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identification of clostridium difficile: evaluation of genotypic, phenotypic and proteomic methods. 201324273901
investigating clostridium difficile. 201324273764
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
[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
[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
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
phage ϕc2 mediates transduction of tn6215, encoding erythromycin resistance, between clostridium difficile strains.in this work, we show that clostridium difficile phage ϕc2 transduces erm(b), which confers erythromycin resistance, from a donor to a recipient strain at a frequency of 10(-6) per pfu. the transductants were lysogenic for ϕc2 and contained the erm(b) gene in a novel transposon, tn6215. this element is 13,008 bp in length and contains 17 putative open reading frames (orfs). it could also be transferred at a lower frequency by filter mating.201324255122
variations in virulence and molecular biology among emerging strains of clostridium difficile.clostridium difficile is a gram-positive, spore-forming organism which infects and colonizes the large intestine, produces potent toxins, triggers inflammation, and causes significant systemic complications. treating c. difficile infection (cdi) has always been difficult, because the disease is both caused and resolved by antibiotic treatment. for three and a half decades, c. difficile has presented a treatment challenge to clinicians, and the situation took a turn for the worse about 10 years a ...201324296572
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
diagnosis of clostridium difficile infection: the molecular approach.diagnosis of clostridium difficile infection is based on clinical presentation and laboratory tests. although numerous laboratory methods are now available, the diagnosis of c. difficile infection remains challenging. nucleic acid amplification tests (naats) are the most recent marketed methods. these methods detect genes for toxins a and/or b. they are very sensitive compared with the reference method (toxigenic culture) and are thus very promising, despite their cost. however, a positive naat ...201324266358
clinical and microbiologic characteristics of clostridium difficile infection caused by binary toxin producing strain in korea.binary toxin-producing clostridium difficile infections (cdi) are known to be more severe and to cause higher case fatality rates than those by binary toxin-negative isolates. there has been few data of binary toxin-producing cdi in korea. objective of the study is to characterize clinical and microbiological trait of cdi cause by binary-toxin producing isolates in korea.201324265965
asymptomatic clostridium difficile colonisation and onward transmission.combined genotyping/whole genome sequencing and epidemiological data suggest that in endemic settings only a minority of clostridium difficile infection, cdi, is acquired from other cases. asymptomatic patients are a potential source for many unexplained cases.201324265690
surface-layer protein a (slpa) is a major contributor to host-cell adherence of clostridium difficile.clostridium difficile is a leading cause of antibiotic-associated diarrhea, and a significant etiologic agent of healthcare-associated infections. the mechanisms of attachment and host colonization of c. difficile are not well defined. we hypothesize that non-toxin bacterial factors, especially those facilitating the interaction of c. difficile with the host gut, contribute to the initiation of c. difficile infection. in this work, we optimized a completely anaerobic, quantitative, epithelial-ce ...201324265687
pseudomembranous colitis associated with a triple therapy for helicobacter pylori eradication.helicobacter pylori (h. pylori) is one of the most common chronic bacterial infections in humans, affecting half of world's population. therapy for h. pylori infection has proven to be both effective and safe. the one-week triple therapy including proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate h. pylori infection in countries with low clarithromycin resistance. generally, this therapy is well-tolerated, with onl ...201324259981
mortality following rasburicase-induced methemoglobinemia.to report a case of mortality following rasburicase-induced methemoglobinemia.201324259700
more nutritional research needed to prevent and treat clostridium difficile infections. 201324192962
editorial: ppis and recurrent c. difficile infection: no association?a rigorously conducted cohort study published in this edition of the american journal of gastroenterology shows that the use of a proton-pump inhibitor is not associated with recurrent clostridium difficile infection among hospitalized patients. this contradicts the findings of previous studies that, however, were at a high risk of bias. where does the truth lie? regardless of the answer, it is important that proton-pump inhibitors, not dissimilar to any other drug, are used appropriately.201324192949
gastrointestinal infections, active component, u.s. armed forces, 2002-2012.acute gastroenteritis and other infectious disorders of the gastrointestinal system are common in civilian and military populations. during the years 2002 through 2012, there were 286,305 cases of gastrointestinal infection (gi) diagnosed among members of the active component of the u.s. armed forces. the distribution of presumed causes of these illnesses (as reported in administrative medical records) was bacterial (29%), viral (68%), and parasitic (3%). most recorded diagnoses did not specify ...201324191767
spo0a differentially regulates toxin production in evolutionarily diverse strains of clostridium difficile.clostridium difficile is an important pathogen of humans and animals, representing a significant global healthcare problem. the last decade has seen the emergence of epidemic bi/nap1/027 and ribotype 078 isolates, associated with the onset of more severe disease and higher rates of morbidity and mortality. however, little is known about these isolates at the molecular level, partly due to difficulties in the genetic manipulation of these strains. here we report the development of an optimised tn ...201324236153
prospects and challenges for intestinal microbiome therapy in pediatric gastrointestinal disorders.fecal microbiome (microbiota) transplantation is an emerging treatment not only for refractory/recurrent clostridium difficile infections and chronic gastrointestinal diseases, but also for metabolic syndrome, and even possibly for neurological disorders. this non-conventional therapy has been perhaps more appropriately designated as fecal bacteriotherapy (fb) as well. the employment of fb is spreading into pediatric gastroenterology. this focused review highlights the pediatric applications of ...201324244876
bile salt inhibition of host cell damage by clostridium difficile toxins.virulent clostridium difficile strains produce toxin a and/or toxin b that are the etiological agents of diarrhea and pseudomembranous colitis. treatment of c. difficile infections (cdi) has been hampered by resistance to multiple antibiotics, sporulation, emergence of strains with increased virulence, recurrence of the infection, and the lack of drugs that preserve or restore the colonic bacterial flora. as a result, there is new interest in non-antibiotic cdi treatments. the human conjugated b ...201324244530
differential stress transcriptome landscape of historic and recently emerged hypervirulent strains of clostridium difficile strains determined using rna-seq.c. difficile is the most common cause of nosocomial diarrhea in north america and europe. genomes of individual strains of c. difficile are highly divergent. to determine how divergent strains respond to environmental changes, the transcriptomes of two historic and two recently isolated hypervirulent strains were analyzed following nutrient shift and osmotic shock. illumina based rna-seq was used to sequence these transcriptomes. our results reveal that although c. difficile strains contain a la ...201324244315
diarrhoea in the icu: respective contribution of feeding and antibiotics.diarrhoea is frequently reported in the icu. little is known about diarrhoea incidence and the role of the different risk factors alone or in combination. this prospective observational study aims at determining diarrhoea incidence and risk factors in the first 2 weeks of icu stay, focusing on the respective contribution of feeding, antibiotics, and antifungal drugs.201323883438
the identification and epidemiology of meticillin-resistant staphylococcus aureus and clostridium difficile in patient rooms and the ward environment.research has indicated that the environment may play an important role in the transmission of meticillin-resistant staphylococcus aureus (mrsa) and clostridium difficile in healthcare facilities. despite the significance of this finding, few data exist from longitudinal studies investigating mrsa and c. difficile contamination, concurrently, in both patient rooms and the general ward environment. the objectives of this study were to determine the prevalence of mrsa and c. difficile contamination ...201323883171
editorial commentary: looking to the future: vertical vs horizontal prevention of clostridium difficile infections. 201323881152
use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in clostridium difficile transmission.previous studies have suggested that asymptomatic carriers of toxigenic clostridium difficile are a source of hospital-associated (ha) infections. multilocus variable number of tandem repeats analysis (mlva) is a highly discriminatory molecular subtyping tool that helps to determine possible transmission sources.201323881150
a surview of recent patents on anti-infective therapy for clostridium difficile.clostridium difficile has become the most common infectious cause of healthcare-associated diarrhea, with serious morbidity, prolonged hospitalization and even death. treatment of the disease utilizing today's therapies does not guarantee a successful outcome. in the past decade, many new ideas and inventions have surfaced exploring different treatment strategies of clostridium difficile associated diarrhea (cdad). these treatments include antitoxins, novel antimicrobials, immunoglobulins and la ...201323879822
[infections caused by clostridium difficile. addendum]. 201323876975
comparison of treatment outcomes with vancomycin alone versus combination therapy in severe clostridium difficile infection.the recommended treatment for severe clostridium difficile infection (cdi) is oral vancomycin alone. combination therapy with metronidazole is only recommended in cases complicated by shock, ileus, or toxic megacolon. however, patients with severe infection are often treated with combination therapy despite a lack of data supporting this practice.201323876778
[clostridium difficile infection: epidemiology, disease burden and therapy].c. difficile causes 25 percent of the antibiotic associated infectious nosocomial diarrhoeas. c. difficile infection is a high-priority problem of public health in each country. the available literature of c. difficile infection's epidemiology and disease burden is limited.201323876616
high prevalence of the epidemic clostridium difficile pcr ribotype 078 in iberian free-range pigs.previous studies in intensively raised piglets have detected a high prevalence of the epidemic clostridium difficile pcr ribotype 078. in this article we present a longitudinal survey of c. difficile colonisation in a population of iberian pigs reared under a free-range system. a total of 160 faecal samples from 20 piglets belonging to different litters were obtained by weekly sampling. c. difficile was recovered from samples collected at different times throughout the survey from a 90% of pigle ...201323876331
infections and inflammatory bowel disease: challenges in asia.the diagnosis and management of inflammatory bowel disease (ibd) in asia can be challenging as certain infections can mimic ibd and lead to a misdiagnosis. colitis can be caused by bacterial infections, ileitis can result from yersinia and salmonella infections and ileocolonic ulcers can be seen in intestinal tuberculosis and amebiasis. in addition, cytomegalovirus and clostridium difficile infection may mimic a flare of ibd and their presence is associated with an increased risk of colectomy an ...201323875824
the complex dynamics of antimicrobial activity in the human gastrointestinal tract.the human gastrointestinal tract is a complex environment of mutualistic associations. as bacteria form a major component of fecal content, the natural balance of the colon can be significantly altered by exposure to antimicrobial agents. however, the effects of antimicrobial therapy on fecal content are difficult to predict and can at times be quite surprising. the emergence and spread of vancomycin-resistant enterococci are cases in point. resistance to the glycopeptide vancomycin emerged in e ...201323874016
identification and characterization of clostridium sordellii toxin gene regulator.toxigenic clostridium sordellii causes uncommon but highly lethal infections in humans and animals. recently, an increased incidence of c. sordellii infections has been reported in women undergoing obstetric interventions. pathogenic strains of c. sordellii produce numerous virulence factors, including sordellilysin, phospholipase, neuraminidase, and two large clostridial glucosylating toxins, tcsl and tcsh. recent studies have demonstrated that tcsl toxin is an essential virulence factor for th ...201323873908
fulminant clostridium difficile colitis: a complication of perioperative antibiotic prophylaxis.antibiotic prophylaxis for maxillofacial surgical wounds remains common practice. surgeons must weigh the risks (e.g., clostridium difficile colitis) against the benefits before administering antibiotics for any reason and the relative risk and morbidity of c difficile colitis against those of a potential postoperative wound infection. in addition, the possibility of c difficile infection as a complication of perioperative antibiotic prophylaxis should be discussed with patients before surgery, ...201323871314
reducing health care-associated infections: patients want to be engaged and learn about infection prevention.multidrug-resistant organisms (mdros) are common in health care-associated infection (hai). the aim of this study was to examine patient's willingness to learn about mdros and hais and their preferred ways of education about mdro hais.201323870794
disruption of intrinsic motions as a mechanism for enzyme inhibition.clostridium difficile (c. diff) is one of the most common and most severe hospital-acquired infections; its consequences range from lengthened hospital stay to outright lethality. c. diff causes cellular damage through the action of two large toxins tcda and tcdb. recently, there has been increased effort toward developing antitoxin therapies, rather than antibacterial treatments, in hopes of mitigating the acquisition of drug resistance. to date, no analysis of the recognition mechanism of tcda ...201323870270
fecal transplantation for recurrent clostridium difficile infection in older adults: a review.recurrent clostridium difficile infection (cdi) is a common nosocomial infection that has a large effect on morbidity and quality of life in older adults in hospitals and long-term care facilities. because antibiotics are often unsuccessful in curing this disease, fecal transplantation has emerged as a second-line therapy for treatment of recurrent cdi. a comprehensive literature search of pubmed, embase, and web of science regarding fecal transplantation for cdi was performed to further evaluat ...201323869970
indeterminate tcdb using a clostridium difficile pcr assay: a retrospective cohort study.c. difficile (cd) real-time polymerase chain reaction (pcr) for toxin b gene (tcdb) is more sensitive, and reduces turnaround time when compared to toxin immunoassay. we noted typical amplification curves with high tcdb cycle thresholds (ct) and low endpoints (ept) that are labeled negative by the xpert(®) c. difficile assay (cepheid) and undertook this study to determine their significance.201323865713
clostridium difficile infection: a multicenter study of epidemiology and outcomes in mechanically ventilated patients.clostridium difficile is a leading cause of hospital-associated infection in the united states. the purpose of this study is to assess the prevalence of c. difficile infection among mechanically ventilated patients within the icus of three academic hospitals and secondarily describe the influence of c. difficile infection on the outcomes of these patients.201323863229
comparison of perirectal versus rectal swabs for detection of asymptomatic carriers of toxigenic clostridium difficile.for long-term care and spinal cord injury patients, the sensitivity, specificity, and positive and negative predictive values of perirectal versus rectal cultures for detection of asymptomatic carriers of clostridium difficile were 95%, 100%, 100%, and 97%, respectively. perirectal cultures provide an accurate method to detect asymptomatic carriers of c. difficile.201323926162
fecal transplantation for the treatment of recurrent clostridium difficile infection.clostridium difficile infection (cdi) is currently a leading cause of antibiotic and health care-related diarrhea. the incidence and the severity of cdi-related diarrhea have increased dramatically in the usa and europe in the past few decades. the emergence of multidrug-resistant hypervirulent strains of c. difficile has led to an increase in mortality. fecal microbiota transplantation (fmt) (also known as fecal bacteriotherapy) has been utilized sporadically since the 1950s; and currently, the ...201323923106
clostridium difficile modulates host innate immunity via toxin-independent and dependent mechanism(s).clostridium difficile infection (cdi) is the leading cause of hospital and community-acquired antibiotic-associated diarrhoea and currently represents a significant health burden. although the role and contribution of c. difficile toxins to disease pathogenesis is being increasingly understood, at present other facets of c. difficile-host interactions, in particular, bacterial-driven effects on host immunity remain less studied. using an ex-vivo model of infection, we report that the human gastr ...201323922820
stool therapy may become a preferred treatment of recurrent clostridium difficile?fecal enemas were first reported to successfully treat life threatening enterocolitis in 1958, but fecal therapy to treat clostridium difficile (c. difficile) infection has remained esoteric and not well investigated until recently. in the past few years, systematic reviews of case series and case reports of fecal microbiota transplant for recurrent c. difficile infection have become available and validate use of fecal transplant for c. difficile enterocolitis. methods of fecal transplant report ...201323922461
antidepressant drugs and infectious disease.clostridium difficile (c.difficile) infection (cdi) is a common and clinically significant cause of diarrhea associated with the use of antibiotic drugs. two observational studies have suggested that antidepressant drug use is associated with an increased risk of developing cdi. because of the potential public health significance of this finding, this article critically evaluates the methodology of these studies and provides evidence to question the plausibility and validity of this finding. the ...201323919230
detection of mixed populations of clostridium difficile from symptomatic patients using capillary-based polymerase chain reaction ribotyping.to investigate the simultaneous occurrence of more than 1 clostridium difficile ribotype in patients' stool samples at the time of diagnostic testing.201323917911
evaluation of a commercial real-time polymerase chain reaction assay for detection of environmental contamination with clostridium difficile.contaminated environmental surfaces are an important source for transmission of clostridium difficile. however, there are no efficient and easy methods to assess contamination. the performance of a commercial real-time polymerase chain reaction (pcr) assay was evaluated for detection of environmental toxigenic c. difficile in comparison with anaerobic culture followed by toxin testing of isolates. for 66 sites sampled, pcr had a sensitivity of 17.39%, specificity 100%, positive predictive value ...201323916890
clostridium difficile infection after adult autologous stem cell transplantation: a multicenter study of epidemiology and risk factors.we sought to describe the epidemiology of clostridium difficile infection (cdi) among adult recipients of autologous hematopoietic stem cell transplantation (auto-hsct) within the first year after hsct in centers with variable epidemiology of hypertoxigenic strains. a multicenter, retrospective nested case-control study was conducted among 873 auto-hsct recipients at johns hopkins hospital (jhh) and hôpital maisonneuve-rosemont (hmr) between january 2003 and december 2008. despite center differe ...201323916741
is the prevalence of clostridium difficile in animals underestimated?reported prevalence rates of clostridium difficile infection in animals differ considerably depending on the nature of the study and the population surveyed. the methods used to recover this organism from faecal samples may account for some of the prevalence variation. the objective of this study was to assess the performance of two different methods of detecting c. difficile in animal faeces in comparison with a conventional isolation procedure ('ethanol shock' of faecal samples followed by cul ...201323911042
fecal microbiota transplant for recurrent clostridium difficile infection: mayo clinic in arizona experience.to report the initial experience of treating recurrent clostridium difficile infection (cdi) with fecal microbiota transplant (fmt) at mayo clinic in arizona.201323910407
influence of cohorting patients with clostridium difficile infection on risk of symptomatic recurrence.cohorting of patients with clostridium difficile infection (cdi) is recommended when single side-rooms are unavailable. although patients may remain infectious after cessation of diarrhoea, continued cohorting may place them at increased risk of reinfection.201323910403
temporal phenome analysis of a large electronic health record cohort enables identification of hospital-acquired complications.to develop methods for visual analysis of temporal phenotype data available through electronic health records (ehr).201323907284
[laboratory diagnosis of clostridium difficile infection].for the diagnosis of clostridium difficile infection (cdi), it is necessary to obtain microbiological evidence of toxigenic c. difficile with a compatible clinical picture (diarrhoea or ileus). two gold standards exist: cell culture cytotoxicity neutralization assay (specific, but less sensitive than previously acknowledged) and toxigenic culture (very sensitive but less specific because it also detects asymptomatic colonization). these gold standards are not used routinely because at least 2 or ...201323906566
molecular epidemiology of clostridium difficile infection in a major chinese hospital: an underrecognized problem in asia?clostridium difficile infection is almost unrecognized in mainland china. we have undertaken a study in a large chinese teaching hospital in changsha, hunan, china, to identify cases of c. difficile, record patient characteristics, and define the molecular epidemiology with respect to ribotype distribution and cross-infection. between april 2009 and february 2010, we examined fecal samples from 70 hospitalized patients with diarrhea who were receiving or had received antibiotics within the previ ...201323903542
[largest eu prevalence studies of clostridium difficile infection reveals that perhaps more than one-fifth of the patient are wrongly diagnosed]. 201323901614
establishment of the intestinal microbiota and its role for atopic dermatitis in early childhood.perturbations in the intestinal microbiota may disrupt mechanisms involved in the development of immunologic tolerance. the present study aimed to examine the establishment of the infant microbiota and its association to the development of atopic dermatitis (ad).201323900058
effect of nucleic acid amplification testing on population-based incidence rates of clostridium difficile infection.nucleic acid amplification testing (naat) is increasingly being adopted for diagnosis of clostridium difficile infection (cdi). data from 3 states conducting population-based cdi surveillance showed increases ranging from 43% to 67% in cdi incidence attributable to changing from toxin enzyme immunoassays to naat. cdi surveillance requires adjustment for testing methods.201323899677
alteration of intestinal dysbiosis by fecal microbiota transplantation does not induce remission in patients with chronic active ulcerative colitis.in patients with ulcerative colitis (uc), alterations of the intestinal microbiota, termed dysbiosis, have been postulated to contribute to intestinal inflammation. fecal microbiota transplantation (fmt) has been used as effective therapy for recurrent clostridium difficile colitis also caused by dysbiosis. the aims of the present study were to investigate if patients with uc benefit from fmt and if dysbiosis can be reversed.201323899544
in vivo physiological and transcriptional profiling reveals host responses to clostridium difficile toxin a and toxin b.toxin a (tcda) and toxin b (tcdb) of clostridium difficile cause gross pathological changes (e.g., inflammation, secretion, and diarrhea) in the infected host, yet the molecular and cellular pathways leading to observed host responses are poorly understood. to address this gap, we evaluated the effects of single doses of tcda and/or tcdb injected into the ceca of mice, and several endpoints were analyzed, including tissue pathology, neutrophil infiltration, epithelial-layer gene expression, chem ...201323897615
clostridium difficile colitis: is severity increased with previous appendectomy? 201323896227
outpatient healthcare settings and transmission of clostridium difficile.recent reports suggest that community-associated clostridium difficile infection (cdi) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. we hypothesized that outpatient clinics could be an important source for acquisition of community-associated cdi.201323894609
inappropriate use of antibiotics and clostridium difficile infection.we assessed appropriateness of preceding and concurrent antibiotics in 126 consecutive patients with hospital-associated clostridium difficile infection. in 93 (73.8%) episodes, at least 1 preceding course of antibiotics was inappropriate. we provided feedback on concurrent antibiotics on the day of diagnosis during the final 8 months: 17 of 74 (23.0%) patients were on inappropriate antibiotics. our recommendations were well received. reviewing c difficile-infected patients allowed for identific ...201323932828
lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and clostridium difficile diarrhoea in older inpatients (placide): a randomised, double-blind, placebo-controlled, multicentre trial.antibiotic-associated diarrhoea (aad) occurs most frequently in older (≥65 years) inpatients exposed to broad-spectrum antibiotics. when caused by clostridium difficile, aad can result in life-threatening illness. although underlying disease mechanisms are not well understood, microbial preparations have been assessed in the prevention of aad. however, studies have been mostly small single-centre trials with varying quality, providing insufficient data to reliably assess effectiveness. we aimed ...201323932219
advanced techniques for detection and identification of microbial agents of gastroenteritis.gastroenteritis persists as a worldwide problem, responsible for approximately 2 million deaths annually. traditional diagnostic methods used in the clinical microbiology laboratory include a myriad of tests, such as culture, microscopy, and immunodiagnostics, which can be labor intensive and suffer from long turnaround times and, in some cases, poor sensitivity. [corrected]. this article reviews recent advances in genomic and proteomic technologies that have been applied to the detection and id ...201323931837
impact of adding prophylactic probiotics to a bundle of standard preventative measures for clostridium difficile infections: enhanced and sustained decrease in the incidence and severity of infection at a community hospital.in 2003, hospitals in quebec, canada experienced an increase of nap1/027 clostridium difficile infections following antibiotic administration (cdiaa). at pierre-le gardeur hospital (plgh), the incidence increased from 10 to over 25 cases per 1000 patient admissions.201323931498
treatment of an initial infection with clostridium difficile in patients with inflammatory bowel disease.: although the incidence of clostridium difficile-associated diarrhea in the general population has increased dramatically over the past decade, an even greater rate of infection exists in patients with inflammatory bowel disease. susceptibility in this population is likely inherent to the pathophysiology and treatment of these diseases. c. difficile infection can cause serious complications and death. consequently, early diagnosis and initiation of effective antibacterial therapy is imperative. ...201323929262
healthcare-associated infections studies project: an american journal of infection control and national healthcare safety network data quality collaboration-labid clostridium difficile event 2013.this is the first in a series of case studies that will be published in american journal of infection control following the centers for disease control and prevention/national healthcare safety network (nhsn) surveillance definition update of 2013. these cases reflect some of the complex patient scenarios infection professionals encounter during daily surveillance of health care-associated infections using nhsn definitions. answers to the questions posed and immediate feedback in the form of ans ...201323928030
perils and pitfalls of long-term effects of proton pump inhibitors.this review summarizes the literature regarding long-term adverse effects of proton pump inhibitors (ppis). a pubmed search (1966 to february 2013) for english language studies was conducted using key terms ppi: omeprazole, esomeprazole, pantoprazole, lansoprazole, dexlansoprazole, rabeprazole, pneumonia, clostridium difficile, osteoporosis, risk of fractures, thrombocytopenia, rhabdomyolysis, anemia, iron deficiency, hypomagnesemia, vitamin b₁₂ and nephritis. the risk of pneumonia was increased ...201323927671
analysis of metabolic evolution in bacteria using whole-genome metabolic models.recent advances in the automation of metabolic model reconstruction have led to the availability of draft-quality metabolic models (predicted reaction complements) for multiple bacterial species. these reaction complements can be considered as trait representations and can be used for ancestral state reconstruction to infer the most likely metabolic complements of common ancestors of all bacteria with generated metabolic models. we present here an ancestral state reconstruction for 141 extant ba ...201323992299
clostridium difficile infection in the twenty-first century.clostridium difficile is a spore-forming gram-positive bacillus, and the leading cause of antibiotic-associated nosocomial diarrhea and colitis in the industrialized world. with the emergence of a hypervirulent strain of c. difficile (bi/nap1/027), the epidemiology of c. difficile infection has rapidly changed in the last decade. c. difficile infection, once thought to be an easy to treat bacterial infection, has evolved into an epidemic that is associated with a high rate of mortality, causing ...201326038491
effects of nitric oxide and reactive oxygen species on hif-1α stabilization following clostridium difficile toxin exposure of the caco-2 epithelial cell line.stabilization of the hypoxia-inducible factor (hif-1α) is proposed to provide a protective host-response to c. difficile intoxication. here, we aimed to elucidate whether nitric oxide and/or reactive oxygen species produced during c. difficile toxin exposure could influence hif-1α stability and initiate protection against epithelial cell damage.201323988581
[include representations of caregivers coping with nosocomial clostridium difficile in quebec to promote better health]. 201323986384
alerting physicians during electronic order entry effectively reduces unnecessary repeat pcr testing for clostridium difficile.hospital information systems (his) alerts restricting repeat clostridium difficile pcr ordering by physicians in patients with a prior result within 7 days eliminated 91% of repeat tests, from 14.5% (282/1,949) repeats preintervention to 1.3% (135/10,285) postintervention. his alerting is an effective, targeted, patient-specific tool for improving the quality and utilization of c. difficile results.201323985918
fulminant clostridium difficile infection: an association with prior appendectomy?to examine if fulminant clostridium difficile infections (cdi) resulting in colectomy was associated with a prior appendectomy and whether any association affected the severity of the disease.201323983904
fecal transplantation: re-discovering the value of stool.for over 1000 years, stool in various forms has been used to treat disease. within the past few decades, fecal infusion either rectally or via a nasogastric tube has become a viable option for the treatment of refractory clostridium difficile infection (cdi), and, more recently, it has shown promise in treating inflammatory bowel disease (ibd) and metabolic disease. the purpose of this article is to review the use of feces as a treatment option in pediatric disease.201323995428
leukemoid reaction: spectrum and prognosis of 173 adult patients.the prognosis of patients with leukemoid reaction (lr) depends mainly on their underlying illness. our aim was to investigate the etiologies and prognosis of a mixed group of patients with lr.201323994818
multifocal clinical performance improvement across 21 hospitals.improving quality and safety across an entire healthcare system in multiple clinical areas within a short time frame is challenging. we describe our experience with improving inpatient quality and safety at kaiser permanente northern california. the foundations of performance improvement are a "four-wheel drive" approach and a comprehensive driver diagram linking improvement goals to focal areas. by the end of 2011, substantial improvements occurred in hospital-acquired infections (central-line- ...201324001267
clostridium difficile antibodies: a patent evaluation (wo2013028810).incidence and severity of clostridium difficile infection (cdi) are increasing worldwide. toxins a (tcda) and b (tcdb) and host immune response are the major determinates of cd pathogenesis and represent a new, stimulating therapeutic target to control cdi.201323978053
fidaxomicin: a minimally absorbed macrocyclic antibiotic for the treatment of clostridium difficile infections.fidaxomicin was approved for the treatment of clostridium difficile infections in 2011. it has a novel mechanism of action and narrow spectrum of activity that makes it unique among the currently used therapies for this disease. phase iii clinical studies demonstrated a benefit of fidaxomicin over vancomycin for the outcomes of recurrence and global cure or sustained clinical response. this observation was confirmed within specific populations, including those of older age, immunocompromised due ...201323977933
clostridium difficile infection caused by binary toxin-positive strains. 201323977836
current status of surgical treatment for fulminant clostridium difficile colitis.mortality rates attributable to fulminant clostridium difficile (c. difficile) colitis remain high and are reported to be 38%-80%. historically, the threshold for surgical intervention has been judged empirically because level i evidence to guide decision making is lacking. studies of the surgical management of c. difficile infection have been limited by small sample size and the lack of a standard definition of fulminancy. multiple small and medium-sized series have examined the surgical manage ...201323977418
[drug therapy of infectious diarrhea: part 1: acute diarrhea].diarrhea is one of the most commonly occurring diseases.201323974914
investigating the candidacy of a lipoteichoic acid-based glycoconjugate as a vaccine to combat clostridium difficile infection.a lipoteichoic acid has recently been shown to be conserved in the majority of strains from clostridium difficile and as such is being considered as a possible vaccine antigen. in this study we examine the candidacy of the conserved lipoteichoic acid by demonstrating that it is possible to elicit antibodies against c. difficile strains following immunisation of rabbits and mice with glycoconjugates elaborating the conserved lipoteichoic acid antigen. the present study describes a conjugation str ...201323974722
presence of clostridium difficile in pigs and cattle intestinal contents and carcass contamination at the slaughterhouse in belgium.the objective of this study was to evaluate the presence of clostridium difficile in intestinal and carcass samples collected from pigs and cattle at a single slaughterhouse. c. difficile was isolated in 1% and 9.9% of the pig and cattle intestinal contents and in 7.9% and 7% of cattle and pig carcass samples respectively. a total of 19 different pcr-ribotypes were identified, among them types 078 and 014. seven of 19 ribotypes correlated with the pcr-ribotypes involved in human c. difficile inf ...201323973837
[clostridium difficile infection: epidemiology, risk factors, pathogenesis, clinical features, diagnosis and therapy].clostridium difficile is a gram-positive, spore-forming anaerobic bacterium. c.difficile is the leading cause of antibiotic associated diarrhea and colitis. the clinical spectrum of c.difficile infection (cdi) is highly variable, ranging from mild diarrhea to severe forms of intestinal illness including toxic megacolon, ileus, bowel perforation, and pseudomembranous colitis. advanced age, long duration of hospitalization, and exposure to certain antimicrobial agents are the most common risk fact ...201323971935
fecal transplant for recurrent clostridium difficile infection.clostridium difficile infection (cdi) results in clinical manifestations ranging from mild diarrhea to life-threatening pseudomembranous colitis. infection is most often initiated by antimicrobial therapy which causes an imbalance in normal colonic microflora. the pathogenesis of c. difficile is predominantly controlled by the production of its two cytotoxins, a and b, which damage the intestinal mucosa. in recent years a nationwide increase in the rate of cdi has been noted as well as an increa ...201323967542
one-day point prevalence of emerging bacterial pathogens in a nationwide sample of 62 german hospitals in 2012 and comparison with the results of the one-day point prevalence of 2010.antibiotic resistance of bacterial pathogens is an emerging problem worldwide. to combat multidrug resistant organisms (mrdos) networks of care providers have been established in all states in germany. the hicare-network, a project to combat mrdos, founded by the federal ministry of education and research, has published data from 2010 of a voluntary, german-wide, multicenter point-prevalence survey in 2011 conducted in collaboration with the german society of hospital hygiene. the aim of the pre ...201323967398
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