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challenges and opportunities in the management of clostridium difficile infection.clostridium difficile infection (cdi) is increasing in all regions of the world where sought. there is no gold standard for diagnosis of cdi, with available tests having limitations. prevention of cdi will be seen with antibiotic stewardship, improved disinfection of hospitals and nursing homes, chemo- and immuno-prophylaxis and next generation probiotics. the important therapeutic agents are oral vancomycin and fidaxomicin with metronidazole being used only in mild cases or when oral therapy ca ...201425012255
detecting clostridium difficile spores from inanimate surfaces of the hospital environment: which method is best?the recovery of clostridium difficile spores from hospital surfaces was assessed using rayon swabs, flocked swabs, and contact plates. the contact plate method was less laborious, achieved higher recovery percentages, and detected spores at lower inocula than swabs. rayon swabs were the least efficient method. however, further studies are required in health care settings.201425009047
the impact of clostridium difficile on paediatric surgical practice: a systematic review.the pathogenic potential of clostridium difficile in children remains a controversial subject as healthy infants can be colonised by this organism. however recent analyses have clarified that c. difficile is an important enteropath in paediatric populations, particularly in antibiotic-associated diarrhoea. paediatric surgical patients including those with hirschsprung's disease (hd) may be especially vulnerable to c. difficile infection (cdi) and complicated c. difficile enterocolitis such as ps ...201425008231
effects of polysaccharopeptide from trametes versicolor and amoxicillin on the gut microbiome of healthy volunteers: a randomized clinical trial.interactions between the microbial flora of the intestine and the human host play a critical role inmaintaining intestinal health and in the pathophysiology of a wide variety of disorders such as antibiotic associated diarrhea, clostridium difficile infection, and inflammatory bowel disease. prebiotics can confer health benefits by beneficial effects on the intestinal microbiome, whereas antibiotics can disrupt the microbiome leading to diarrhea andother side effects.201425006989
serine/threonine protein phosphatase-mediated control of the peptidoglycan cross-linking l,d-transpeptidase pathway in enterococcus faecium.the last step of peptidoglycan polymerization involves two families of unrelated transpeptidases that are the essential targets of β-lactam antibiotics. d,d-transpeptidases of the penicillin-binding protein (pbp) family are active-site serine enzymes that use pentapeptide precursors and are the main or exclusive cross-linking enzymes in nearly all bacteria. however, peptidoglycan cross-linking is performed mainly by active-site cysteine l,d-transpeptidases that use tetrapeptides in mycobacterium ...201425006233
the structure of the cysteine protease and lectin-like domains of cwp84, a surface layer-associated protein from clostridium difficile.clostridium difficile is a major problem as an aetiological agent for antibiotic-associated diarrhoea. the mechanism by which the bacterium colonizes the gut during infection is poorly understood, but undoubtedly involves a myriad of components present on the bacterial surface. the mechanism of c. difficile surface-layer (s-layer) biogenesis is also largely unknown but involves the post-translational cleavage of a single polypeptide (surface-layer protein a; slpa) into low- and high-molecular-we ...201425004975
structural and biochemical analyses of alanine racemase from the multidrug-resistant clostridium difficile strain 630.clostridium difficile, a gram-positive, spore-forming anaerobic bacterium, is the leading cause of infectious diarrhea among hospitalized patients. c. difficile is frequently associated with antibiotic treatment, and causes diseases ranging from antibiotic-associated diarrhea to life-threatening pseudomembranous colitis. the severity of c. difficile infections is exacerbated by the emergence of hypervirulent and multidrug-resistant strains, which are difficult to treat and are often associated w ...201425004969
organization and scope of surveillance of infections in polish hospitals. results of the project prohibit.the paper presents results of a survey on organization of surveillance programs in polish hospitals. survey was performed by means of the standardized questionnaire in the year 2012. materialand method: completed questionnaires were obtained from 9 hospitals of different size and type: 3 small, 2 medium and 4 large, most of them public (6 hospitals). questions concerning general organization of the infection control in hospitals were answered by infection control teams.201425004628
the evolution of urban c. difficile infection (cdi): cdi in 2009-2011 is less severe and has better outcomes than cdi in 2006-2008.over the past decade, the epidemiology of clostridium difficile infection (cdi) has shown a remarkable increase in incidence with an associated increase in severity. this study was designed to compare the demographics, medication exposure, evaluation, treatment patterns, and outcomes of patients with cdi in two different time periods: 2006-2008 and 2009-2011. we hypothesized that mortality is decreasing with increasing appropriateness of medical management.201425001255
clostridium difficile recurrence is characterized by pro-inflammatory peripheral blood mononuclear cell (pbmc) phenotype.clostridium difficile infection (cdi) is a prevalent nosocomial and increasingly community-acquired problem. little is known about the productive cellular response in patients. we used flow cytometry to define inflammatory (th1 and th17) and regulatory [foxp3(+) t-regulatory (treg)] cells present in circulating peripheral blood mononuclear cells (pbmc) from cdi patients. we consented 67 inpatients that tested either positive or negative for cdi and 16 healthy controls and compared their pbmc phe ...201425001105
extended antimicrobial use in patients undergoing percutaneous nephrolithotomy and associated antibiotic related complications.despite global concern about antibiotic related complications the duration of antibiotic therapy at percutaneous nephrolithotomy varies based on individual physician practice. we evaluated perioperative antibiotic related complications in patients who received extended antimicrobial therapy at percutaneous nephrolithotomy.201424998482
hospitalization stay and costs attributable to clostridium difficile infection: a critical review.in most healthcare systems, third-party payers fund the costs for patients admitted to hospital for clostridium difficile infection (cdi) whereas, for cdi cases arising as complications of hospitalization, not all related costs are refundable to the hospital. we therefore aimed to critically review and categorize hospital costs and length of hospital stay (los) attributable to clostridium difficile infection and to investigate the economic burden associated with it. a comprehensive literature re ...201424996516
role of microbiota and innate immunity in recurrent clostridium difficile infection.recurrent clostridium difficile infection represents a burdensome clinical issue whose epidemiology is increasing worldwide. the pathogenesis is not yet completely known. recent observations suggest that the alteration of the intestinal microbiota and impaired innate immunity may play a leading role in the development of recurrent infection. various factors can cause dysbiosis. the causes most involved in the process are antibiotics, nsaids, acid suppressing therapies, and age. gut microbiota im ...201424995345
high rates of intestinal colonisation with fluoroquinolone-resistant esbl-harbouring enterobacteriaceae in hospitalised patients with antibiotic-associated diarrhoea.the purposes of this study were to investigate the intestinal carriage of extended-spectrum β-lactamase-harbouring enterobacteriaceae (esbl-en) and associated fluoroquinolone resistance (fq-r) in 120 hospitalised patients with antibiotic-associated diarrhoea, and to investigate a correlation between clostridium difficile (c. difficile) infection and intestinal colonisation with esbl-en in these patients. stool samples were screened for c. difficile infection by toxin a/b enzyme-linked immunosorb ...201424993152
clostridium difficile infection: epidemiology, pathogenesis, risk factors, and therapeutic options.the incidence and mortality rate of clostridium difficile infection have increased remarkably in both hospital and community settings during the last two decades. the growth of infection may be caused by multiple factors including inappropriate antibiotic usage, poor standards of environmental cleanliness, changes in infection control practices, large outbreaks of c. difficile infection in hospitals, alteration of circulating strains of c. difficile, and spread of hypervirulent strains. detectio ...201424991448
funding may influence trial results examining probiotics and clostridium difficile diarrhea rates. 201424989097
clostridium difficile infection in patients with ileal pouches.clostridium difficile (c. difficile) infection (cdi) following total proctocolectomy and ileal pouch-anal anastomosis has been increasingly recognized over the past 5 years. cdi of the ileal pouch has been recognized in ∼10% of symptomatic patients seen at a tertiary referral center for pouch dysfunction. in contrast to colonic cdi in the general population or in patients with inflammatory bowel disease, postoperative antibiotic exposure and the use of immunosuppressive agents or proton pump inh ...201424989088
lactobacillus rhamnosus l34 and lactobacillus casei l39 suppress clostridium difficile-induced il-8 production by colonic epithelial cells.clostridium difficile is the main cause of hospital-acquired diarrhea and colitis known as c. difficile-associated disease (cdad).with increased severity and failure of treatment in cdad, new approaches for prevention and treatment, such as the use of probiotics, are needed. since the pathogenesis of cdad involves an inflammatory response with a massive influx of neutrophils recruited by interleukin (il)-8, this study aimed to investigate the probiotic effects of lactobacillus spp. on the suppre ...201424989059
metabolomics analysis identifies intestinal microbiota-derived biomarkers of colonization resistance in clindamycin-treated mice.the intestinal microbiota protect the host against enteric pathogens through a defense mechanism termed colonization resistance. antibiotics excreted into the intestinal tract may disrupt colonization resistance and alter normal metabolic functions of the microbiota. we used a mouse model to test the hypothesis that alterations in levels of bacterial metabolites in fecal specimens could provide useful biomarkers indicating disrupted or intact colonization resistance after antibiotic treatment.201424988418
bugs or drugs: are probiotics safe for use in the critically ill?probiotics are living microorganisms which have demonstrated many benefits in prevention, mitigation, and treatment of various disease states in critically ill populations. these diseases include antibiotic-associated diarrhea, clostridium difficile diarrhea, ventilator-associated pneumonia, clearance of vancomycin-resistant enterococci from the gi tract, pancreatitis, liver transplant, major abdominal surgery, and trauma. however, their use has been severely limited due to a variety of factors ...201424986534
a population-based spatio-temporal analysis of clostridium difficile infection in queensland, australia over a 10-year period.to identify the spatio-temporal patterns and environmental factors associated with clostridium difficile infection (cdi) in queensland, australia.201424984276
fecal microbiota transplantation for clostridium difficile-associated colitis in a severely immunocompromized critically ill aids patient: a case report. 201424983544
clostridium difficile contains plasmalogen species of phospholipids and glycolipids.analysis of the polar lipids of many pathogenic and non-pathogenic clostridia has revealed the presence of plasmalogens, alk-1'-enyl ether-containing phospholipids and glycolipids. an exception to this finding so far has been clostridium difficile, an important human pathogen which is the cause of antibiotic-associated diarrhea and other more serious complications. we have examined the polar lipids of three strains of c. difficile by thin-layer chromatography and have found acid-labile polar lip ...201424983203
clostridium difficile infection. 201424982288
measuring the impact of clostridium difficile infection with the nap1 strain on severity and mortality. 201424982035
bortezomib for refractory autoimmunity in pediatrics.therapy of refractory autoimmunity remains challenging. in this study, we evaluated the therapeutic effect of bortezomib, a proteasome inhibitor, by targeting plasma cells in 7 patients (median age, 9.9 years). four doses of bortezomib were administered at a dose of 1.3 mg/m(2) intravenously (n = 6) or subcutaneously (n = 1) every 72 hours. bortezomib was administered at a median of 120 days from laboratory confirmation of autoantibodies. all patients had failed 2 or more standard therapies. rit ...201424979732
clostridium difficile and clostridium perfringens from wild carnivore species in brazil.despite some case reports, the importance of clostridium perfringens and clostridium difficile for wild carnivores remains unclear. thus, the objective of this study was to identify c. perfringens and c. difficile strains in stool samples from wild carnivore species in brazil. a total of 34 stool samples were collected and subjected to c. perfringens and c. difficile isolation. suggestive colonies of c. perfringens were then analyzed for genes encoding the major c. perfringens toxins (alpha, bet ...201424979683
clostridium difficile colitis in patients undergoing lumbar spine surgery.retrospective database analysis.201424979408
intestinal microbiota and the efficacy of fecal microbiota transplantation in gastrointestinal disease.fecal microbiota transplantation (fmt) refers to the infusion of a fecal suspension from a healthy person into the gastrointestinal (gi) tract of another person to cure a specific disease. fmt is by no means a new therapeutic modality, although it was only relatively recently that stool was shown to be a biologically active, complex mixture of living organisms with great therapeutic potential for recurrent clostridium difficile infection and perhaps other gi and non-gi disorders. the published r ...201424976806
pomegranate extract exhibits in vitro activity against clostridium difficile.to determine the possible utility of pomegranate extract in the management or prevention of clostridium difficile infections or colonization.201424976424
patience is a virtue: an argument for delayed surgical intervention in fulminant clostridium difficile colitis.recently, the incidence and severity of clostridium difficile infection (cdi) has increased. in cases of fulminant infection, surgery is a viable therapeutic option but associated with high mortality. we sought to examine factors associated with mortality in a large sample of patients with severe cdi that underwent surgery. a retrospective study was conducted in patients with severe cdi undergoing colectomy. demographics, risk factors, comorbidities, clinical and laboratory data, and time betwee ...201424887802
detection of clostridium difficile infection clusters, using the temporal scan statistic, in a community hospital in southern ontario, canada, 2006-2011.in hospitals, clostridium difficile infection (cdi) surveillance relies on unvalidated guidelines or threshold criteria to identify outbreaks. this can result in false-positive and -negative cluster alarms. the application of statistical methods to identify and understand cdi clusters may be a useful alternative or complement to standard surveillance techniques. the objectives of this study were to investigate the utility of the temporal scan statistic for detecting cdi clusters and determine if ...201424885351
appendicectomy and clostridium difficile infection: is there a link?clostridium difficile infection (cdi) is a gradually emerging healthcare problem in the western world, occurring predominantly from the de-arrangement of the gut microbiota and the widespread use of antibiotics. recently, it has been proposed that the presence or absence of the appendix could be a factor influencing the occurrence and/or the severity of cdi. we performed a review of the literature, aiming to identify and interpret in an accumulative way the results of the published clinical stud ...201424883147
[contamination of healthcare workers hands with clostridium difficile spores after caring for patients with c. difficile infection.] 201424878917
fatal spontaneous clostridium septicum gas gangrene: a possible association with iatrogenic gastric acid suppression.the long-term use of proton pump inhibitors has been linked to an increased risk for the development of gastric polyps, hip fractures, pneumonia, and clostridium difficile colitis. there is evidence that chronic acid suppression from long-term use of proton pump inhibitors poses some risk for the development of c difficile-associated diarrhea by decreasing the elimination of pathogenic microbes before reaching the lower gastrointestinal tract. here we present a case of a 51-year-old woman with a ...201424878026
genes encoding toxin of clostridium difficile in children with and without diarrhea.the presence of gene 16s rrna and genes encoding toxin a (tcda), toxin b (tcdb), and binary toxin (cdta/cdtb) of clostridium difficile in stool samples from children with (110) and without (150) diarrhea was determined by using a taqman system. fifty-seven (21.9%) out of 260 stool samples harbored the 16s rrna gene. the genetic profile of tcda+/tcdb- and cdta+/cdtb+ was verified in one c. difficile-positive diarrhea sample and of tcda+/tcdb+ in three c. difficile-positive nondiarrhea samples. th ...201424876992
risk of aki with gentamicin as surgical prophylaxis.in 2009, the scottish government issued a target to reduce clostridium difficile infection by 30% in 2 years. consequently, scottish hospitals changed from cephalosporins to gentamicin for surgical antibiotic prophylaxis. this study examined rates of postoperative aki before and after this policy change. the study population comprised 12,482 adults undergoing surgery (orthopedic, urology, vascular, gastrointestinal, and gynecology) with antibiotic prophylaxis between october 1, 2006, and septemb ...201424876113
results from the first 12 months of the national surveillance of healthcare associated outbreaks in germany, 2011/2012.in august 2011, the german protection against infection act was amended, mandating the reporting of healthcare associated infection (hai) outbreak notifications by all healthcare workers in germany via local public health authorities and federal states to the robert koch institute (rki).201424875674
pyknotic cell death induced by clostridium difficile tcdb: chromatin condensation and nuclear blister are induced independently of the glucosyltransferase activity.tcda and tcdb are the main pathogenicity factors of clostridium difficile-associated diseases. both toxins inhibit rho gtpases, and consequently, apoptosis is induced in the affected cells. we found that tcdb at higher concentrations exhibits cytotoxic effects that are independent on rho glucosylation. tcdb and the glucosyltransferase-deficient mutant tcdb d286/288n induced pyknotic cell death which was associated with chromatin condensation and reduced h3 phosphorylation. affected cells showed ...201424898616
an antimicrobial stewardship program's real-world experience with fidaxomicin for treatment of clostridium difficile infection: a case series.to evaluate real-world clinical and economic outcomes in patients with clostridium difficile infection (cdi) treated with fidaxomicin.201424898525
risk factors for recurrent clostridium difficile infection (cdi) hospitalization among hospitalized patients with an initial cdi episode: a retrospective cohort study.recurrent clostridium difficile infection (rcdi) is observed in up to 25% of patients with an initial cdi episode (icdi). we assessed risk factors for rcdi among patients hospitalized with icdi.201424898123
risk factors for recurrence, complications and mortality in clostridium difficile infection: a systematic review.clostridium difficile infection (cdi) can lead to complications, recurrence, and death. numerous studies have assessed risk factors for these unfavourable outcomes, but systematic reviews or meta-analyses published so far were limited in scope or in quality.201424897375
outcomes from rectal vancomycin therapy in patients with clostridium difficile infection. 201424896763
national trends and inpatient outcomes of inflammatory bowel disease patients with concomitant chronic liver disease.there is little information on the frequency of chronic liver disease among hospitalized patients with inflammatory bowel disease (ibd). in this study, we seek to define the common etiologies contributing to chronic liver disease among ibd patients and to identify potential risk factors predictive of increased mortality in this population.201424895841
clinical characteristics of relapses and re-infections in clostridium difficile infection.the purpose of this study was to identify factors associated with relapses or re-infections in patients with recurring clostridium difficile infections (cdis). from september 2008 to january 2012, cases with two or more isolates from consecutive cdi episodes were included. pcr-ribotyping and multilocus variable-number tandem-repeat analysis were performed using paired isolates. among 473 patients, 68 (14.4%) experienced one to five recurrences. fifty-one of these with two or more isolates from c ...201424894547
carriage and acquisition rates of clostridium difficile in hospitalized horses, including molecular characterization, multilocus sequence typing and antimicrobial susceptibility of bacterial isolates.clostridium difficile has been identified as a significant agent of diarrhoea and enterocolitis in both foals and adult horses. hospitalization, antibiotic therapy or changes in diet may contribute to the development of c. difficile infection. horses admitted to a care unit are therefore at greater risk of being colonized. the aim of this study was to investigate the carriage of c. difficile in hospitalized horses and the possible influence of some risk factors in colonization. during a seven-mo ...201424894133
clostridium difficile infection (cdi) in solid organ and hematopoietic stem cell transplant recipients.patients undergoing solid organ and stem cell transplantation are at increased risk of clostridium difficile infection (cdi) compared with nontransplant patients. cdi may be associated with significant morbidity in this population including prolonged hospitalization, increased hospital charges, and complications in the transplanted organ. a combination of host factors, including both b-cell and t-cell immunosuppression, in addition to traditional risk factors for cdi such as broad-spectrum antib ...201424893981
herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth.patients with small intestine bacterial overgrowth (sibo) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. present treatment of sibo is limited to oral antibiotics with variable success. a growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health. the objective was to determine the remission rate of sibo using either the antibiotic rifaximin or herbals in a tertiary care re ...201424891990
lactobacillus acidophilus modulates the virulence of clostridium difficile.clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium that colonizes the human gastrointestinal tract. this pathogen causes antibiotic-associated diarrhea and colitis in animals and humans. antibiotic-associated diseases may be treated with probiotics, and interest is increasing in such uses of probiotics. this study investigated the effect of lactobacillus strains on the quorum-sensing signals and toxin production of c. difficile. in addition, an in vivo experiment was ...201424856984
species and genus level resolution analysis of gut microbiota in clostridium difficile patients following fecal microbiota transplantation.clostridium difficile is an opportunistic human intestinal pathogen, and c. difficile infection (cdi) is one of the main causes of antibiotic-induced diarrhea and colitis. one successful approach to combat cdi, particularly recurrent form of cdi, is through transplantation of fecal microbiota from a healthy donor to the infected patient. in this study we investigated the distal gut microbial communities of three cdi patients before and after fecal microbiota transplantation, and we compared thes ...201424855561
clinical and economic consequences of vancomycin and fidaxomicin for the treatment of clostridium difficile infection in canada.clostridium difficile infection (cdi) represents a public health problem with increasing incidence and severity.201424855476
timing and type of surgical treatment of clostridium difficile-associated disease: a practice management guideline from the eastern association for the surgery of trauma.clostridium difficile infection is the leading cause of nosocomial diarrhea in the united states; however, few patients will develop fulminant c. difficile-associated disease (cdad), necessitating an urgent operative intervention. mortality for patients who require operative intervention is very high, up to 80% in some series. since there is no consensus in the literature regarding the best operative treatment for this disease, we sought to answer the following:pico [population, intervention, co ...201424854320
puerperal retroperitoneal abscess caused by clostridium difficile: case report and review of the literature.retroperitoneal infection can be lethal. optimal management is still elusive to describe because of the small number of case reports. we presented here a case of retroperitoneal abscess caused by clostridium difficile arising in the puerperal period.201424853835
fecal microbiota transplantation in children with recurrent clostridium difficile infection.clostridium difficile eradication using fecal microbiota transplantation (fmt) has been successful in adults but little information is available in pediatrics. we report 6 pediatric patients with refractory c. difficile cured by fmt with no recurrences to date. our results demonstrate that fmt can be an effective treatment for refractory c. difficile infection in pediatrics. long-term safety and efficacy need to be studied.201424853539
serum bacterial toxins are related to the progression of inflammatory bowel disease.inflammatory bowel disease (ibd), including crohn's disease (cd) and ulcerative colitis (uc), is an autoimmune disease. disorder of intestinal microbes is thought to play a critical role in the pathogenesis of ibd. detection of bacterial toxins could become a new approach to judge the situation of this disease.201424853095
asymptomatic clostridium difficile colonization as a reservoir for clostridium difficile infection.clostridium difficile (cd) infection (cdi) is the leading cause of healthcare associated diarrhea despite intense hospital infection prevention programs. a substantial proportion of the population is asymptomatically colonized with cd, and evidence is mounting that these individuals serve as a reservoir for cdi. the purpose of this review is to discuss the mechanisms by which individuals may harbor toxigenic cd but remain asymptomatic, the evidence that asymptomatically colonized individuals ser ...201424848084
[clostridium difficile infections: update on new european recommendations].clostridium difficile infections: update on new european recommandations while metronidazole and vancomycin have been the only drug options to date for the treatment of c. difficile infection, new therapeutic approaches with promising results have recently emerged for the treatment of the first episode and relapses. fidaxomicin is a new macrocyclic antibiotic more active against c. difficile and with a narrow spectrum allowing preservation of the intestinal microbiota. while having the same effi ...201424843988
managing clostridium difficile in inflammatory bowel disease (ibd).clostridium difficile (c. difficile) infection has emerged as a significant clinical challenge for patients suffering from inflammatory bowel disease (ibd). c. difficile can both precipitate and worsen flares of ibd, contributing to emergent colectomies and mortality. advances in the management of c. difficile infection in ibd include recommendations for testing for this infection in the setting of clinical flare and hospitalization, improved diagnostic testing, identification of high rates of c ...201424838421
a high-throughput small-molecule screen to identify a novel chemical inhibitor of clostridium difficile.clostridium difficile, a highly drug-resistant gram-positive, spore-forming bacterium, remains a leading cause of hospital-acquired diarrhoea and antibiotic-associated colitis. clinically, only a handful of antibiotics are used for treating c. difficile infection (cdi), suggesting a necessity for the development of new treatment options. here we performed a high-throughput screen of 2000 drug-like compounds for inhibition of c. difficile. from this screen, one compound, 5-nitro-1,10-phenanthroli ...201424837414
the effect of pharmacy restriction of clindamycin on clostridium difficile infection rates in an orthopedics ward.a high consumption of clindamycin was noted in an orthopedics ward with high rates of clostridium difficile infection (cdi). we restricted clindamycin for the entire ward. a reduction of 88% in cdi (1.07 to 0.12 × 1,000 patients-days, p = .056) and 84% for all-cause diarrhea (2.40 to 0.38 × 1,000 patients-days, p = .021) was achieved. clindamycin was reduced 92.61% without an increase in other antibiotics. we identified high consumption of clindamycin as a risk factor for cdi.201424837129
risk factors associated with clostridium difficile infection severity in hospitalized patients. 201424837124
hospital clostridium difficile outbreak linked to laundry machine malfunction.clostridium difficile is a gram-positive, spore-forming anaerobic bacillus that is associated with diarrheal disease. c difficile is shed in the feces of affected individuals and its spores can survive on surfaces for prolonged periods of time. these spores can contaminate a hospital environment by spread through health care workers and suboptimal environmental cleaning practices. we report an outbreak of health care facility-onset c difficile infection that was eventually linked to contaminated ...201424837118
implementation and impact of ultraviolet environmental disinfection in an acute care setting.multiple-drug-resistant organisms (mdros) and clostridium difficile (cd) are significant problems in health care. evidence suggests that these organisms are transmitted to patients by the contaminated environment.201424837107
prevalence and in-hospital mortality trends of infections among patients with cirrhosis: a nationwide study of hospitalised patients in the united states.data on bacterial infections in hospitalised patients in the us with cirrhosis are derived largely from single centre data. countrywide data in this population are lacking.201424832591
transanal minimally invasive surgery for benign and malignant rectal neoplasia.transanal minimally invasive surgery (tamis), an alternative technique to transanal endoscopic microsurgery, was developed in 2009. herein, we describe our initial experience using tamis for benign and malignant rectal neoplasia.201424832238
concomitant cmv and clostridium difficile colitis in an immunocompetent patient treated with ganciclovir and fecal transplantation. 201424949617
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 ...201424947622
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 ...201424946087
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 ...201424944791
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 ...201424944124
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.201424942955
[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.201424940894
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 ...201424939885
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 ...201424936597
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 ...201424935925
antibiotic overuse and clostridium difficile: a teachable moment. 201424935617
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 2012.201424932484
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, ...201424932422
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.201424930867
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 ...201424929733
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 ...201424927151
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.201424926170
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.201424917658
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.201424916866
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 ...201424915901
hospital clostridium difficile infection testing rates: is "don't ask, don't tell" at play? 201424915231
pediatric clostridium difficile infection: 6-year active surveillance in a defined patient population. 201424915227
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.201424915226
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 ...201424915103
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 ...201424914822
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.201424914383
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 ...201424913174
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.201424913157
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 ...201424910370
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 ...201424907488
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 ...201424905543
rhode island clostridium difficile infection trends and laboratory id events ranking. 201424905379
[development of gastrointestinal infectious diseases between 2000 and 2012].infectious gastroenterological diseases are of increasing medical and health-economic significance.201424905106
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 ...201424903619
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.201424903143
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