Publications

clostridium difficile infection in liver transplant recipients: a retrospective study of rates, risk factors and outcomes.	clostridium difficile infection (cdi) occurs in 3-7% of liver transplant recipients (ltr). however, few data exist on the recent epidemiology, predictors and outcomes of cdi in ltr. a cohort study was performed including ltr from 2000 to 2010 at a tertiary care hospital in detroit. cdi was defined as diarrhea with a stool c. difficile positive test. data analyzed included demographics, comorbidities, length of stay (los), severity of cdi, rates of recurrence (<12 weeks), relapse (<4 weeks) and o ...	2014	24902610
clinical efficacy of fidaxomicin compared with vancomycin and metronidazole in clostridium difficile infections: a meta-analysis and indirect treatment comparison.	to evaluate the efficacy of fidaxomicin treatment, which has a limited effect on the normal gut flora, compared with vancomycin and metronidazole treatment in clostridium difficile infections (cdis).	2014	25074856
a phase ii study of v-beam as conditioning regimen before second auto-sct for multiple myeloma.	high-dose melphalan has been the standard conditioning regimen for auto-sct in multiple myeloma (mm) for decades. a more effective conditioning regimen may induce deeper responses and longer remission duration. it is especially needed in the setting of second auto-sct, which rarely achieves comparable results with the first auto-sct using the same conditioning regimen. here we conducted a phase ii study to investigate the efficacy and safety of a conditioning regimen v-beam (bortezomib-beam) bef ...	2014	25068418
reinforcement of the intestinal mucus layer protects against clostridium difficile intestinal injury in vitro.	clostridium difficile infection is increasing in incidence and severity. attributable factors include virulence factors, including c difficile toxins a and b, as well as host immunologic status. the mucus component of the intestinal barrier is impaired by malnutrition, shock insults, and alterations in the gut microbiome. exogenous phosphatidylcholine (pc) administration results in reinforcement of the mucus layer and is of therapeutic benefit in chronic ulcerative colitis. we therefore studied ...	2014	25067805
community-acquired diarrhea associated with clostridium difficile in an hiv-positive cancer patient: first case report in latin america.	clostridium difficile is the most important cause of nosocomial diarrhea, mainly associated with antibiotic use and immunodeficiency. although, an increased incidence of community-acquired c. difficile infection (ca-cdi) has been reported worldwide, this infection has been under-diagnosed in latin america. this is the first report of a ca-cdi case in latin america, in an hiv-positive patient with cancer.	2014	25066118
incidence of polymerase chain reaction-diagnosed clostridium difficile in a large high-risk cohort, 2011-2012.	to describe incidence rates (irs) of polymerase chain reaction (pcr)-diagnosed clostridium difficile infection (cdi) in a large high-risk cohort.	2014	25064782
tigecycline for severe clostridium difficile infection.	limited data suggest that tigecycline may be of value in the treatment of clostridiumdifficile infection. we reviewed our experience using tigecycline to treat severe c. difficile and compared outcomes to similarly ill patients who did not receive tigecycline. we found no difference between the groups. further study is needed before tigecycline can be recommended for use in severe c. difficile infection.	2014	25064460
infectious diarrhea: an overview.	diarrheal disease, which is most often caused by infectious pathogens, is a significant cause of morbidity and mortality worldwide, especially in children. this is particularly true in developing countries. recent outbreaks of infectious diarrhea in developed countries, including the usa, are often attributed to food handling and distribution practices and highlight the need for continued vigilance in this area. another common cause of infectious diarrhea, clostridium difficile infection (cdi), ...	2014	25064318
clostridium difficile in children: to treat or not to treat?	clostridium difficile infection has been increasing since 2000 in children and in adults. frequent antibiotics use, comorbidity, and the development of hypervirulent strains have increased the risk of infection. despite the high carriage rates of c. difficile, infants rarely develop clinical infection. discontinuing antibiotics and supportive management usually leads to resolution of disease. antibiotics use should be stratified depending on the patient's age and severity of the disease.	2014	25061582
a bundle strategy including patient hand hygiene to decrease clostridium difficile infections.	prevention strategies for clostridium difficile infection traditionally have addressed barrier precautions, environmental disinfection, and health care worker hand hygiene. when applied as a bundle, this approach has been used widely as an evidence-based strategy to prevent hospital-acquired c. difficile infection. expanding the bundle to include patient hand hygiene is a nurse-driven approach to prevent c. difficile transmission.	2014	25137788
[diagnosis and therapy of clostridium difficile infection: czech national guidelines].	clostridium difficile infection (cdi) is a disease of varying severity. its manifestations range from mild diarrhea to life-threatening paralytic ileus, painful distension of the large bowel, and sepsis. another possible manifestation of the disease is recurring colitis that can exhaust the patient. for establishing the diagnosis, the patient's stool should be examined with two or three different microbiological methods (testing for clostridial toxins a and b; testing for clostridial glutamate d ...	2014	25135141
pharmacological therapy of feed intolerance in the critically ills.	feed intolerance in the setting of critical illness is associated with higher morbidity and mortality, and thus requires promptly and effective treatment. prokinetic agents are currently considered as the first-line therapy given issues relating to parenteral nutrition and post-pyloric placement. currently, the agents of choice are erythromycin and metoclopramide, either alone or in combination, which are highly effective with relatively low incidence of cardiac, hemodynamic or neurological adve ...	2014	25133043
comparative nutritional and chemical phenome of clostridium difficile isolates determined using phenotype microarrays.	clostridium difficile infection (cdi) is the leading cause of infectious diarrhea in north america and europe. the risk of cdi increases significantly in the case where antimicrobial treatment reduces the number of competing bacteria in the gut, thus leading to the increased availability of nutrients and loss of colonization resistance. the objective of this study was to determine comprehensive nutritional utilization and the chemical sensitivity profile of historic and newer c. difficile isolat ...	2014	25130165
concordance of the shea-idsa severity classification for clostridium difficile infection and the atlas bedside scoring system in hospitalized adult patients.	the society for healthcare epidemiology of america and infectious diseases society of america (shea-idsa) guidelines for the treatment of clostridium difficile infection (cdi) recommend initial treatment of cdi based on disease severity. this severity definition has not been validated or evaluated based on clinical outcomes. the atlas scoring system is a validated tool useful in predicting treatment response and mortality in cdi. the main purpose of this study is to evaluate the concordance of t ...	2014	25129565
action of nitroheterocyclic drugs against clostridium difficile.	the nitroheterocyclic classes of drugs have a long history of use in treating anaerobic infections, as exemplified by metronidazole as a first-line treatment for mild-to-moderate clostridium difficile infection (cdi). since direct comparisons of the three major classes of nitroheterocyclic drugs (i.e. nitroimidazole, nitazoxanide and nitrofurans) and nitrosating agents against c. difficile are under-examined, in this study their actions against c. difficile were compared. results show that whils ...	2014	25129314
fulminant pseudomembranous colitis caused by clostridium difficile pcr ribotype 027 in a healthy young woman in japan.	in the past two decades, clostridium difficile polymerase chain reaction ribotype 027 strain has rapidly emerged as the leading cause of antibiotic-associated colitis in north america and europe; however, it has been reported only occasionally in japan. we report a case of fulminant pseudomembranous colitis caused by this strain in a healthy young woman in japan without any previous medical history. the strain isolated from our patient was susceptible to both gatifloxacin and moxifloxacin, thus ...	2014	25127156
environmental sampling for clostridium difficile on alcohol-based hand rub dispensers in an academic medical center.	clostridum difficile is a gram-positive, spore-forming anaerobic bacillus that has substantial associated morbidity, mortality, and associated healthcare burdens. clostridium difficile spores are not destroyed by alcohol. alcohol gel dispensers are used commonly as the hand sanitization method of choice in hospitals. it is possible that gel dispensers are fomites for c. difficile.	2014	25126976
clinical characteristics of patients who test positive for clostridium difficile by repeat pcr.	the high sensitivity of pcr assays for diagnosing clostridium difficile infection (cdi) has greatly reduced the need for repeat testing after a negative result. nevertheless, a small subset of patients do test positive within 7 days of a negative test. the aim of this study was to evaluate the clinical characteristics of these patients to determine when repeat testing may be appropriate. the results of all xpert c. difficile pcr (cepheid, sunnyvale ca) tests performed in the clinical microbiolog ...	2014	25122866
laboratory detection of clostridium difficile in piglets in australia.	clostridium difficile is a well-known enteric pathogen of humans and the causative agent of high-morbidity enteritis in piglets aged 1 to 7 days. c. difficile prevalence in australian piglets is as high as 70%. the current diagnostic assays have been validated only for human infections, and there are no published studies assessing their performance in australian piglets. we evaluated the suitability of five assays for detecting c. difficile in 157 specimens of piglet feces. the assays included a ...	2014	25122859
proton pump inhibitors and risk for clostridium difficile associated diarrhea.	increased incidence of clostridium difficile infection (cdi) among in-patients is associated with significant increased mortality, morbidity, and stay in the hospitals. this has occurred despite heightened awareness of the risks of broad-spectrum antibiotics, overall reduction in antibiotic use and increased focus on hospital hygiene. so though the main risk factor for cdi is use of broad-spectrum antibiotics, the use of proton pump inhibitors (ppis) as a novel potential contributor has been imp ...	2014	25116712
association of clostridium difficile infections with acid suppression medications in children.	multiple studies have confirmed associations between acid suppression medication and clostridium difficile infections (cdis) in adults. therefore, we sought to evaluate an association between acid suppression medications and cdi in children.	2014	25112692
clostridium difficile: improving the prevention paradigm in healthcare settings.	clostridium difficile infection (cdi) is a major public health problem worldwide with significant morbidity and mortality that is spread by spores and fecal oral transmission. a variety of risk factors have been identified. some risk factors such as age, are not amenable to change, while others such as antimicrobial utilization have resulted in broadly implemented antimicrobial stewardship programs. new risk factors are emerging such as proton pump inhibitor (ppi) use, irritable bowel disease (i ...	2014	25109301
corticosteroid use is associated with a reduced incidence of clostridium difficile-associated diarrhea: a retrospective cohort study.	the impact of corticosteroid use on the incidence of clostridium difficile-associated diarrhea (cdad) was examined retrospectively in 532 patients receiving antibiotic treatment for respiratory infections. as determined by logistic regression, corticosteroids were associated with a decreased incidence of cdad (odds ratio 0.12, 95% confidence interval 0.006-0.95).	2014	25108272
emergence of fecal microbiota transplantation as an approach to repair disrupted microbial gut ecology.	in the recent years fecal microbiota transplantation (fmt) has emerged as an effective therapeutic option for patients with refractory clostridium difficile infection that is not responding to antibiotic therapy. it results in implantation of donor microbiota into recipients and restoration of normal distal gut microbial community structure. we anticipate that this form of therapy represents merely the first entry into a new class of therapeutics. there is great interest in application of fmt or ...	2014	25106113
community hospital experience of refractory clostridium difficile colitis: treatment and efficacy of diverting loop ileostomy and colonic lavage.		2014	25105383
evaluation of the luminex xtag gastrointestinal pathogen panel and the savyon diagnostics gastrointestinal infection panel for the detection of enteric pathogens in clinical samples.	infectious gastrointestinal disease is caused by a diverse array of pathogens, and is a challenging syndrome to correctly diagnose and manage. conventional laboratory diagnostic methods are often time-consuming and frequently suffer from low detection rates. two commercial multiplex nucleic acid amplification tests [luminex xtag gastrointestinal pathogen panel (gpp) and savyon diagnostics gastrointestinal infection panel (gip)] were applied to 1000 stored diarrhoeal clinical stool samples. the l ...	2014	25102908
vancomycin-resistant clostridium innocuum bacteremia following oral vancomycin for clostridium difficile infection.	an 85 year-old male initially admitted for septic shock due to urinary tract infection experienced clostridium difficile-associated diarrhea during hospitalization and was treated by oral vancomycin. his clinical course was complicated by cytomegalovirus colitis and then vancomycin-resistant clostridium innocuum bacteremia, which was cured by uneventfully parenteral piperacillin-tazobactam therapy.	2014	25102472
clostridium difficile infection in patients with inflammatory bowel disease.	clostridium difficile is a bacterium widely distributed in the human environment. in the last decade the incidence and severity of clostridium difficile infection has grown, particularly in europe and north america, making it one of the more common nosocomial infections. a group particularly susceptible to clostridium difficile infection are patients with inflammatory bowel disease, especially those with involvement of the colon. this paper presents relevant data on clostridium difficile infecti ...	2014	25097707
cost-effectiveness analysis of fidaxomicin versus vancomycin in clostridium difficile infection.	fidaxomicin was non-inferior to vancomycin with respect to clinical cure rates in the treatment of clostridium difficile infections (cdis) in two phase iii trials, but was associated with significantly fewer recurrences than vancomycin. this economic analysis investigated the cost-effectiveness of fidaxomicin compared with vancomycin in patients with severe cdi and in patients with their first cdi recurrence.	2014	25096079
nursing staff can be a source of clostridium difficile infection.		2014	25095957
[recurrent clostridium difficile infection treated with faecal microbiota transplantation].	treatment of severe clostridium difficile infection (cdi) poses a clinical challenge. emerging evidence supports the use of faecal microbiota transplantation (fmt). an 81-year-old man was admitted with a third recurrent episode of cdi within two months. because of clinical deterioration with development of pancolitis in spite of two weeks of metronidazole and vanco-mycin treatment, fmt was performed using a duodenal tube. the patient recovered completely without further relapse during follow-up. ...	2014	25095866
[faecal transplantation as a treatment for clostridium difficile infection, ulcerative colitis and the metabolic syndrome].	faecal transplantation as a therapeutic tool is increasingly reported in the scientific literature. faecal transplantation is currently becoming a treatment for nosocomial, refractory infections with c. difficile. furthermore, faecal transplantation has been suggested as a treatment for ulcerative colitis as well as for the metabolic syndrome. in the accumulated literature faecal transplantations appear to be safe, effective and superior to current treatments. faecal transplantation remains a sp ...	2014	25095865
[clostridium difficile ribotype 027 is a challenge].	infection with clostridium difficile is the primary infective cause of antibiotic-associated diarrhoea. in 2008, a major outbreak of cd027 took place in north zealand, denmark. we described this infection in a single medical department. patients positive for c. difficile enlisted at medical department o, herlev hospital, in 2009 were included and demographic data were recorded. in total, 69 patients were included, average age 83 years, charlson comorbidity score 4. of all patients 24 died. furth ...	2014	25095864
[successful measures to combat clostridium difficile at herlev hospital].	clostridium difficile is a common cause of health-care associated diarrhoea. we describe the supplementary measures taken at herlev hospital to combat a concerning rise in number of cases. the measures taken involve implementation of antibiotic stewardship; meetings every two weeks between the cleaning department, head nurses, infection control nurse and a clinical microbiologist with plans for near future actions; prompt isolation of patients with diarrhoea; rapid, pcr-based diagnostics; room d ...	2014	25095863
[antibiotic stewardship has been established at herlev hospital].	a high incidence of clostridium difficile and multiresistant organisms and increasing consumption of cephalosporins and quinolones have required an antibiotic stewardship programme, and antibiotic audits with feedback, revised guidelines and stringent prescription rules have been successful. the hospital intervention was managed by an antibiotic team combined with contact persons in all departments, a pocket edition of the guideline was available, and monthly commented reports about antibiotic c ...	2014	25095862
antibiotics and community clostridium difficile infection.		2014	25095570
clostridium difficile infection after colorectal surgery: a rare but costly complication.	the incidence and virulence of clostridium difficile infection (cdi) are on the rise. the characteristics of patients who develop cdi following colorectal resection have been infrequently studied.	2014	25091840
clostridium difficile infection and candida colonization of the gut: is there a correlation?		2014	25091308
delayed presentation of dpd deficiency in colorectal cancer.	case study mr. d., a 55-year-old male, presented to the medical oncology service with a diagnosis of stage iii adenocarcinoma of the sigmoid colon. he presented 7 weeks post sigmoid colectomy with lymph node resection and was initiated on adjuvant chemotherapy with capox (capecitabine [xeloda] and oxaliplatin [eloxatin]). standard dosing was used: oxaliplatin at 130 mg/m(2) on day 1 and capecitabine at approximately 2,000 mg/m(2)/day (rounded to the nearest 500-mg tablet size) for 14 days on an ...	2014	25089219
clostridium difficile infection: clinical challenges and management strategies.	clostridium difficile has become the leading cause of nosocomial diarrhea in adults. a substantial increase has occurred in morbidity and mortality associated with disease caused by c difficile and in the identification of new hypervirulent strains, warranting a high clinical index of suspicion for infections due to this organism. prevention of infection requires a multidisciplinary approach, including early recognition of disease, effective contact isolation precautions, adherence to disinfecta ...	2014	25086091
helicobacter pylori: friend or foe?	helicobacter pylori (h. pylori) is a gram-negative spiral bacterium that is present in nearly half the world's population. it is the major cause of peptic ulcer disease and a recognized cause of gastric carcinoma. in addition, it is linked to non-ulcer dyspepsia, vitamin b12 deficiency, iron-deficient anemia and immune thrombocytopenic purpura. these conditions are indications for testing and treatment according to current guidelines. an additional indication according to the guidelines is "anyo ...	2014	25083071
three-week summer period prevalence of clostridium difficile in farm animals in a temperate region of the united states (ohio).	the cross-sectional (period) prevalence of clostridium difficile in 875 farm animals from 29 commercial operations during the summer of 2008 in ohio, usa was quantified. compared to an external referent population of intensively managed race horses (12.7%), intensively managed commercially mature food animals (poultry, cattle, swine; < 0.6%) were infrequent shedders of c. difficile (p < 0.00001) during the warmest weeks of 2008.	2014	25082995
first clinical and microbiological characterization of clostridium difficile infection in a croatian university hospital.	clinical background and molecular epidemiology of clostridium difficile infection (cdi) in the university hospital centre split were investigated from january 2010 to december 2011. in total, 54 patients with first episode of cdi were consecutively included in the study based on the positive eia test specific for a and b toxins. demographic and clinical data were prospectively analyzed from medical records. cdi incidence rate was 0.6 per 10,000 patient-days. thirty six cases (70.6%) were healthc ...	2014	25079669
passive and active immunization strategies against clostridium difficile infections: state of the art.	the pathophysiology of clostridium difficile infections (cdi) could be considered as a three-step process that takes place after disruption of the digestive microbiota by antibiotics: 1) germination of spores; 2) multiplication and persistence of c. difficile in the colonic niche thanks to colonization factors; 3) production of the two toxins tcda and tcdb and for some strains an additional toxin, the binary toxin cdt. different immunization strategies against c. difficile have been developed, f ...	2014	25079668
severe community onset healthcare-associated clostridium difficile infection complicated by carbapenemase producing klebsiella pneumoniae bloodstream infection.	clostridium difficile infection (cdi) and klebsiella pneumoniae carbapenemase producing-klebsiella pneumoniae (kpc-kp) bloodstream infection (bsi) are emerging health-care associated (hca) diseases of public health concern, in terms of morbidity, mortality, and insufficient response to antibiotic therapy. both agents can be acquired in the hospital but clinical disease can develop in a community setting, after discharge. we report here a putative link between the above-mentioned healthcare assoc ...	2014	25178451
clostridium difficile increases the risk for venous thromboembolism.	inflammatory bowel disease is associated with a higher risk for venous thromboembolism (vte). whether clostridium difficile infection similarly increases this risk is unknown.	2014	25175741
clostridium difficile in the pediatric population of monroe county, new york.	clostridium difficile infection (cdi) incidence in hospitalized children has increased over the past decade and disease has been reported in the community. therefore, population surveillance that includes nonhospitalized cases is important to accurately estimate the burden of cdi in children. we describe the epidemiology of cdi in the pediatric population of monroe county, new york.	2014	26625381
calprotectin and lactoferrin faecal levels in patients with clostridium difficile infection (cdi): a prospective cohort study.	measurement of both calprotectin and lactoferrin in faeces has successfully been used to discriminate between functional and inflammatory bowel conditions, but evidence is limited for clostridium difficile infection (cdi). we prospectively recruited a cohort of 164 cdi cases and 52 controls with antibiotic-associated diarrhoea (aad). information on disease severity, duration of symptoms, 30-day mortality and 90-day recurrence as markers of complicated cdi were recorded. specimens were subject to ...	2014	25170963
evaluation of an automated rapid diagnostic test for detection of clostridium difficile.	the verigene clostridium difficile nucleic acid test (verigene cdf test) (nanosphere, northbrook, il, usa) is a new multiplex qualitative polymerase chain reaction (pcr) test used to detect c. difficile toxin genes in fecal specimens. to evaluate the performance of the new method, we tested 69 fecal samples from patients with suspected c. difficile infection using the verigene cdf test, an enzyme immunoassay (eia) and pcr following anaerobic fecal culture. the sensitivity, specificity, and accur ...	2014	25170836
serum mannose-binding lectin concentration, but not genotype, is associated with clostridium difficile infection recurrence: a prospective cohort study.	mannose-binding lectin (mbl) plays a key role in the activation of the lectin-complement pathway of innate immunity, and its deficiency has been linked with several acute infections. however, its role in predisposing to, or modulating disease severity in, clostridium difficile infection (cdi) has not been investigated.	2014	25170052
agent-based model of fecal microbial transplant effect on bile acid metabolism on suppressing clostridium difficile infection: an example of agent-based modeling of intestinal bacterial infection.	agent-based modeling is a computational modeling method that represents system-level behavior as arising from multiple interactions between the multiple components that make up a system. biological systems are thus readily described using agent-based models (abms), as multi-cellular organisms can be viewed as populations of interacting cells, and microbial systems manifest as colonies of individual microbes. intersections between these two domains underlie an increasing number of pathophysiologi ...	2014	25168489
total synthesis of five lipoteichoic acids of clostridium difficile.	the emergence of hypervirulent resistant strains have made clostridium difficile a notorious nosocomial pathogen and has resulted in a renewed interest in preventive strategies, such as vaccines based on (synthetic) cell wall antigens. recently, the structure of the lipoteichoic acid (lta) of this species has been elucidated. additionally, this lta was found to induce the formation of protective antibodies against c. difficile in rabbits and mice. the lta from c. difficile is isolated as a micro ...	2014	25168290
the use of fidaxomicin for treatment of relapsed clostridium difficile infections in patients with cancer.	to report our experience with the use of fidaxomicin (fdx), an oral macrocyclic antibiotic, in cancer patients with clostridium difficile infection (cdi).	2014	25164587
extraction and sensitive detection of toxins a and b from the human pathogen clostridium difficile in 40 seconds using microwave-accelerated metal-enhanced fluorescence.	clostridium difficile is the primary cause of antibiotic associated diarrhea in humans and is a significant cause of morbidity and mortality. thus the rapid and accurate identification of this pathogen in clinical samples, such as feces, is a key step in reducing the devastating impact of this disease. the bacterium produces two toxins, a and b, which are thought to be responsible for the majority of the pathology associated with the disease, although the relative contribution of each is current ...	2014	25162622
abundant and diverse clustered regularly interspaced short palindromic repeat spacers in clostridium difficile strains and prophages target multiple phage types within this pathogen.	clostridium difficile is an important human-pathogenic bacterium causing antibiotic-associated nosocomial infections worldwide. mobile genetic elements and bacteriophages have helped shape c. difficile genome evolution. in many bacteria, phage infection may be controlled by a form of bacterial immunity called the clustered regularly interspaced short palindromic repeats/crispr-associated (crispr/cas) system. this uses acquired short nucleotide sequences (spacers) to target homologous sequences ( ...	2014	25161187
opinions and practice of stress ulcer prophylaxis in australian and new zealand intensive care units.	intensivists frequently prescribe proton pump inhibitors (ppis) or histamine-2 receptor blockers (h2rbs) to intensive care unit patients for stress ulcer prophylaxis (sup). despite the common use of sup medicines, there is limited high-level evidence to support the choice between them.	2014	25161018
a multicentre feasibility study evaluating stress ulcer prophylaxis using hospital-based registry data.	it is unclear whether histamine-2 receptor blockers (h2rbs) or proton pump inhibitors (ppis) are preferred for stress ulcer prophylaxis (sup) in intensive care unit patients. suitably powered comparative effectiveness trials are warranted.	2014	25161016
the magnitude and duration of clostridium difficile infection risk associated with antibiotic therapy: a hospital cohort study.	antibiotic therapy is the principal risk factor for clostridium difficile infection (cdi), but little is known about how risks cumulate over the course of therapy and abate after cessation. we prospectively identified cdi cases among adults hospitalized at a tertiary hospital between june 2010 and may 2012. poisson regression models included covariates for time since admission, age, hospitalization history, disease pressure, and intensive care unit stay. impacts of antibiotic use through time we ...	2014	25157757
procalcitonin elevation suggests a septic source.	procalcitonin is used as a marker for sepsis but there is little known about the correlation of the procalcitonin elevation with the causative organism in sepsis. all patients aged 18 to 80 years who were admitted to the surgery service from june 2010 to may 2012 and who had a procalcitonin drawn were evaluated. culture data were reviewed to determine the causative organism. infections analyzed included pneumonia, urinary tract infection (uti), bloodstream infection, and clostridium difficile. o ...	2014	25197879
appendicostomy for intraluminal antibiotic administration and extracorporeal membrane oxygenation support in severe hirschsprung's enterocolitis.	a term male infant with hirschsprung's disease underwent an uncomplicated laparoscopic-assisted endorectal pull-through procedure. four weeks after discharge, the patient developed severe clostridium difficile enterocolitis with hemodynamic instability and peritonitis. bedside laparotomy confirmed intestinal viability and accommodated an appendicostomy for antegrade vancomycin colonic irrigations. the patient required venoarterial extracorporeal membrane oxygenation for physiological support for ...	2014	25197866
antiinfective therapy with a small molecule inhibitor of staphylococcus aureus sortase.	methicillin-resistant staphylococcus aureus (mrsa) is the most frequent cause of hospital-acquired infection, which manifests as surgical site infections, bacteremia, and sepsis. due to drug-resistance, prophylaxis of mrsa infection with antibiotics frequently fails or incites nosocomial diseases such as clostridium difficile infection. sortase a is a transpeptidase that anchors surface proteins in the envelope of s. aureus, and sortase mutants are unable to cause bacteremia or sepsis in mice. h ...	2014	25197057
in vitro antibiotic susceptibility profile of clostridium difficile excluding pcr ribotype 027 outbreak strain in hungary.	our study showed the antibiotic susceptibility profile of toxigenic clostridium difficile isolated from nosocomial and community-acquired cdi between 2008 and 2010. mics of 200 c. difficile strains were determined using e®test method in the case of erythromycin, clindamycin, moxifloxacin, rifampicin, and metronidazole. all strains were susceptible to metronidazole in the study period. resistance rates to erythromycin, clindamycin and moxifloxacin were 31%, 29.5%, and 21.5%, respectively. in the ...	2014	25150212
factors influencing the development of antibiotic associated diarrhea in ed patients discharged home: risk of administering iv antibiotics.	antibiotic-associated diarrhea (aad) and clostridium difficile infection (cdi) are well-known outcomes from antibiotic administration. because emergency department (ed) visits frequently result in antibiotic use, we evaluated the frequency of aad/cdi in adults treated and discharged home with new prescriptions for antibiotics to identify risk factors for acquiring aad/cdi.	2014	25149599
use of adenosine 5'-triphosphate bioluminescence assays to measure cleaning: the role of spores and clostridium difficile infection rates.		2014	25148937
performance of severity of illness classification for clostridium difficile infection to predict need-for-colectomy or inpatient death.	in current state of practice, disease severity assessment for clostridium difficile infection (cdi) lacks consensus between different organizations. in the latest guidelines for management of cdi, authors have proposed a new disease severity classification. this classification has been derived from expert opinion and includes previously reported patient related factors that predict unfavorable outcome in cdi.	2014	25147642
can rapid integrated polymerase chain reaction-based diagnostics for gastrointestinal pathogens improve routine hospital infection control practice? a diagnostic study.	every year approximately 5000-9000 patients are admitted to a hospital with diarrhoea, which in up to 90% of cases has a non-infectious cause. as a result, single rooms are 'blocked' by patients with non-infectious diarrhoea, while patients with infectious diarrhoea are still in open bays because of a lack of free side rooms. a rapid test for differentiating infectious from non-infectious diarrhoea could be very beneficial for patients.	2014	25146932
reverse transcription polymerase chain reaction-based method for selectively detecting vegetative cells of toxigenic clostridium difficile.	the laboratory diagnostic methods for clostridium difficile infection (cdi) include toxigenic culture, enzyme immunoassays (eias) to detect the toxins of c. difficile, and nucleic acid amplification tests (naats) to detect c. difficile toxin genes, but each of these methods has disadvantages; toxigenic cultures require a long time to produce results, eias have low sensitivity, and naats that target dna cannot distinguish vegetative cells from spores and dead cells. here we report a new detection ...	2014	25145894
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
update on clostridium difficile infections.	clostridium difficile infections (cdi) occur primarily in hospitalized patients with risk factors such as concomitant or recent use of antibiotics. cdi related additional costs are important for the global population and health-care facilities. cdi epidemiology has changed since 2003: they became more frequent boosted by large outbreaks, more severe, more resistant to antibiotic treatment, and spread to new groups of population without any risk factor. this is partly due to the emergence and wor ...	2014	25156678
is pediatric clostridium difficile infection associated with prior antibiotic exposure?		2014	25156370
[diarrhea in the elderly].	the causes of acute and chronic diarrheal disorders and their underlying pathophysiologic mechanisms are common at all ages. the impact of diarrhea, however, may be more pronounced in the elderly due to various causes, such as age-related structural and functional intestinal changes, concomittant illnesses, consume of preventive and therapeutic drugs, impaired sense of hunger and thirst, compromised nutrition and hydration to withstand the effect of diarrhea, more frequent hospital admissions an ...	2014	25154690
clostridium difficile infection in elderly nursing home residents.	age-related changes in intestinal flora and host defences, the receipt of antibiotic treatment, and the presence of underlying diseases are some of the most common risk factors associated with clostridium difficile infection. therefore, retirement care facilities for elderly people have been pinpointed as frequent sources of contamination. there is only limited data regarding the presence and epidemiology of c. difficile in nursing homes, and this gap in the current literature emphasises the nee ...	2014	25152228
proton pump inhibitors induce changes in colonocyte gene expression that may affect clostridium difficile infection.	proton pump inhibitors seem to promote clostridium difficile infection (cdi). although the current literature suggests that this association is mediated through gastric acid suppression, there has been little investigation into whether a direct effect on expression of colonocyte genes may also have a role. the aim of this study was to investigate the effect of omeprazole on genome-wide gene expression in a human colonic cell line.	2014	25151556
john g. bartlett: contributions to the discovery of clostridium difficile antibiotic-associated diarrhea.	in 1975 john bartlett began trials investigating the problem of antibiotic-associated diarrhea and pseudomembranous colitis. his work led the discovery of clostridium difficile and he identified it as the leading cause of hospital-associated infections.	2014	25151480
the potential beneficial role of faecal microbiota transplantation in diseases other than clostridium difficile infection.	this review gives an outline of the indications for faecal microbiota transplantation (fmt) for diseases other than clostridium difficile (c. difficile) infection. the remarkable efficacy of fmt against c. difficile infection has already been demonstrated. the use of fmt for other diseases, such as inflammatory bowel disease (ibd), irritable bowel syndrome (ibs), and metabolic syndrome, is now being evaluated. the currently available data suggest that fmt might be beneficial for ibd (including u ...	2014	25274035
practical implementation of faecal transplantation.	clostridium difficile infection is a leading cause of antibiotic-related and healthcare-related diarrhoea. in the past decade, faecal microbiota transplantation or transfer has attracted increasing interest as an effective treatment strategy for severe recurrent c. difficile infection, with a global success rate of >80%. however, experience with this procedure is limited by a lack of randomized trials supporting its efficacy and the lack of standardization of the procedure. this review will addr ...	2014	25273614
faecal microbiota transplantation: from practice to legislation before considering industrialization.	recurrent clostridium difficile infections constitute an important medical concern. evidence has been provided showing that faecal microbiota transplantation is a more efficient treatment than antibiotics. serious side effects are unusual, and acceptability is not an obstacle. nevertheless, protocols are heterogeneous with respect to the selection of donors and the methodology used for the faecal transplantation. regulations by both the food and drug administration and the french authorities con ...	2014	25273480
factors associated with clostridium difficile diarrhea in a hospital in beijing, china.	clostridium difficile is the most common cause of hospital-acquired diarrhea in patients treated with antibiotics, chemotherapeutic agents, and other drugs that alter the normal equilibrium of the intestinal flora. a better understanding of the risk factors for c. difficile-associated disease (cdad) could be used to reduce the incidence of cdad and the costs associated with its treatment. the aim of this study was to identify the risk factors for cdad in a cohort of chinese patients in a beijing ...	2014	25271845
[can the antibiotic prescription practice in a hospital be influenced by in-house guidelines? an interventional study at the university hospital halle (saale), germany].	in-house guidelines are an essential tool of antibiotic stewardship (abs) programs to guide antimicrobial therapy. we studied the effect of in-house guidelines adapted to the local pathogen and resistance epidemiology on prescribing behavior.	2014	25271804
characterization of clostridium difficile isolates from human fecal samples and retail meat from pennsylvania.	a study was conducted to determine the prevalence of clostridium difficile and characterize c. difficile isolates from human stool and retail grocery meat samples. human stool samples (n=317) were obtained from a clinical laboratory and meat samples (n=303) were collected from 8 retail grocery stores from october 2011 through september 2012 from centre county of pennsylvania and were examined for c. difficile. c. difficile was isolated from 16.7% of stool samples (n=317) and 6.9%, 11.5%, 14.5%, ...	2014	25269079
clostridium difficile and pediatric inflammatory bowel disease: a prospective, comparative, multicenter, espghan study.	clostridium difficile infection is associated with pediatric inflammatory bowel disease (ibd) in several ways. we sought to investigate c. difficile infection in pediatric patients with ibd in comparison with a group of children with celiac disease and to evaluate ibd disease course of c. difficile infected patients.	2014	25268634
clostridium difficile is emerging in romania: a story of 027 ribotype and excessive antibiotic consumption.		2014	25267968
beneficial effect of oral tigecycline treatment on clostridium difficile infection in gnotobiotic piglets.	the efficacy of oral tigecycline treatment (2 mg/kg of body weight for 7 days) of clostridium difficile infection (cdi) was evaluated in the gnotobiotic pig model, and its effect on human gut microflora transplanted into the gnotobiotic pig was determined. tigecycline oral treatment improved survival, clinical signs, and lesion severity and markedly decreased concentrations of firmicutes but did not promote cdi. our data showed that oral tigecycline treatment has a potential beneficial effect on ...	2014	25267665
clostridium difficile carriage in hospitalized cancer patients: a prospective investigation in eastern china.	clostridium difficile carriage has been considered as a potential source for the deadly infection, but its role in cancer patients is still unclear. we aimed to identify the clinical and immunological factors that are related to c. difficile carriage in chinese cancer patients.	2014	25267108
fulminant clostridium difficile colitis: comparing computed tomography with histopathology: are they concordant?	a total abdominal colectomy (tac) is recommended for fulminant clostridium difficile colitis (fcdc) because intraoperative assessment of diseased segments is inaccurate. to determine whether computerized tomography (ct) provides an accurate assessment of disease, we examined the concordance between ct and histopathologic colitis distribution in patients undergoing tac for fcdc. the ileocolon was divided into seven distinct segments. of 20 patients meeting criteria, the median interval between pr ...	2014	25264661
carriage of clostridium difficile in free-living south american coati (nasua nasua) in brazil.	the objective of this study was to isolate and characterize clostridium difficile strains in stool samples from a wild urban mammal, a south american coati (nasua nasua) in brazil. forty-six free-living n. nasua were trapped, and stool samples were collected. c. difficile was isolated from three (6.5%) sampled animals, two strains were toxigenic (a+b+cdt-, pcr ribotype 014/020 and 106) and one was non toxigenic (a-b-cdt-, pcr ribotype 053). the present work confirms that ring-tailed coati (n. na ...	2014	25263534
clostridium difficile infection: a review of the literature.	clostridium difficile is a gram-positive, strictly anaerobic, spore-forming bacterium. it is the most common cause of antibiotic-associated diarrhea in hospitals and other healthcare facilities and is of significant concern because of the increasing morbidity and mortality rates as well as increased health care costs. spectrum of presentation of clostridium difficile infection ranges from mild, self-limiting diarrhea, to serious diarrhea, pseudomembranous colitis and life-threatening fulminant c ...	2014	25312190
infant botulism: is there an association with thiamine deficiency?	infant botulism is an acute life-threatening condition and diagnosis is frequently delayed. therefore, the best time window to administer specific antibodies, at present the only etiology-based therapy, is often missed, entailing long periods of hospitalization in the picu. here we present a 3-month-old boy with infant botulism and respiratory failure, who quickly and favorably responded to thiamine supplementation. from the feces we isolated clostridium botulinum serotype a2. in addition to pro ...	2014	25311602
structural and functional changes in the gut microbiota associated to clostridium difficile infection.	antibiotic therapy is a causative agent of severe disturbances in microbial communities. in healthy individuals, the gut microbiota prevents infection by harmful microorganisms through direct inhibition (releasing antimicrobial compounds), competition, or stimulation of the host's immune defenses. however, widespread antibiotic use has resulted in short- and long-term shifts in the gut microbiota structure, leading to a loss in colonization resistance in some cases. consequently, some patients d ...	2014	25309515
a search for clostridium difficile ribotypes 027 and 078 in brazil.	toxigenic strains of clostridium difficile may be disseminating. here we prospectively screened patients with nosocomial diarrhoea in two hospitals in brazil. to identify c. difficile polymerase chain reaction ribotypes 027/078 strains, we used high resolution melting and multiplex polymerase chain reaction. among 116 screened patients, 11 were positive for c. difficile. the polymerase chain reaction ribotypes 027/078 strains were not identified in this study.	2014	25307680
clostridium difficile sortase recognizes a (s/p)pxtg sequence motif and can accommodate diaminopimelic acid as a substrate for transpeptidation.	covalent attachment of surface proteins to the cell wall of gram-positive bacteria requires a sortase-mediated transpeptidation reaction. in almost all gram-positive bacteria, the housekeeping sortase, sortase a, recognizes the canonical recognition sequence lpxtg (x=any amino acid). the human pathogen clostridium difficile carries a single putative sortase gene (cd2718) but neither transpeptidation activity nor specificity of cd2718 has been investigated. we produced recombinant cd2718 and exam ...	2014	25305382
performance assessment of the bd max cdiff assay in comparison to xpert c. difficile assay in a setting with very low prevalence of toxigenic clostridium difficile pcr ribotype 027.	in a clinical setting with low prevalence of 'epidemic' pcr ribotype 027, the bd max cdiff assay was found to be a suitable alternative to the xpert c. difficile assay for the detection of toxigenic clostridium difficile in samples which are reflex pcr tested after obtaining a discrepant immunoassay result. there was no significant difference between the sensitivities and specificities of both commercial molecular assays.	2014	25305151
clostridium difficile infection: update on diagnosis, epidemiology, and treatment strategies.	clostridium difficile infection (cdi) has increased in incidence and severity over the past quarter century, and is now considered a major cause of healthcare-associated infections.	2014	25314344
oral, capsulized, frozen fecal microbiota transplantation for relapsing clostridium difficile infection.	fecal microbiota transplantation (fmt) has been shown to be effective in treating relapsing or refractory clostridium difficile infection, but practical barriers and safety concerns have prevented its widespread use.	2014	25322359
clostridium difficile in retail baskets, trolleys, conveyor belts, and plastic bags in saudi arabia.	to determine clostridium difficile (c. difficile) prevalence on retail surfaces and shoppers plastic bags.	2014	25316477
clostridium difficile infection after cardiac surgery: prevalence, morbidity, mortality, and resource utilization.	despite increasing efforts to prevent infection, the prevalence of hospital-associated clostridium difficile infections (cdi) is increasing. heightened awareness prompted this study of the prevalence and morbidity associated with cdi after cardiac surgery.	2014	25242055
evaluation of the illumigene c. difficile assay for toxigenic clostridium difficile detection: a prospective study of 302 consecutive clinical fecal samples.	toxigenic clostridium difficile is a major pathogen causing nosocomial diarrhea. consequently, rapid detection of toxigenic c. difficile is very important in clinical laboratories. the illumigene c. difficile dna amplification assay (illumigene; meridian bioscience, inc.) is a rapid method that detects the toxin a gene (tcda) by loop-mediated isothermal amplification. in the present study, we evaluated the diagnostic performance of the illumigene assay using 302 consecutive stool specimens in co ...	2014	25241189
biofilms of clostridium species.	the biofilm is a microbial community embedded in a synthesized matrix and is the main bacterial way of life. a biofilm adheres on surfaces or is found on interfaces. it protects bacteria from the environment, toxic molecules and may have a role in virulence. clostridium species are spread throughout both environments and hosts, but their biofilms have not been extensively described in comparison with other bacterial species. in this review we describe all biofilms formed by clostridium species d ...	2014	25242197