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the nose knows not: poor predictive value of stool sample odor for detection of clostridium difficile. 201323166192
the intestinal microbiota dysbiosis and clostridium difficile infection: is there a relationship with inflammatory bowel disease?gut microbiota is a compilation of microorganisms dwelling in the entire mammalian gastrointestinal tract. they display a symbiotic relationship with the host contributing to its intestinal health and disease. even a slight fluctuation in this equipoise may be deleterious to the host, leading to many pathological conditions like clostridium difficile infection or inflammatory bowel disease (ibd). in this review, we focus on the role of microbial dysbiosis in initiation of c. difficile infection ...201323320050
a laboratory-developed taqman array card for simultaneous detection of 19 enteropathogens.the taqman array card (tac) system is a 384-well singleplex real-time pcr format that has been used to detect multiple infection targets. here we developed an enteric taqman array card to detect 19 enteropathogens, including viruses (adenovirus, astrovirus, norovirus gii, rotavirus, and sapovirus), bacteria (campylobacter jejuni/c. coli, clostridium difficile, salmonella, vibrio cholerae, diarrheagenic escherichia coli strains including enteroaggregative e. coli [eaec], enterotoxigenic e. coli [ ...201323175269
fecal microbiota transplantation: the state of the art.clostridium difficile infection (cdi) is an emerging problem in terms of incidence, morbidity and mortality. currently available treatment options are not always effective, especially in cases of recurrent/refractory or complicated cdi. the gut microbiota transplantation is a technique that has been sporadically practiced since the '50s, but its clinical efficacy has only recently been supported by scientific evidence. in the present article, we report the pathophysiological basis and the clinic ...201324470963
treatment of clostridium difficile infection: recent trial results.clostridium difficile is a major cause of infection worldwide and is associated with increasing morbidity and mortality in vulnerable patient populations. metronidazole and oral vancomycin are the currently recommended therapies for the treatment of c. difficile infection (cdi) but are associated with unacceptably high rates of disease recurrence. novel therapies for the treatment of cdi and prevention of recurrent cdi are urgently needed. important developments in the treatment of cdi are curre ...201325525499
genetically diverse clostridium difficile strains harbouring abundant prophages in an estuarine environment.clostridium difficile is the leading cause of antibiotic-associated diarrhoeal disease in healthcare settings across the world. despite its pathogenic capacity, it can be carried asymptomatically and has been found in terrestrial and marine ecosystems outside hospital environments. less is known about these environmental strains and few studies have been conducted on estuarine systems. although prophage abundance and diversity is known within in clinical strains, prophage carriage within environ ...201323913427
norovirus gastroenteritis after fecal microbiota transplantation for treatment of clostridium difficile infection despite asymptomatic donors and lack of sick contacts. 201323912408
adaptive strategies and pathogenesis of clostridium difficile from in vivo transcriptomics.clostridium difficile is currently the major cause of nosocomial intestinal diseases associated with antibiotic therapy in adults. in order to improve our knowledge of c. difficile-host interactions, we analyzed the genome-wide temporal expression of c. difficile 630 genes during the first 38 h of mouse colonization to identify genes whose expression is modulated in vivo, suggesting that they may play a role in facilitating the colonization process. in the ceca of the c. difficile-monoassociated ...201323897605
identification of a novel zinc metalloprotease through a global analysis of clostridium difficile extracellular proteins.clostridium difficile is a major cause of infectious diarrhea worldwide. although the cell surface proteins are recognized to be important in clostridial pathogenesis, biological functions of only a few are known. also, apart from the toxins, proteins exported by c. difficile into the extracellular milieu have been poorly studied. in order to identify novel extracellular factors of c. difficile, we analyzed bacterial culture supernatants prepared from clinical isolates, 630 and r20291, using liq ...201324303041
a severe case of rat lungworm disease in hawa'i.a 23-year-old man living on the island of hawa'i developed a life threatening case of eosinophilic meningitis caused by infection with angiostrongylus cantonensis (rat lungworm disease: rlwd). he was comatose for 3 months, incurring brain and nerve damage sufficiently extensive that he was not expected to recover. the case was complicated by secondary infections of methicillin-resistant staphylococcus aureus, clostridium difficile, and pneumonia, which resulted in an empyema requiring a thoracos ...201323900708
the rise of carbapenem-resistant acinetobacter baumannii.acinetobacter spp. are gram-negative bacteria that have become one of the most difficult pathogens to treat. the species a. baumannii, largely unknown 30 years ago, has risen to prominence particularly because of its ability to cause infections in immunocompromised patients. it is now a predominant pathogen in many hospitals as it has acquired resistance genes to virtually all antibiotics capable of treating gram-negative bacteria, including the fluoroquinolones and the cephalosporins. some memb ...201322894617
impact of electronic surveillance on isolation practices.to assess the impact of an electronic surveillance system on isolation practices and rates of methicillin-resistant staphylococcus aureus (mrsa).201323739073
risk factors of mild rectal bleeding in very low birth weight infants: a case control study.mild rectal bleeding (mrb) is a particular clinical entity different from necrotizing enterocolitis, which significantly influences neonatal care in preterm infants. we aimed to determine the risk factors and to evaluate prospectively the clinical course of mrb.201324283213
bacteriotherapy for the treatment of intestinal dysbiosis caused by clostridium difficile infection.faecal microbiota transplantation (fmt) has been used for more than five decades to treat a variety of intestinal diseases associated with pathological imbalances within the resident microbiota, termed dysbiosis. fmt has been particularly effective for treating patients with recurrent clostridium difficile infection who are left with few clinical options other than continued antibiotic therapy. our increasing knowledge of the structure and function of the human intestinal microbiota and c. diffi ...201323866975
microbial and metabolic interactions between the gastrointestinal tract and clostridium difficile infection.antibiotics disturb the gastrointestinal tract microbiota and in turn reduce colonization resistance against clostridium difficile. the mechanism for this loss of colonization resistance is still unknown but likely reflects structural (microbial) and functional (metabolic) changes to the gastrointestinal tract. members of the gut microbial community shape intestinal metabolism that provides nutrients and ultimately supports host immunity. this review will discuss how antibiotics alter the struct ...201324335555
equine hyperimmune serum protects mice against clostridium difficile spore challenge.clostridium (c.) difficile is a common cause of nosocomial diarrhea in horses. vancomycin and metronidazole have been used as standard treatments but are only moderately effective, which highlights the need for a novel alternative therapy. in the current study, we prepared antiserum of equine origin against both c. difficile toxins a and b as well as whole-cell bacteria. the toxin-neutralizing activities of the antibodies were evaluated in vitro and the prophylactic effects of in vivo passive im ...201324136208
gut microbiota patterns associated with colonization of different clostridium difficile ribotypes.c. difficile infection is associated with disturbed gut microbiota and changes in relative frequencies and abundance of individual bacterial taxons have been described. in this study we have analysed bacterial, fungal and archaeal microbiota by denaturing high pressure liquid chromatography (dhplc) and with machine learning methods in 208 faecal samples from healthy volunteers and in routine samples with requested c. difficile testing. the latter were further divided according to stool consisten ...201323469128
active surveillance for carbapenem-resistant enterobacteriaceae using stool specimens submitted for testing for clostridium difficile.active surveillance to identify asymptomatic carriers of carbapenem-resistant enterobacteriaceae (cre) is a recommended strategy for cre control in healthcare facilities. active surveillance using stool specimens tested for clostridium difficile is a relatively low-cost strategy to detect cre carriers. further evaluation of this and other risk factor-based active surveillance strategies is warranted.201324334803
evaluation of a new automated homogeneous pcr assay, genomera c. difficile, for rapid detection of toxigenic clostridium difficile in fecal specimens.we evaluated a new automated homogeneous pcr assay to detect toxigenic clostridium difficile, the genomera c. difficile assay (abacus diagnostica, finland), with 310 diarrheal stool specimens and with a collection of 33 known clostridial and nonclostridial isolates. results were compared with toxigenic culture results, with discrepancies being resolved by the genexpert c. difficile pcr assay (cepheid). among the 80 toxigenic culture-positive or genexpert c. difficile assay-positive fecal specime ...201323804386
the spore differentiation pathway in the enteric pathogen clostridium difficile.endosporulation is an ancient bacterial developmental program that culminates with the differentiation of a highly resistant endospore. in the model organism bacillus subtilis, gene expression in the forespore and in the mother cell, the two cells that participate in endospore development, is governed by cell type-specific rna polymerase sigma subunits. σ(f) in the forespore, and σ(e) in the mother cell control early stages of development and are replaced, at later stages, by σ(g) and σ(k), resp ...201324098139
genome-wide analysis of cell type-specific gene transcription during spore formation in clostridium difficile.clostridium difficile, a gram positive, anaerobic, spore-forming bacterium is an emergent pathogen and the most common cause of nosocomial diarrhea. although transmission of c. difficile is mediated by contamination of the gut by spores, the regulatory cascade controlling spore formation remains poorly characterized. during bacillus subtilis sporulation, a cascade of four sigma factors, σ(f) and σ(g) in the forespore and σ(e) and σ(k) in the mother cell governs compartment-specific gene expressi ...201324098137
global analysis of the sporulation pathway of clostridium difficile.the gram-positive, spore-forming pathogen clostridium difficile is the leading definable cause of healthcare-associated diarrhea worldwide. c. difficile infections are difficult to treat because of their frequent recurrence, which can cause life-threatening complications such as pseudomembranous colitis. the spores of c. difficile are responsible for these high rates of recurrence, since they are the major transmissive form of the organism and resistant to antibiotics and many disinfectants. des ...201323950727
expression and display of clostridium difficile protein flid on the surface of bacillus subtilis spores.the endospores of bacillus subtilis can serve as a tool for surface presentation of heterologous proteins. the unique properties of the spore protective layers make them perfect vehicles for orally administered vaccines. in this study, we successfully displayed a fragment of clostridium difficile flid protein on the surface of b. subtilis spores using the cotb, cotc, cotg and cotz spore coat proteins. the presence of the fusion proteins in the spore coat was verified by western blotting and immu ...201323475909
in vitro biological effects of two anti-diabetic medicinal plants used in benin as folk medicine.extracts from polygonum senegalensis (polygonaceae) and pseudocedrela kotschyi (meliaceae) are two important traditionally used medicinal plants in rural benin to treat many diseases and notably type 2 diabetes. the aim of the study was to investigate the α-glucosidase inhibition, antioxidant and antibacterial activities of those plants extract: polygonum senegalensis leaves, and pseudocedrela kotschyi root.201323452899
spoiva and sipl are clostridium difficile spore morphogenetic proteins.clostridium difficile is a major nosocomial pathogen whose infections are difficult to treat because of their frequent recurrence. the spores of c. difficile are responsible for these clinical features, as they resist common disinfectants and antibiotic treatment. although spores are the major transmissive form of c. difficile, little is known about their composition or morphogenesis. spore morphogenesis has been well characterized for bacillus sp., but bacillus sp. spore coat proteins are poorl ...201323292781
cyclodextrin derivatives as anti-infectives.cyclodextrin derivatives can be utilized as anti-infectives with pore-forming proteins as the targets. the highly efficient selection of potent inhibitors was achieved because per-substituted cyclodextrins have the same symmetry as the target pores. inhibitors of several bacterial toxins produced by bacillus anthracis, staphylococcus aureus, clostridium perfringens, clostridium botulinum, and clostridium difficile were identified from a library of ∼200 cd derivatives. it was demonstrated that mu ...201324011515
architecture and assembly of the gram-positive cell wall.the bacterial cell wall is a mesh polymer of peptidoglycan--linear glycan strands cross-linked by flexible peptides--that determines cell shape and provides physical protection. while the glycan strands in thin 'gram-negative' peptidoglycan are known to run circumferentially around the cell, the architecture of the thicker 'gram-positive' form remains unclear. using electron cryotomography, here we show that bacillus subtilis peptidoglycan is a uniformly dense layer with a textured surface. we f ...201323600697
identification of novel host-targeted compounds that protect from anthrax lethal toxin-induced cell death.studying how pathogens subvert the host to cause disease has contributed to the understanding of fundamental cell biology. bacillus anthracis, the causative agent of anthrax, produces the virulence factor lethal toxin to disarm host immunity and cause pathology. we conducted a phenotypic small molecule screen to identify inhibitors of lethal toxin-induced macrophage cell death and used an ordered series of secondary assays to characterize the hits and determine their effects on cellular function ...201323343607
in pursuit of protein targets: proteomic characterization of bacterial spore outer layers.bacillus cereus, responsible for food poisoning, and clostridium difficile, the causative agent of clostridium difficile-associated diarrhea (cdad), are both spore-forming pathogens involved in food spoilage, food intoxication, and other infections in humans and animals. the proteinaceous coat and the exosporium layers from spores are important for their resistance and pathogenicity characteristics. the exosporium additionally provides an ability to adhere to surfaces eventually leading to spore ...201323998435
probiotics for the treatment of clostridium difficile associated disease.the purpose of this review paper is to update the current and potential future role of probiotics for clostridium difficile-associated disease (cdad). included in this review, is an update on the testing of newer probiotics (e.g., bacillus coagulans gbi-30, 6086) in animal models of cdad. there is a focus on the modulation of signal transduction pathways (i.e., transcription factors like camp response element-binding, activator protein 1, and nuclear factor kappa b), as well as the inhibition of ...201323946887
expanded therapeutic potential in activity space of next-generation 5-nitroimidazole antimicrobials with broad structural diversity.metronidazole and other 5-nitroimidazoles (5-ni) are among the most effective antimicrobials available against many important anaerobic pathogens, but evolving resistance is threatening their long-term clinical utility. the common 5-nis were developed decades ago, yet little 5-ni drug development has since taken place, leaving the true potential of this important drug class unexplored. here we report on a unique approach to the modular synthesis of diversified 5-nis for broad exploration of thei ...201324101497
growth-inhibiting and morphostructural effects of constituents identified in asarum heterotropoides root on human intestinal bacteria.the growth-inhibiting and morphostructural effects of seven constituents identified in asarum heterotropoides root on 14 intestinal bacteria were compared with those of the fluoroquinolone antibiotic ciprofloxacin.201324083511
loss of nhe3 alters gut microbiota composition and influences bacteroides thetaiotaomicron growth.changes in the intestinal microbiota have been linked to diabetes, obesity, inflammatory bowel disease, and clostridium difficile (c. difficile)-associated disease. despite this, it remains unclear how the intestinal environment, set by ion transport, affects luminal and mucosa-associated bacterial composition. na(+)/h(+)-exchanger isoform 3 (nhe3), a target of c. difficile toxin b, plays an integral role in intestinal na(+) absorption. thus the nhe3-deficient mouse model was chosen to examine t ...201324072680
microbiota-liberated host sugars facilitate post-antibiotic expansion of enteric pathogens.the human intestine, colonized by a dense community of resident microbes, is a frequent target of bacterial pathogens. undisturbed, this intestinal microbiota provides protection from bacterial infections. conversely, disruption of the microbiota with oral antibiotics often precedes the emergence of several enteric pathogens. how pathogens capitalize upon the failure of microbiota-afforded protection is largely unknown. here we show that two antibiotic-associated pathogens, salmonella enterica s ...201323995682
comparative in vitro activities of smt19969, a new antimicrobial agent, against clostridium difficile and 350 gram-positive and gram-negative aerobic and anaerobic intestinal flora isolates.the comparative in vitro activity of smt19969, a novel, narrow-spectrum, nonabsorbable agent, was studied against 50 ribotype-defined clostridium difficile strains, 174 gram-positive and 136 gram-negative intestinal anaerobes, and 40 gram-positive aerobes. smt19969 was one dilution more active against c. difficile isolates (mic range, 0.125 to 0.5 μg/ml; mic90, 0.25 μg/ml), including ribotype 027 strains, than fidaxomicin (range, 0.06 to 1 μg/ml; mic90, 0.5 μg/ml) and two to six dilutions lower ...201323877700
in vitro evaluation of antimicrobial activity of lactic acid bacteria against clostridium difficile.clostridium difficile infection (cdi) has become a significant threat to public health. although broad-spectrum antibiotic therapy is the primary treatment option for cdi, its use has evident limitations. probiotics have been proved to be effective in the treatment of cdi and are a promising therapeutic option for cdi. in this study, 4 strains of lactic acid bacteria (lab), namely, lactobacillus rhamnosus (lr5), lactococcuslactis (sl3), bifidobacterium breve (br3), and bifidobacterium lactis (bl ...201324278635
antipathogenic activity of probiotics against salmonella typhimurium and clostridium difficile in anaerobic batch culture systems: is it due to synergies in probiotic mixtures or the specificity of single strains?probiotics are currently being investigated for prevention of infections caused by enteric pathogens. the aim of this in vitro study was to evaluate the influence of three single probiotics: lactobacillus casei ncimb 30185 (pxn 37), lactobacillus acidophilus ncimb 30184 (pxn 35), bifidobacterium breve ncimb 30180 (pxn 25) and a probiotic mixture containing the above strains plus twelve other strains belonging to the lactobacillus, bifidobacterium, lactococcus, streptococcus and bacillus genera o ...201324091275
in vitro inhibition of clostridium difficile and clostridium perfringens by commercial probiotic strains.probiotics have gained importance in human and veterinary medicine to prevent and control clostridial enteric disease. limited information is available on the ability of different probiotic bacteria used in food products to inhibit clostridium difficile and clostridium perfringens. the objective of this study was to examine the in vitro inhibitory effects of selected commercial bacterial strains on pathogenic clostridia and their growth characteristics under simulated gastrointestinal conditions ...201323471038
evaluation of nvb302 versus vancomycin activity in an in vitro human gut model of clostridium difficile infection.first-line treatment options for clostridium difficile infection (cdi) are limited. nvb302 is a novel type b lantibiotic under evaluation for the treatment of cdi. we compared the responses to nvb302 and vancomycin when used to treat simulated cdi in an in vitro gut model.201322966180
[outcomes of clostridium difficile enterocolitis after administration of antibiotics along with probiotic supplement].clostridium difficile enterocolitis is a potentially fatal disease showing increasing incidence in hospital environment. therapeutic approach in the management of clostridium difficile enterocolitis is highly complex, particularly because of its tendency to relapse and reinfection. the study was aimed at investigating the factors influencing the development of clostridium difficile enterocolitis and outcomes of enterocolitis after administration of standard antimicrobial therapy combined with pr ...201323888728
a probiotics-containing biscuit modulates the intestinal microbiota in the elderly.evaluation of the impact of a biscuit containing the probiotics bifidobacterium longum bar33 and lactobacillus helveticus bar13 on the intestinal microbiota in the elderly.201323364497
protective effect of bifidobacteria in an experimental model of clostridium difficile associated colitis.the aim of this study was to evaluate the ability of bifidobacterium strains to prevent the effects associated with clostridium difficile infection in a hamster model of enterocolitis. after clindamycin treatment (30 mg/kg), animals were infected intragastrically with c. difficile (5×108 cfu per animal). seven days prior to antibiotic administration, probiotic treatment was started by administering bacterial suspensions of bifidobacteria in drinking water. strains cidca 531, cidca 5310, cidca 53 ...201323611644
a culture-independent sequence-based metagenomics approach to the investigation of an outbreak of shiga-toxigenic escherichia coli o104:h4.identification of the bacterium responsible for an outbreak can aid in disease management. however, traditional culture-based diagnosis can be difficult, particularly if no specific diagnostic test is available for an outbreak strain.201323571589
high incidence of campylobacter concisus in gastroenteritis in north jutland, denmark: a population-based study.the incidence of non-thermophilic campylobacter species was assessed in an unselected population-based study in a mixed urban and rural community in north jutland, denmark. in a 2-year study period, 11,314 faecal samples from 8302 patients with gastroenteritis were cultured with supplement of the filter method. we recovered a high incidence of campylobacter concisus (annual incidence 35/100,000 inhabitants), almost as high as the common campylobacter jejuni/coli. in contrast, there was a very lo ...201322512739
essential oil composition and antimicrobial activity of aerial parts and ripe fruits of echinophora spinosa (apiaceae) from italy.the chemical composition and antimicrobial activity of the essential oils obtained from the flowering aerial parts and ripe fruits of echinophora spinosa l. (apiaceae) from central italy were analyzed by gc/ms. the major constituents of the oil from the aerial parts were beta-phellandrene (34.7%), myristicin (16.5%), delta3-carene (12.6%), alpha-pinene (6.7%) and alpha-phellandrene (6.2%), and of the oil from the ripe fruits p-cymene (50.2%), myristicin (15.3%), alpha-pinene (15.1%) and alpha-ph ...201323738471
[nosocomial diarrhea in intensive care unit: other than clostridium difficile].to investigate the incidence and clinical features of non-clostridium difficile (c. difficile) associated nosocomial diarrhea in intensive care unit (icu) caused by klebsiella oxytoca and clostridium perfringens.201324059125
safety of long-term ppi therapy.proton pump inhibitors have become the mainstay of medical treatment of acid-related disorders. long-term use is becoming increasingly common, in some cases without a proper indication. a large number of mainly observational studies on a very wide range of possible associations have been published in the past decade and are critically reviewed in this article and the existing evidence is evaluated and translated into possible clinical consequences. based on the existing evidence the benefits of ...201323998981
is clostridium difficile associated with relapse of inflammatory bowel disease? results from a retrospective and prospective cohort study in the netherlands.although clostridium difficile may be associated with exacerbations in inflammatory bowel diseases (ibd), prospective studies identifying the role of c. difficile in disease activity are currently lacking. we examined the prevalence of c. difficile in feces of (1) symptomatic ibd patients retrospectively and (2) consecutive outpatients in relation to disease activity prospectively.201323867869
systematic application of multiplex pcr enhances the detection of bacteria, parasites, and viruses in stool samples.to determine whether systematic testing of faecal samples with a broad range multiplex pcr increases the diagnostic yield in patients with diarrhoea compared with conventional methods and a clinician initiated testing strategy.201323603249
antibacterial and cytotoxic activity of isoprenylated coumarin mammea a/aa isolated from mammea africana.the stem bark of mammea africana is widely distributed in tropical africa and commonly used in traditional medicine. this study aims to identify the active compound in mammea africana and to evaluate its antimicrobial and antiproliferative activity.201323466248
temporal bacterial community dynamics vary among ulcerative colitis patients after fecal microbiota transplantation.fecal microbiota transplantation (fmt) from healthy donors, which is an effective alternative for treatment of clostridium difficile-associated disease, is being considered for several disorders such as inflammatory bowel disease, irritable bowel syndrome, and metabolic syndrome. disease remission upon fmt is thought to be facilitated by an efficient colonization of healthy donor microbiota, but knowledge of the composition and temporal stability of patient microbiota after fmt is lacking.201324060759
clostridium difficile: case report and concise review of fecal microbiota transplantation. 201324902394
intestinal microbiota transplantation: a case of crohn's colitis with superimposed clostridium difficile infection. 201324831911
clostridium difficile infection in older adults.clostridium difficile infection, the most frequent cause of nosocomial diarrhea, disproportionately affects older adults. the two most important risk factors for developing c. difficile infection are antimicrobial exposure and age >65 years old. risk factors specific to older adults are frequent interactions with healthcare systems and age-related changes in physiology, including immune senescence and changes to the gut microbiome. metronidazole and oral vancomcyin are the mainstays of conventio ...201324955106
clostridium difficile infection at a tertiary care hospital in south india.the objective of this study was to detect c. difficile in patients presenting with antibiotic associated diarrhoea.201324974492
effect of vancomycin dose on treatment outcomes in severe clostridium difficile infection.current guidelines recommend vancomycin 125 mg four times daily for the treatment of severe clostridium difficile infection (cdi). however, the optimal dose of vancomycin has not been elucidated. this study was conducted to evaluate outcome differences in patients with severe cdi treated with either low-dose (≤500 mg daily) or high-dose (>500 mg daily) oral vancomycin. the medical records of 78 patients with severe cdi were evaluated retrospectively. the primary outcome was time to clinical cure ...201324103633
faecal microbiota transplantation for the treatment of recurrent clostridium difficile infection: current promise and future needs.the use of faecal microbiota transplantation (fmt) as treatment for recurrent clostridium difficile infection (cdi) has increased rapidly over the past few years. in this review, we highlight clinical studies of fmt for treatment of recurrent cdi and discuss the safety, standardization and future of this treatment option. the major risk factor for cdi is prior antibiotic use, which results in an altered state of the gut microbiota characterized by decreased microbial diversity. this altered gut ...201324100717
defining the vulnerable period for re-establishment of clostridium difficile colonization after treatment of c. difficile infection with oral vancomycin or metronidazole.clostridium difficile is an anaerobic, spore-forming bacterium that is the most common cause of healthcare-associated diarrhea in developed countries. a significant proportion of patients receiving oral vancomycin or metronidazole for treatment of clostridium difficile infection (cdi) develop recurrences. however, the period of vulnerability to re-establishment of colonization by c. difficile after therapy is not well defined.201324098459
microbiota-mediated colonization resistance against intestinal pathogens.commensal bacteria inhabit mucosal and epidermal surfaces in mice and humans, and have effects on metabolic and immune pathways in their hosts. recent studies indicate that the commensal microbiota can be manipulated to prevent and even to cure infections that are caused by pathogenic bacteria, particularly pathogens that are broadly resistant to antibiotics, such as vancomycin-resistant enterococcus faecium, gram-negative enterobacteriaceae and clostridium difficile. in this review, we discuss ...201324096337
abdominal catastrophes in the intensive care unit setting.patients in the setting of the intensive care unit can develop intra-abdominal complications that may worsen outcome. clinical suspicion of such complications coupled with early diagnosis and treatment may reduce morbidity and mortality associated with these processes. this article addresses the diagnosis and management of some of the common causes of intra-abdominal catastrophes.201324094389
overview of severe clostridium difficile infection.clostridium difficile is an anaerobic, spore-forming, gram-positive bacillus that can produce severe colitis resulting in death. there has been an overall increase in the incidence of clostridium difficile-associated disease and, particularly, an increase in the more virulent forms of the disease. treatment of severe c difficile infection includes management of severe sepsis and shock, pathogen-directed antibiotic therapy, and, in selected cases, surgical intervention. ultimately, prevention is ...201324094379
depression and clostridium difficile infection. 201324093925
physician outlook toward fecal microbiota transplantation in the treatment of clostridium difficile infection. 201324091517
a clostridium difficile infection (cdi) stewardship initiative improves adherence to practice guidelines for management of cdi.a clostridium difficile infection (cdi) stewardship initiative reduced inappropriate prescription of empirical cdi therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of cdi. the initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.201324113611
occurrence of zoonotic clostridia and yersinia in healthy cattle.zoonotic pathogens are a frequent cause of disease worldwide. this study was designed to determine the occurrence of clostridium difficile, clostridium botulinum, and yersinia enterocolitica in cattle in southern bavaria, germany. the study population included 49 farms; 34 were dairy farms (30 also fattening beef cattle) and 15 were solely beef cattle farms. fecal and dust samples were collected from summer 2011 to summer 2012 and analyzed using a combination of enrichment procedures and real-ti ...201324112568
trends in orthopaedic antimicrobial prophylaxis in the uk between 2005 and 2011.antimicrobial prophylaxis remains the most powerful tool used to reduce infection rates in orthopaedics but the choice of antibiotic is complex. the aim of this study was to examine trends in antimicrobial prophylaxis in orthopaedic surgery involving the insertion of metalwork between 2005 and 2011.201324112496
clostridium difficile bacteremia. 201324111758
comparison of multilocus variable-number tandem-repeat analysis and whole-genome sequencing for investigation of clostridium difficile transmission.no study to date has compared multilocus variable-number tandem-repeat analysis (mlva) and whole-genome sequencing (wgs) in an investigation of the transmission of clostridium difficile infection. isolates from 61 adults with ongoing and/or recurrent c. difficile infections and 17 asymptomatic carriage episodes in children (201 samples), as well as from 61 suspected outbreaks affecting 2 to 41 patients in 31 hospitals in the united kingdom (300 samples), underwent 7-locus mlva and wgs in paralle ...201324108611
molecular epidemiology of clostridium difficile at a medical center in taiwan: persistence of genetically clustering of a⁻b⁺ isolates and increase of a⁺b⁺ isolates.we investigated the changing trend of various toxigenic clostridium difficile isolates at a 3 500-bed hospital in taiwan. genetic relatedness and antimicrobial susceptibility of toxigenic c. difficile isolates were also examined.201324116048
clostridium difficile carriage and serum antitoxin responses in children with inflammatory bowel disease.adults with inflammatory bowel disease (ibd) have a high prevalence of clostridium difficile carriage, but little data exist regarding pediatric patients with ibd. serum antibody responses to c. difficile toxins in correlation with organism carriage are not described in ibd. this study determines the prevalence of c. difficile carriage and compares serum antibody responses to c. difficile toxins in pediatric outpatients with ibd and controls.201324145927
a quantitative method for assessment of prescribing patterns using electronic health records.most available quality indicators for hospitals are represented by simple ratios or proportions, and are limited to specific events. a generalized method that can be applied to diverse clinical events has not been developed. the aim of this study was to develop a simple method of evaluating physicians' prescription patterns for diverse events and their level of awareness of clinical practice guidelines.201324130689
[challenges of clostridium difficile infection].clostridium difficile infections remain a problem especially for patients in the intensive care unit. the fact that c. difficile infections are strongly associated with antibiotic therapy calls for more caution in the use of antibiotics, especially in patients with a high risk of developing c. difficle infections. severe infections and recurrent episodes are usually difficult to manage and therapeutic options are often limited. the method of stool transplantation, though not new, has received mo ...201324129852
severe clostridium difficile infection in new zealand associated with an emerging strain, pcr-ribotype 244.to compare disease severity and clinical outcome of clostridium difficile infection (cdi) due to pcr-ribotype (rt) 244 with cdi due to other strains present in auckland.201324126745
common gastrointestinal symptoms: risks of long-term proton pump inhibitor therapy.more than 11 million individuals receive proton pump inhibitor (ppi) prescriptions each year in the united states. although ppis are effective treatment for peptic ulcers and esophagitis and provide symptom relief for many other conditions, their use carries risks. they decrease gastric acid and can lower blood levels of drugs whose absorption is acid dependent, including several antiretroviral and cancer therapy drugs. other drugs, such as digoxin, may be absorbed more extensively when gastric ...201324124705
a retrospective study on the etiological diagnoses of diarrhea in neonatal piglets in ontario, canada, between 2001 and 2010.laboratory surveillance data from the animal health laboratory, university of guelph, on the etiological diagnoses of neonatal diarrhea in piglets were analyzed to determine the relative importance and trends of different enteric pathogens in ontario. a total of 237 cases, including live and dead 1- to 7-day-old piglets, were submitted for diagnosis of gastrointestinal illness between 2001 and 2010. the combined frequencies for cases of gastrointestinal illness involving escherichia coli, clostr ...201324124267
ultrastructure of clostridium difficile colonies.the ultrastructural colony architecture of six clostridium difficile strains belonging to four different ribotypes (001, 027, 078/126 and 036) was studied by scanning electron microscopy (sem). in 2-day-old colonies several microareas differing in cell length and organization could be differentiated. some cells at colony edges were extremely long and exhibited invasiveness into the agar. the ultrastructure of 5-day-old colonies is more homogenous and characterized by presence of sporulating cell ...201324120350
microbiological, pathological and histological findings in four danish pig herds affected by a new neonatal diarrhoea syndrome.neonatal diarrhoea is a frequent clinical condition in commercial swine herds, previously regarded to be uncomplicated to treat. however, since 2008 it seems that a new neonatal diarrhoeic syndrome unresponsive to antibiotics and common management practices has emerged. routine laboratory examinations have not detected any pathogen related to this syndrome. the primary purpose of this study was to evaluate if well-known enteric pathogens could be associated with outbreaks of neonatal diarrhoea, ...201324119974
a new plant-derived antibacterial is an inhibitor of efflux pumps in staphylococcus aureus.an in-depth evaluation was undertaken of a new antibacterial natural product (1) recently isolated and characterised from the plant hypericum olympicum l. cf. uniflorum. minimum inhibitory concentrations (mics) were determined for a panel of bacteria, including: meticillin-resistant and -susceptible strains of staphylococcus aureus, staphylococcus epidermidis and staphylococcus haemolyticus; vancomycin-resistant and -susceptible enterococcus faecalis and enterococcus faecium; penicillin-resistan ...201324119569
horizontal gene transfer converts non-toxigenic clostridium difficile strains into toxin producers.clostridium difficile is a major nosocomial pathogen and the main causative agent of antibiotic-associated diarrhoea. the organism produces two potent toxins, a and b, which are its major virulence factors. these are chromosomally encoded on a region termed the pathogenicity locus (paloc), which also contains regulatory genes, and is absent in non-toxigenic strains. here we show that the paloc can be transferred from the toxin-producing strain, 630δerm, to three non-toxigenic strains of differen ...201324131955
the impact of cefepime as first line therapy for neutropenic fever on clostridium difficile rates among hematology and oncology patients.after changing empiric treatment of febrile neutropenia from meropenem to cefepime, the effect on clostridium difficile infection (cdi) was investigated. the change was assessed using an autoregressive model. a significant increase in cdi rates occurred following the introduction of cefepime. there may be an association between increased cefepime usage and cdi.201324140078
a polymorphic, mucocutaneous eruption in a patient with end-stage renal disease.an 81-year-old man is presented who developed cryptococcal infection after treatment for clostridium difficile infection.201324139366
linking clostridium difficile infection with depression. 201324137729
fidaxomicin: a review of its use in patients with clostridium difficile infection.oral fidaxomicin (dificid(®); dificlir(®)) is a first-in-class macrocyclic antibacterial that is approved in several countries for the treatment of adult patients with clostridium difficile-associated diarrhoea. fidaxomicin 200 mg twice daily for 10 days was an effective and generally well tolerated treatment in adult patients with a first episode or first recurrence of c. difficile infection. in two multinational phase iii trials, fidaxomicin treatment was noninferior to vancomycin treatment wi ...201324136090
fever in the postoperative patient.postprocedure fevers vary in the timing of their occurrence, duration, and severity. such fevers do not all have an infectious cause, but they all require thorough investigation to rule out life-threatening conditions. this article summarizes the principles of diagnosis and management of postprocedure fevers for the emergency care provider.201324176478
quality focus: clostridium difficile. 201324175503
[the use of molecular methods in the diagnosis of clostridium difficile infections].the aim of this study was to use molecular methods to identify selected strains of c. difficile isolated from patients hospitalized at independent public central teaching hospital [sp csk] between 2008 and 2011 in order to demonstrate their toxicgenic character and to determine their epidemic potential, including the incidence of a suspected c. difficile strain 027/nap1/b1.201324180138
histologic findings and clinical characteristics in acutely symptomatic ulcerative colitis patients with superimposed clostridium difficile infection.to examine biopsy specimens for histologic features suggestive of clostridium difficile infection in patients with ulcerative colitis (uc).201324225751
clostridium difficile 027 emerging outbreak in marseille, france. 201324225631
the impact of observation units on the rate of hospital-acquired infection.using clostridium difficile as an example, we calculated the impact that reduced inpatient-day denominators resulting from implementation of hospital observation units would have on hospital-acquired infection rates. using proposed scenarios of reduced inpatient-days, we estimated an increase in the hospital-acquired c. difficile infection rate of up to 12%.201324225619
possible association between obesity and clostridium difficile infection. 201324188730
role of lactobacillus in the prevention of clostridium difficile-associated diarrhea: a meta-analysis of randomized controlled trials.clostridium difficile-associated diarrhea (cdad) is a major public health problem because of significant morbidity and mortality, and many clinicians pay attention to lactobacillus as a potentially effective treatment. the purpose of this meta-analysis was to evaluate the efficacy of lactobacillus in the prevention of cdad.201324229690
clostridium difficile surveillance: harnessing new technologies to control transmission.clostridium difficile surveillance allows outbreaks of cases clustered in time and space to be identified and further transmission prevented. traditionally, manual detection of groups of cases diagnosed in the same ward or hospital, often followed by retrospective reference laboratory genotyping, has been used to identify outbreaks. however, integrated healthcare databases offer the prospect of automated real-time outbreak detection based on statistically robust methods, and accounting for conta ...201324151834
quality of care delivered to hospitalized inflammatory bowel disease patients.hospitalized patients with inflammatory bowel disease (ibd) are at high risk for morbidity, mortality, and health care utilization costs. while the literature on trends in hospitalization rates for this disease is conflicting, there does appear to be significant variation in the delivery of care to this complex group, which may be a marker of suboptimal quality of care. there is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce admissions. moreover ...201324151354
fulminant colitis.fulminant colitis is an ill-defined entity that is usually viewed as the most severe form of uncomplicated acute colitis. it usually occurs in the course of ulcerative colitis and infectious colitis, but can also be seen in other forms of colitis. every patient with clinical criteria for severe or fulminant colitis should be approached in a systematic way, based on two premises - intense medical treatment and early surgery in non-responders.201324160933
detection of toxins a/b and isolation of clostridium difficile and clostridium perfringens from dogs in minas gerais, brazil.the objective of this study was to detect c. difficile a/b toxins and to isolate strains of c. perfringens and c. difficile from diarrheic and non-diarrheic dogs in brazil. stool samples were collected from 57 dogs, 35 of which were apparently healthy, and 22 of which were diarrheic. c. difficile a/b toxins were detected by elisa, and c. perfringens and c. difficile were identified by multiplex pcr. c. difficile a/b toxins were detected in 21 samples (36.8%). of these, 16 (76.2%) were from diarr ...201324159295
epidemiology of clostridium difficile-associated disease (cdad): a shift from hospital-acquired infection to long-term care facility-based infection.previous epidemiological studies on clostridium-difficile-associated diarrhea (cdad) have focused on hospitalized patients with nosocomial transmission. however, increasing numbers of patients with cdad are being admitted to acute-care hospitals from long-term care facilities (ltcfs) and the local community. the purpose of our study was to study the changing epidemiological trends of cdad patients admitted to an acute-care hospital and examine factors contributing to this shift in epidemiology.201324154638
is fidaxomicin the drug of choice for treating clostridium difficile-associated diarrhea in patients with cancer? 201324166524
clostridium difficile infection in the community: are proton pump inhibitors to blame?once a nosocomial disease, clostridium difficile infection (cdi) now appears frequently in the community in the absence of exposure to antibiotics. prior studies have shown that patients with community-acquired cdi are younger, more likely to be female, and have fewer comorbidities compared to patients with hospital-associated cdi. because most studies of cdi are hospital-based, comparatively little is known about community-acquired cdi. the recent study by chitnis has received widespread attent ...201324187445
clostridium difficile infection in hospitalized patients at university clinical center tuzla, bosnia and herzegovina: a 4 year experience.clostridium difficile (c. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of c. difficile infection (cdi) in bosnia and herzegovina.201324167425
clostridium difficile toxin b-induced necrosis is mediated by the host epithelial cell nadph oxidase complex.clostridium difficile infection (cdi) is a leading cause of health care-associated diarrhea and has increased in incidence and severity over the last decade. pathogenesis is mediated by two toxins, tcda and tcdb, which cause fluid secretion, inflammation, and necrosis of the colonic mucosa. tcdb is a potent cytotoxin capable of inducing enzyme-independent necrosis in both cells and tissue. in this study, we show that tcdb-induced cell death depends on assembly of the host epithelial cell nadph o ...201324167244
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