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parameters for the mathematical modelling of clostridium difficile acquisition and transmission: a systematic review.mathematical modelling of clostridium difficile infection dynamics could contribute to the optimisation of strategies for its prevention and control. the objective of this systematic review was to summarise the available literature specifically identifying the quantitative parameters required for a compartmental mathematical model of clostridium difficile transmission.201324376797
use of fidaxomicin through a nasogastric tube for the treatment of septic shock caused by clostridium difficile infection in a patient with oral cancer admitted to the surgical critical care unit. 201324399354
epidemiology of clostridium difficile infection among active duty united states military personnel (1998-2010).clostridium difficile associated disease (cdad) has risen in incidence and the experience in the us military has not been described.201324373384
colonization with clostridium difficile in children with cancer.clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus. usually it does not cause disease unless a patient who is colonized with toxin-producing strains has been treated with antibiotics, particularly those that change the anaerobic flora of the large intestine.201324427503
combination of culture, antigen and toxin detection, and cytotoxin neutralization assay for optimal clostridium difficile diagnostic testing.there has been a growing interest in developing an appropriate laboratory diagnostic algorithm for clostridium difficile, mainly as a result of increases in both the number and severity of cases of c difficile infection in the past decade. a c difficile diagnostic algorithm is necessary because diagnostic kits, mostly for the detection of toxins a and b or glutamate dehydrogenase (gdh) antigen, are not sufficient as stand-alone assays for optimal diagnosis of c difficile infection. in addition, ...201324421808
treatment of relapsing clostridium difficile infection using fecal microbiota transplantation.clostridium difficile infection (cdi) has become a global concern over the last decade. in the united states, cdi escalated in incidence from 1996 to 2005 from 31 to 64/100,000. in 2010, there were 500,000 cases of cdi with an estimated mortality up to 20,000 cases a year. the significance of this problem is evident from the hospital costs of over 3 billion dollars annually. fecal microbiota transplant (fmt) was first described in 1958 and since then about 500 cases have been published in litera ...201324421645
reductions in intestinal clostridiales precede the development of nosocomial clostridium difficile infection.antimicrobial use is thought to suppress the intestinal microbiota, thereby impairing colonization resistance and allowing clostridium difficile to infect the gut. additional risk factors such as proton-pump inhibitors may also alter the intestinal microbiota and predispose patients to clostridium difficile infection (cdi). this comparative metagenomic study investigates the relationship between epidemiologic exposures, intestinal bacterial populations and subsequent development of cdi in hospit ...201324450844
prevention and treatment of diarrhoea with saccharomyces boulardii in children with acute lower respiratory tract infections.the aim of this study was to determine whether saccharomyces boulardii prevents and treats diarrhoea and antibiotic-associated diarrhoea (aad) in children. a total of 333 hospitalised children with acute lower respiratory tract infection were enrolled in a 2-phase open randomised controlled trial. during the 1st phase, all children received intravenous antibiotics (ab). they were randomly allocated to group a (s. boulardii 500 mg/day + ab, n=167) or group b (ab alone, n=166) and followed for 2 w ...201324311316
antimicrobial effects of virgin coconut oil and its medium-chain fatty acids on clostridium difficile.clostridium difficile is the leading cause of hospital-acquired antibiotic-associated diarrhea worldwide; in addition, the proliferation of antibiotic-resistant c. difficile is becoming a significant problem. virgin coconut oil (vco) has been shown previously to have the antimicrobial activity. this study evaluates the lipid components of vco for the control of c. difficile. vco and its most active individual fatty acids were tested to evaluate their antimicrobial effect on c. difficile in vitro ...201324328700
characterization of the sigd regulon of c. difficile and its positive control of toxin production through the regulation of tcdr.clostridium difficile intestinal disease is mediated largely by the actions of toxins a (tcda) and b (tcdb), whose production occurs after the initial steps of colonization involving different surface or flagellar proteins. in b. subtilis, the sigma factor sigd controls flagellar synthesis, motility, and vegetative autolysins. a homolog of sigd encoding gene is present in the c.difficile 630 genome. we constructed a sigd mutant in c. difficile 630 ∆erm to analyze the regulon of sigd using a glob ...201324358307
treatment strategies for recurrent clostridium difficile infection.recurrent clostridium difficile infection represents a major clinical challenge. treatment is often based on empiric selection from relatively few options supported by limited clinical evidence.201324357868
predictors of first recurrence in clostridium difficile-associated disease. a study of 306 patients hospitalized in a romanian tertiary referral center.clostridium difficile is recognized as the major cause of nosocomial gastroenteritis usually related to antibiotic treatment. although treatable, c. difficile--associated disease (cdad) tends to recur in many patients. the purpose of the study was to analyze the risk factors for recurrence in patients with cdad after the first treatment with vancomycin, metronidazole or both.201324369321
probiotics for the prevention of antibiotic-associated diarrhea and clostridium difficile infection among hospitalized patients: systematic review and meta-analysis.antibiotic-associated diarrhea (aad) and clostridium difficile infection (cdi) are associated with high morbidity, mortality, and health care costs. probiotics may mitigate the existing disease burden. we performed a systematic review and meta-analysis to evaluate the efficacy of co-administration of probiotics with antibiotics in preventing these adverse outcomes in adult inpatients.201324348885
ecological modeling from time-series inference: insight into dynamics and stability of intestinal microbiota.the intestinal microbiota is a microbial ecosystem of crucial importance to human health. understanding how the microbiota confers resistance against enteric pathogens and how antibiotics disrupt that resistance is key to the prevention and cure of intestinal infections. we present a novel method to infer microbial community ecology directly from time-resolved metagenomics. this method extends generalized lotka-volterra dynamics to account for external perturbations. data from recent experiments ...201324348232
clostridium difficile progress lags other infection-control goals. 201323292259
the c-di-gmp recognition mechanism of the pilz domain of bacterial cellulose synthase subunit a.in some proteobacteria and firmicutes such as pseudomonas aeruginosa, vibrio cholerae, xanthomonas campestris, and clostridium difficile, cyclic dimeric guanosine monophosphate (c-di-gmp) is known to regulate cellular processes, including motility, biofilm formation, and virulence, as a second messenger. cellulose production in acetobacter xylinum, a model organism of cellulose biosynthesis, also depends on by cellular c-di-gmp level. in cellulose-synthesizing bacteria, a terminal complex locali ...201323291177
all-cause and disease-specific mortality in hospitalized patients with clostridium difficile infection: a multicenter cohort study.mortality among patients with clostridium difficile infection (cdi) is high. because of high age and multiple underlying diseases, cdi-related mortality is difficult to estimate. we estimated cdi-related mortality in an endemic situation, not influenced by outbreaks and consequently certain patients and c. difficile strains.201323300235
proteomic comparison of historic and recently emerged hypervirulent clostridium difficile strains.clostridium difficile in recent years has undergone rapid evolution and has emerged as a serious human pathogen. proteomic approaches can improve the understanding of the diversity of this important pathogen, especially in comparing the adaptive ability of different c. difficile strains. in this study, tmt labeling and nanolc-ms/ms driven proteomics were used to investigate the responses of four c. difficile strains to nutrient shift and osmotic shock. we detected 126 and 67 differentially expre ...201323298230
the changing faces of clostridium difficile: a personal reflection of the past 34 years.late in 1978 my boss gave me a folder with "clostridium difficile (diffikilé)" written on it. inside were a few recent and now classic papers by bartlett, larson and co. it was suggested that this might be an interesting research topic. so began a continuing adventure which has resulted in at least 50 publications from my group. over the years we have made several important contributions to the field. beginning in 1982 we showed that c. difficile was a common cause of community-acquired infectio ...201323296302
clostridium difficile infection and limitations of markers for severity in patients with hematologic malignancy.to describe characteristics of clostridium difficile infection (cdi) and markers of severe cdi among patients with hematologic malignancies.201323295558
unnecessary antimicrobial use in patients with current or recent clostridium difficile infection.to determine the fraction of unnecessary antimicrobial use among patients with current and/or recent clostridium difficile infection (cdi).201323295554
mortality and clostridium difficile infection in an australian setting.to quantify the risk of death associated with clostridium difficile infection, in an australian tertiary hospital.201323294464
lack of clostridium difficile infection in patients treated with rifaximin for hepatic encephalopathy: a retrospective analysis.the purpose of this study was to assess the incidence of clostridium difficile infection in patients who received rifaximin for the treatment of hepatic encephalopathy (he).201323314671
incidence and risk factors for hospital-acquired clostridium difficile infection among inpatients in an orthopaedic tertiary care hospital.the aim of this retrospective study was to identify risk factors for hospital-acquired clostridium difficile infection (ha-cdi) in orthopaedic patients. thirty-two ha-cdi cases were each matched with two controls. incidence rate was 0.33 cases per 1000 patient-days. univariate analyses showed that surgery >24 h after admission, antibiotics for treatment, and proton pump inhibitors were associated with ha-cdi. multivariate analyses revealed that surgery >24 h after admission was associated with h ...201323313026
in recurrent c. difficile, the crp response to the primary c. difficile infection predicts whether the same strain or a different strain will cause a second infection.clostridium difficile is the leading cause of antibiotic-associated diarrhoea and is associated with an increase in morbidity and mortality. there is a wide variance in disease severity with some patients suffering a single, self-limiting episode of diarrhoea while others suffer more intractable problems with recurrent attacks or toxic dilatation. numerous different c. difficile ribotypes exist, some of which are considered hypervirulent. the magnitude of toxin production alone is not sufficient ...201323306854
clostridium difficile tcdc protein binds four-stranded g-quadruplex structures.clostridium difficile infections are increasing worldwide due to emergence of virulent strains. infections can result in diarrhea and potentially fatal pseudomembranous colitis. the main virulence factors of c. difficile are clostridial toxins tcda and tcdb. transcription of the toxins is positively regulated by the sigma factor tcdr. negative regulation is believed to occur through tcdc, a proposed anti-sigma factor. here, we describe the biochemical properties of tcdc to understand the mechani ...201323303781
proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis.critically ill patients may develop bleeding caused by stress ulceration. acid suppression is commonly prescribed for patients at risk of stress ulcer bleeding. whether proton pump inhibitors are more effective than histamine 2 receptor antagonists is unclear.201323318494
american journal of gastroenterology lecture: intestinal microbiota and the role of fecal microbiota transplant (fmt) in treatment of c. difficile infection.the vital roles that intestinal flora, now called microbiota, have in maintaining our health are being increasingly appreciated. starting with birth, exposure to the outside world begins the life-long intimate association our microbiota will have with our diet and environment, and initiates determination of the post-natal structural and functional maturation of the gut. moreover, vital interactions of the microbiota with our metabolic activities, as well as with the immunological apparatus that ...201323318479
the rise of clostridium difficile infection in lung transplant recipients in the modern era.clostridium difficile infection (cdi) rates have been rising in recent years. we aimed to characterize cdi in lung transplant recipients in the modern era and hypothesized that cdi would increase the mortality risk.201323316931
multiple pulmonary nodules: a complex case of wegener's granulomatosis.wegener's granulomatosis is a granulomatous vasculitis that can present with a wide spectrum of clinical manifestations. this disease entity predominantly affects the respiratory tract and the kidneys. two forms of wegener's granulomatosis have been recognized: systemic and limited. it has not been established if the two forms represent separate disease entities or different stages of the same condition. in the limited form of wegener's granulomatosis there is no immediate threat to the function ...201324765494
rifaximin in the treatment of irritable bowel syndrome: is there a high risk for development of antimicrobial resistance?irritable bowel syndrome (ibs), a chronic, nonfatal illness is commonly encountered in clinical practice; however, treatment options are limited and often ineffectual. despite this, there is increasing evidence that bacterial overgrowth in the bowel (dysbiosis) may be an etiological factor in ibs. this has lead to studies in which the antibiotic agent rifaximin has been used to reduce the microbial burden in the bowel, to some extent alleviating the symptoms of ibs. rifaximin is a member of the ...201323340064
antimicrobial susceptibilities of clostridium difficile isolated in japan.clostridium difficile is a common causative organism of antimicrobial-associated diarrhea and is often responsible for nosocomial infection. c. difficile infection has traditionally been treated with metronidazole (mnz) or vancomycin (vcm); however, mnz-resistant strains have reported in some countries. in this study the broth microdilution method was used to determine the minimum inhibitory concentrations (mics) of 15 drugs against 157 clinical isolates of c. difficile in japan. all c. difficil ...201323338015
length of stay and mortality due to clostridium difficile infection acquired in the intensive care unit.the purpose of this study was to determine the attributable intensive care unit (icu) and hospital length of stay and mortality of icu-acquired clostridium difficile infection (cdi).201323337482
impact of clostridium difficile colitis following closure of a diverting loop ileostomy: results of a matched cohort study.previous reports describing clostridium difficile colitis (cdc) developing after the closure of a loop ileostomy suggest it is severe. in this study the incidence of cdc following ileostomy closure and its effect on the postoperative outcome have been studied.201323336347
functional characterization of clostridium difficile spore coat proteins.spores of clostridium difficile play a key role in the dissemination of this important human pathogen, and until recently little has been known of their functional characteristics. genes encoding six spore coat proteins (cota, cotb, cotcb, cotd, cote, and soda) were disrupted by clostron insertional mutagenesis. mutation of one gene, cota, presented a major structural defect in spore assembly, with a clear misassembly of the outermost layers of the spore coat. the cota protein is most probably s ...201323335421
ecological impact of doxycycline at low dose on normal oropharyngeal and intestinal microflora.this study included 34 healthy volunteers (16 male and 18 female) aged 19-37 years, of whom 17 received doxycycline 40 mg capsules orally once daily (o.d.) and 17 received placebo 40 mg capsules orally o.d. for 16 weeks. plasma, saliva and faecal samples were collected before drug administration and at 4, 8, 16 and 20 weeks. plasma samples were assayed for doxycycline concentrations, and saliva and faecal samples were investigated for doxycycline concentrations and microbiological analyses. plas ...201323332619
[the effect of clostridium difficile infection on length of hospital stay. a cohort study].clostridium difficile is responsible for a spectrum of diseases known as "clostridium difficile infection" (cdi). it is currently the leading cause of nosocomial diarrhea in developed countries. this infection has been associated with both increased hospital stay and mortality, and to a greater likelihood of readmission. in our country these undesirable effects have not yet been characterized. our objective was to quantify the increase in hospital stay attributable to infection by c.difficile.201323332449
risk factors and outcome of pcr-detected clostridium difficile infection in ileal pouch patients.the clinical implication of clostridium difficile infection (cdi) in patients with ileal pouch-anal anastomosis (ipaa) for underlying inflammatory bowel disease (ibd) has not been well studied. this study was designed to investigate the cumulative incidence, risk factors, and outcome of cdi in patients with ileal pouches.201323328770
postoperative antibacterial prophylaxis for the prevention of infectious complications associated with tube thoracostomy in patients undergoing elective general thoracic surgery: a double-blind, placebo-controlled, randomized trial.to determine whether extended postoperative antibacterial prophylaxis for patients undergoing elective thoracic surgery with tube thoracostomy reduces the risk of infectious complications compared with preoperative prophylaxis only.201323325435
clostridium difficile in foods and animals: history and measures to reduce exposure.many articles have summarized the changing epidemiology of clostridium difficile infections (cdi) in humans, but the emerging presence of c. difficile in foods and animals and possible measures to reduce human exposure to this important pathogen have been infrequently addressed. cdis have traditionally been assumed to be restricted to health-care settings. however, recent molecular studies indicate that this is no longer the case; animals and foods might be involved in the changing epidemiology ...201323324529
a mixture of functionally oligoclonal humanized monoclonal antibodies that neutralize clostridium difficile tcda and tcdb with high levels of in vitro potency shows in vivo protection in a hamster infection model.clostridium difficile infections are a major cause of antibiotic-associated diarrhea in hospital and care facility patients. in spite of the availability of effective antibiotic treatments, c. difficile infection (cdi) is still a major cause of patient suffering, death, and substantial health care costs. clostridium difficile exerts its major pathological effects through the actions of two protein exotoxins, tcda and tcdb, which bind to and disrupt gut tissue. antibiotics target the infecting ba ...201323324518
duodenal infusion of donor feces for recurrent clostridium difficile.recurrent clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. we studied the effect of duodenal infusion of donor feces in patients with recurrent c. difficile infection.201323323867
infections following facial composite tissue allotransplantation--single center experience and review of the literature.we reviewed medical records of all patients (n = 4) who underwent facial composite tissue allotransplantation (fcta) at our center between april 2009 and may 2011; data were censored in june 2012. we searched for fcta publications and reviewed them for infectious complications and prophylaxis strategies. three patients received full and one partial fcta at our institution. two recipients were cytomegalovirus (cmv) donor (d)+/recipient (r)- and two cmv d+/r+. perioperative prophylaxis included va ...201323279299
clostridium difficile infection in travelers--a neglected pathogen?until recently, clostridium difficile infection (cdi) has been mostly diagnosed in hospitalized elderly patients treated with antibacterial agents. the epidemiology of c difficile is changing as the ribotype 027 strain is spreading worldwide, and more infections are diagnosed in patients residing in the community. although only few data about the epidemiology of cdi in developing countries are available, a number of reports seem to indicate that the incidence of cdi may be high in some such coun ...201323279229
clostridium difficile infection in infants and children.infections caused by clostridium difficile in hospitalized children are increasing. the recent publication of clinical practice guidelines for c difficile infection in adults did not address issues that are specific to children. the purpose of this policy statement is to provide the pediatrician with updated information and recommendations about c difficile infections affecting pediatric patients.201323277317
[detailed methodological recommendations for the treatment of clostridium difficile-associated diarrhea with faecal transplantation].the incidence of clostridium difficile associated enteral disease shows dramatic increase worldwide, with appallingly high treatment costs, mortality figures, recurrence rates and treatment refractoriness. it is not surprising, that there is significant interest in the development and introduction of alternative therapeutic strategies. among these only stool transplantation (or faecal bacteriotherapy) is gaining international acceptance due to its excellent cure rate (≈92%), low recurrence rate ...201323274229
clostridium difficile outcomes difficult to generalize. authors' response. 201325237683
[pseudomembranous colitis: pathogenesis, prevention, treatment].the article reviews a pathogenesis of pseudomembranous colitis. questions of prevention and treatment of clostridium difficile--associated diarrhea are shown by the evidence-based medicine. there is an accent on the rational prescription of antibiotics.201324933996
[dynamics of contamination and persistence of clostridium difficile in intestinal microbiota in newborn infants during antibiotic therapy and use of probiotic strain enterococcus faecium l3].ninety four infants were observed as inpatients. thirty nine of them were mature neonates and 55 were premature infants with a very low body weight. the majority of the patients were treated with antibiotics. the mature infants were treated with penicillins, aminoglycosides, cephalosporins and the premature neonates were treated in addition with carbapenems, fluoroquinolones, glycopeptides. the mature infants were randomized into 2 groups: the control group (n=18) received the standard therapy a ...201324734423
[the use of two-stage algorithm in the diagnosis of patients with low levels of clostridium difficile toxins a/b in feces confirmed by using enzyme immunoassay].clostridium difficile infection (cdi) is a serious problem in hospitalized patients. rapid and accurate laboratory diagnosis is the key to reducing of cdi. the suboptimal sensitivity and specificity of many commercial enzyme immunoassays have limited their utility. the aim of this study was analysis of faecal samples obtained from patients with clinical evidence of cdi, with non-detectable or questionable result of toxins a/b c. difficile recognized by toxins a/b eia test.201324730214
uk renal registry 16th annual report: chapter 15 epidemiology of reported infections amongst patients receiving dialysis for established renal failure in england from may 2011 to april 2012: a joint report from public health england and the uk renal registry.infection remains one of the leading causes of mortality in established renal failure patients receiving renal replacement therapy (rrt). since 2007, centres providing rrt in england have been asked to provide additional data on patients with methicillin resistant staphylococcus aureus (mrsa) bacteraemia. since 2011, the option to provide data on methicillin sensitive stapylococcus aureus (mssa) and escherichia coli bacteraemia, as well as clostridium difficile infection has also been available.201324662179
a genomic analysis of clostridium difficile infections in blunt trauma patients.evidence demonstrates that susceptibility to clostridium difficile infection is related to host risk factors as much as bacterial potency. using blood leukocyte genome-wide expression patterns of severe blunt trauma patients obtained by the national institute of general medical sciences-sponsored glue grant inflammation and the host response to injury, we examined leukocyte genomic profiles of patients with c. difficile infection to determine preinfection and postinfection gene expression change ...201323271108
evaluation of the chromogenic agar chromid c. difficile.three selective media (chromid c. difficile agar, taurocholate cycloserine cefoxitin agar [tcca; homemade], and clo medium) were compared from 406 stool samples of patients suspected of having clostridium difficile infection. the sensitivities of chromid c. difficile agar at 24 h and 48 h, clo medium, and tcca were 74.1%, 87%, 85.2%, and 70.4%, respectively.201323269743
performance of clostridium difficile toxin enzyme immunoassay and nucleic acid amplification tests stratified by patient disease severity.many clinical laboratories in the united states are transitioning from toxin enzyme immunoassays (eia) to nucleic acid amplification tests (naats) as the primary diagnostic test for clostridium difficile infection (cdi). while it is known that the analytical sensitivity of the toxin eia is poor, there are limited clinical data on the performance of these assays for patients with mild or severe cdi. two hundred ninety-six hospital inpatients with diarrhea and clinical suspicion for cdi were teste ...201323269736
clostridium difficile healthcare-associated epidemics. 201323268129
local injection of dsrna targeting calcitonin receptor-like receptor (clr) ameliorates clostridium difficile toxin a-induced ileitis.enteritis caused by clostridium difficile toxin (tx) is a nosocomial disease of increasing clinical concern, but the local mediators of c. difficile txa inflammation are unknown. the potent vasodilator calcitonin gene-related peptide mediates neurogenic inflammation via the calcitonin receptor-like receptor (clr). here we examined the ileum-specific effects of reducing clr on txa ileitis by local preinjection of double-stranded rnas. treatment with clr dsrna for 7 d decreased clr immunoreactivit ...201323267070
the membrane as a target for controlling hypervirulent clostridium difficile infections.the stationary phase of clostridium difficile, which is primarily responsible for diarrhoeal symptoms, is refractory to antibiotic killing. we investigated whether disrupting the functions of the clostridial membrane is an approach to control c. difficile infections by promptly removing growing and non-growing cells.201323264511
risk factors for recurrence of clostridium difficile-associated diarrhoea.clostridium difficile associated disease (cdad) is one of the most common causes of hospital-acquired diarrhea. despite increasing incidence of clostridium difficile-associated diarrhea, there are few data on risk factors associated with its relapse.201323262313
clostridium difficile flagellin stimulates toll-like receptor 5, and toxin b promotes flagellin-induced chemokine production via tlr5.clostridium difficile is an important pathogen in nosocomial infections. although c. difficile toxins are considered to be major virulence factors, pathogenesis of c. difficile associated diseases remains to be determined. in this study, we investigated whether c. difficile flagellin is involved in the pathogenesis of c. difficile-associated diseases.201323261530
[when should request a stool culture?].a stool culture needs a medical prescription and is justified only in a case of clearly defined acute diarrhea. the clinical context must be suggestive of a bacterial etiology. the detection of the bacterial agents has to follow a well-defined strategy to optimize a rigorous prescription. standardized stool culture is for patients treated in medical community practice and for patients hospitalized for less than 3 days. clostridium difficile toxin testing is systematically performed in case of no ...201323260762
influence of environmental conditions on the expression and the maturation process of the clostridium difficile surface associated protease cwp84.expression of the clostridium difficile protease gene, cwp84, was moderately up-regulated by decreasing ph due to glucose metabolism. purification under different ph conditions influenced the proteolytic process of cwp84. given this, acidic ph could favor the appearance of different forms of cwp84 that may have different roles during the infection.201323257307
microbial ecosystems therapeutics: a new paradigm in medicine?increasing evidence indicates that the complex microbial ecosystem of the human intestine plays a critical role in protecting the host against disease. this review discusses gut dysbiosis (here defined as a state of imbalance in the gut microbial ecosystem, including overgrowth of some organisms and loss of others) as the foundation for several diseases, and the applicability of refined microbial ecosystem replacement therapies as a future treatment modality. consistent with the concept of a 'co ...201323257018
[acute infectious diarrhea in adults: epidemiology and management].acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days. more than three millions cases of acute diarrhea, presumably due to intestinal infections, are seen in general practice every year in france. most of the cases are benign and resolve under symptomatic treatment within 3 days, without need for biological tests or antibiotics. in special contexts (septicemic syndrome, visible blood in stools, severe dehydratio ...201323253255
surveillance for clostridium difficile infection in nursing homes.to define the time of onset of clostridium difficile infection (cdi) in the community nursing home setting.201323253029
letter: clostridium difficile colitis in patients with ulcerative colitis. 201323252787
infection: understanding how clostridium difficile infection in health-care settings spread around the world. 201323247509
a systematic evaluation of methods to optimize culture-based recovery of clostridium difficile from stool specimens.with the increasing prevalence of clostridium difficile infection among hospitalized patients, a clear understanding of c. difficile epidemiology is needed to evaluate current prevention policies, and to create new and effective policies. to determine the epidemiology of c. difficile, the most sensitive methods for detection of c. difficile are required. the purpose of this study was to systematically assess multiple methods to determine the most sensitive method to recover c. difficile from sto ...201323247066
recent trends in the epidemiology and treatment of c. difficile infection in children.clostridium difficile is the most common cause of healthcare-associated diarrhea among adults in western countries, and is increasingly recognized as an important pathogen in children. this review provides an update on the changing epidemiology of c. difficile infection (cdi) for pediatric providers and summarizes current knowledge regarding available therapies.201323241874
[four new drugs on the market: abiraterone, belatacept, vandetanib and fidaxomycine].among the 35 new molecular entities approved by the fda in 2011, 17 were particularly notable for their significant contributions to the health of patients, including abiraterone acetate, vandetanib, belatacept and fidaxomicin. thus, abiraterone acetate, namely zytiga®, was included as the first in a new class of drugs to treat late-stage prostate cancer. the ability of zytiga® to prolong survival in these patients was considered as significant because they have few other treatments options and ...201323537410
editorial commentary: clostridium difficile in children: colonization and consequences. 201323532471
clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children.clostridium difficile infection (cdi) is associated with significant morbidity and mortality among adults. however, outcomes are poorly defined among children.201323532470
validation of the chronic disease score-infectious disease (cds-id) for the prediction of hospital-associated clostridium difficile infection (cdi) within a retrospective cohort.aggregate comorbidity scores are useful for summarizing risk and confounder control in studies of hospital-associated infections. the chronic disease score - infectious diseases (cds-id) was developed for this purpose, but it has not been validated for use in studies of clostridium difficile infection (cdi). the aim of this study was to assess the discrimination, calibration and potential for confounder control of cds-id compared to age alone or individual comorbid conditions.201323530876
derivation and validation of a simple clinical bedside score (atlas) for clostridium difficile infection which predicts response to therapy.clostridium difficile infection (cdi) continues to be a frequent and potentially severe infection. there is currently no validated clinical tool for use at the time of cdi diagnosis to categorize patients in order to predict response to therapy.201323530807
counterpoint: is clostridium difficile a food-borne disease?the increase in community associated clostridium difficile disease paired with recent data on c. difficile in retail foods has led to speculation that c. difficile is a food-borne pathogen. however, there is no current epidemiologic evidence (i.e. restaurant or food-associated outbreaks) to support this hypothesis. rates of c. difficile recovery from food vary widely across laboratories and may be due to a number of confounding factors. this commentary discusses the results of two published inve ...201323528985
confocal laser endomicroscopy for in vivo diagnosis of clostridium difficile associated colitis - a pilot study.clostridium difficile infection (cdi) is one of the most dreaded causes of hospital-acquired diarrhea. main objective was to investigate whether confocal laser endomicroscopy (cle) has the capability for in vivo diagnosis of c. difficile associated histological changes. second objective was to prove the presence of intramucosal bacteria using cle.201323527018
clostridium difficile as a cause of acute diarrhea: a prospective study in a tertiary care center.clostridium difficile-associated diarrhea (cdad) is an increasing problem. recent reports suggest presence of community acquired cdad (ca cdad). studies in india have shown varied results.201323526401
similar outcomes of ibd inpatients with clostridium difficile infection detected by elisa or pcr assay.clostridium difficile infection (cdi) is known as a risk factor for exacerbation of inflammatory bowel disease (ibd). cdi has been most commonly tested with enzyme-linked immunosorbent assay for toxins, but with a suboptimal sensitivity. compared with conventional elisa, the polymerase chain reaction-based assay (pcr) is a highly sensitive detection technique for c. difficile. however, its pure detection of only the dna of toxin b may lead to over-treatment.201323525735
molecular epidemiology and resistance profiles of clostridium difficile in a tertiary care hospital in spain.epidemiological surveillance of clostridium difficile infection has gained importance in recent years as a result of the rapid spread of epidemic strains, including hypervirulent strains and strains with reduced susceptibility to antimicrobials. the molecular epidemiology and antimicrobial susceptibility of c. difficile in the reference hospital of the balearic islands (spain) is reported in this study. one hundred isolates of toxigenic c. difficile from different patients were selected using ra ...201323523477
clostridium difficile infection in italian urban hospitals: data from 2006 through 2011.in developed countries, clostridium difficile infection (cdi) represents an emerging threat in terms of morbidity and mortality rates. in our country limited cdi epidemiological data can be found.201323522431
fecal microbiota transplantation for recurrent c difficile infection: ready for prime time?recurrent clostridium difficile infection has been a major challenge for patients and clinicians. recurrence of infection after treatment with standard antibiotics is becoming more common with the emergence of more-resistant strains of c difficile. fecal microbiota transplantation is an alternative treatment for recurrent c difficile infection, but it is not yet widely used.201323376915
preoperative risk factors for postoperative clostridium difficile infection in colectomy patients.wide variation among hospitals in the rate of clostridium difficile infection (cdi) after surgery was hypothesized to be related to different prophylactic antibiotic practices.201323375705
clostridium difficile erm(b)-containing elements and the burden on the in vitro fitness.in clostridium difficile, resistance to the macrolide-lincosamide-streptogramin b group of antibiotics generally relies on erm(b) genes. in this study, we investigated elements with a genetic organization different from tn5398, the mobilizable non-conjugative element identified in c. difficile strain 630. our results suggested that the elements most frequently found in strains isolated during the european surveillance study in 2005 were related to tn6194, the conjugative transposon recently dete ...201323741023
burden of hospital-onset clostridium difficile infection in patients discharged from rhode island hospitals, 2010-2011: application of present on admission indicators.the year 2010 is the first time that the rhode island hospital discharge database included present on admission (poa) indicators, which give us the opportunity to distinguish cases of hospital-onset clostridium difficile infection (cdi) from cases of community-onset cdi and to assess the burden of hospital-onset cdi in patients discharged from rhode island hospitals during 2010 and 2011.201323739074
prevalence of colonization and infection with methicillin-resistant staphylococcus aureus and vancomycin-resistant enterococcus and of clostridium difficile infection in canadian hospitals.to determine the prevalence of methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci (vre), and clostridium difficile infection (cdi) in canadian hospitals.201323739072
clostridium difficile infection associated with pig farms. 201323735347
assessment of 30-day all-cause mortality in metronidazole-treated patients with clostridium difficile infection.the society for healthcare epidemiology (shea) and the infectious diseases society of america (idsa) clinical practice guidelines for clostridium difficile infection (cdi) help to define and make recommendations for the treatment of mild to moderate disease with metronidazole and severe disease with vancomycin. we retrospectively evaluated 285 patients who were initially treated with metronidazole and stratified them by severity of illness using the guideline criteria. we compared the outcomes i ...201323746336
the role of the surface environment in healthcare-associated infections.this article reviews the evidence demonstrating the importance of contamination of hospital surfaces in the transmission of healthcare-associated pathogens and interventions scientifically demonstrated to reduce the levels of microbial contamination and decrease healthcare-associated infections.201323743816
coinfection in acute gastroenteritis predicts a more severe clinical course in children.the objectives of this study were to determine the incidence of enteric pathogens causing acute gastroenteritis (age) among hospitalized children in a large italian hospital, to measure the incidence of coinfections, and to compare the clinical characteristics of those infected with one versus multiple agents. a prospective study was conducted from march 2010 to april 2011 at the bambino gesù pediatric hospital in rome, italy. all patients between 1 month and 16 years of age admitted to the pedi ...201323370970
current application and future perspectives of molecular typing methods to study clostridium difficile infections.molecular typing is an essential tool to monitor clostridium difficile infections and outbreaks within healthcare facilities. molecular typing also plays a key role in defining the regional and global changes in circulating c. difficile types. the patterns of c. difficile types circulating within europe (and globally) remain poorly understood, although international efforts are under way to understand the spatial and temporal patterns of c. difficile types. a complete picture is essential to pro ...201323369393
clostridium difficile infection and fecal bacteriotherapy.clostridium difficile, also called "c. diff," is a gram-positive bacillus associated with nosocomial infections involving diarrhea, most often seen in developing countries. the severity of c. diff-associated diarrhea varies tremendously from mild and self-limiting to fulminant and life-threatening. c. diff has become an extremely important pathogen in community health but can be minimized with attention to proper hygiene. this article presents a case study regarding the treatment and management ...201323364365
evaluation of an algorithmic approach in comparison with the illumigene assay for laboratory diagnosis of clostridium difficile infection.the following three diagnostic algorithms were evaluated in comparison with the illumigene assay as a stand-alone test for clostridium difficile detection: glutamate dehydrogenase antigen screen (gdh) followed by toxin a/b antigen testing (tox a/b) with the cell cytotoxicity assay for discordant specimens (algorithm 1), gdh followed by the illumigene (algorithm 2), and gdh followed by tox a/b with the illumigene for discordant specimens (algorithm 3). a total of 428 stool specimens submitted to ...201323363829
the host immune response to clostridium difficile infection.clostridium difficile infection (cdi) is the most common infectious cause of healthcare-acquired diarrhoea. outcomes of c. difficile colonization are varied, from asymptomatic carriage to fulminant colitis and death, due in part to the interplay between the pathogenic virulence factors of the bacterium and the counteractive immune responses of the host. secreted toxins a and b are the major virulence factors of c. difficile and induce a profound inflammatory response by intoxicating intestinal e ...201325165542
pseudomembranous colitis within radiotherapy field following concurrent chemoradiation therapy: a case report.development of nonantibiotic-associated pseudomembranous colitis has been reported in patients receiving chemotherapy. herein, we report a case of a 70-year-old man with diabetes mellitus and hypertension who received concurrent chemoradiation therapy after surgery for stage iii pt3n1m0 rectal cancer. after completion of the therapy, the patient presented with a 2-week history of intermittent watery diarrhea (seven to nine times per day). however, the patient was afebrile and laboratory examinat ...201323359785
intestinal epithelial restitution after tcdb challenge and recovery from clostridium difficile infection in mice with alanyl-glutamine treatment.clostridium difficile is an anaerobic bacterium that causes antibiotic-associated diarrhea. it produces toxin a and toxin b (tcdb), which cause injury to the gut epithelium. glutamine is a fundamental fuel for enterocytes, maintaining intestinal mucosal health. alanyl-glutamine (aq) is a highly soluble dipeptide derivative of glutamine. we studied whether administration of aq ameliorates the effects of tcdb in the intestinal cells and improves the outcome of c. difficile infection in mice.201323359592
clostridium difficile infection: real or fake--faecal matter does the trick for recurrent cdi. 201323358398
length of stay and hospital costs among high-risk patients with hospital-origin clostridium difficile-associated diarrhea.hospital-onset clostridium difficile-associated diarrhea (ho-cdad) has been associated with longer length of stay (los) and higher hospital costs among patients in general. the burden of ho-cdad is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [ibd]), and those with concomitant antibiotic (cabx) use during treatment for cdad.201323356421
mixed infection by clostridium difficile in an in vitro model of the human gut.clostridium difficile infection (cdi) is still a major clinical challenge. previous studies have demonstrated multiple distinct c. difficile strains in the faeces of patients with cdi; yet whether true mixed cdi occurs in vivo is unclear. in this study we evaluated whether two distinct c. difficile strains could co-germinate and co-proliferate in an in vitro human gut model.201323354280
is colectomy for fulminant clostridium difficile colitis life saving? a systematic review.it is unclear whether colectomy for fulminant clostridium difficile colitis (fcdc) leads to a improvement in survival compared with continued medical therapy for this moribund population.201323350898
activate to eradicate: inhibition of clostridium difficile spore outgrowth by the synergistic effects of osmotic activation and nisin.germination is the irreversible loss of spore-specific properties prior to outgrowth. because germinating spores become more susceptible to killing by stressors, induction of germination has been proposed as a spore control strategy. however, this strategy is limited by superdormant spores that remain unaffected by germinants. harsh chemicals and heat activation are effective for stimulating germination of superdormant spores but are impractical for use in a hospital setting, where clostridium d ...201323349961
characterization of a stable, metronidazole-resistant clostridium difficile clinical isolate.clostridium difficile are gram-positive, spore forming anaerobic bacteria that are the leading cause of healthcare-associated diarrhea, usually associated with antibiotic usage. metronidazole is currently the first-line treatment for mild to moderate c. difficile diarrhea however recurrence occurs at rates of 15-35%. there are few reports of c. difficile metronidazole resistance in the literature, and when observed, the phenotype has been transient and lost after storage or exposure of the bacte ...201323349739
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