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correlation between clostridium difficile bacterial load, commercial real-time pcr cycle thresholds, and results of diagnostic tests based on enzyme immunoassay and cell culture cytotoxicity assay.the impact of clostridium difficile fecal loads on diagnostic test results is poorly understood, but it may have clinical importance. in this study, we investigated the relationship between c. difficile fecal load and the results of four assays: a glutamate dehydrogenase (gdh) enzyme immunoassay (eia), a toxin a/b antigen eia (toxab), a cell culture cytotoxicity assay (cca), and pcr targeting the tcdb gene. we also compared the pcr cycle threshold (ct) with the results of quantitative culture us ...201323966497
fecal microbiota transplantation and emerging treatments for clostridium difficile infection.due to the increased incidence and recurrence of clostridium difficile infection, health care providers are seeking new and alternative treatments to the standard antibiotic therapy. the objective of this article is to present a review on the background, microbiologic efficacy, clinical efficacy, and safety of fecal microbiota transplantation and to provide an overview of emerging treatment options currently under investigation. emerging treatment options discussed include the use of monoclonal ...201323966282
acute gastroenteritis.acute gastroenteritis is a common infectious disease syndrome, causing a combination of nausea, vomiting, diarrhea, and abdominal pain. there are more than 350 million cases of acute gastroenteritis in the united states annually and 48 million of these cases are caused by foodborne bacteria. traveler's diarrhea affects more than half of people traveling from developed countries to developing countries. in adult and pediatric patients, the prevalence of clostridium difficile is increasing. contac ...201323958366
asymptomatic carriage of toxigenic clostridium difficile by hospitalized patients.asymptomatic carriage of clostridium difficile is common in hospitals, but the risk for transmission by carriers is unclear. in this point prevalence culture survey of asymptomatic hospitalized patients, 18 of 149 (12%) were carriers of toxigenic c. difficile. by comparison with c. difficile infection (cdi) patients, the prevalence of skin and/or environmental contamination was significantly lower in asymptomatic carriers (3/18, 17% versus 5/6, 83%; p = 0.007), but carriers outnumbered cdi patie ...201323954113
clostridium difficile infection after lung transplantation: are we really doing everything possible? 201323953917
is clostridium difficile infection influenced by antimicrobial use density in wards?this study was performed to elucidate the relationship between antimicrobial use density (aud) and clostridium difficile infection (cdi) manifesting as antimicrobial-associated diarrhea (aad) in hospital wards during a 4-year period. case definition of cdi was an adult exhibiting aad with a daily stool frequency of three or more, arising at least 48 hours after ward admission, and fecal samples testing positive for toxin (a and/or b). metronidazole or vancomycin was orally administered as treatm ...201323951727
clostridium difficile--special collection. 201323950217
clostridium difficile exposure as an insidious source of infection in healthcare settings: an epidemiological model.clostridium difficile is the leading cause of infectious diarrhea in hospitalized patients. its epidemiology has shifted in recent years from almost exclusively infecting elderly patients in whom the gut microbiota has been disturbed by antimicrobials, to now also infecting individuals of all age groups with no recent antimicrobial use.201323947736
severe hemorrhagic colitis in a patient with chronic myeloid leukemia in the blastic phase after dasatinib use.dasatinib is a second-line tyrosine kinase inhibitor used in patients with imatinib resistant or intolerant chronic myeloid leukemia (cml) and philadelphia chromosome-positive acute leukemia. gastrointestinal bleeding may occur in up to 7% of patients using dasatinib, although, severe dasatinib-related acute colitis had rarely been reported. here, we present the case of a 36-year-old female who progressed to acute myeloid leukemia after fourteen months of receiving imatinib for cml in the chroni ...201323946889
antimicrobial stewardship and clostridium difficile-associated diarrhea.antimicrobial stewardship programs are essential to health care institutions to promote the appropriate use of antibiotics not only to decrease antimicrobial resistance but to prevent the spread and infection of clostridium difficile. clostridium difficile-associated diarrhea is increasing rapidly in the united states and is now considered a major public health problem that poses an immediate threat to the health of patients prescribed antibiotics, more so than antimicrobial resistance. clostrid ...201323946208
[severe eosinophilia in a patient with clostridium colitis and gastric cancer].a case of a 77-year-old male repeatedly hospitalized with the diagnosis of clostridium difficile colitis associated with eosinophilia is presented. the percentage and number of eosinophils achieved maximal values (54 %, 5.4 times 1.000.000.000/l) during repeated treatment with metronidazole. eosinophilia was accompanied by significant elevation of serum ige and presence of charcot-leyden crystals in stool. helminth infections and hemoblastosis were ruled out as the cause and a working diagnosis ...201323945831
evaluation of a new immunochromatography test for rapid and simultaneous detection of clostridium difficile antigen and toxins.clostridium difficile infection is considered the most common cause of nosocomial infectious diarrhea among adults in the developed world. it is responsible for virtually all cases of pseudomembranous colitis. the tox a/b enzyme immunoassay (eia) is the most widely used test for the detection of c. difficile toxins a and b. however, it is associated with poor sensitivity and an unacceptable high rate of false-negative results.201323943984
recurrent clostridium difficile infection. 201323943969
antimicrobial selection and its impact on the incidence of clostridium difficile-associated diarrhea.the study objective was to determine which antimicrobials place patients at a higher risk for clostridium difficile-associated diarrhea (cdad) and which interventions can reduce their risk. all patients with diarrhea and a positive toxin assay for clostridium difficile for 3 months were included in the study. patients were broken down into either community-acquired infection or health care-associated infection based on symptom onset, antibiotic usage prior to admission, and where the patient was ...201323940122
the role of vancomycin and metronidazole for the treatment of clostridium difficile-associated diarrhea.for the treatment of clostridium difficile-associated diarrhea (cdad), metronidazole and vancomycin remain the most commonly used agents. the major advantage of metronidazole is its low cost, while the advantage of oral vancomycin is a more favorable pharmacokinetic profile. the epidemiology and clinical severity of cdad have changed due to the emergence of a hypervirulent strain (bi/nap1/027). in 2010, the infectious diseases society of america/society for health care epidemiology of america ex ...201323940121
nontoxigenic clostridium difficile protects hamsters against challenge with historic and epidemic strains of toxigenic bi/nap1/027 c. difficile.nontoxigenic clostridium difficile (ntcd) has been shown to prevent fatal c. difficile infection in the hamster model when hamsters are challenged with standard toxigenic c. difficile strains. the purpose of this study was to determine if ntcd can prevent c. difficile infection in the hamster model when hamsters are challenged with restriction endonuclease analysis group bi c. difficile strains. groups of 10 hamsters were given oral clindamycin, followed on day 2 by 10(6) cfu of spores of ntcd s ...201323939887
depression and use of antidepressants is associated with increased risk of clostridium difficile infection. 201323939678
risk factors of fecal toxigenic or non-toxigenic clostridium difficile colonization: impact of toll-like receptor polymorphisms and prior antibiotic exposure.this study is to investigate the significance and risk factors of fecal toxigenic (tcdc) or non-toxigenic clostridium difficile colonization (ntcdc) among hospitalized patients.201323936050
clostridium difficile 027/bi/nap1 encodes a hypertoxic and antigenically variable form of tcdb.the clostridium difficile exotoxin, tcdb, which is a major virulence factor, varies between strains of this pathogen. herein, we show that tcdb from the epidemic bi/nap1/027 strain of c. difficile is more lethal, causes more extensive brain hemorrhage, and is antigenically variable from tcdb produced by previously studied strains of this pathogen (tcdb003). in mouse intoxication assays, tcdb from a ribotype 027 strain (tcdb027) was at least four fold more lethal than tcdb003. tcdb027 caused a pr ...201323935501
probiotics for the prevention of clostridium difficile. 201324029510
clostridium difficile genotypes in piglet populations in germany.clostridium difficile was isolated from 147 of 201 (73%) rectal swabs of piglets from 15 farms of lower saxony and north rhine-westphalia. in 14 farms, 14 to 100% (mean, 78%) of the animals tested were culture positive. the rate of isolation was 68% postpartum, increased to 94% in animals 2 to 14 days of age, and declined to 0% for animals 49 days of age and older. there was no link between isolation and antibiotic treatment or diarrhea of piglets. strains were assigned to 10 pcr ribotypes, and ...201324025903
fate of ingested clostridium difficile spores in mice.clostridium difficile infection (cdi) is a leading cause of antibiotic-associated diarrhea, a major nosocomial complication. the infective form of c. difficile is the spore, a dormant and resistant structure that forms under stress. although spore germination is the first committed step in cdi onset, the temporal and spatial distribution of ingested c. difficile spores is not clearly understood. we recently reported that camsa, a synthetic bile salt analog, inhibits c. difficile spore germinatio ...201324023628
risk factors for clostridium difficile-associated diarrhea and the effectiveness of prophylactic probiotic therapy.measures for prevention of clostridium difficile-associated diarrhea, a common nosocomial infection, in hospital settings are urgently needed. this study was conducted to identify the risk factors contributing to c. difficile-associated diarrhea and to evaluate the clinical benefit of probiotics in its prevention. the study included 2716 patients at least 20 years old who received an injected antibiotic at any time between february 2010 and february 2011; a total of 2687 patients (98.9%) were as ...201324020129
does organic material on hospital surfaces reduce the effectiveness of hypochlorite and uv radiation for disinfection of clostridium difficile?an organic load of 5%-10% fetal calf serum significantly reduced hypochlorite and uv radiation killing of clostridium difficile spores, but organic material collected from hospital surfaces did not affect hypochlorite and only modestly affected uv killing of spores. hypochlorite reduced aerobic microorganisms on unclean surfaces with no wiping.201324018930
a systematic literature review and meta-analysis of factors associated with methicillin-resistant staphylococcus aureus colonization at time of hospital or intensive care unit admission.screening for methicillin-resistant staphylococcus aureus (mrsa) in high-risk patients is a legislative mandate in 9 us states and has been adopted by many hospitals. definitions of high risk differ among hospitals and state laws. a systematic evaluation of factors associated with colonization is lacking. we performed a systematic review of the literature to assess factors associated with mrsa colonization at hospital admission.201324018925
bed occupancy rates and hospital-acquired clostridium difficile infection: a cohort study.an emergent strain (ribotype 027) of clostridium difficile infection (cdi) has been implicated in epidemics worldwide. organizational factors such as bed occupancy have been associated with an increased incidence of cdi; however, the data are sparse, and the association has not been widely demonstrated. we investigated the association of bed occupancy and cdi within a large hospital organization in the united kingdom.201324018923
impact of change to molecular testing for clostridium difficile infection on healthcare facility-associated incidence rates.change from nonmolecular to molecular testing techniques is thought to contribute to the increasing trend in incidence of clostridium difficile infection (cdi); however the degree of effect attributed to this versus other time-related epidemiologic factors is unclear.201324018922
multiplex pcr targeting slpa: a rapid screening method to predict common clostridium difficile ribotypes among fluoroquinolone resistant clinical strains.based on the relationship between clostridium difficile surface layer protein a (slpa) sequence types (sts) and pcr-ribotypes (rts), a multiplex polymerase chain reaction (mpcr) assay was developed to rapidly confirm c. difficile toxigenicity and, simultaneously, to identify any of five slpa sts, gr, hr, fr, gc8 and 078, that usually correspond with globally distributed rts, 001, 014, 017, 027 and 078, respectively.201324018815
therapeutic potential of fecal microbiota transplantation.there has been growing interest in the use of fecal microbiota for the treatment of patients with chronic gastrointestinal infections and inflammatory bowel diseases. lately, there has also been interest in its therapeutic potential for cardiometabolic, autoimmune, and other extraintestinal conditions that were not previously considered to be associated with the intestinal microbiota. although it is not clear if changes in the microbiota cause these conditions, we review the most current and bes ...201324018052
detection of clostridium sordellii strains expressing hemorrhagic toxin (tcsh) and implications for diagnostics and regulation of veterinary vaccines.clostridium sordellii is a gram positive anaerobic bacterium that causes multiple disease syndromes in both humans and animals. as with many clostridial pathogens, toxins contribute to the virulence of c. sordellii. two large toxins have been identified: a lethal toxin (tcsl) and a hemorrhagic toxin (tcsh) which are similar in structure and function to clostridium difficile toxin b (tcdb) and toxin a (tcda), respectively. while tcda, tcdb, and tcsl have been extensively studied, relatively littl ...201324016805
treatment approaches including fecal microbiota transplantation for recurrent clostridium difficile infection (rcdi) among infectious disease physicians.clostridium difficile infection (cdi) was the most common nosocomial infection in the u.s. in 2010. most cases of cdi respond to a standard course of antibiotics, but recurrent c. difficile infections (rcdi) are increasingly common. given the lack of randomized clinical trials, it is important to understand how infectious disease physicians are managing rcdi to inform future clinical research.201324012687
proton pump inhibitors and the risk for hospital-acquired clostridium difficile infection.to examine the relationship between proton pump inhibitor (ppi) usage and nosocomial clostridium difficile infection (cdi) and determine the duration of therapy at which cdi risk increases.201324012413
fecal microbiota transplantation and donor standardization.clostridium difficile diarrhea is a common and severe infectious disease. antibiotics, which are standard initial treatment, are less effective for treating refractory or recurrent infection. fecal microbiota transplantation, where healthy donor stool is transplanted into a patient, is an alternative to antibiotic therapy that requires standardization for donors and patients.201324012274
transmission of clostridium difficile in foods.clostridium difficile is a human intestinal pathogen most frequently involved in diarrheal illnesses following the administration of antibiotics. there is growing concern that some c difficile infections (cdi) may be acquired from ingestion of c difficile spores in contaminated foods. the number of cdi cases is increasing with a heightening in the severity of disease symptoms and an increasing number of community-associated infections not connected to health care-associated risk. this article pr ...201324011836
intestinal inflammatory biomarkers and outcome in pediatric clostridium difficile infections.to identify specific fecal biomarkers for symptomatic clostridium difficile infection and predictors of poor outcomes.201324011765
clostridium difficile colitis in the united states: a decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy.clostridium difficile colitis (cdc) is a major health concern in the united states (us), with earlier reports demonstrating a rising incidence. studies analyzing predictors for total colectomy and mortality after colectomy are limited by small numbers.201324011436
clostridium difficile colitis induced by long-term low-dosage erythromycin. 201324008746
laboratory diagnosis of clostridium difficile. 201324007916
differences in outcome according to clostridium difficile testing method: a prospective multicentre diagnostic validation study of c difficile infection.diagnosis of clostridium difficile infection is controversial because of many laboratory methods, compounded by two reference methods. cytotoxigenic culture detects toxigenic c difficile and gives a positive result more frequently (eg, because of colonisation, which means that individuals can have the bacterium but no free toxin) than does the cytotoxin assay, which detects preformed toxin in faeces. we aimed to validate the reference methods according to clinical outcomes and to derive an optim ...201324007915
[colitis precipitated by clostridium difficile -  a serious current problem].clostridium difficile is currently considered a significant cause of nosocomial infection. the probability of a colonisation of hospitalised patients rises with the length of their stay in hospital and depends on the local epidemiologic situation. interdisciplinary collaboration is the foundation of the effort to limit the development of this very serious, often fatal disease. the basic element is a rational antibiotic therapy which builds on the knowledge that the administration of antibiotics, ...201324007234
increase in reported clostridium difficile cases as unintended consequence of enhanced norovirus testing. 201324035257
creating the right evidence for system change.most evaluative research is focused on assessing new technologies at the patient level. comparatively little is focused on assessing how system changes could improve the delivery of healthcare. in this article, the authors describe an opportunity to conduct evaluative trials of system changes affordably and efficiently by using a cluster randomized design and mandatory reporting data, using the prevention of clostridium difficile infection as an example. they then describe what must be done to m ...201324034773
risk factors, preemptive therapy, and antiperistaltic agents for clostridium difficile infection in cancer patients.clostridium difficile infection (cdi) is a serious complication of chemotherapy including high-dose regimens with autologous stem cell transplantation (asct). antiperistaltic agents are contraindicated in cdi and preemptive cdi therapy is not recommended. we assessed the incidence, risk factors, and outcomes of cdi in patients with newly diagnosed multiple myeloma (mm) receiving similar antineoplastic therapy and supportive care including antiperistaltic agents and preemptive cdi antibiotics for ...201324034141
muricholic acids inhibit clostridium difficile spore germination and growth.infections caused by clostridium difficile have increased steadily over the past several years. while studies on c. difficile virulence and physiology have been hindered, in the past, by lack of genetic approaches and suitable animal models, newly developed technologies and animal models allow these processes to be studied in detail. one such advance is the generation of a mouse-model of c. difficile infection. the development of this system is a major step forward in analyzing the genetic requi ...201324040011
appendectomy and clostridium difficile colitis: relationships revealed by clinical observations and immunology.advances in understanding the interaction between the human immune system and the microbiome have led to an improved understanding of the function of the vermiform appendix as a safe-house for beneficial bacteria in the colon. these advances have been made despite long standing clinical observations that the appendectomy is a safe and effective procedure. however, more recent clinical data show that an appendectomy puts patients at increased risk for recurrent clostridium difficile (c. difficile ...201324039352
the second messenger cyclic di-gmp regulates clostridium difficile toxin production by controlling expression of sigd.the gram-positive obligate anaerobe clostridium difficile causes potentially fatal intestinal diseases. how this organism regulates virulence gene expression is poorly understood. in many bacterial species, the second messenger cyclic di-gmp (c-di-gmp) negatively regulates flagellar motility and, in some cases, virulence. c-di-gmp was previously shown to repress motility of c. difficile. recent evidence indicates that flagellar gene expression is tightly linked with expression of the genes encod ...201324039264
reprint of new opportunities for improved ribotyping of c. difficile clinical isolates by exploring their genomes.clostridium difficile causes outbreaks of infectious diarrhoea, most commonly occurring in healthcare institutions. recently, concern has been raised with reports of c. difficile disease in those traditionally thought to be at low risk i.e. community acquired rather than healthcare acquired. this has increased awareness for the need to track outbreaks and pcr-ribotyping has found widespread use to elucidate epidemiologically linked isolates. pcr-ribotyping uses conserved regions of the 16s rrna ...201324050948
fecal microbiota transplantation: an innovative approach to treating clostridium difficile disease.normal gut flora or microbiota, which is key to a healthy digestive tract, can be disrupted by antibiotic therapy, potentially leading to clostridium difficile-associated disease (cdad). fecal microbiota transplant has shown promise in quickly and safely eradicating cdad at low cost.201324049940
solution nmr structure of cd1104b from pathogenic clostridium difficile reveals a distinct α-helical architecture and provides first structural representative of protein domain family pf14203.a high-quality structure of the 68-residue protein cd1104b from clostridium difficile strain 630 exhibits a distinct all α-helical fold. the structure presented here is the first representative of bacterial protein domain family pf14203 (currently 180 members) of unknown function (duf4319) and reveals that the side-chains of the only two strictly conserved residues (glu 8 and lys 48) form a salt bridge. moreover, these two residues are located in the vicinity of the largest surface cleft which i ...201324048810
clostridium difficile infection in lung cancer patients.clostridium difficile infection (cdi) is a common nosocomial infection. lung cancer patients have a high risk of developing cdi because of continuous antibiotic treatment or chemotherapy, prolonged hospitalization, and general weakness. this study aimed to analyze predisposing or associated risk factors for cdi in lung cancer patients receiving chemotherapy. this study was a retrospective review of 188 lung cancer patients who were admitted to the wonkwang university hospital between 2008 and 20 ...201324047734
distinguishing community-associated from hospital-associated clostridium difficile infections in children: implications for public health surveillance.children are increasingly recognized as being at risk for c. difficile infection (cdi), even without prior exposure to antibiotics or the healthcare environment. we aimed to distinguish risk factors, clinical course, and outcomes between healthcare facility-associated (ha) and community-associated (ca) cdi.201324046303
editorial commentary: community-associated clostridium difficile infection in children. 201324046300
clostridium difficile infection: how safe are the household contacts? 201324045053
[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
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
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
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
human vaccines & immunotherapeutics: news.infant rotavirus vaccination provides for herd immunity nonreplicating sporozoite vaccine protects humans against malaria personalized brain cancer vaccine enters phase 2 trial novel implantable therapeutic cancer vaccine to be tested in humans clostridium difficile vaccine candidate successful in phase 1 cdc reports strong uptake of hpv vaccine in boys whooping cough outbreak in texas.201324056006
therapy of clostridium difficile infection: perspectives on a changing paradigm.clostridium difficile disease (cdi) have increased in frequency and severity over the past decade and are a leading cause of hospital acquired infections, contributing to increased hospital length of stay and costs, as well as associated increased mortality, especially amongst the elderly. standard therapy has been associated with 20 - 30% relapse rates. consequently, new cdi therapeutic approaches have emerged.201324053182
a tool to assess student performance in a clostridium difficile infection simulation scenario.to develop and validate an evaluation tool to assess student pharmacists' performance in a simulation scenario involving a patient with clostridium difficile infection (cdi).201324052652
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
oral absorption of enteral vancomycin in a child with clostridium difficile colitis and renal impairment.vancomycin is a glycopeptide antibiotic that is used by the enteral route for the treatment of clostridium difficile infections and is not thought to be absorbed into the systemic circulation. we report on a 2-year-old, 12.5-kg patient with confirmed c difficile colitis and renal insufficiency that was treated with 125 mg of enteral vancomycin (10 mg/kg); the patient developed measurable systemic concentrations as high as 17.8 mg/l. however, as the patient's colitis began to improve, the serial ...201324719593
[experience with laboratory diagnosis of clostridium difficile].clostridium difficile is currently a significant cause of nosocomial diarrhea. for several years, the number of infectious cases in the community has also been increasing. since the beginning of 2010, quite a large increase in the number of clostridium difficile infections (cdis) has been noted in pardubice regional hospital (prh). the objectives of this study were to describe and evaluate the methods used in the laboratory diagnosis of cdis in prh, and to describe the laboratory diagnostic algo ...201324579451
antimicrobial susceptibility of clostridium difficile clinical isolates in iran.clostridium difficile infection (cdi) is major growing problem in hospitals and its high incidence has been reported in recent years.201324578839
why were molecular studies not considered to classify clostridium difficile isolates implicated in an outbreak? 201324553766
why were molecular studies not considered to classify clostridium difficile isolates implicated in an outbreak? 201324553765
therapeutic approaches for clostridium difficile infections.metronidazole and vancomycin remain the front-line therapies for most clostridium difficile infections (cdi). however, recurrent cdi occurs in ∼ 25% of patients, causing significant morbidity and mortality and healthcare costs. for this population, traditional antibiotic therapies fail and new treatment options are greatly needed. the us food and drug administration recently approved fidaxomicin for cdi treatment. this narrow-spectrum antibiotic preserves the normal gut microbiota and shows prom ...201324510892
[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
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
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
[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
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
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