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fecal microbiota transplantation for the treatment of clostridium difficile infection: a systematic review.by systematic review, we assessed the impact of fecal microbiota transplantation (fmt) for the treatment of clostridium difficile (cd)-associated diarrhea.201424440934
acidified nitrite: a host defence against colonization with c. difficile spores?proton pump inhibitor (ppi) use increases the risk of clostridium difficile infection (cdi) despite c. difficile spores being acid resistant. swallowed saliva contains nitrite which reacts with gastric acid, producing bactericidal nitrogen oxides. with 5mm nitrite at ph 2 (reflecting normal gastric conditions) all c. difficile spores were killed within 15 min. no reduction in count was seen with the same nitrite concentration at ph 5, representing gastric conditions in patients taking ppis, even ...201424440371
efficacy of combined jejunal and colonic fecal microbiota transplantation for recurrent clostridium difficile infection.the prevalence of recurrent clostridium difficile infection (rcdi) is increasing; fecal microbiota transplantation (fmt) is an effective therapy. however, there have been no studies of the efficacy of a single session of combined enteral and colonic fmt or characterizations of changes in the microbiota between donors and recipients. we performed a study of 27 patients with rcdi who were given a fixed volume of processed fecal filtrate via enteroscopy and colonoscopy in a single session. patients ...201424440222
a novel subtyping assay for detection of clostridium difficile virulence genes.this proof-of-concept study demonstrates the application of a novel nucleic acid detection platform to detect clostridium difficile in subjects presenting with acute diarrheal symptoms. this method amplifies three genes associated with c. difficile infection, including genes and deletions (cdtb and tcdc) associated with hypervirulence attributed to the nap1/027/bi strain. amplification of dna from the tcdb, tcdc, and cdtb genes was performed using a droplet-based sandwich platform with quantitat ...201424434086
fecal microbiota transplantation for refractory clostridium difficile colitis in solid organ transplant recipients.fecal microbiota transplantation (fmt) has been shown to be safe and efficacious in individuals with refractory clostridium difficile. it has not been widely studied in individuals with immunosuppression due to concerns about infectious complications. we describe two solid organ transplant recipients, one lung and one renal, in this case report that both had resolution of their diarrhea caused by c. difficile after fmt. both recipients required two fmts to achieve resolution of their symptoms an ...201424433460
an examination of longitudinal cauti, ssi, and cdi rates from key hhs data systems.in response to the growing concern about healthcare-associated infections (hais), us department of health and human services (hhs) developed the national action plan to prevent healthcare-associated infections. a key focus of the action plan is the setting of hai metrics and targets and the enhancement and development of data systems to support hai surveillance.201424430270
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.201424458048
faecal transplantation for clostridium difficile infection. three cases treated in italy. 201424457126
prevention of clostridium difficile spore formation by sub-inhibitory concentrations of tigecycline and piperacillin/tazobactam.sporulation of clostridium difficile during infection and persistence of spores within the gut could partly explain treatment failures and recurrence. however, the influence of antibiotics on sporulation is unclear. the objective of our study was to evaluate the impact of ciprofloxacin, metronidazole, piperacillin/tazobactam, tigecycline, and vancomycin on c. difficile sporulation in vitro.201424422950
comparison of chromid agar and clostridium difficile selective agar for effective isolation of c. difficile from stool specimens.chromid clostridium difficile agar (idcd; biomérieux sa, france) is a recently developed chromogenic medium for rapid and specific isolation of c. difficile. we compared the performance of idcd with that of clostridium difficile selective agar (cdsa).201424422190
molecular epidemiology of clostridium difficile strains from nosocomial-acquired infections.the purpose of this study is to analyze isolates of clostridium difficile from patients with nosocomial acquired infection in respect to their molecular type and antimicrobial susceptibility. fifty-nine randomly selected clinical isolates were characterized. molecular typing was performed by rep-pcr (diversilab). isolates were tested by disk diffusion towards 11 different antibiotics. all isolates were susceptible to metronidazole and vancomycin. fifty five (93 %) isolates were resistant to eryt ...201424081935
emerging clinical role of pivmecillinam in the treatment of urinary tract infection in the context of multidrug-resistant bacteria.the continuing spread of resistant gram-negative bacteria is a therapeutic challenge and prudent use of antimicrobials is therefore essential. urinary tract infections (utis), usually due to gram-negative bacteria, are among the most common infections seen in the community. moreover, bacterial strains producing extended-spectrum β-lactamases (esbls) that are resistant not only to cephalosporins and penicillins, but also to fluoroquinolones and trimethoprim, are becoming more prevalent in the com ...201424068280
sensitivity to antibiotics of clostridium difficile toxigenic nosocomial strains.clostridium difficile is the etiological agent of diarrhoea and colitis, especially in elderly patients. the incidence of these diseases has increased during the last 10 years. emergence of so-called hypervirulent strains is considered as one of the main factors responsible for the more severe disease and changed profile of sensitivity to antimicrobial agents. the aim of this work was to determine the sensitivity profile of toxigenic strains of c. difficile in the czech republic in 2011-2012 to ...201424114414
metabolic engineering of escherichia coli for biosynthesis of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) from glucose.the escherichia coli xl1-blue strain was metabolically engineered to synthesize poly(3-hydroxybutyrate-co-3-hydroxyvalerate) [p(3hb-co-3hv)] through 2-ketobutyrate, which is generated via citramalate pathway, as a precursor for propionyl-coa. two different metabolic pathways were examined for the synthesis of propionyl-coa from 2-ketobutyrate. the first pathway is composed of the dickeya dadantii 3937 2-ketobutyrate oxidase or the e. coli pyruvate oxidase mutant (poxb l253f v380a) for the conver ...201424113828
how do university education and clinical experience influence pre-registration nursing students' infection control practice? a descriptive, cross sectional survey.this study aims to explore nursing students' knowledge of infection control and investigate how university education and clinical experience influence their infection control practice.201424090618
first case of autochthonous clostridium difficile pcr ribotype 027 detected in spain.clostridium difficile ribotype 027 (cd027) has caused outbreaks in the united states, canada, and europe since 2001. in spain, the importance of cd027 is still unknown. in 2007, we began active surveillance of cd027 to determine its incidence in our hospital.201424074903
risk factors for clostridium difficile infection in the community: a case-control study in patients in general practice, denmark, 2009-2011.to identify risk factors for clostridium difficile infection (cdi) in danish patients consulting general practice with gastrointestinal symptoms, a prospective matched case-control study was performed; cases (n = 259) had positive cultures for toxigenic c. difficile and controls (n = 455) negative cultures. data were analysed by conditional logistic regression. in patients aged ⩾2 years (138 cases), hospitalization [odds ratio (or) 8·4, 95% confidence interval (ci) 3·1-23], consumption of beef ( ...201424073613
utility of a commercial pcr assay and a clinical prediction rule for detection of toxigenic clostridium difficile in asymptomatic carriers.a commercial pcr assay of perirectal swab specimens detected 17 (68%) of 25 asymptomatic carriers of toxigenic clostridium difficile, including 93% with skin and/or environmental contamination. a clinical prediction rule, followed by pcr screening, could be used to identify carriers at high risk of c. difficile shedding.201424153132
surveillance cultures in pediatric allogeneic hematopoietic stem cell transplantation.the value of surveillance cultures in predicting systemic infections and in guiding antimicrobial treatment is controversial. we investigated 57 pediatric allo-scts between 2007 and 2009. all (34), aml (5), and severe aplastic anemia (4) were the largest patient groups. conditioning was tbi-based in 87% and 54% developed gvhd (21% grade iii-iv). of the 2594 weekly colonization samples, 24% were positive (fecal bacteria 86%, fecal fungi 16%, clostridium difficile 16%; throat bacteria 17% and thro ...201424152015
simple approach for ultrasensitive electrochemical immunoassay of clostridium difficile toxin b detection.clostridium difficile toxin b (tcd b), as one of the primary contributing factors to the pathogenesis of c. difficile-associated diseases, has raised serious public concerns due to its virulence, spore-forming ability and persistence with major types of infectious diarrhea diseases, and been used as a potential biomarker in clinical diagnoses. thus, a simple method for the determination of tcd b was developed based on a sandwich-type electrochemical immunosensor. greatly enhanced sensitivity was ...201424141113
functional analysis of slec from clostridium difficile: an essential lytic transglycosylase involved in spore germination.clostridium difficile is the most common cause of enteric disease and presents a major burden on healthcare systems globally due in part to the observed rapid rise in antibiotic resistance. the ability of c. difficile to form endospores is a key feature in the organism's pathogenesis and transmission, and contributes greatly to its resilient nature. endospores are highly resistant to disinfection, allowing them to persist on hospital surfaces. in order for the organism to cause disease, the spor ...201424140647
added value of multiplex luminex gastrointestinal pathogen panel (xtag® gpp) testing in the diagnosis of infectious gastroenteritis.the luminex gastrointestinal pathogen panel (xtag(®) gpp) detects in one assay the most common gastroenteritis-causing pathogens and toxins, namely adenovirus 40/41, norovirus genogroup (ng) i/ii, rotavirus a, clostridium difficile toxin a/b, campylobacter sp., escherichia coli o157, enterotoxigenic e. coli heat-labile enterotoxin/heat-stable enterotoxin, salmonella sp., shiga-toxin producing e. coli, shiga-like toxin (stx)1/2, shigella sp., vibrio cholerae, yersinia enterocolitica, cryptosporid ...201424131399
colonic decompression and direct intraluminal medical therapy for clostridium difficile-associated megacolon using a tube placed endoscopically in the proximal colon.urgent colectomy for severe clostridium difficile infection can be associated with increased morbidity and mortality. we aimed to use endoscopic methods for treatment.201424134562
[clostridium difficile infection (cdi) in the course of time - an issue only for the internist?].toxigenic strains of clostridium (c.) difficile are the most prevalent pathogens of antibiotic associated intestinal disease and nosocomial diarrhoea. during the last 10 years, incidences of c. difficile infection (cdi) have increased worldwide.201424132675
fecal transplantation therapy for clostridium difficile-associated pouchitis. 201424132529
what is the value of a food and drug administration investigational new drug application for fecal microbiota transplantation to treat clostridium difficile infection? 201424148361
european society of clinical microbiology and infectious diseases: update of the treatment guidance document for clostridium difficile infection.in 2009 the first european society of clinical microbiology and infection (escmid) treatment guidance document for clostridium difficile infection (cdi) was published. the guideline has been applied widely in clinical practice. in this document an update and review on the comparative effectiveness of the currently available treatment modalities of cdi is given, thereby providing evidence-based recommendations on this issue. a computerized literature search was carried out to investigate randomiz ...201424118601
guidance on preparing an investigational new drug application for fecal microbiota transplantation studies.fecal microbiota transplantation (fmt) is an effective treatment for clostridium difficile infections that are refractory to antibiotic therapy. because of the important roles of the microbiota in the function of the gastrointestinal tract and other aspects of human physiology, there is a growing interest in studying fmt for other clinical indications. the us food and drug administration regulates clinical studies to evaluate the safety and efficacy of fmt. studies of fmt for recurrent clostridi ...201424107393
clinical differences in clostridium difficile infection based on age: a multicenter study.advancing age is a well-known risk factor for clostridium difficile infection (cdi). however, age-specific clinical differences in cdi are uncertain. a retrospective comparative analysis was performed based on age in 1367 patients with cdi in korea. most clinical features were similar in the two age groups studied, however malignancy was more common in the older group (age ≥ 65 y) (p < 0.001), while chemotherapy and transplantation were more common in the younger group (age < 65 y) (p < 0.001). ...201424106984
cadazolid, a novel antibiotic with potent activity against clostridium difficile: safety, tolerability and pharmacokinetics in healthy subjects following single and multiple oral doses.current treatment options for clostridium difficile-associated diarrhoea (cdad) leave a high unmet medical need for new therapies. cadazolid is a new antibiotic in development for the treatment of cdad. the objectives of this study were to evaluate its tolerability and pharmacokinetics following single ascending doses (ac-061-101) and multiple ascending doses (ac-061-102).201424106141
[severe colitis due to community-acquired ribotype 027 clostridium difficile]. 201424252599
comparative in vitro activities of smt19969, a new antimicrobial agent, against 162 strains from 35 less frequently recovered intestinal clostridium species: implications for clostridium difficile recurrence.we determined the comparative activity of smt19969 (smt) against 162 strains representing 35 well-characterized clostridium species in clusters i to xix and 13 clostridium species that had no 16s rrna match. smt mics ranged from 0.06 to >512 μg/ml and were not species related. smt might have less impact on normal gut microbiota than other clostridium difficile infection (cdi) antimicrobials.201424247123
faecal microbiota transplantation in 2013: developing human gut microbiota as a class of therapeutics.although the idea of faecal transplantation dates back many decades, only with advances in scientific technologies can we begin systematic development of this new class of therapeutics. the primary focus remains on treatment of clostridium difficile infection—new applications are beginning to emerge, but a long journey remains ahead.201424296579
therapeutic faecal microbiota transplantation: current status and future developments.faecal microbiota transplantation (fmt) has undergone dramatic progression over the past year and continues to evolve as knowledge of the gastrointestinal microbiota (gimb) develops. this review summarizes therapeutic advances in fmt, latest fmt therapies and presents the potential of fmt therapeutics in other gastrointestinal and extra-intestinal conditions.201424257037
gastrointestinal infections after transplantation.recipients of both solid organ transplant and hematopoietic stem cell transplantation are at increased risk for infectious morbidity and mortality after transplantation due to on-going immunosuppression. gastrointestinal infections have been increasingly reported in these populations.201424257036
fecal microbiota transplantation: facts and controversies.to review the current evidence on fecal microbiota transplantations (fmts) for recurrent clostridium difficile infections (cdis), metabolic syndrome and inflammatory bowel disease.201424241245
progress in the discovery of treatments for c. difficile infection: a clinical and medicinal chemistry review.clostridium difficile is an anaerobic, gram-positive pathogen that causes c. difficile infection, which results in significant morbidity and mortality. the incidence of c. difficile infection in developed countries has become increasingly high due to the emergence of newer epidemic strains, a growing elderly population, extensive use of broad spectrum antibiotics, and limited therapies for this diarrheal disease. because treatment options currently available for c. difficile infection have some ...201424236721
discrepancies among three laboratory methods for clostridium difficile detection and a proposal for their optimal use.clostridium difficile is the major cause of nosocomial diarrhoea. several detection methods are available for the laboratory diagnosis of c. difficile, but these vary in terms of sensitivity and specificity. in this study, we compared the performance of three following laboratory tests to detect c. difficile: in-house real-time pcr aiming for toxin b gene (tcdb), eia for detection of toxins a and b (premier toxins a & b) and c. difficile culture in selective medium (biomerieux). our results were ...201424236508
comparison of simplexa universal direct pcr with cytotoxicity assay for diagnosis of clostridium difficile infection: performance, cost, and correlation with disease.simplexa clostridium difficile universal direct pcr, a real-time pcr assay for the detection of the c. difficile toxin b (tcdb) gene using the 3m integrated cycler, was compared with a two-step algorithm which includes the c. diff chek-60 glutamate dehydrogenase (gdh) antigen assay followed by cytotoxin neutralization. three hundred forty-two liquid or semisolid stools submitted for diagnostic c. difficile testing, 171 gdh antigen positive and 171 gdh antigen negative, were selected for the stud ...201424226924
investigations of the mode of action and resistance development of cadazolid, a new antibiotic for treatment of clostridium difficile infections.cadazolid is a new oxazolidinone-type antibiotic currently in clinical development for the treatment of clostridium difficile-associated diarrhea. here, we report investigations on the mode of action and the propensity for spontaneous resistance development in c. difficile strains. macromolecular labeling experiments indicated that cadazolid acts as a potent inhibitor of protein synthesis, while inhibition of dna synthesis was also observed, albeit only at substantially higher concentrations of ...201424277035
in vitro and in vivo antibacterial evaluation of cadazolid, a new antibiotic for treatment of clostridium difficile infections.clostridium difficile is a leading cause of health care-associated diarrhea with significant morbidity and mortality, and new options for the treatment of c. difficile-associated diarrhea (cdad) are needed. cadazolid is a new oxazolidinone-type antibiotic that is currently in clinical development for treatment of cdad. here, we report the in vitro and in vivo antibacterial evaluation of cadazolid against c. difficile. cadazolid showed potent in vitro activity against c. difficile with a mic rang ...201424277020
probing the metal specificity mechanism of superoxide dismutase from human pathogen clostridium difficile.the molecular mechanism of the metal specificity to superoxide dismutase from human pathogen c. difficile (sodcd) was investigated by x-ray crystallography, spectroscopy, sod activity assay, electrochemistry, and dft calculations, and the results indicate that the cognate metal characters tuned by the metal micro-environment dominate the metal specificity of the sodcd.201424275896
emerging infectious colitis.the present review will highlight recent advances in the knowledge of emerging pathogens causing infectious colitis and provide a description of the most important food-borne outbreaks.201424275672
fecal microbiota transplantation for clostridium difficile infection: benefits and barriers.the incidence and severity of clostridium difficile infection (cdi) have increased worldwide in the past two decades. a principal function of the gut microbiota is to protect the intestine against colonization by exogenous pathogens. increasingly, the gut microbiota have been shown to influence susceptibility to other genetic and environmentally acquired conditions. transplantation of healthy donor fecal material in patients with cdi may re-establish the normal composition of the gut microbiota ...201424275671
multiplex molecular testing for management of infectious gastroenteritis in a hospital setting: a comparative diagnostic and clinical utility study.laboratory diagnosis and clinical management of inpatients with diarrhoea is complex and time consuming. tests are often requested sequentially and undertaken in different laboratories. this causes prolonged unnecessary presumptive isolation of patients, because most cases are non-infectious. a molecular multiplex test (luminex(®) gastrointestinal pathogen panel (gpp)) was compared with conventional testing over 8 months to determine diagnostic accuracy, turnaround times, laboratory costs, use o ...201424274687
clostridium difficile toxins facilitate bacterial colonization by modulating the fence and gate function of colonic epithelium.the contribution of clostridium difficile toxin a and b (tcda and tcdb) to cellular intoxication has been studied extensively, but their impact on bacterial colonization remains unclear. by setting up 2- and 3-dimensional in vitro models of polarized gut epithelium, we investigated how c. difficile infection is affected by host cell polarity and whether tcda and tcdb contribute to such events. indeed, we observed that c. difficile adhesion and penetration of the mucosal barrier are substantially ...201424273043
use of proton pump inhibitors for the provision of stress ulcer prophylaxis: clinical and economic consequences.the provision of stress ulcer prophylaxis (sup) for the prevention of clinically significant bleeding is widely recognized as a crucial component of care in critically ill patients. nevertheless, sup is often provided to non-critically ill patients despite a risk for clinically significant bleeding of roughly 0.1 %. the overuse of sup therefore introduces added risks for adverse drug events and cost, with minimal expected benefit in clinical outcome. historically, histamine-2-receptor antagonist ...201424271943
clostridium difficile infection in the elderly.clostridium difficile-associated illness is an increasingly prevalent and morbid condition. the elderly population is at a disproportionate risk of developing symptomatic disease and associated complications, including progression to severe or fulminant disease, and development of recurrent infections. this article analyzes the factors that influence c difficile disease propensity and severity, with particular attention directed toward features relevant to the rapidly aging population.201424267604
acute inflammatory surgical disease.infectious and inflammatory diseases comprise some of the most common gastrointestinal disorders resulting in hospitalization in the united states. accordingly, they occupy a significant proportion of the workload of the acute care surgeon. this article discusses the diagnosis, management, and treatment of appendicitis, acute cholecystitis/cholangitis, acute pancreatitis, diverticulitis, and clostridium difficile colitis.201424267493
toxin-producing clostridium difficile strains as long-term gut colonizers in healthy infants.clostridium difficile is a colonizer of the human gut, and toxin-producing strains may cause diarrhea if the infectious burden is heavy. infants are more frequently colonized than adults, but they rarely develop c. difficile disease. it is not known whether strains of c. difficile differ in the capacity to colonize and persist in the human gut microbiota. here, we strain typed isolates of c. difficile that had colonized 42 healthy infants followed from birth to ≥12 months of age by using pcr rib ...201424172156
predictors of first recurrence of clostridium difficile infections in children.little is known regarding the risk of recurrence of clostridium difficile infection (cdi) in children. in a 9-year cohort, 12% of hospitalized children with cdi had recurrent disease. receipt of concomitant antibiotics and community-associated cdi were independently associated with recurrent disease in children hospitalized with cdi. antibiotics administered for reasons other than treatment of cdi should be discontinued whenever possible.201424168983
clostridium difficile: epidemiology, diagnostic and therapeutic possibilities-a systematic review.this literature review looks at the epidemiology, clinical manifestations, diagnostics and current medical and surgical management of clostridium difficile (c. difficile) infection. a literature search of pubmed and cochrane database regarding c. difficile infection was performed. information was extracted from 43 published articles from 2000 to the present day which met inclusion criteria. c. difficile is a gram-positive, anaerobic bacillus, which is widely found in the environment, especially ...201424178946
hypersensitivity reactions associated with fidaxomicin use.we report hypersensitivity reactions associated with fidaxomicin, an antibacterial drug approved for the treatment of clostridium difficile-associated diarrhea. these reactions are viewed as significant because of severity and unexpected because fidaxomicin is minimally absorbed. the fidaxomicin labeling was revised to include information about the possibility of hypersensitivity reactions.201424178248
antibiotic-associated complications following lower limb arthroplasty: a comparison of two prophylactic regimes.as part of a wider drive to reduce clostridium difficile rates (cdad), our trust switched from cefuroxime to gentamicin and flucloxacillin prophylaxis for joint replacement surgery. anecdotal evidence suggested that we were seeing an increased incidence of acute kidney injury (aki) following elective total hip replacement (thr) and total knee replacement (tkr) since this change. the aim of this study was to compare rates of aki and post-operative infection between the two antibiotic regimes.201424178085
genetic analysis of tn916-like elements conferring tetracycline resistance in clinical isolates of clostridium difficile.as an important clinically relevant pathogen, clostridium difficile has a high multidrug resistance rate. conjugative transposons play a vital role in its resistance phenotype. in the present study, 34 tetracycline-resistant clinical isolates of c. difficile were studied to detect tetracycline resistance genes and the presence of transposons. thirty-two isolates were found to harbour tn916-like elements carrying the tet(m) resistance gene, of which only one copy existed in the genome by southern ...201424176599
predicting a complicated course of clostridium difficile infection at the bedside.clostridium difficile infections (cdis) are a common cause of antibiotic-associated diarrhoea and associated with cdi-related mortality in c. 10%. to date, there is no prediction model in use that guides clinicians to identify patients at high risk for complicated cdi. from 2006 to 2009, nine dutch hospitals included hospitalized cdi patients in a prospective cohort. potential predictors of a complicated course (icu admission, colectomy or death due to cdi) were evaluated in uni- and multivariat ...201424188103
role of leptin-mediated colonic inflammation in defense against clostridium difficile colitis.the role of leptin in the mucosal immune response to clostridium difficile colitis, a leading cause of nosocomial infection, was studied in humans and in a murine model. previously, a mutation in the receptor for leptin (lepr) was shown to be associated with susceptibility to infectious colitis and liver abscess due to entamoeba histolytica as well as to bacterial peritonitis. here we discovered that european americans homozygous for the same lepr q223r mutation (rs1137101), known to result in d ...201424166957
an antibiotic-altered microbiota provides fuel for the enteric foe.antibiotic therapies disrupt the intestinal microbiota and render the host susceptible to enteric infections. a recent report by ng et al. explores the ability of two intestinal pathogens (salmonella enterica serovar typhimurium and clostridium difficile) to use this disruption to their advantage and consume host carbohydrates that would otherwise be unavailable in the presence of a normal gut microbiota.201424165893
health care use and serious infection prevalence associated with penicillin "allergy" in hospitalized patients: a cohort study.penicillin is the most common drug "allergy" noted at hospital admission, although it is often inaccurate.201424188976
incidence and mortality associated with clostridium difficile infection at a japanese tertiary care center.although increases in clostridium difficile infection (cdi) incidence and severity have been observed in numerous countries, the incidence of cdi in japan remains unclear. the goal of this study was to determine the incidence and outcomes of cdi at a japanese tertiary care center.201424184291
bacterial counts from five over-the-counter probiotics: are you getting what you paid for?there is concern that the bacterial colony counts present at the time of manufacture and listed on the probiotic package may not be reflective of the numbers viable colonies at the time of purchase and patient consumption thereby diminishing efficacy. we performed a colony count study of three separate samples of five different probiotics purchased from three different stores: bifidobacterium infantis (align(®)); lactobacillus acidophilus cl1285(®) and lactobacillus casei lbc80r(®) (bio-k+(®)); ...201424184290
bacteremia as an adverse event of fecal microbiota transplantation in a patient with crohn's disease and recurrent clostridium difficile infection. 201424184170
evolution of interventional vancomycin trials in light of new antibiotic development in the usa, 1999-2012.use of vancomycin has increased following the emergence of resistant gram-positive bacterial infections. investigation into recent vancomycin clinical studies provides insight into the optimal use of vancomycin and the development of novel antibiotics for the treatment of resistant infections. interventional vancomycin trials registered in clinicaltrials.gov from january 1999 to december 2012 were identified. trial trends and characteristics were evaluated in the context of vancomycin use and ne ...201424183801
acute oxalate nephropathy associated with clostridium difficile colitis.we report the case of a 69-year-old man who presented with acute kidney injury in the setting of community-acquired clostridium difficile-associated diarrhea and biopsy-proven acute oxalate nephropathy. we discuss potential mechanisms, including increased colonic permeability to oxalate. we conclude that c difficile-associated diarrhea is a potential cause of acute oxalate nephropathy.201424183111
clostridium difficile infection in children with inflammatory bowel disease: current evidence.inflammatory bowel disease (ibd) is a chronic, immune-mediated disease of the gastrointestinal tract that develops in genetically susceptible individuals. questions about the role of infections in the development and exacerbations of inflammatory bowel disease remain unanswered. among numerous bacteria that have been linked to ibd, the most frequently associated is clostridium difficile. clinical symptoms of c. difficile infection and an exacerbation of inflammatory bowel disease are often indis ...201424180405
constructing identities in the media: newspaper coverage analysis of a major uk clostridium difficile outbreak.to examine how a major clostridium difficile outbreak in the uk was represented in the media.201424224760
whole-genome sequencing demonstrates that fidaxomicin is superior to vancomycin for preventing reinfection and relapse of infection with clostridium difficile.whole-genome sequencing was used to determine whether the reductions in recurrence of clostridium difficile infection observed with fidaxomicin in pivotal phase 3 trials occurred by preventing relapse of the same infection, by preventing reinfection with a new strain, or by preventing both outcomes. paired isolates of c. difficile were available from 93 of 199 participants with recurrences (28 were treated with fidaxomicin, and 65 were treated with vancomycin). given c. difficile evolutionary ra ...201424218500
accuracy of administrative code data for the surveillance of healthcare-associated infections: a systematic review and meta-analysis.administrative code data (acd), such as international classifications of diseases, ninth revision, clinical modification codes, are widely used in surveillance and public reporting programs that seek to identify healthcare-associated infections (hais); however, little is known about their accuracy. this systematic review summarizes evidence for the accuracy of acd for the detection of selected hais, including catheter-associated urinary tract infection, clostridium difficile infection (cdi), cen ...201424218103
clostridium difficile infection in children hospitalized due to diarrhea.the frequency of clostridium difficile infection (cdi)-related hospitalizations is increasing. the aim of this study was to determine the extent of cdi among children hospitalized with diarrhea, risk factors or predictors for severe cdi, the prevalence of nap1, and to compare the course of cdi depending on bacteria toxicity profile. a retrospective analysis of case records of 64 children (age range 3 months-16 years, median age 2.12 years) with cdi as defined by diarrheal disease and positive po ...201424213847
clinical comparison of simplexa universal direct and bd geneohm tests for detection of toxigenic clostridium difficile in stool samples.we compared the performance characteristics of the simplexa universal direct (focus diagnostics, cypress, ca) and bd geneohm (bd diagnostics/geneohm sciences, san diego, ca) tests for detection of toxigenic clostridium difficile in 459 stool samples (9.4% positive). the observed agreement for the results of the two tests with 452 samples with valid test results was 98.2% (kappa, 0.9; p value of 0.73 by the mcnemar test). when samples with discordant or invalid results were retested, the agreemen ...201424197886
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 ...201424636428
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 ...201424633989
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.201424633688
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.201424633207
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.201424633021
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 ...201424630303
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, ...201424627655
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 ...201424627239
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 ...201424625665
[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 ...201424624733
[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 ...201424624732
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 ...201424623624
the clostridium difficile pcr ribotype 027 lineage: a pathogen on the move.clostridium difficile is a gram-positive, spore-forming, human and animal pathogen that is the major cause of antibiotic-associated diarrhoea worldwide. the past decade has seen the rapid emergence of the hypervirulent pcr ribotype (rt) 027 complex, which has been associated with increases in the incidence and severity of disease and mortality. in this review, we describe the potential virulence factors that have been reported in strains from the rt 027 complex. we review the emergence, populati ...201424621128
international prevalence of adverse drug events in hospitals: an analysis of routine data from england, germany, and the usa.adverse drug events (ades) are frequent in hospitals, occurring either in patients before admission or as a nosocomial event, and either as a drug reaction or as a consequence of a medication error. routine data primarily recorded for reimbursement purposes are increasingly being used on a national level both in pharmacoepidemiological studies and in trigger tools. the aim of this study was to compare the prevalence rates of coded ades in hospitals on a transnational level.201424620750
clostridium difficile enteritis: a new role for an old foe.small bowel involvement of clostridium difficile is increasingly encountered. data on many management aspects are lacking.201424618362
clostridium difficile infection in patients with acute myelogenous leukemia and in patients undergoing allogeneic stem cell transplantation: epidemiology and risk factor analysis.patients receiving treatment for acute myelogenous leukemia (aml) and recipients of allogeneic stem cell transplantation (asct) are at high risk of contracting clostridium difficile infection (cdi), the most frequently observed nosocomial diarrhea and enterocolitis. data were retrieved from the prospective cologne cohort of neutropenic patients. patients hospitalized for asct as well as patients receiving treatment for aml were included in the analysis. risk factor analysis for the occurrence of ...201424607558
nap1 strain type predicts outcomes from clostridium difficile infection.studies are conflicting regarding the importance of the fluoroquinolone-resistant north american pulsed-field gel electrophoresis type 1 (nap1) strain in clostridium difficile infection (cdi) outcome. we describe strain types causing cdi and evaluate their association with patient outcomes.201424604900
editorial commentary: host-pathogen interactions in clostridium difficile infection: it takes two to tango. 201424604896
harnessing microbiota to kill a pathogen: the sweet tooth of clostridium difficile. 201424603797
harnessing microbiota to kill a pathogen: fixing the microbiota to treat clostridium difficile infections. 201424603796
use and outcomes of extended antibiotic prophylaxis in urological cancer surgery.although perioperative antibiotic prophylaxis prevents postoperative infectious complications, national guidelines recommend cessation of antibiotics within 24 hours after the procedure. extended antibiotic prophylaxis beyond 24 hours may contribute to hospital acquired infections such as clostridium difficile colitis. we evaluated practice patterns of antibiotic prophylaxis in genitourinary cancer surgery and assessed the impact of antibiotic prophylaxis on hospital acquired c. difficile infect ...201424603103
trends and changes in clostridium difficile diagnostic policies and their impact on the proportion of positive samples: a national survey.in june 2012, israeli guidelines for laboratories were published defining the recommended methods for diagnosis of clostridium difficile infection (cdi). we conducted this survey to examine the effects of the new recommendations on the proportions of rejected and positive samples by the different methods. a survey was mailed to the directors of all general hospital (gh) and health maintenance organization (hmo) clinical microbiology laboratories. the report was divided into two periods, before a ...201424674056
multicenter evaluation of the quidel lyra direct c. difficile nucleic acid amplification assay.clostridium difficile is a gram-positive bacterium commonly found in health care and long-term-care facilities and is the most common cause of antibiotic-associated diarrhea. rapid detection of this bacterium can assist physicians in implementing contact precautions and appropriate antibiotic therapy in a timely manner. the purpose of this study was to compare the clinical performance of the quidel lyra direct c. difficile assay (lyra assay) (quidel, san diego, ca) to that of a direct cell cultu ...201424671790
community-acquired clostridium difficile infection: an increasing public health threat.there has been a startling shift in the epidemiology of clostridium difficile infection over the last decade worldwide, and it is now increasingly recognized as a cause of diarrhea in the community. classically considered a hospital-acquired infection, it has now emerged in populations previously considered to be low-risk and lacking the traditional risk factors for c. difficile infection, such as increased age, hospitalization, and antibiotic exposure. recent studies have demonstrated great gen ...201424669194
toxic megacolon after abdominoplasty: a case report.after an accepted technique of abdominoplasty, a 66-year-old woman developed clostridium difficile-associated diarrhea, leading to toxic megacolon and subsequent subtotal colectomy. the presumed etiology is chronic use of a proton pump inhibitor. this was addressed in a 2012 "white paper" warning issued by the food and drug administration. this article presents the course of this case as well as a review of the pertinent literature.201424667886
detection of clostridium difficile diarrhoea in harare, zimbabwe.clostridium difficile is associated with nosocomial and community-acquired diarrhoea and pseudomembranous colitis in humans. little information is available on the importance of c. difficile as a causative agent of diarrhoea in developing countries such as zimbabwe. the current study was carried out to determine the prevalence of c. difficile in diarrhoeal stools of outpatients over 2 years of age presenting at healthcare centres in harare, zimbabwe, and to determine the antimicrobial susceptibi ...201424664819
clostridium difficile extracytoplasmic function σ factor σv regulates lysozyme resistance and is necessary for pathogenesis in the hamster model of infection.clostridium difficile is a clinically important pathogen and the most common cause of hospital-acquired infectious diarrhea. expression of the c. difficile gene csfv, which encodes σ(v), an extracytoplasmic function σ factor, is induced by lysozyme, which damages the peptidoglycan of bacteria. here we show that σ(v) is required for lysozyme resistance in c. difficile. using microarray analysis, we identified the c. difficile genes whose expression is dependent upon σ(v) and is induced by lysozym ...201424664503
early clostridium difficile infection during allogeneic hematopoietic stem cell transplantation.clostridium difficile infection (cdi) is frequently diagnosed in recipients of allogeneic hematopoietic stem cell transplantation (allo-hsct). we characterized early-transplant cdi and its associations, and analyzed serially-collected feces to determine intestinal carriage of toxigenic c. difficile. fecal specimens were collected longitudinally from 94 patients during allo-hsct hospitalization, from the start of pre-transplant conditioning until up to 35 days after stem cell infusion. presence o ...201424662889
development of a recombinant toxin fragment vaccine for clostridium difficile infection.clostridium difficile infection (cdi) is the major cause of antibiotic-associated diarrhea and pseudomembranous colitis, a disease associated with significant morbidity and mortality. the disease is mostly of nosocomial origin, with elderly patients undergoing anti-microbial therapy being particularly at risk. c. difficile produces two large toxins: toxin a (tcda) and toxin b (tcdb). the two toxins act synergistically to damage and impair the colonic epithelium, and are primarily responsible for ...201424662701
investigation of potentially pathogenic clostridium difficile contamination in household environs.as clostridium difficile spores are resistant to many household cleaning products, the potential for community household contamination is high. the purpose of this study was to assess the prevalence of toxigenic c. difficile from environmental sources from a large urban area. three to 5 household items or environmental dust was collected from 30 houses in houston, texas. a total of 127 environmental samples were collected from shoe bottoms (n = 63), bathroom surfaces (n = 15), house floor dusts ...201424657158
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