow-up of 94 patients with recurrent and refractory clostridium difficile infection using single to multiple fecal microbiota transplantation via retention enema.	clostridium difficile infection (cdi) is one of the most frequent causes of healthcare-associated infections, and its rates are also increasing in the community. the management of cdi has become a major challenge, given growing rates of recurrences and failures with standard antibiotic therapy. mounting evidence suggests that fecal microbiota transplantation (fmt) may be effective; however, as there is a paucity of data with regard to repeat fmt for primary non-response to this treatment, this s ...	2014	24627239
carvacrol and trans-cinnamaldehyde reduce clostridium difficile toxin production and cytotoxicity in vitro.	clostridium difficile is a nosocomial pathogen that causes a serious toxin-mediated enteric disease in humans. reducing c. difficile toxin production could significantly minimize its pathogenicity and improve disease outcomes in humans. this study investigated the efficacy of two, food-grade, plant-derived compounds, namely trans-cinnamaldehyde (tc) and carvacrol (cr) in reducing c. difficile toxin production and cytotoxicity in vitro. three hypervirulent c. difficile isolates were grown with or ...	2014	24625665
[general internal medicine in hospital practice: the year 2013 put into perspective by residents].	2013 was full of significant advances in all areas of medicine, which may have an impact on daily practice in general internal medicine. from salt and water restriction in heart failure to transfusion threshold in upper gastrointestinal bleeding and fecal infusion in clostridium difficile colitis; from new data in resuscitation and persistent questions in palliative care and intensive care medicine, through pneumology, nephrology and endocrinology, the literature has been rich in new considerati ...	2014	24624733
[2013 literature findings in internal general medicine].	the prescribing of antibiotics for uncomplicated skin abscesses and diverticulitis has no benefit. some antibiotics are more at risk of causing a clostridium difficile infection. the tests used to exclude a history of a penicillin allergy are safe. a threshold of d-dimer adjusted for the age significantly improves the specificity of the test without affecting the sensitivity. the prescription of paraclinics tests is not an effective "treatment" for the patient's anxiety. in the sleep apnea syndr ...	2014	24624732
development and optimization of a high-throughput assay to measure neutralizing antibodies against clostridium difficile binary toxin.	clostridium difficile strains producing binary toxin, in addition to toxin a (tcda) and toxin b (tcdb), have been associated with more severe disease and increased recurrence of c. difficile infection in recent outbreaks. binary toxin comprises two subunits (cdta and cdtb) and catalyzes the adp-ribosylation of globular actin (g-actin), which leads to the depolymerization of filamentous actin (f-actin) filaments. a robust assay is highly desirable for detecting the cytotoxic effect of the toxin a ...	2014	24623624