Publications

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
the impact of hospital-onset clostridium difficile infection on outcomes of hospitalized patients with sepsis.	to examine the impact of hospital-onset clostridium difficile infection (hocdi) on the outcomes of patients with sepsis.	2014	24715578
incidence and outcomes of clostridium difficile-associated disease in hematopoietic cell transplant recipients.	hematopoietic stem cell transplant (hsct) recipients are at a high risk of clostridium difficile-associated disease (cdad) given frequent hospitalizations, prolonged antibiotic usage and altered integrity of intestinal mucosa. the prevalence and trends of cdad in hsct patients have not been extensively studied. in this study, the international classification of diseases, ninth revision, clinical modification (icd-9-cm) codes were used to identify cdad in hsct patients using a nationwide inpatien ...	2014	24715522
the lexa regulated genes of the clostridium difficile.	the sos response including two main proteins lexa and reca, maintains the integrity of bacterial genomes after dna damage due to metabolic or environmental assaults. additionally, derepression of lexa-regulated genes can result in mutations, genetic exchange and expression of virulence factors. here we describe the first comprehensive description of the in silico lexa regulon in clostridium difficile, an important human pathogen.	2014	24713082
clostridium difficile toxin a attenuates wnt/β-catenin signaling in intestinal epithelial cells.	clostridium difficile toxins a and b (tcda and tcdb) are homologous glycosyltransferases that inhibit a group of small gtpases within host cells, but several mechanisms underlying their pathogenic activity remain unclear. in this study, we evaluated the effects of tcda on the wnt/β-catenin pathway, the major driving force behind the proliferation of epithelial cells in colonic crypts. iec-6 and rko cells stimulated with wnt3a-conditioned medium were incubated with 10, 50, and 100 ng/ml of tcda f ...	2014	24711571
time-resolved cellular effects induced by tcda from clostridium difficile.	the anaerobe clostridium difficile is a common pathogen that causes infection of the colon leading to diarrhea or pseudomembranous colitis. its major virulence factors are toxin a (tcda) and toxin b (tcdb), which specifically inactivate small gtpases by glucosylation leading to reorganization of the cytoskeleton and finally to cell death. in the present work a quantitative proteome analysis using the isotope-coded protein label (icpl) approach was conducted to investigate proteome changes in the ...	2014	24711272
reduction in clostridium difficile infections among neurosurgical patients associated with discontinuation of antimicrobial prophylaxis for the duration of external ventricular drain placement.		2014	24709732
community-associated clostridium difficile infection among veterans with spinal cord injury and disorder.	the impact of community-associated clostridium difficile infection (ca-cdi) on patients with spinal cord injuries and disorders (sci/ds) is not fully understood. we examined ca-cdi cases among veterans with sci/d, comparing them with community-onset, healthcare facility-associated (co-hcfa) cases. generally, patients with ca-cdi had less comorbidity, less severe cdi, and lower likelihood of antibiotic exposure.	2014	24709729
the role of the humoral immune response to clostridium difficile toxins a and b in susceptibility to c. difficile infection: a case-control study.	antibody levels to clostridium difficile toxin a (tcda), but not toxin b (tcdb), have been found to determine risk of c. difficile infection (cdi). historically, tcda was thought to be the key virulence factor; however the importance of tcdb in disease is now established. we re-evaluated the role of antibodies to tcda and tcdb in determining patient susceptibility to cdi in two separate patient cohorts. in contrast to earlier studies, we find that cdi patients have lower pre-existing iga titres ...	2014	24708941
restoring the gut microbiome for the treatment of inflammatory bowel diseases.	fecal microbiota transplantation (fmt) is considered to be a highly successful therapy for recurrent and refractory clostridium difficile infection (cdi) based on recent clinical trials. the pathogenesis of inflammatory bowel diseases (ibd) is thought to be due in part to perturbations in the gut microflora that disrupt homeostasis. fmt restores essential components of the microflora which could reverse the inflammatory processes observed in ibd. case reports and series for the treatment of ibd ...	2014	24707129
enteric infections.	cancer patients, particularly those with neutropenia, are at risk for enteric and intra-abdominal infections. specific infections and infectious syndromes in this setting include neutropenic enterocolitis, bacterial infections such as clostridium difficile infection (cdi), viral infections such as cmv colitis, and parasitic infections such as strongyloidiasis. diagnosing and gauging the severity of cdi presents challenges, as chemotherapy may produce symptoms that mimic cdi and laboratory findin ...	2014	24706227
early infection of hip joint prosthesis by clostridium difficile in an hiv-1 infected patient.	anaerobes are less frequently described as causative pathogen of prosthetic joint infection (pji). we report the first case of early pji after hip arthroplasty due to clostridium difficile in a diabetic and hiv-1 infected patient with bacteremia. our patient was successfully treated through surgical debridement and prosthesis retention combined with targeted antibiotic therapy.	2014	24705255
editorial commentary: changing epidemiology of clostridium difficile and emergence of new virulent strains.		2014	24704726
emergence of a ribotype 244 strain of clostridium difficile associated with severe disease and related to the epidemic ribotype 027 strain.	we identified 12 patients with clostridium difficile infection between july 2011 and march 2012 from whom an unusual c. difficile strain was isolated. this strain had a single-nucleotide deletion of the tcdc gene at position 117 and binary toxin genes, which are characteristic of the hypervirulent ribotype (rt) 027 strain.	2014	24704722
[clostridium colitis at a surgical department].	the aim of our study was to identify risk factors associated with the development of clostridium difficile colitis and determining the severity of clostridial colitis in a group of surgical patients. identification of its predispositions is necessary for preventive interventions and effective treatment.	2014	24702290
development and validation of a recurrent clostridium difficile risk-prediction model.	recurrent clostridium difficile infection (rcdi) affects 10% to 25% of patients with initial cdi (icdi). initiation of new therapies that reduce recurrences rests on identifying patients at high risk for rcdi at icdi onset.	2014	24700708
re: proton pump inhibitors and risk for recurrent clostridium difficile infection among inpatients.		2014	24698870
safety and tolerability of rifaximin for the treatment of irritable bowel syndrome without constipation: a pooled analysis of randomised, double-blind, placebo-controlled trials.	the efficacy of rifaximin, a nonsystemic, gut-targeted antibiotic for reducing non-constipation-predominant irritable bowel syndrome (non-c ibs) symptoms, has been demonstrated in one phase 2b and two phase 3 randomised, double-blind, placebo-controlled trials, but detailed data about rifaximin safety and tolerability during treatment and subsequent follow-up periods are lacking.	2014	24697851
the changes of pcr ribotype and antimicrobial resistance of clostridium difficile in a tertiary care hospital over 10 years.	the aims of this study were to investigate any change in pcr ribotypes and to determine the antimicrobial resistance of common pcr ribotypes over a 10-year period in a tertiary care hospital. we conducted pcr ribotyping, antimicrobial susceptibility testing and dna gyrase sequencing to identify changes in 1407 clostridium difficile non-duplicated isolates obtained between 2000 and 2009. a total of 74 different ribotypes were found. the most prevalent ribotype was ribotype 001 (26.1 %). the preva ...	2014	24696516
common questions about clostridium difficile infection.	clostridium difficile infection is a common cause of antibiotic-associated diarrhea. it causes no symptoms in more than one-half of infected patients, but can also cause a wide spectrum of illnesses and death. the incidence and severity have increased in recent years. the most important modifiable risk factor for c. difficile infection is antibiotic exposure; this risk is dose-related and higher with longer courses and combination therapy. c. difficile infection is also associated with older age ...	2014	24695562
comparison of sensitivity of enzyme immunoassays for toxin a and b in different c. difficile pcr ribotypes.	enzyme immunoassays (eias) for toxins a and b are the most common assays for the diagnosis of clostridium difficile infection due to their rapidity and ease of use. however, the sensitivity of different kits varies greatly. the predominant pcr ribotypes of c. difficile vary according to the region or country studied, and it was recently reported that the sensitivity of eias can be affected by the strain type. the aim of this study was to assess the sensitivity of eias in different pcr ribotypes ...	2014	24695472
temporal changes in serum albumin and total protein in patients with hospital-acquired clostridium difficile infection.	studies have demonstrated low serum levels of total protein (tp) and albumin (alb) in patients with clostridium difficile infection (cdi), especially with refractory and recurrent disease. however, it is not known whether low tp and/or alb levels are a risk factor for cdi or merely a result of diarrheal loss. the aim of this study is to determine if low tp and/or alb level is an antecedent or sequela of cdi, which would be useful in risk stratification of hospitalized or nursing home patients. a ...	2014	24695471
comparison of two molecular methods for detecting toxigenic clostridium difficile.	clostridium difficile is one of the most common causes of nosocomial diarrhea, and diagnostic methods for detecting c. difficile infection have shifted from conventional to more recent molecular techniques. this study aimed to compare the performance of two molecular assays (meridian illumigene™ and advansure cd real-time pcr) in detecting c. difficile using a toxigenic culture as a reference standard.	2014	24695470
the clostridium difficile proline racemase is not essential for early logarithmic growth and infection.	proline racemase (prdf), which is important for energy metabolism via the stickland pathway and is unique to certain clostridia, was investigated as a potential anti-clostridium difficile target by examining its effects on the growth and virulence of c. difficile. inactivation of prdf by insertional mutagenesis did not affect early logarithmic growth but only attenuated growth in the mid- and late logarithmic phases. there was no effect on virulence in vivo, suggesting that prdf is also not requ ...	2014	24693984
cost-effectiveness of competing strategies for management of recurrent clostridium difficile infection: a decision analysis.	clostridium difficile infection (cdi) is an important cause of morbidity and healthcare costs, and is characterized by high rates of disease recurrence. the cost-effectiveness of newer treatments for recurrent cdi has not been examined, yet would be important to inform clinical practice. the aim of this study was to analyze the cost effectiveness of competing strategies for recurrent cdi.	2014	24692533
rho gtpases control ciliary epithelium cells proliferation and progenitor profile induction in vivo.	rho gtpases play a central role in actin-based cytoskeleton reorganization and regulate multiple signaling pathways that control gene transcription, cell survival, and proliferation. we investigated the effect of rho gtpases on cell cycle regulation and progenitor genes expression on mouse ciliary epithelium (ce), a potential source of progenitor/stem cells in the adult retina.	2014	24692128
drug-safety alerts issued by regulatory authorities: usefulness of meta-analysis in predicting risks earlier.	the purpose of this study was to evaluate how risk estimates generated from cumulative meta-analysis performs over time for drugs having their benefit/risk ratio re-evaluated due to safety issues and, additionally, assess whether results are consistent with regulatory authorities' conclusions.	2014	24691786
treatment of recurrent clostridium difficile infection with fecal transplantation.	clostridium difficile infection is an increasingly common clinical challenge in hospitals and healthcare facilities. the infection often results in severe complications for the infected individual including relentless diarrhea, abdominal pain, dehydration, and mortality. currently, there is a significant gap between research and practice in the management of recurrent clostridium difficile infection, and treatment guidelines are limited. numerous attempts at treating this infection have been mad ...	2014	24691086
investigation of a clostridium difficile cluster by multilocus sequence typing in a bone marrow transplant unit.		2014	24690456
the epidemiology of clostridium difficile infection in romania: what we know, or do not know and why?		2014	24689105
improving hospital staff compliance with environmental cleaning behavior.	reducing the incidence of healthcare-associated infections requires proper environmental cleanliness of frequently touched objects within the hospital environment. an intervention was launched in june 2012 and repeated in february 2013 and august 2013 to increase hospital room cleanliness with repeated education and training of nursing and environmental services staff to reduce healthcare-associated infections at cook children's medical center. random rooms were tested, staff were trained about ...	2014	24688183
clostridium difficile and the microbiota.	clostridium difficile infection (cdi) is the leading health care-associated illness. both human and animal models have demonstrated the importance of the gut microbiota's capability of providing colonization resistance against c. difficile. risk factors for disease development include antibiotic use, which disrupts the gut microbiota, leading to the loss of colonization resistance and subsequent cdi. identification of the specific microbes capable of restoring this function remains elusive. futu ...	2014	25036699
[using the real-time pcr assay to establish taqman-mgb probe for rapid identification of clostridium difficile and its toxin].	to develop a real-time pcr assay for the rapid identification of clostridium(c.)difficile and its toxin.	2014	25059372
intracolonic administration of vancomycin for clostridium difficile infection.		2014	25140945
clostridium difficile infection: an undeniably common problem among hematopoietic transplant recipients.		2014	25139684
expression of the large clostridial toxins is controlled by conserved regulatory mechanisms.	the clostridia cause many human and animal diseases, resulting in significant morbidity and mortality. host damage results from the action of potent exotoxins, an important group of which is the large clostridial toxins (lcts) produced by clostridium difficile, clostridium sordellii, clostridium perfringens and clostridium novyi. knowledge of the structure and function of these toxins has been attained, however, apart from c. difficile, the regulatory pathways that control lct production remain ...	2014	25190355
clostridium difficile infection after allogeneic hematopoietic stem cell transplant: strain diversity and outcomes associated with nap1/027.	allogeneic hematopoietic stem cell transplantation (hsct) recipients are at high risk for developing clostridium difficile infection (cdi). we studied the incidence, risk factors, nap1/027 prevalence, and clinical outcomes, including acute lower gastrointestinal graft-versus-host disease (gi gvhd), associated with early cdi in this population. a retrospective review was conducted of patients who underwent allogeneic hsct at memorial sloan kettering cancer center from january 1, 2005 to september ...	2014	24973628
a detection dog to identify patients with clostridium difficile infection during a hospital outbreak.	early and rapid identification of clostridium difficile infections (cdi) is important to prevent transmission. in this study we assessed the diagnostic accuracy of a trained detection dog for detecting cdi cases on hospital wards in an outbreak setting.	2014	24973552
international clostridium difficile animal strain collection and large diversity of animal associated strains.	clostridium difficile is an important cause of intestinal infections in some animal species and animals might be a reservoir for community associated human infections. here we describe a collection of animal associated c. difficile strains from 12 countries based on inclusion criteria of one strain (pcr ribotype) per animal species per laboratory.	2014	24972659
c. difficile ribotype 027 or 176?	clostridium difficile is a major nosocomial pathogen of present times. the analysis of 624 c. difficile strains from 11 hospitals in the czech republic in 2013 revealed that 40% of isolates belonged to ribotype 176. these results suggest that the incidence of cdi (c. difficile infection) in the czech republic has increased probably in connection with c. difficile ribotype 176. the molecular systems xpert c. difficile epi assay (cepheid inc., sunnyvale, ca) diagnoses toxigenic strains and support ...	2014	24970104
modulating the microbiota in inflammatory bowel diseases: prebiotics, probiotics or faecal transplantation?	crohn's disease (cd) and ulcerative colitis (uc) are the two major phenotypes of inflammatory bowel diseases (ibd) which constitute a spectrum of chronic, debilitating diseases characterised by a relapsing inflammation of the intestinal mucosal lining. evidence from a variety of disciplines implicates the intestinal microbiota in the pathogenesis of idiopathic ibd and their complications, including pouchitis. many studies have reported a dysbiosis in ibd, characterised by a decrease in diversity ...	2014	24969143
recurrent clostridium difficile infections: the importance of the intestinal microbiota.	clostridium difficile infections (cdi) are a leading cause of antibiotic-associated and nosocomial diarrhea. despite effective antibiotic treatments, recurrent infections are common. with the recent emergence of hypervirulent isolates of c. difficile, cdi is a growing epidemic with higher rates of recurrence, increasing severity and mortality. fecal microbiota transplantation (fmt) is an alternative treatment for recurrent cdi. a better understanding of intestinal microbiota and its role in cdi ...	2014	24966611
clostridium difficile in goats and sheep in slovenia: characterisation of strains and evidence of age-related shedding.	diversity of clostridium difficile in different age groups of goats (n = 109) and sheep (n = 105) was investigated. c. difficile was detected in 9.2% of goats and 5.7% of sheep. none of the adult animals were positive. isolates belonged to four toxinotypes (0, v, xia, xii), six pcr-ribotypes (010, 014/020, 045, 056, slo 061, slo 151) and six pulsotypes. pcr-ribotypes 010, 014/020, 045 and 056 were found previously in other animal species and humans in slovenia. additionally, three pulsotypes wer ...	2014	24960532
sensitive and selective culture medium for detection of environmental clostridium difficile isolates without requirement for anaerobic culture conditions.	effective and easy-to-use methods for detecting clostridium difficile spore contamination would be useful for identifying environmental reservoirs and monitoring the effectiveness of room disinfection. culture-based detection methods are sensitive for detecting c. difficile, but their utility is limited due to the requirement of anaerobic culture conditions and microbiological expertise. we developed a low-cost selective broth medium containing thioglycolic acid and l-cystine, termed c. difficil ...	2014	24958803
sequence variation in tcda and tcdb of clostridium difficile: st37 with truncated tcda is a potential epidemic strain in china.	clostridium difficile is a well-known nosocomial infectious pathogen. research on c. difficile infection has primarily focused on strains such as the hypervirulent pcr ribotype 027 (sequence type 1 [st1]) emerging in europe and north america. however, other new emerging ribotypes in some countries have attracted attention, such as pcr ribotype 17 (st37) in asia and latin america. we collected 70 strains and sequenced their toxin genes, tcda and tcdb. multilocus sequence typing (mlst) was used to ...	2014	24958798
national european guidelines for the prevention of clostridium difficile infection: a systematic qualitative review.	clostridium difficile is the most frequent infectious cause of nosocomial diarrhoea and a major topic in infection prevention.	2014	24957805
clostridium difficile ribotype 126 in southern taiwan: a cluster of three symptomatic cases.	several virulent clostridium difficile clones, designated as polymerase chain reaction (pcr) ribotypes 017, 027, or 078, are well recognized in western countries. however, the ribotype distribution of clinical c. difficile isolates in taiwan remains unclear.	2014	24956433
cephalosporins currently in early clinical trials for the treatment of bacterial infections.	healthcare-associated infections caused by multi-drug resistant bacteria remain a major cause of worldwide mortality. with the recent approval of agents such as hetero-resistant cocci (i.e., ceftaroline, ceftobiprole, telavancin) for the treatment of gram-positive infections by and drugs like fidaxomicin for treating clostridium difficile, present-day research on antibacterials has largely shifted to developing interventions for diseases caused by gram-negative bacilli. cephalosporins have gaine ...	2014	24956017
fecal microbiota transplantation in the treatment of refractory clostridium difficile infection in children: an update.	the use of transplanted fecal material for the treatment of diarrheal illness dates back to the fourth-century china. while fecal microbiota transplant has gained increasing popularity over the past 50 years for the treatment of refractory clostridium difficile infections (rcdis) in adults, it has only been recently utilized in children. the purpose of this article is to review the use of fecal microbiota transplant (fmt) in the treatment of pediatric rcdis.	2014	25046331
role of gm-csf in the inflammatory cytokine network that regulates neutrophil influx into the colonic mucosa during clostridium difficile infection in mice.	clostridium difficile infection in antibiotic-treated mice results in acute colitis characterized by severe intestinal histopathology, robust neutrophil influx, and increased expression of numerous inflammatory cytokines, including gm-csf. we utilized a neutralizing monoclonal antibody (mab) against gm-csf in a murine model to study the role of gm-csf during acute c. difficile colitis. cefoperazone-treated mice were challenged with c. difficile (strain 630) spores. expression of gm-csf was signi ...	2014	25045999
increasing incidence of clostridium difficile infection, australia, 2011-2012.		2014	25045987
5-aminosalicylic acid inhibits acute clostridium difficile toxin a-induced colitis in rats.	we tested the hypothesis that 5-aminosalicylic acid (5-asa) inhibits toxin a-induced generation of colonic leukotriene b4 (ltb4) and toxin a colitis in rats. isolated colonic segments in anesthetized rats were treated intraluminally with toxin a for 3 hours with or without 30 minutes of pretreatment with either 5-asa or sulfapyridine and then colonic tissue levels of ltb4 were measured and inflammation was assessed. separately, sulfasalazine was administered to rats in their drinking water for 5 ...	2014	25045574
reply to hughes et al.: impact of cleaning and other interventions on the reduction of hospital-acquired clostridium difficile infections in two hospitals in england assessed using a breakpoint model.		2014	25044362
humoral immune response as predictor of recurrence in clostridium difficile infection.	low serum concentrations of antibodies directed against the toxins tcda and tcdb have been associated with a higher risk of recurrence of clostridium difficile infection (cdi) after successful antibiotic treatment. however, there are conflicting reports. herein, we compared serum levels of antibodies of patients with a single episode of cdi with those of patients who subsequently suffered a recurrence. we used a serum bank from patients who received an experimental whey protein product following ...	2014	25041274
risk factors for recurrent clostridium difficile infection in hematopoietic stem cell transplant recipients.	recurrent clostridium difficile infection (cdi) represents a significant burden on the healthcare system and is associated with poor outcomes in hematopoietic stem cell transplant (hsct) patients. data are limited evaluating recurrence rates and risk factors for recurrence in hsct patients.	2014	25040545
diarrhoea in general practice: when should a clostridium difficile infection be considered? results of a nested case-control study.	clostridium difficile infections (cdis) are frequent in hospitals, but also seem to increase in the community. here, we aim to determine the incidence of cdi in general practice and to evaluate current testing algorithms for cdi. three dutch laboratories tested all unformed faeces (12,714) for c. difficile when diagnostic testing (for any enteric pathogen) was requested by a general practitioner (gp). additionally, a nested case-control study was initiated, including 152 cdi patients and 304 age ...	2014	25040463
clinical predictors of recurrent clostridium difficile infection in out-patients.	clostridium difficile infection (cdi) recurs in 20-30% of patients.	2014	25039269
comparison of culture based methods for the isolation of clostridium difficile from stool samples in a research setting.	effective isolation of clostridium difficile from stool samples is important in the research setting, especially where low numbers of spores/vegetative cells may be present within a sample. in this study, three protocols for stool culture were investigated to find a sensitive, cost effective and timely method of c. difficile isolation. for the initial enrichment step, the effectiveness of two different rich media, cycloserine-cefoxitin fructose broth (ccfb) and cycloserine-cefoxitin mannitol bro ...	2014	25038491
the cd27l and ctp1l endolysins targeting clostridia contain a built-in trigger and release factor.	the bacteriophage φcd27 is capable of lysing clostridium difficile, a pathogenic bacterium that is a major cause for nosocomial infection. a recombinant cd27l endolysin lyses c. difficile in vitro, and represents a promising alternative as a bactericide. to better understand the lysis mechanism, we have determined the crystal structure of an autoproteolytic fragment of the cd27l endolysin. the structure covers the c-terminal domain of the endolysin, and represents a novel fold that is identified ...	2014	25058163
healthcare resource utilization for recurrent clostridium difficile infection in a large university hospital in houston, texas.	there are limited data examining healthcare resource utilization in patients with recurrent clostridium difficile infection (cdi).	2014	25057871
inter- and intraspecies transfer of a clostridium difficile conjugative transposon conferring resistance to mlsb.	resistance to the macrolide-lincosamide-streptogramin b group of antibiotics in clostridium difficile is generally due to erm(b) genes. tn6194, a conjugative transposon initially detected in pcr-ribotype 027 isolates, is an erm(b)-containing element also detected in other relevant c. difficile pcr-ribotypes. in this study, the genome of a c. difficile pcr-ribotype 001 strain was sequenced, and an element with two nucleotidic changes compared to tn6194 was detected. this element was transferred b ...	2014	25055190
the combined repetitive oligopeptides of clostridium difficile toxin a counteract premature cleavage of the glucosyl-transferase domain by stabilizing protein conformation.	toxin a (tcda) and b (tcdb) from clostridium difficile enter host cells by receptor-mediated endocytosis. a prerequisite for proper toxin action is the intracellular release of the glucosyltransferase domain by an inherent cysteine protease, which is allosterically activated by inositol hexaphosphate (ip6). we found that in in vitro assays, the c-terminally-truncated tcda1-1065 was more efficient at ip6-induced cleavage compared with full-length tcda. we hypothesized that the c-terminally-locate ...	2014	25054784
investigation of toxin gene diversity and antimicrobial resistance of clostridium difficile strains.	the incidence of clostridium difficile infection (cdi) has been previously reported in a number of studies. however, data collected from the chinese population is limited. in the present study, the diversity of the toxin genes, tcda and tcdb, of 57 clostridium difficile (c. difficile) isolates from a chinese population were investigated by polymerase chain reaction (pcr) (38 a(+)b(+), 14 a(-)b(+) and 5 a(-)b(-)). quantitative pcr was used to check the expression of these two genes and it was fou ...	2014	25054021
clostridium difficile infection: nursing considerations.	clostridium difficile is a bacterium which commonly causes diarrhoea in inpatients. c. difficile affects hospitalised patients worldwide and can pose a significant risk to patients. this article explores the transmission and risk factors for c. difficile infection (cdi). there are many aspects to the prevention and control of cdi: appropriate antibiotic use, early instigation and maintenance of prevention and control strategies, and high standards of environmental cleanliness, education, and sur ...	2014	25052676
concomitant cmv and clostridium difficile colitis in an immunocompetent patient treated with ganciclovir and fecal transplantation.		2014	24949617
clinical information on admission is insufficient to determine the appropriate isolation regimen for acute gastroenteritis.	the number of admissions for acute gastroenteritis (ge) is increasing. the majority of patients pass through a single high-flow emergency department (ed) area which increases the risk of spreading ge. the aim of this study was to determine the frequency and aetiology of ge for acutely admitted patients and to analyse their clinical information focusing on risk indicators of contagious aetiology and on the chosen isolation regime to determine if the ge required a contact precaution isolation regi ...	2014	24947622
the human volatilome: volatile organic compounds (vocs) in exhaled breath, skin emanations, urine, feces and saliva.	breath analysis is a young field of research with its roots in antiquity. antoine lavoisier discovered carbon dioxide in exhaled breath during the period 1777-1783, wilhelm (vilém) petters discovered acetone in breath in 1857 and johannes müller reported the first quantitative measurements of acetone in 1898. a recent review reported 1765 volatile compounds appearing in exhaled breath, skin emanations, urine, saliva, human breast milk, blood and feces. for a large number of compounds, real-time ...	2014	24946087
comparison of polymerase chain reaction ribotyping, toxinotyping and nutritional aspects of toxin production of clostridium difficile strains.	clostridium difficile (c. difficile) is the leading cause of infectious diarrhea in hospitals worldwide. enterotoxin a (tcda) and cytotoxin b (tcdb), have been identified as the main virulence factors of c. difficile. in china, data on polymerase chain reaction (pcr) ribotypes and abilities of hospital-derived c. difficile isolates to produce tcda and tcdb are sparse. in this study, we identified 40 c. difficile isolates from the taizhou hospital and investigated their pcr ribotypes based on the ...	2014	24944791
clostridium perfringens and clostridium difficile in cooked beef sold in côte d'ivoire and their antimicrobial susceptibility.	the aim of this study was to evaluate the prevalence of clostridium difficile and clostridium perfringens in cooked beef sold in the streets in côte d'ivoire and their antimicrobial susceptibility. a total of 395 kidney and flesh samples of cooked beef were collected from vendors at abidjan and subjected to c. difficile and c. perfringens isolation and identification by using biochemical tests, api 20a system and pcr detection. subsequently, the antimicrobial susceptibility test was performed fo ...	2014	24944124
clostridium difficile infection in hospitalized patients at a czech tertiary center: analysis of epidemiology, clinical features, and risk factors of fulminant course.	clostridium difficile infection (cdi) has been increasing in incidence, with significant morbidity and mortality, and is subject to geographical and institutional variability. we aimed to characterize epidemiology and clinical manifestations of cdi in a czech tertiary care center and to identify risk factors of fulminant course.	2014	24942955
[epidemiology of clostridium difficile-associated disease (cdad) in salamanca].	clostridium difficile infection is considered a major cause of nosocomial diarrhoea in developed countries and is increasingly becoming more important as an etiologic agent of community diarrhoea, also in patients without risk factors.	2014	24940894
recovery of the gut microbiome following fecal microbiota transplantation.	clostridium difficile infection is one of the most common health care-associated infections, and up to 40% of patients suffer from recurrence of disease following standard antibiotic therapy. recently, fecal microbiota transplantation (fmt) has been successfully used to treat recurrent c. difficile infection. it is hypothesized that fmt aids in recovery of a microbiota capable of colonization resistance to c. difficile. however, it is not fully understood how this occurs. here we investigated ch ...	2014	24939885
decreasing clostridium difficile infections by an antimicrobial stewardship program that reduces moxifloxacin use.	clostridium difficile infections (cdi) in hospitalized patients are known to be closely related to antibiotic exposure. although several substances can cause cdi, the risk differs between individual agents. in vienna and other eastern parts of austria, cdi ribotype 027 is currently highly prevalent. this ribotype has the characteristic of intrinsic moxifloxacin resistance. therefore, we hypothesized that moxifloxacin restriction can decrease the number of cdi cases in hospitalized patients. our ...	2014	24936597
tryptophan catabolism restricts ifn-γ-expressing neutrophils and clostridium difficile immunopathology.	the interplay between clostridium difficile and the host's metabolome is believed to influence the severity of infection. however, the mechanism for this phenomenon remains unclear. in this study, we model one of these metabolic pathways by focusing on tryptophan metabolism in the host. we found that inhibition of tryptophan catabolism in ido1-knockout mice led to increased mucosal destruction, cecal hemorrhage, and increased production of ifn-γ in response to c. difficile infection, but no sign ...	2014	24935925
antibiotic overuse and clostridium difficile: a teachable moment.		2014	24935617
nosocomial transmission of c. difficile in english hospitals from patients with symptomatic infection.	recent evidence suggests that less than one-quarter of patients with symptomatic nosocomial clostridium difficile infections (cdi) are linked to other in-patients. however, this evidence was limited to one geographic area. we aimed to investigate the level of symptomatic cdi transmission in hospitals located across england from 2008 to 2012.	2014	24932484
survey of c. difficile-specific infection control policies in local long-term care facilities.	the incidence and severity of clostridium difficile infection (cdi) has been increasing and long-term care facility (ltcf) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. infection control policies are crucial for controlling cdi, but there are currently no regulatory guidelines in the united states. therefore, we evaluated infection control policies in local ltcfs to define the cdi-specific policies and the administrative and staff understanding of cdi, ...	2014	24932422
fate of clostridium difficile during wastewater treatment and incidence in southern ontario watersheds.	to investigate the prevalence of clostridium difficile encountered during sewage treatment and in water sources into which treated effluent was directly or indirectly discharged.	2014	24930867
multilocus sequence typing analysis and antibiotic resistance of clostridium difficile strains isolated from retail meat and humans in belgium.	clostridium difficile has been isolated from food animals and meat, specially ground pork and ground beef. the recovered isolates were closely related to c. difficile human strains, indicating that animals and food are possible transmission routes of human c. difficile infection. the main objective of this study was to characterize c. difficile isolates from retail meat and to compare with human isolates recovered from hospital patients in belgium. raw meat (beef and pork) was obtained from the ...	2014	24929733
clostridium difficile infection in solid organ transplant recipients.	clostridium difficile infection (cdi) is one of the most common healthcare-associated infections, and the threat associated with cdi continues to grow in all patient populations. there is increasing evidence that cdi has a substantial impact on the morbidity and mortality in solid organ transplant (sot) recipients. furthermore, new diagnostic and treatment options and strategies for cdi have emerged over the last decade. the purpose of this review is to provide a general understanding of cdi and ...	2014	24927151
intravenous immunoglobulin in the treatment of severe clostridium difficile colitis.	intravenous immunoglobulin (ivig) has been utilized in patients with recurrent and refractory clostridium difficile colitis. it is increasingly being used in patients with initial clinical presentation of severe colitis. herein, we report a case of severe c. difficile colitis successfully treated with ivig with a review of the medical literature to identify the optimal timing and clinical characteristics for this treatment strategy.	2014	24926170
staggered and tapered antibiotic withdrawal with administration of kefir for recurrent clostridium difficile infection.	daily administration of the probiotic kefir given in combination with a staggered and tapered antibiotic withdrawal regimen may resolve recurrent clostridium difficile infection as effectively as fecal microbiota transplantation.	2014	24917658
occurrence of clostridium difficile infections due to pcr ribotype 027 in bucharest, romania.	little is known about prevailing ribotypes of clostridium difficile infection in romania where cdi is not a mandatory notifiable disease.	2014	24916866
structural, spectroscopic and functional investigation into fe-substituted mnsod from human pathogen clostridium difficile.	clostridium difficile, which inhabits the human digestive tract, is an etiological agent that causes pseudomembranous colitis and antibiotic-associated diarrhea. the oxidative stress tightly relates to its virulence, which highlights the function of its superoxide dismutase (sod). the sod from clostridium difficile (sodcd) is a mn/fe cambialistic sod with mnsodcd exhibiting an optimal activity while fe-sub-mnsodcd showing 10-fold less activity. to explain why the fe-loaded protein exhibits a muc ...	2014	24915901
hospital clostridium difficile infection testing rates: is "don't ask, don't tell" at play?		2014	24915231
pediatric clostridium difficile infection: 6-year active surveillance in a defined patient population.		2014	24915227
the prediction of complicated clostridium difficile infections in children.	we validated proposed definitions for severe clostridium difficile infection (cdi) in adults for prediction of complicated cdi in children. complicated cdi occurred in 9 of 202 cases. definitions for severe cdi in adults showed poor measures for discrimination of complicated cdi in children, which calls into question the usefulness of such definitions in pediatric cohorts.	2014	24915226
protein expression, characterization, crystallization and preliminary x-ray crystallographic analysis of a fic protein from clostridium difficile.	fic domains in proteins are found in abundance in nature from the simplest prokaryotes to animals. interestingly, fic domains found in two virulence factors of gram-negative bacteria have recently been demonstrated to catalyse the transfer of the amp moiety from atp to small host gtpases. this post-translational modification has attracted considerable interest and a role for adenylylation in pathology and physiology is emerging. this work was aimed at the structural characterization of a newly i ...	2014	24915103
clostridium difficile infection in the hematopoietic unit: a meta-analysis of published studies.	hematopoietic stem cell transplant (hsct) recipients are at high risk of contracting clostridium difficile infection (cdi). we systematically searched the pubmed and embase databases through march 2014 and performed a random-effects meta-analysis to estimate the prevalence and trends of cdi over time. among 48 eligible articles that included 12,025 patients at risk, we estimated that 7.9% (95% confidence interval [ci], 6.5% to 9.5%) of hsct patients are diagnosed with cdi during the peri-transpl ...	2014	24914822
hematologic diseases: high risk of clostridium difficile associated diarrhea.	to investigate the incidence and clinical outcome of clostridium difficile (c. difficile) associated diarrhea (cdad) in patients with hematologic disease.	2014	24914383
antibiotics for treatment of clostridium difficile infection in hospitalized patients with inflammatory bowel disease.	patients with inflammatory bowel disease (ibd), namely ulcerative colitis (uc) and crohn's disease (cd), have worse outcomes with clostridium difficile infection (cdi), including increased readmissions, colectomy, and death. oral vancomycin is recommended for the treatment of severe cdi, while metronidazole is the standard of care for nonsevere infection. we aimed to assess treatment outcomes of cdi in ibd. we conducted a retrospective observational study of inpatients with cdi and ibd from janu ...	2014	24913174
multidisciplinary analysis of a nontoxigenic clostridium difficile strain with stable resistance to metronidazole.	stable resistance to metronidazole in a nontoxigenic clostridium difficile strain was investigated at both the genomic and proteomic levels. alterations in the metabolic pathway involving the pyruvate-ferredoxin oxidoreductase were found, suggesting that reduction of metronidazole, required for its activity, may be less efficient in this strain. proteomic studies also showed a cellular response to oxidative stress.	2014	24913157
initiation of sporulation in clostridium difficile: a twist on the classic model.	the formation of dormant endospores is a complex morphological process that permits long-term survival in inhospitable environments for many gram-positive bacteria. sporulation for the anaerobic gastrointestinal pathogen clostridium difficile is necessary for survival outside of the gastrointestinal tract of its host. while the developmental stages of spore formation are largely conserved among endospore-forming bacteria, the genus clostridium appears to be missing a number of conserved regulato ...	2014	24910370
clostridium difficile infection among immunocompromised patients in rio de janeiro, brazil and detection of moxifloxacin resistance in a ribotype 014 strain.	clostridium difficile is a gram-positive spore forming anaerobic bacterium, often associated with nosocomial diarrhea and pseudomembranous colitis. the acquisition of this organism occurs primarily in hospitals through accidental ingestion of spores, and its establishment and proliferation in the colon results from the removal of members of the normal intestinal flora during or after antibiotic therapy. in this study, stool samples from patients admitted to the university hospital clementino fra ...	2014	24907488
haemorrhagic toxin and lethal toxin from clostridium sordellii strain vpi9048: molecular characterization and comparative analysis of substrate specificity of the large clostridial glucosylating toxins.	large clostridial glucosylating toxins (lcgts) are produced by toxigenic strains of clostridium difficile, clostridium perfringens, clostridium novyi and clostridium sordellii. while most c. sordellii strains solely produce lethal toxin (tcsl), c. sordellii strain vpi9048 co-produces both hemorrhagic toxin (tcsh) and tcsl. here, the sequences of tcsh-9048 and tcsl-9048 are provided, showing that both toxins retain conserved lcgt features and that tcsl and tcsh are highly related to toxin a (tcda ...	2014	24905543
rhode island clostridium difficile infection trends and laboratory id events ranking.		2014	24905379
[development of gastrointestinal infectious diseases between 2000 and 2012].	infectious gastroenterological diseases are of increasing medical and health-economic significance.	2014	24905106
study of the frequency of clostridium difficile tcda, tcdb, cdta and cdtb genes in feces of calves in south west of iran.	clostridium difficile (c. difficile) is a gram-positive, toxin-producing bacillus which is an intestinal pathogen in both humans and animals and causes a range of digestive disorders including inflammation of the bowel, abdominal pain, fever and diarrhea. c. difficile toxins include enterotoxin (toxin a), cytotoxin (toxin b) and a binary toxin. two large protein toxins a and b are encoded by separate genes, tcda and tcdb. clostridium difficile infection (cdi) mainly caused by the activity of the ...	2014	24903619
severe clostridium difficile infection: incidence and risk factors at a tertiary care university hospital in vienna, austria.	clostridium difficile infection (cdi) is the major cause of hospital-acquired bacterial diarrhoea. the incidence of cdi has been increasing in canada, the us and europe and severe cases are becoming more common.	2014	24903143