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physician outlook toward fecal microbiota transplantation in the treatment of clostridium difficile infection. 201324091517
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
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
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
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
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
[epidemiological characteristics of nosocomial diarrhea caused by clostridium difficile in a tertiary level hospital in serbia].among the most important causes of diarrhea in modern hospitals is clostridium difficile (c. difficile). a wide spectrum of diseases caused by this bacterium is now known as c. difficile associated disease (cdad). the development of cdad is usually preceded by the administration of antimicrobial therapy and fecal-oral infections with c. difficile. over the last years epidemiology of cdad has significantly changed. recently, a hypervirulent bi/nap1/027 strain, the cause of severe epidemics in nor ...201324073554
proton pump inhibitors and clostridium difficile infection: are we propagating an already rapidly growing healthcare problem?proton pump inhibitors (ppis) have been associated with clostridium difficile infection (cdi) in several recent studies. the exact mechanism through which ppis may cause clostridium difficile infection is not well understood. one potential mechanism to explain this association may be that elevated gastric ph levels facilitate the growth of potentially pathogenic upper and lower gastrointestinal tract flora. although clostridium difficile spores are acid resistant, vegetative forms are susceptibl ...201327785249
cervical spine fractures in the elderly: morbidity and mortality after operative treatment.although there are currently many different strategies and recommendations in the therapy of cervical spine fractures in elderly patients, there are still no generally accepted treatment algorithms. the aim of the present study was to analyze the morbidity, mortality, and outcome of operated cervical spine injuries in the elderly.201326815442
investigating clostridium difficile.clostridium difficile is one of the leading health-care-associated infections in the uk and has a significant clinical and economic impact. optimal laboratory testing for this pathogen is controversial and interpretation of results can lead to confusion. in the context of the clinical syndrome of c. difficile infection, this article reviews disease presentation, the diagnostic tests available, and their translation into information that can assist clinical management at the bedside.201324145598
alteration of the intestinal microbiome: fecal microbiota transplant and probiotics for clostridium difficile and beyond.clostridium difficile infection is increasingly common with a high risk of recurrence despite antibiotic treatment. in cases of recurrent c. difficile infection, fecal microbiota transplant (fmt) is a highly effective treatment option promoting the restoration of normal gut microbiota. furthermore, preliminary uncontrolled evidence demonstrates possible benefit of fmt in the management of some cases of inflammatory bowel disease and chronic constipation. in addition to presenting an overview of ...201324070153
a review of ischemic colitis: is our clinical recognition and management adequate?ischemic colitis is a common cause of hospital admissions; however it is frequently confused intellectually with mesenteric ischemia and often misdiagnosed as infectious diarrhea or clostridium difficile colitis. ischemic colitis is caused by non-occlusive insult to the small vessels supplying the colon without a clear precipitating factor. it is more common in females and in patients above 60 years of age. the classic presentation includes sudden onset of lower abdominal pain followed by the ur ...201324070152
[fulminant clostridium difficile colitis].clostridium difficile is a common cause of nosocomial diarrhea and it's most difficult fulminant form is increasing in prevalence and severity in hospitalized patients. the early diagnostics and intensive conservative therapy are essential in the treatment of this ominous disease. the physicians must be aware of the possibility of this disease, when treating patients, who have received preceding antibiotic therapy. these patients have to be followed up in the surgical units. if the general condi ...201324069637
[fecal transfusion as treatment of clostridium difficile infection].clostridium difficile is the major identified cause of antibiotic-associated diarrhea. metronidazole has been applied as the first-line treatment, while vancomycin has been used in recurring cases of the disease. fecal transfusion has already long been applied as experimental therapy in the treatment of recurring c. difficile infection. the aim of fecal transfusion is normalization of the intestinal microbial flora. an only recently published extensive finnish patient series and a randomized stu ...201324069636
concurrent infections of giardia duodenalis, enterocytozoon bieneusi, and clostridium difficile in children during a cryptosporidiosis outbreak in a pediatric hospital in china.over 200 cryptosporidiosis outbreaks have been reported, but little is known if other enteric pathogens were also involved in some of these outbreaks. recently, an outbreak of cryptosporidiosis linked to poor hygiene by two cryptosporidium hominis subtypes occurred in a pediatric hospital ward (ward a) in china, lasting for more than 14 months. in this study, the concurrence during the outbreak of three other enteric pathogens with a similar transmission route, giardia duodenalis, enterocytozoon ...201324069491
prevalence of clostridium difficile colonization among healthcare workers.clostridium difficile infection (cdi) has increased to epidemic proportions in recent years. the carriage of c. difficile among healthy adults and hospital inpatients has been established. we sought to determine whether c. difficile colonization exists among healthcare workers (hcws) in our setting.201324090343
multicenter evaluation of the verigene clostridium difficile nucleic acid assay.the verigene clostridium difficile nucleic acid test (verigene cdf test) (nanosphere, northbrook, il) is a multiplex qualitative pcr assay that utilizes a nanoparticle-based array hybridization method to detect c. difficile tcda and tcdb in fecal specimens. in addition, the assay detects binary toxin gene sequences and the single base pair deletion at nucleotide 117 (δ 117) in tcdc to provide a presumptive identification of the epidemic strain 027/nap1/bi (referred to here as ribotype 027). this ...201324088862
the role of flagella in clostridium difficile pathogenesis: comparison between a non-epidemic and an epidemic strain.clostridium difficile is a major cause of healthcare-associated infection and inflicts a considerable financial burden on healthcare systems worldwide. disease symptoms range from self-limiting diarrhoea to fatal pseudomembranous colitis. whilst c. difficile has two major virulence factors, toxin a and b, it is generally accepted that other virulence components of the bacterium contribute to disease. c. difficile colonises the gut of humans and animals and hence the processes of adherence and co ...201324086268
culturing and maintaining clostridium difficile in an anaerobic environment.clostridium difficile is a gram-positive, anaerobic, sporogenic bacterium that is primarily responsible for antibiotic associated diarrhea (aad) and is a significant nosocomial pathogen. c. difficile is notoriously difficult to isolate and cultivate and is extremely sensitive to even low levels of oxygen in the environment. here, methods for isolating c. difficile from fecal samples and subsequently culturing c. difficile for preparation of glycerol stocks for long-term storage are presented. te ...201324084491
poor functional status as a risk factor for severe clostridium difficile infection in hospitalized older adults.to determine the role of impaired functional status as a risk factor for severe clostridium difficile infection (cdi) in older adults.201324083842
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
clostridium difficile--beyond the usual suspects. 201324066748
diverse sources of c. difficile infection identified on whole-genome sequencing.it has been thought that clostridium difficile infection is transmitted predominantly within health care settings. however, endemic spread has hampered identification of precise sources of infection and the assessment of the efficacy of interventions.201324066741
proteomic analysis and label-free quantification of the large clostridium difficile toxins.clostridium difficile is the leading cause of antibiotic-associated diarrhea in hospitals worldwide, due to hypervirulent epidemic strains with the ability to produce increased quantities of the large toxins tcda and tcdb. unfortunately, accurate quantification of tcda and tcdb from different toxinotypes using small samples has not yet been reported. in the present study, we quantify c. difficile toxins in <0.1 ml of culture filtrate by quantitative label-free mass spectrometry (ms) using data-i ...201324066231
dna detection of clostridium difficile infection based on real-time resistance measurement.we used a newly developed electrochemical method, real-time resistance measurement, based on loop-mediated isothermal amplification (lamp), with real-time resistance monitoring and derivative analysis. dna extracted from specimens was amplified through lamp reaction. the 2 products of lamp, dna and pyrophosphate, both are negative ions; they combine with positive dye (crystal violet) and positive ions (mg(2+)), which leads to an increase in the resistivity of the reaction liquid. the changes of ...201324065671
role of fidaxomicin for the treatment of clostridium difficile infection.clostridium difficile is a gram-negative, anaerobic, spore-forming emerging pathogen within health care systems and community-based populations that has a high associated morbidity and mortality as well as cost for the health care system. recent studies reported high rates of recurrence thus a need for new pharmacological agents to treat c difficile infections (cdis). fidaxomicin is a novel macrocyclic antibiotic, originally isolated from fermentation broth of dactylosporangium aurantiacum spp h ...201324064437
antibiotic-associated diarrhea: a refresher on causes and possible prevention with probiotics--continuing education article.antibiotic-associated diarrhea (aad) describes any unexplained diarrhea associated with the use of an antibiotic. aad also includes infection caused by clostridium difficile, however this organism only accounts for a small percentage of diarrhea caused by antibiotics. aad can be caused by multiple other organisms including c perfringens, s aureus, and candida. some antibiotics are more likely to cause non-c difficile aad, such as erythromycin and the penicillin class. aad develops through the lo ...201324064436
epidemiology of clostridium difficile infection.there has been dramatic change in the epidemiology of clostridium difficile infection (cdi) since the turn of the 21st century noted by a marked increase in incidence and severity, occurring at a disproportionately higher frequency in older patients. historically considered a nosocomial infection associated with antibiotic exposure, cdi has now also emerged in the community in populations previously considered low risk. emerging risk factors and disease recurrence represent continued challenges ...201324064435
clostridium difficile-associated diarrhea: role of the pharmacist in the health system. 201324064434
the situation and management of clostridium difficile infection in spain: an opinion document. 201324080894
oral vancomycin desensitisation to treat clostridium difficile infection in a vancomycin allergic patient.the prevalence of clostridium difficile infection (cdi) is increasing worldwide. oral vancomycin is an effective and frequently used treatment. however, patients with cdi who are allergic to intravenous vancomycin cannot receive oral vancomycin due to the risk of anaphylaxis if given the oral form.we present a case where oral vancomycin desensitisation was used to successfully treat a vancomycin allergic patient with recurrent cdi.201324079362
murine models to study clostridium difficile infection and transmission.clostridium difficile is the leading cause of antibiotic-associated diarrhea in healthcare facilities worldwide. c. difficile infections are difficult to treat because of the high rate of disease recurrence after antibiotic therapy, leaving few treatment options for patients. c. difficile is also difficult to contain within a healthcare setting due to a highly-transmissible, resistant spore form that challenges standard infection control measures. the recent development of murine infection model ...201324076318
molecular methods in the diagnosis of clostridium difficile infections: an update.nucleic acid amplification techniques (naats) represent a major advance in the diagnosis of clostridium difficile (c. difficile) infection. this review analyzes the different options available for a molecular diagnosis of c. difficile infection, as well as the strengths and weaknesses of naats. the performances of seven commercials naats are compared (bd geneohm cdiff, illumigene c. difficile, xpert c. difficile, bd max cdiff, portrait toxigenic c. difficile, progastro cd, seeplex diarrhea ace). ...201324063396
hype or hypervirulence: a reflection on problematic c. difficile strains.clostridium difficile infections (cdi) have emerged as a major cause of healthcare associated disease, and recent epidemiological evidence also suggests an important role in community-acquired diarrhea. this increase is associated with specific types, especially pcr ribotypes 027 and 078, which are sometimes referred to as "hypervirulent". over the past years major advances have been made in our understanding of c. difficile pathogenicity, with the identification and characterization of the majo ...201324060961
proton pump inhibitors and risk for recurrent clostridium difficile infection among inpatients.observational studies suggest that proton pump inhibitors (ppis) are a risk factor for incident clostridium difficile infection (cdi). data also suggest an association between ppis and recurrent cdi, although large-scale studies focusing solely on hospitalized patients are lacking. we therefore performed a retrospective cohort analysis of inpatients with incident cdi to assess receipt of ppis as a risk factor for cdi recurrence in this population.201324060760
combination of culture, antigen and toxin detection, and cytotoxin neutralization assay for optimal clostridium difficile diagnostic testing.there has been a growing interest in developing an appropriate laboratory diagnostic algorithm for clostridium difficile, mainly as a result of increases in both the number and severity of cases of c difficile infection in the past decade. a c difficile diagnostic algorithm is necessary because diagnostic kits, mostly for the detection of toxins a and b or glutamate dehydrogenase (gdh) antigen, are not sufficient as stand-alone assays for optimal diagnosis of c difficile infection. in addition, ...201324421808
treatment of relapsing clostridium difficile infection using fecal microbiota transplantation.clostridium difficile infection (cdi) has become a global concern over the last decade. in the united states, cdi escalated in incidence from 1996 to 2005 from 31 to 64/100,000. in 2010, there were 500,000 cases of cdi with an estimated mortality up to 20,000 cases a year. the significance of this problem is evident from the hospital costs of over 3 billion dollars annually. fecal microbiota transplant (fmt) was first described in 1958 and since then about 500 cases have been published in litera ...201324421645
a case of an acquired factor viii inhibitor complicated by multiple treatment-related opportunistic infections and review of the literature.this case report describes a patient with an idiopathic acquired factor viii inhibitor and severe bleeding. she was treated with rituximab after failing first-line treatment with steroids and cyclophosphamide. two months following rituximab treatment, our patient developed a succession of severe opportunistic infections requiring intensive care unit admission. over a period of 12 weeks she required treatment for pseudomonas aeruginosa septicaemia, herpes simplex gingivostomatitis and pharyngoton ...201324455336
metronidazole induced liver injury: a rare immune mediated drug reaction.drug induced liver injury (dili) can result either from dose-dependent direct hepatotoxicity or from an unpredictable dose-independent idiosyncratic reaction. incidence of idiosyncratic dili is estimated to be approximately 10-15 per 100,000 patient years. here we report an extremely rare case of metronidazole induced delayed immune-allergic hepatocellular liver injury masquerading as autoimmune hepatitis. a previously healthy 54-year-old caucasian male, who was treated with metronidazole for cl ...201324455335
colonization with clostridium difficile in children with cancer.clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus. usually it does not cause disease unless a patient who is colonized with toxin-producing strains has been treated with antibiotics, particularly those that change the anaerobic flora of the large intestine.201324427503
clostridium difficile-associated disease: adherence with current guidelines at a tertiary medical center.to assess adherence with the the society for healthcare epidemiology of america (shea)/ the infectious diseases society of america (idsa) guidelines for management of clostridium difficile (c. difficile)-associated disease (cdad) at a tertiary medical center.201324379582
parameters for the mathematical modelling of clostridium difficile acquisition and transmission: a systematic review.mathematical modelling of clostridium difficile infection dynamics could contribute to the optimisation of strategies for its prevention and control. the objective of this systematic review was to summarise the available literature specifically identifying the quantitative parameters required for a compartmental mathematical model of clostridium difficile transmission.201324376797
epidemiology of clostridium difficile infection among active duty united states military personnel (1998-2010).clostridium difficile associated disease (cdad) has risen in incidence and the experience in the us military has not been described.201324373384
reductions in intestinal clostridiales precede the development of nosocomial clostridium difficile infection.antimicrobial use is thought to suppress the intestinal microbiota, thereby impairing colonization resistance and allowing clostridium difficile to infect the gut. additional risk factors such as proton-pump inhibitors may also alter the intestinal microbiota and predispose patients to clostridium difficile infection (cdi). this comparative metagenomic study investigates the relationship between epidemiologic exposures, intestinal bacterial populations and subsequent development of cdi in hospit ...201324450844
use of fidaxomicin through a nasogastric tube for the treatment of septic shock caused by clostridium difficile infection in a patient with oral cancer admitted to the surgical critical care unit. 201324399354
[the problem of clostridium dlfficile infection in children with inflammatory bowel disease].the last decade has seen a significant increase in the incidence of diseases related to infection by clostridium difficile (clostridium difficile-associated disease--cdad) in the u.s.a., canada and european countries, which is probably due to the widespread environmental hipervirulent c. difficile strain nap 1 / bi / 027. those particularly affected by cdad are patients with inflammatory bowel disease (ibd) who observed more severe infections, prolonged hospital stay, higher risk of complication ...201324490471
[steroid-resistant nephrotic syndrome complicated with severe streptococcus pneumonlae peritonitis in a 10-year-old girl--case report].primary bacterial peritonitis is a rare complication of idiopathic nephrotic syndrome (ins) in children, found in 1.5-3.7% cases. the 10-year-old girl was admitted with ins relapse: generalized edema, proteinuria 630 mg/kg/24 h, hypoalbuminemia 1.8 g/dl, hypogammaglobulinemia 74.0 mg/dl (n: 618-1537 mg/dl), gfr 71.6 ml/min/1.73 m2. she was treated with prednisone 60 mg/24 h. on 5th day severe pain, fever, crp (15.5 mg/dl) and leukocytosis (19.5 tys/mm3) rise occurred. on 6th day due to suspicion ...201324490466
overview of clostridium difficile infection: implications for china.the incidence and severity of clostridium difficile infection (cdi) have dramatically increased in the western world in recent years. in contrast, cdi is rarely reported in china, possibly due to under-diagnosis. this article briefly summarizes cdi incidence, management and preventive strategies. the authors intend to raise awareness of this disease among chinese physicians and health workers, in order to minimize the medical and economic burden of a potential epidemic in the future.201324759960
severity assessment scores to guide empirical use of antibiotics in community acquired pneumonia.severity assessment scores were first developed to predict the 30 day mortality in community acquired pneumonia; however, several guidelines have extended their use to guide empirical antibiotic prescription decisions. this approach has theoretical advantages because a decrease in broad-spectrum antibiotic treatment in low-risk patients might reduce antibiotic-related side-effects, and to give broad-spectrum therapy to patients at higher risk of death is intuitive. however, evidence in support o ...201324461668
clostridium difficile and cytomegalovirus colitis coinfection after bariatric surgery: case report. 201324463907
stool substitute transplant therapy for the eradication of clostridium difficile infection: 'repoopulating' the gut.fecal bacteriotherapy ('stool transplant') can be effective in treating recurrent clostridium difficile infection, but concerns of donor infection transmission and patient acceptance limit its use. here we describe the use of a stool substitute preparation, made from purified intestinal bacterial cultures derived from a single healthy donor, to treat recurrent c. difficile infection that had failed repeated standard antibiotics. thirty-three isolates were recovered from a healthy donor stool sam ...201324467987
[screening for opportunistic infections and vaccination before introduction of biologic therapy].patients on anti-tnfalpha medications carry a higher risk for developing opportunistic infections. in order to introduce anti-tnfalpha therapy, screening for hepatitis viruses b and c, hiv, ebv, hpv, tbc, bacterial, fungal and parasitic infections should be performed. screening involves patient's history of earlier infectious diseases, vaccinations and traveling to parts of the world with endemic diseases. clinical examination should be supplemented with stomatologic and gynecologic exams. labor ...201324471299
cags clinical practice committee report: the science of clostridium difficile and surgery. 201324284142
[new treatment options for infections with clostridium difficile].currently available broad spectrum antibiotics are not sufficiently effective against recurrent clostridium difficile infections (cdi). donor faecal microbiota transplantation is a very effective treatment for second and recurrent infection but is time-consuming and requires careful screening of donors. the new narrow spectrum antibiotic fidaxomicin is a good alternative in a first cdi or a first recurrence, but treatment is expensive and there are no data on its effectiveness in a second or lat ...201324279951
more on antidepressant drugs and infectious disease.three observational studies have suggested that depression and/or antidepressant drug use is associated with an increased risk of developing clostridium difficile (c. difficile) infection (cdi), which is a clinically significant cause of diarrhea typically associated with the use of antibiotic drugs. establishing causality from observed associations requires evidence from a variety of different scientific perspectives. the authors of these studies do not consider the complex relationship among d ...201324278963
the p2y6 receptor mediates clostridium difficile toxin-induced cxcl8/il-8 production and intestinal epithelial barrier dysfunction.c. difficile is a gram-positive spore-forming anaerobic bacterium that is the leading cause of nosocomial diarrhea in the developed world. the pathogenesis of c. difficile infections (cdi) is driven by toxin a (tcda) and toxin b (tcdb), secreted factors that trigger the release of inflammatory mediators and contribute to disruption of the intestinal epithelial barrier. neutrophils play a key role in the inflammatory response and the induction of pseudomembranous colitis in cdi. tcda and tcdb alt ...201324278446
a simulation-based assessment of strategies to control clostridium difficile transmission and infection.clostridium difficile is one of the most common and important nosocomial pathogens, causing severe gastrointestinal disease in hospitalized patients. although "bundled" interventions have been proposed and promoted, optimal control strategies remain unknown.201324278304
[recurrent clostridium difficile infections: the importance of the intestinal microbiota].clostridium difficile infections (cdi) represent 20-30% of diarrhea caused by antibiotics and relapse in more than 25% of cases after treatment with metronidazole or vancomycin. given the high prevalence of cdi and the significant rate of recurrence despite successful initial treatment, cdi therapy represents a real challenge. a better understanding of the intestinal microbiota and its role in cdi opens the way to promising new therapeutic approaches, such as fecal transplantation. the studies p ...201324298714
proton pump inhibitors: clostridium difficile infections.data on the adverse effect profile of proton pump inhibitors continue to accumulate. in addition to increasing the risk of bacterial pneumonia, proton pump inhibitors appear to increase the risk of intestinal clostridium difficile infection. a meta-analysis of epidemiological studies showed a statistically significant increase in c. difficile infection among patients taking proton pump inhibitors, most of whom were hospital patients.the estimated relative risk was 1.7 for primary infections (95% ...201324298587
environmental contaminants in hospital settings and progress in disinfecting techniques.medical devices, such as stethoscopes, and other objects found in hospital, such as computer keyboards and telephone handsets, may be reservoirs of bacteria for healthcare-associated infections. in this cross-over study involving an italian teaching hospital we evaluated microbial contamination (total bacterial count (tbc) at 36°c/22°c, staphylococcus spp., moulds, enterococcus spp., pseudomonas spp., e. coli, total coliform bacteria, acinetobacter spp., and clostridium difficile) of these devic ...201324286078
[clostridium difficile infections, specific issues in the elderly].clostridium difficile is a well-established cause of infectious nosocomial diarrhea in adults. each time diarrhea is observed in a patient receiving antibiotic treatment, clostridium colitis should be suspected; diagnosis should be confirmed by the identification of toxin in the patient's stools. its incidence is increasing due to growing use of several classes of antibiotics, and is associated with a high relapse rate and a significant case-fatality rate. the elderly are particularly at risk fo ...201324308141
predictors of clostridium difficile infection severity in patients hospitalised in medical intensive care.to describe and analyse factors associated with clostridium difficile infection (cdi) severity in hospitalised medical intensive care unit patients.201324307797
microbiota dynamics in patients treated with fecal microbiota transplantation for recurrent clostridium difficile infection.clostridium difficile causes antibiotic-associated diarrhea and pseudomembraneous colitis and is responsible for a large and increasing fraction of hospital-acquired infections. fecal microbiota transplantation (fmt) is an alternate treatment option for recurrent c. difficile infection (rcdi) refractory to antibiotic therapy. it has recently been discussed favorably in the clinical and scientific communities and is receiving increasing public attention. however, short- and long-term health conse ...201324303043
immunization using groel decreases clostridium difficile intestinal colonization.clostridium difficile is a pathogen which is responsible for diarrhea and colitis, particularly after treatment with antibiotics. clinical signs are mainly due to two toxins, tcda and tcdb. however, the first step of pathogenesis is the colonization process. we evaluated c. difficile surface proteins as vaccine antigens in the hamster model to prevent intestinal colonization. this vaccination induced a partial protection of hamsters against death after a c. difficile challenge. a proteomic analy ...201324303034
a high-dose preparation of lactobacilli and bifidobacteria in the prevention of antibiotic-associated and clostridium difficile diarrhoea in older people admitted to hospital: a multicentre, randomised, double-blind, placebo-controlled, parallel arm trial (placide).antibiotic-associated diarrhoea (aad) occurs most commonly in older people admitted to hospital and within 12 weeks of exposure to broad-spectrum antibiotics. although usually a mild and self-limiting illness, the 15-39% of cases caused by clostridium difficile infection [c. difficile diarrhoea (cdd)] may result in severe diarrhoea and death. previous research has shown that probiotics, live microbial organisms that, when administered in adequate numbers, are beneficial to health, may be effecti ...201324309198
analysis of the intestinal microbiome of a recovered clostridium difficile patient after fecal transplantation.clostridium difficile infections upon antibiotic disruption of the gut microbiota are potentially lethal. fecal microbiota transplantation (fmt) is a promising treatment option for recurrent c. difficile-associated disease (cdad). here, we present a patient with recurrent cdad that received fmt, leading to full recovery for what has now been 3 years. we performed metagenomic sequencing on stool samples to assess if there are indications for recolonization with c. difficile and changes in the gut ...201324335204
long term effect of infection control practices and associated factors during a major clostridium difficile outbreak in costa rica.the c. difficile bi/nap 1 hyper virulent strain has been responsible for the nosocomial outbreaks in several countries. the present study describes the infection control strategies utilized to achieve outbreak control as well as the factors associated with a c. difficile bi/nap 1 hyper virulent strain outbreak in costa rica.201324334937
prevention and treatment of diarrhoea with saccharomyces boulardii in children with acute lower respiratory tract infections.the aim of this study was to determine whether saccharomyces boulardii prevents and treats diarrhoea and antibiotic-associated diarrhoea (aad) in children. a total of 333 hospitalised children with acute lower respiratory tract infection were enrolled in a 2-phase open randomised controlled trial. during the 1st phase, all children received intravenous antibiotics (ab). they were randomly allocated to group a (s. boulardii 500 mg/day + ab, n=167) or group b (ab alone, n=166) and followed for 2 w ...201324311316
predictors of first recurrence in clostridium difficile-associated disease. a study of 306 patients hospitalized in a romanian tertiary referral center.clostridium difficile is recognized as the major cause of nosocomial gastroenteritis usually related to antibiotic treatment. although treatable, c. difficile--associated disease (cdad) tends to recur in many patients. the purpose of the study was to analyze the risk factors for recurrence in patients with cdad after the first treatment with vancomycin, metronidazole or both.201324369321
characterization of the sigd regulon of c. difficile and its positive control of toxin production through the regulation of tcdr.clostridium difficile intestinal disease is mediated largely by the actions of toxins a (tcda) and b (tcdb), whose production occurs after the initial steps of colonization involving different surface or flagellar proteins. in b. subtilis, the sigma factor sigd controls flagellar synthesis, motility, and vegetative autolysins. a homolog of sigd encoding gene is present in the c.difficile 630 genome. we constructed a sigd mutant in c. difficile 630 ∆erm to analyze the regulon of sigd using a glob ...201324358307
treatment strategies for recurrent clostridium difficile infection.recurrent clostridium difficile infection represents a major clinical challenge. treatment is often based on empiric selection from relatively few options supported by limited clinical evidence.201324357868
probiotics for the prevention of antibiotic-associated diarrhea and clostridium difficile infection among hospitalized patients: systematic review and meta-analysis.antibiotic-associated diarrhea (aad) and clostridium difficile infection (cdi) are associated with high morbidity, mortality, and health care costs. probiotics may mitigate the existing disease burden. we performed a systematic review and meta-analysis to evaluate the efficacy of co-administration of probiotics with antibiotics in preventing these adverse outcomes in adult inpatients.201324348885
ecological modeling from time-series inference: insight into dynamics and stability of intestinal microbiota.the intestinal microbiota is a microbial ecosystem of crucial importance to human health. understanding how the microbiota confers resistance against enteric pathogens and how antibiotics disrupt that resistance is key to the prevention and cure of intestinal infections. we present a novel method to infer microbial community ecology directly from time-resolved metagenomics. this method extends generalized lotka-volterra dynamics to account for external perturbations. data from recent experiments ...201324348232
antimicrobial effects of virgin coconut oil and its medium-chain fatty acids on clostridium difficile.clostridium difficile is the leading cause of hospital-acquired antibiotic-associated diarrhea worldwide; in addition, the proliferation of antibiotic-resistant c. difficile is becoming a significant problem. virgin coconut oil (vco) has been shown previously to have the antimicrobial activity. this study evaluates the lipid components of vco for the control of c. difficile. vco and its most active individual fatty acids were tested to evaluate their antimicrobial effect on c. difficile in vitro ...201324328700
antibiotic prophylaxis for hip fracture surgery: three-dose cefuroxime versus single-dose gentamicin and amoxicillin.to compare a 3-dose cefuroxime regimen with a single-dose gentamicin and amoxicillin regimen as antibiotic prophylaxis for hip hemiarthroplasty in terms of microbiological outcome.201324366793
an analysis of risk factors of clostridiumdifficile infection in patients hospitalized in the teaching hospital in 2008.the last decade saw an increase in the incidence of clostridium difficile infections.approximately 80% of these infections occur in hospitalized patients. there are ongoing studies on the increase in the incidence of infections with this microorganism.201324340558
postoperative clostridium difficile infection with pcr ribotype 078 strain identified at necropsy in five thoroughbred racehorses.clostridium difficile is an important cause of acute enterocolitis in horses. we describe five cases of c difficile infection occurring postoperatively in thoroughbred racehorses. following diarrhoea or colic accompanied by a marked increase in packed cell volume (to ≥60 per cent) and leucopenia (≤4000 cells/μl) within two to four days after surgery in all five horses, four of them died or were euthanased because of colitis or severe diarrhoea. in these four horses, necrotising entero-typhlo-col ...201324336792
evaluation of cycloserine-cefoxitin fructose agar (ccfa), ccfa with horse blood and taurocholate, and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme for recovery of clostridium difficile isolates from fecal samples.cycloserine-cefoxitin fructose agar (ccfa), ccfa with horse blood and taurocholate (ccfa-ht), and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme (ccmb-tal) were compared for recovery of clostridium difficile from 120 stool specimens. compared to ccfa, ccfa-ht enhanced c. difficile growth and improved recovery by 4%. in a separate study, 9% (8/91) of stool samples previously c. difficile negative on plate medium were c. difficile positive when cultured in ccmb-tal.201323804392
intestinal dysbiosis and depletion of butyrogenic bacteria in clostridium difficile infection and nosocomial diarrhea.clostridium difficile infection (cdi) causes nearly half a million cases of diarrhea and colitis in the united states each year. although the importance of the gut microbiota in c. difficile pathogenesis is well recognized, components of the human gut flora critical for colonization resistance are not known. culture-independent high-density roche 454 pyrosequencing was used to survey the distal gut microbiota for 39 individuals with cdi, 36 subjects with c. difficile-negative nosocomial diarrhea ...201323804381
ceftaroline fosamil: a review of its use in the treatment of complicated skin and soft tissue infections and community-acquired pneumonia.ceftaroline, the active metabolite of the prodrug ceftaroline fosamil (zinforo, teflaro), is an advanced-generation, parenteral cephalosporin with broad-spectrum antibacterial activity in vitro against gram-positive bacteria, including methicillin-resistant staphylococcus aureus (mrsa) and multidrug resistant streptococcus pneumoniae and gram-negative bacteria, including haemophilus influenzae and moraxella catarrhalis, but not pseudomonas aeruginosa. ceftaroline has demonstrated a low potential ...201323801418
correlation between virulence gene expression and proton pump inhibitors and ambient ph in clostridium difficile: results of an in vitro study.proton pump inhibitors (ppis) are associated with the development of clostridium difficile infection in humans. though it is assumed that ppis mediate this effect through gastric acid suppression, there has been little investigation into whether ppis, or ambient ph, might directly affect the expression of c. difficile toxin genes. in the present study, c. difficile ribotypes 001, 027 and 078 obtained from human subjects were grown under anaerobic conditions prepared at phs of 5, 7.3 and 9. match ...201323800596
quinolone prophylaxis for the prevention of bk virus infection in kidney transplantation: study protocol for a randomized controlled trial.bk virus infection has emerged as a major complication in kidney transplantation leading to a significant reduction in graft survival. there are currently no proven strategies to prevent or treat bk virus infection. quinolone antibiotics, such as levofloxacin, have demonstrated activity against bk virus. we hypothesize that administration of a quinolone antibiotic, when given early post-transplantation, will prevent the establishment of bk viral replication in the urine and thus prevent systemic ...201323800312
imipenem versus piperacillin/tazobactam for empiric treatment of neutropenic fever in adults.australian guidelines for neutropenic fever recommend piperacillin/tazobactam (pip-taz) or cefepime for first-line empiric treatment of neutropenic fever. we compared outcomes among haematology patients before and after changing our first-line neutropenic fever treatment from imipenem to pip-taz. forty-five patients received imipenem and 60 pip-taz. despite a higher rate of antibiotic modification in the pip-taz cohort, treatment success and time to defervescence were similar, with a trend towar ...201323800137
increased hospital length of stay attributable to clostridium difficile infection in patients with four co-morbidities: an analysis of hospital episode statistics in four european countries.hospital-onset clostridium difficile infection (cdi) places a significant burden on health care systems throughout europe, estimated at around €3 billion per annum. this burden is shared between national payers and hospitals that support additional bed days for patients diagnosed with cdi while in hospital or patients re-admitted from a previous hospitalisation. this study was performed to quantify additional hospital stay attributable to cdi in four countries, england, germany, spain, and the n ...201323797490
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