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retrospective analysis of fluoroquinolone prophylaxis in patients undergoing allogeneic hematopoietic stem cell transplantation.patients undergoing allogeneic hematopoietic stem cell transplant are at a high risk for infection-related mortality in the immediate post-transplantation phase. prophylaxis with a fluoroquinolone is now recommended to reduce this risk with the stipulation that surveillance for increased fluoroquinolone resistance clostridium difficile associated diarrhea be conducted.201323184539
fecal microbiome transplantation for recurrent clostridium difficile infection: report on a case series.clostridium difficile infection (cdi) continues to increase in incidence and severity, and was the most common nosocomial infection in the usa in 2010. most cases of cdi respond to a standard course of antibiotics, but recurrent c. difficile infection (rcdi) has become increasingly frequent, and alternative treatments are needed. we examined the efficacy of fecal microbiota transplantation (fmt) instilled into the upper gastrointestinal tract for rcdi.201323182843
preventing clostridium difficile infection in the intensive care unit.clostridium difficile is a formidable problem in the twenty-first century. because of injudicious use of antibiotics, the emergence of the hypervirulent epidemic strain of this organism has been difficult to contain. the nap1/bi/027 strain causes more-severe disease than other widely prevalent strains and affects patients who were not traditionally thought to be at risk for clostridium difficile infection. critically ill patients remain at high risk for this pathogen, and preventive measures, su ...201323182524
real-time polymerase chain reaction method for detection of toxigenic clostridium difficile from stools and presumptive identification of nap1 clone.this study describes the development of a cost-effective, multiplex real-time polymerase chain reaction (rtpcr) method for detection of toxigenic clostridium difficile from stools and presumptive identification of the nap-1 strain. the diagnostic value of the new method is for the detection of toxigenic c. difficile which has the following performance characteristics: 99.8% specificity, 95.1% sensitivity, 97.5% positive predictive value, and 99.5% negative predictive value. examination of 24 spe ...201323182075
lymphopenia as a novel marker of clostridium difficile infection recurrence.treatment of clostridium difficile infection (cdi) is often limited by recurrence in 25% of cases. the objective of this study was to determine risk factors of cdi recurrence during a provincial endemic.201323178420
clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines--is there a problem?acute severe colitis (asc) is a serious condition with possible outcomes of emergency colectomy and mortality. validated guidelines exist to help avoid these.201323176535
multiple factors modulate biofilm formation by the anaerobic pathogen clostridium difficile.bacteria within biofilms are protected from multiple stresses, including immune responses and antimicrobial agents. the biofilm-forming ability of bacterial pathogens has been associated with increased antibiotic resistance and chronic recurrent infections. although biofilms have been well studied for several gut pathogens, little is known about biofilm formation by anaerobic gut species. the obligate anaerobe clostridium difficile causes c. difficile infection (cdi), a major health care-associa ...201323175653
development and evaluation of a novel, semiautomated clostridium difficile typing platform.we describe a novel, semiautomated clostridium difficile typing platform that is based on pcr-ribotyping in conjunction with a semiautomated molecular typing system. the platform is reproducible with minimal intra- or interassay variability. this method exhibited a discriminatory index of 0.954 and is therefore comparable to more arduous typing systems, such as pulsed-field gel electrophoresis.201323175261
epidemiology, risk factors, and outcomes of clostridium difficile infection in kidney transplant recipients.we sought to describe the epidemiology and risk factors for clostridium difficile infection (cdi) among kidney transplant recipients (ktr) between 1 january 2008 and 31 december 2010.201323173772
clostridium difficile isolated from the fecal contents of swine in japan.a total of 250 fecal content samples were collected from 25 farrow-to-finish pig farms and examined for the prevalence of clostridium difficile by using ethanol treatment followed by plating onto selective media--cycloserine-cefoxitin-mannitol agar--for the isolation of clostridium difficile. two specimens (0.8%, 95% confidential interval: 0-2.9%) were positive for c. difficile. one isolate was only positive for toxin b, and the other isolate was negative for both toxins a and b. thus, prevalenc ...201323171688
significance of proton pump inhibitor types for clostridium difficile infection. 201323164689
relationship of symptom duration and fecal bacteriotherapy in clostridium difficile infection-pooled data analysis and a systematic review.clostridium difficle-associated infection (cdi) is usually treated with antibiotics; nevertheless, the infection has a high relapse rate. case series and case reports using fecal microbiota transplant (fmt) for cdi show promising results. however, there are no large studies to provide evidence for the efficacy of this therapy. the aim of this pooled patient data meta-analysis was to determine the efficacy of fmt in cdi.201323163886
simultaneous detection of viral and bacterial enteric pathogens using the seeplex® diarrhea ace detection system.a panel of 223 faecal samples was analysed to determine the clinical utility of the seeplex® diarrhea ace detection multiplex pcr system (seeplex system; seegene, korea), a qualitative multiplexing pcr technology that enables simultaneous multi-pathogen detection of four viruses and/or ten bacteria associated with acute gastroenteritis. conventional diagnostic methods and a norovirus-specific multiplex real-time rt–pcr detected 98 pathogens in 96 samples. the seeplex system detected 81 pathogens ...201323211606
fidaxomicin inhibits toxin production in clostridium difficile.fidaxomicin, which was recently approved for the treatment of clostridium difficile-associated diarrhoea, demonstrates narrow-spectrum bactericidal activity via inhibition of rna polymerase. in this study we evaluated its inhibitory activity versus c. difficile toxin gene expression and toxin production by quantifying toxin mrna and protein.201323208832
important clinical advances in the understanding of clostridium difficile infection.clostridium difficile remains an important cause of infectious colitis, particularly in healthcare facilities. this review summarizes recent advances in the epidemiology, diagnosis, and treatment of this endemic pathogen.201323207596
ribotyping in the detection of clostridium difficile outbreaks in a single university hospital.clostridium difficile infection (cdi) is the most important bacterial cause of hospital-acquired diarrhoea. although reports of deaths associated with cdi have been decreasing since a peak in 2007 in england and northern ireland, it remains a major cause of morbidity and mortality. the health protection agency's clostridium difficile ribotyping network (cdrn) aims to provide information to help optimize the management of cases of cdi. this study assesses the value of ribotyping to detect outbrea ...201323158685
quantitative fecal lactoferrin in toxin-positive and toxin-negative clostridium difficile specimens.quantitative fecal lactoferrin was measured in 112 patients tested for toxigenic clostridium difficile using glutamate dehydrogenase (gdh) and toxin immunoassays combined with tcdb pcr. lactoferrin levels were higher in the gdh-positive/toxin-positive group (79 μg/ml) than in the gdh-positive/toxin-negative/pcr-positive (21 μg/ml) and the gdh-negative groups (13 μg/ml). differences in fecal lactoferrin levels suggest variable presence or severity of c. difficile infection among toxin-positive an ...201323135940
the surgical management of active ulcerative colitis complicated by clostridium difficile infection.clostridium difficile stool toxin is detected in 5-20 % of patients with acute exacerbations of ulcerative colitis (uc). there is little data regarding the safety of surgery for uc with concurrent c. difficile.201323135837
antimicrobial susceptibility and resistance mechanisms of clinical clostridium difficile from a chinese tertiary hospital.clostridium difficile is a predominant cause of antibiotic-associated diarrhoea. it is increasingly difficult to treat c. difficile infection efficiently owing to its multidrug resistance. in the present study, 60 clinical c. difficile isolates were collected and analysed for their genotype, antimicrobial susceptibility and resistance mechanisms. tandem repeat sequence typing (trst) generated 21 types, including the epidemic clone tr017. antimicrobial susceptibility testing of eight antibiotics ...201323148985
vancomycin treatment's association with delayed intestinal tissue injury, clostridial overgrowth, and recurrence of clostridium difficile infection in mice.antibiotic treatment, including vancomycin, for clostridium difficile infection (cdi) has been associated with recurrence of disease in up to 25% of infected persons. this study investigated the effects of vancomycin on the clinical outcomes, intestinal histopathology, and anaerobic community during and after treatment in a murine model of cdi. c57bl/6 mice were challenged with c. difficile strain vpi 10463 after pretreatment with an antibiotic cocktail. twenty-four hours after infection, mice w ...201323147742
both fidaxomicin and vancomycin inhibit outgrowth of clostridium difficile spores.fidaxomicin (fdx) is approved to treat clostridium difficile-associated diarrhea and is superior to vancomycin in providing a sustained clinical response (cure without recurrence in the subsequent 25 days). the mechanism(s) behind the low recurrence rate of fdx-treated patients could be multifactorial. here, we tested effects of fdx, its metabolite op-1118, and vancomycin on spore germination and determined that none affected the initiation of spore germination but all inhibited outgrowth of veg ...201323147724
protective antibody responses against clostridium difficile elicited by a dna vaccine expressing the enzymatic domain of toxin b.a dna vaccination approach was used in the current study to screen for the immunogenicity of different fragments of toxin a and toxin b from clostridium difficile. with this approach, protein antigens do not need to be produced in vitro and the immunogenicity of candidate c. difficile antigens can be identified directly in animals. codon optimized toxin gene fragments were individually cloned into the dna vaccine vector and tested in mice and rabbits for their ability to elicit c. difficile toxi ...201323143772
colectomy in intensive care patients: operative findings and outcomes.with a critical illness, intestinal complications are associated with high morbidity and mortality.201323142989
antibody against tcdb, but not tcda, prevents development of gastrointestinal and systemic clostridium difficile disease.a dramatic increase in morbidity and mortality from clostridium difficile infection (cdi) due to the recent emergence of virulent, antibiotic-resistant strains has led to a search for alternatives to antibiotics, including vaccines and immune-based therapy that target the 2 key toxins-tcda and tcdb.201323125448
viral co-infections are common and are associated with higher bacterial burden in children with clostridium difficile infection.clostridium difficile infections in children are increasing. in this cohort study, we enrolled 62 children with diarrhea and c difficile. we performed polymerase chain reaction assays to detect viral agents of gastroenteritis and quantify c difficile burden. fifteen (24%) children diagnosed as having c difficile infection had a concomitant viral co-infection. these patients tended to be younger and had a higher c difficile bacterial burden than children with no viral co-infections (median differ ...201323838821
clostridium difficile infection in pediatric acute myeloid leukemia: from the canadian infections in acute myeloid leukemia research group.the prevalence and severity of clostridium difficile infection (cdi) has increased over time in adult patients, but little is known about cdi in pediatric cancer. the primary objectives were to describe the incidence and characteristics of cdi in children with de novo acute myeloid leukemia (aml). the secondary objective was to describe factors associated with cdi.201323838731
utility of an adenosine triphosphate bioluminescence assay to evaluate disinfection of clostridium difficile isolation rooms. 201323838235
discontinuation of reflex testing of stool samples for vancomycin-resistant enterococci resulted in increased prevalence.discontinuation of reflex testing of stool submitted for clostridium difficile testing for vancomycin-resistant enterococci (vre) led to an increase in the number of patients with healthcare-associated vre bacteremia and bacteriuria (0.21 vs 0.36 cases per 1,000 patient-days; p<.01). cost-benefit analysis showed reflex screening and isolation of vre reduced hospital costs.201323838226
[reply to «infections caused by clostridium difficile. addendum»]. 201323838212
antimicrobial regime for cardiac surgery: the safety and effectiveness of short-course flucloxacillin (or teicoplanin) and gentamicin-based prophylaxis.to determine if changing from multidose cefuroxime-based to flucloxacillin (or teicoplanin) and gentamicin-based antibiotic prophylaxis for cardiac surgery was as effective at preventing infections without increasing postoperative renal impairment.201323837413
fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid organ and hematopoietic stem cell transplantation with clostridium difficile-associated diarrhea.the feasibility of fidaxomicin versus vancomycin and metronidazole (conventional therapy) was assessed in 59 transplant recipients with 61 episodes of clostridium difficile-associated diarrhea (cdad). overall clinical cure was achieved in 86% of episodes, and in 7% of episodes, infection recurred. fidaxomicin was well tolerated. clinical cures were not significantly different compared with conventional therapy (67% versus 89%, respectively; p = 0.06). univariate analysis of predictors for lack o ...201323836168
glycan arrays containing synthetic clostridium difficile lipoteichoic acid oligomers as tools toward a carbohydrate vaccine.clostridium difficile is a leading cause of severe nosocomial infections. cell-surface carbohydrate antigens are promising vaccine candidates. here we report the first total synthesis of oligomers of the lipoteichoic acid antigen repeating unit. synthetic glycan microarrays revealed anti-glycan antibodies in the blood of patients that help to define epitopes for vaccine development.201323836132
assessment of treatment patterns and patient outcomes before vs after implementation of a severity-based clostridium difficile infection treatment policy.national guidelines recommend oral vancomycin for severe clostridium difficile infection (cdi) based on results from recent clinical trials demonstrating improved clinical outcomes. however, real-world data to support these clinical trials are scant.201323834988
a genomic update on clostridial phylogeny: gram-negative spore formers and other misplaced clostridia.the class clostridia in the phylum firmicutes (formerly low-g+c gram-positive bacteria) includes diverse bacteria of medical, environmental and biotechnological importance. the selenomonas-megasphaera-sporomusa branch, which unifies members of the firmicutes with gram-negative-type cell envelopes, was recently moved from clostridia to a separate class negativicutes. however, draft genome sequences of the spore-forming members of the negativicutes revealed typically clostridial sets of sporulatio ...201323834245
clinical relevance of a positive molecular test in the diagnosis of clostridium difficile infection.in 2011, the department of health advised that a two-stage test approach should be used to improve accuracy of clostridium difficile infection (cdi) diagnosis. no specific test protocol was established at that time.201323831282
[case report. leukocytosis in the course of clostridium difficile infection].clostridium difficile infections (cdi) are increasing in incidence and severity, amongst other reasons because of the increasing spread of hypervirulent strains. leukocytosis is a sign of severe cdi and is predictive for a complicated course. in this case report, we describe 2 patients with cdi who developed leukocytosis within a leukemoid range. in both cases high white blood cell counts returned totally to normal range under cdi therapy according to guidelines. leukemia-related therapy pattern ...201323828079
[clostridium difficile--an increasing problem]. 201323828075
community-associated clostridium difficile infection among older people in tayside, scotland, is associated with antibiotic exposure and care home residence: cohort study with nested case-control.to estimate the risks of community-associated clostridium difficile infection (ca-cdi) among the population aged ≥ 65 years associated with antibiotic exposure and care home residence.201323825381
caspase activation as a versatile assay platform for detection of cytotoxic bacterial toxins.pathogenic bacteria produce several virulence factors that help them establish infection in permissive hosts. bacterial toxins are a major class of virulence factors and hence are attractive therapeutic targets for vaccine development. here, we describe the development of a rapid, sensitive, and high-throughput assay that can be used as a versatile platform to measure the activities of bacterial toxins. we have exploited the ability of these toxins to cause cell death via apoptosis of sensitive ...201323824772
antimicrobial susceptibility of animal and human isolates of clostridium difficile by broth microdilution.a total of 188 human (n = 92) and animal (n = 96) isolates of clostridium difficile of different pcr ribotypes were screened for susceptibility to 30 antimicrobials using broth microdilution. when comparing the prevalence of antimicrobial resistance, the isolates of animal origin were significantly more often resistant to oxacillin, gentamicin and trimethoprim/sulfamethoxazole (p<0.01). the most significant difference between the animal and human populations (p = 0.0006) was found in the level o ...201323861298
antimicrobial stewardship in pediatrics: how every pediatrician can be a steward.antimicrobial stewardship (as) programs are effective in improving clinical outcomes associated with antimicrobial therapies while improving patient safety by reducing adverse events and development of bacterial resistance. understanding the basic principles of as is essential to the successful development and implementation of as strategies. identifying and developing strategies to address barriers and challenges to as can facilitate the establishment of financial, administrative, and organizat ...201323857121
major infection events over 5 years: how is media coverage influencing online information needs of health care professionals and the public?the last decade witnessed turbulent events in public health. emerging infections, increase of antimicrobial resistance, deliberately released threats and ongoing battles with common illnesses were amplified by the spread of disease through increased international travel. the internet has dramatically changed the availability of information about outbreaks; however, little research has been done in comparing the online behavior of public and professionals around the same events and the effect of ...201323856364
fecal microbiota transplantation: indications, methods, evidence, and future directions.fecal microbiota transplantation (fmt) has attracted great interest in recent years, largely due to the global clostridium difficile infection (cdi) epidemic and major advances in metagenomic sequencing of the gastrointestinal (gi) microbiota, with growing understanding of its structure and function. fmt is now recommended as the most effective therapy for relapsing cdi and, with further refinement, may even be used in "first-time" cdi. there is interest also in other conditions related to gi dy ...201323852569
potent monoclonal antibodies against clostridium difficile toxin a elicited by dna immunization.recent studies have demonstrated that dna immunization is effective in eliciting antigen-specific antibody responses against a wide range of infectious disease targets. the polyclonal antibodies elicited by dna vaccination exhibit high sensitivity to conformational epitopes and high avidity. however, there have been limited reports in literature on the production of monoclonal antibodies (mab) by dna immunization. here, by using clostridium difficile (c. diff) toxin a as a model antigen, we demo ...201323851482
prevalence of gastrointestinal clostridium difficile carriage in australian sheep and lambs.recently, clostridium difficile has been isolated from a wide variety of animals, particularly production animals, mainly cattle and pigs. concurrently, the incidence of c. difficile infection (cdi) in humans has increased in the community, with some suggestions that food-borne transmission of c. difficile is occurring. interestingly, sheep and lambs appear not to have been investigated for carriage/colonization with c. difficile. the aim of this project was to determine the prevalence of carria ...201323851101
efficacy and safety of paromomycin for treating amebiasis in japan.the clinical management of amebiasis is a growing concern, particularly among human immunodeficiency virus (hiv)-infected individuals who are predisposed to severe illness. treatment with a luminal amebicide is strongly recommended following acute-stage treatment with a nitroimidazole. in 2004, the japanese research group on chemotherapy of tropical diseases introduced paromomycin, which was not nationally licensed, and offered it to a number of patients. from 2004 to 2011, 143 case records of a ...201323850836
epidemiology of adverse events and clostridium difficile-associated diarrhea during long-term antibiotic therapy for osteoarticular infections.osteoarticular infections require several weeks of antibiotic therapy, but little is known about the epidemiology of adverse events (ae) including symptomatic clostridium difficile-associated diarrhea during treatment in these patients.201323850617
derivation and validation of a simple, accurate and robust prediction rule for risk of mortality in patients with clostridium difficile infection.clostridium difficile infection poses a significant healthcare burden. however, the derivation of a simple, evidence based prediction rule to assist patient management has not yet been described.201323849267
genetic risk factors for clostridium difficile infection in ulcerative colitis.patients with inflammatory bowel disease (ibd) are at higher risk for clostridium difficile infection (cdi). disruption of gut microbiome and interaction with the intestinal immune system are essential mechanisms for pathogenesis of both cdi and ibd. whether genetic polymorphisms associated with susceptibility to ibd are also associated with risk of cdi is unknown.201323848254
clostridium difficile associated disease in a neurointensive care unit.critically ill patients are at high risk for acquiring clostridium difficile infection. the aim of this study was to investigate the prevalence, severity, and outcome of neurointensive care unit (nicu) acquired clostridium difficile associated disease (cdad).201323847584
comparison of chromid c. difficile agar and cycloserine-cefoxitin-fructose agar for the recovery of clostridium difficile.the rapidly changing epidemiology of clostridium difficile infection highlights the need for improved and continuing surveillance involving stool culturing to enable molecular tracking. culture of c. difficile can be difficult and time consuming. in this report chromid c. difficile agar (cdif) was compared to cycloserine-cefoxitin-fructose-egg-yolk agar which contained 0.1% sodium taurocholate (tccfa) as a germinant.201323846295
the adoptive transfer of behavioral phenotype via the intestinal microbiota: experimental evidence and clinical implications.there is growing interest in the ability of the intestinal microbiome to influence host function within and beyond the gastrointestinal tract. here we review evidence of microbiome-brain interactions in mice and focus on the ability to transfer behavioral traits between mouse strains using fecal microbiota transplantation (fmt). transplantation alters brain chemistry and behavior in recipient ex-germ free mice, raising the possibility of using fmt for disorders of the central nervous system, and ...201323845749
[harnessing nature for treating infectious and autoimmune diseases: good and bad bacteria].clostridium difficile is the etiologic agent of nosocomial and community-acquired diarrhea associated with exposure to antibiotics that disrupt the normal colonic flora. as antibacterials currently used for primary c. difficile infections favor recurrences, new methods able to neutralize the bacterium without affecting the gut microbiota are badly needed. complementary treatment with probiotic agents to reconstitute the physiological intestinal flora does not yield any consistent benefit. in rec ...201323844515
emerging therapies for clostridium difficile infection - focus on fidaxomicin.the epidemiology of clostridium difficile infections (cdi) has evolved during the last decades, with an increase in the reported incidence, severity of cases, and rate of mortality and relapses. these increases have primarily affected some special populations including the elderly, patients requiring concomitant antibiotic therapy, patients with renal failure, and patients with cancer. until recently, the treatment of cdi was limited to either metronidazole or vancomycin. new therapeutic options ...201323843696
clostridium difficile in a hiv-infected cohort: incidence, risk factors, and clinical outcomes.clostridium difficile is the most commonly reported infectious diarrhoea in hiv-infected patients in the united states. we set out to determine the incidence, risk factors and clinical presentation of c. difficile infections (cdis) in a cohort of hiv-infected individuals.201323842125
fecal microbiota transplantation for treating recurrent clostridium difficile infection. 201323841136
excess risk of clostridium difficile infection in ovarian cancer is related to exposure to broad-spectrum antibiotics.the purpose of the study was to determine if a diagnosis of ovarian cancer is independently associated with an increased risk of clostridium difficile infection (cdi).201323839499
evaluation of cycloserine-cefoxitin fructose agar (ccfa), ccfa with horse blood and taurocholate, and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme for recovery of clostridium difficile isolates from fecal samples.cycloserine-cefoxitin fructose agar (ccfa), ccfa with horse blood and taurocholate (ccfa-ht), and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme (ccmb-tal) were compared for recovery of clostridium difficile from 120 stool specimens. compared to ccfa, ccfa-ht enhanced c. difficile growth and improved recovery by 4%. in a separate study, 9% (8/91) of stool samples previously c. difficile negative on plate medium were c. difficile positive when cultured in ccmb-tal.201323804392
intestinal dysbiosis and depletion of butyrogenic bacteria in clostridium difficile infection and nosocomial diarrhea.clostridium difficile infection (cdi) causes nearly half a million cases of diarrhea and colitis in the united states each year. although the importance of the gut microbiota in c. difficile pathogenesis is well recognized, components of the human gut flora critical for colonization resistance are not known. culture-independent high-density roche 454 pyrosequencing was used to survey the distal gut microbiota for 39 individuals with cdi, 36 subjects with c. difficile-negative nosocomial diarrhea ...201323804381
ceftaroline fosamil: a review of its use in the treatment of complicated skin and soft tissue infections and community-acquired pneumonia.ceftaroline, the active metabolite of the prodrug ceftaroline fosamil (zinforo, teflaro), is an advanced-generation, parenteral cephalosporin with broad-spectrum antibacterial activity in vitro against gram-positive bacteria, including methicillin-resistant staphylococcus aureus (mrsa) and multidrug resistant streptococcus pneumoniae and gram-negative bacteria, including haemophilus influenzae and moraxella catarrhalis, but not pseudomonas aeruginosa. ceftaroline has demonstrated a low potential ...201323801418
correlation between virulence gene expression and proton pump inhibitors and ambient ph in clostridium difficile: results of an in vitro study.proton pump inhibitors (ppis) are associated with the development of clostridium difficile infection in humans. though it is assumed that ppis mediate this effect through gastric acid suppression, there has been little investigation into whether ppis, or ambient ph, might directly affect the expression of c. difficile toxin genes. in the present study, c. difficile ribotypes 001, 027 and 078 obtained from human subjects were grown under anaerobic conditions prepared at phs of 5, 7.3 and 9. match ...201323800596
quinolone prophylaxis for the prevention of bk virus infection in kidney transplantation: study protocol for a randomized controlled trial.bk virus infection has emerged as a major complication in kidney transplantation leading to a significant reduction in graft survival. there are currently no proven strategies to prevent or treat bk virus infection. quinolone antibiotics, such as levofloxacin, have demonstrated activity against bk virus. we hypothesize that administration of a quinolone antibiotic, when given early post-transplantation, will prevent the establishment of bk viral replication in the urine and thus prevent systemic ...201323800312
imipenem versus piperacillin/tazobactam for empiric treatment of neutropenic fever in adults.australian guidelines for neutropenic fever recommend piperacillin/tazobactam (pip-taz) or cefepime for first-line empiric treatment of neutropenic fever. we compared outcomes among haematology patients before and after changing our first-line neutropenic fever treatment from imipenem to pip-taz. forty-five patients received imipenem and 60 pip-taz. despite a higher rate of antibiotic modification in the pip-taz cohort, treatment success and time to defervescence were similar, with a trend towar ...201323800137
increased hospital length of stay attributable to clostridium difficile infection in patients with four co-morbidities: an analysis of hospital episode statistics in four european countries.hospital-onset clostridium difficile infection (cdi) places a significant burden on health care systems throughout europe, estimated at around €3 billion per annum. this burden is shared between national payers and hospitals that support additional bed days for patients diagnosed with cdi while in hospital or patients re-admitted from a previous hospitalisation. this study was performed to quantify additional hospital stay attributable to cdi in four countries, england, germany, spain, and the n ...201323797490
vancomycin use for pediatric clostridium difficile infection is increasing and associated with specific patient characteristics.in adults with clostridium difficile infection (cdi), enteral vancomycin is considered the preferred initial regimen for severe disease; however, patterns of antimicrobial use for children with cdi are unknown. we sought to describe trends in and predictors of vancomycin use for the treatment of children with cdi admitted to tertiary-care children's hospitals in the united states. we used a database of freestanding children's hospitals to identify patients 1 to 18 years old with cdi between janu ...201323796942
renal impairment and clinical outcomes of clostridium difficile infection in two randomized trials.patients with chronic kidney disease (ckd) have increased risk for clostridium difficile infection (cdi) and for subsequent mortality. we determined the effect of ckd on response to treatment for cdi.201323796582
immunological evaluation of a synthetic clostridium difficile oligosaccharide conjugate vaccine candidate and identification of a minimal epitope.clostridium difficile is the cause of emerging nosocomial infections that result in abundant morbidity and mortality worldwide. thus, the development of a vaccine to kill the bacteria to prevent this disease is highly desirable. several recently identified bacterial surface glycans, such as ps-i and ps-ii, are promising vaccine candidates to preclude c. difficile infection. to circumvent difficulties with the generation of natural ps-i due to its low expression levels in bacterial cultures, impr ...201323795894
the clostridium difficile exosporium cysteine (cdec)-rich protein is required for exosporium morphogenesis and coat assembly.clostridium difficile is an important nosocomial pathogen that has become a major cause of antibiotic-associated diarrhea. there is a general consensus that c. difficile spores play an important role in c. difficile pathogenesis, contributing to infection, persistence, and transmission. evidence has demonstrated that c. difficile spores have an outermost layer, termed the exosporium, that plays some role in adherence to intestinal epithelial cells. recently, the protein encoded by cd1067 was sho ...201323794627
national variability in surveillance, testing, and infection prevention for clostridium difficile infection in pediatric populations.to assess national variability in methods of identifying and preventing clostridium difficile infection (cdi) in pediatric populations, an anonymous survey was sent to hospital epidemiologists at us children's hospitals. data from 30 hospitals indicate substantial variability in surveillance, testing, and infection control strategies, which may limit reliable interfacility comparison of cdi rates. in addition, only 60% of respondents perform surveillance for community-associated cdi.201323790613
rapid detection of clostridium difficile toxins from stool samples using real-time multiplex pcr.in this study, a total of 650 stool samples were tested to show that our method is capable of detecting four clostridium difficile genes; tcda, tcdb, encoding toxin a (tcda) and toxin b (tcdb), and the binary toxin c. difficile transferase genes (cdta and/or cdtb) encoding cdt toxin. besides detecting the targeted c. difficile genes, our method can be used to detect the presence of any inhibitory components in the pcr. this assay, combined with a selective culture medium, such as the chromid™ c. ...201323788597
clostridium difficile infections in south east scotland: mortality and recurrence in a region without pcr ribotype 027.three hundred and thirty-five patients with laboratory-confirmed clostridium difficile infections (cdis) were studied for epidemiological features, clinical presentation and laboratory markers. they were followed up for 1 year to determine recurrence and mortality. four hundred and thirty-two episodes were recorded. one year mortality was 41.8 % of which cdi was listed on 20 % of the death certificates. one year recurrence rate was 22.9 %. pcr ribotype 001 was the commonest epidemiological type ...201323788595
laboratory diagnosis of clostridium difficile infections: there is light at the end of the colon.single molecular or multistep assays (glutamate dehydrogenase, toxin a/b, ± molecular) are recommended for the diagnosis of cdi in patients with clinically significant diarrhea. rapid and accurate tests can improve resource allocations and improve patient care. enzyme immunoassay (eia) for toxins a/b is too insensitive for use as a stand-alone assay. this guideline will examine the use of molecular tests and multitest algorithms for the diagnosis of clostridium difficile infection (cdi). these n ...201323788237
impact of cleaning and other interventions on the reduction of hospital-acquired clostridium difficile infections in two hospitals in england assessed using a breakpoint model.clostridium difficile infection remains a major challenge for hospitals. although targeted infection control initiatives have been shown to be effective in reducing the incidence of hospital-acquired c. difficile infection, there is little evidence available to assess the effectiveness of specific interventions.201323787167
challenges for standardization of clostridium difficile typing methods.typing of clostridium difficile facilitates understanding of the epidemiology of the infection. some evaluations have shown that certain strain types (for example, ribotype 027) are more virulent than others and are associated with worse clinical outcomes. although restriction endonuclease analysis (rea) and pulsed-field gel electrophoresis have been widely used in the past, pcr ribotyping is the current method of choice for typing of c. difficile. however, global standardization of ribotyping r ...201323784128
clostridium difficile infection in newly diagnosed pediatric inflammatory bowel disease in the mid-southern united states.clostridium difficile is an emerging opportunistic pathogen that infects patients with underlying chronic disorders such as inflammatory bowel diseases (ibd) at high rates. an extremely high prevalence of clostridium difficile infection (cdi) was noted recently in new-onset pediatric ibd from eastern europe (poland). we examined the rate of cdi in our new pediatric ibd patients (123 tested) from 2010 to 2012. the overall prevalence of cdi at disease onset was 8.1%, significantly (p < 0.0001) low ...201323783013
the functional vangcd cluster of clostridium difficile does not confer vancomycin resistance.vangcd, a cryptic gene cluster highly homologous to the vang gene cluster of enterococcus faecalis is largely spread in clostridium difficile. since emergence of vancomycin resistance would have dramatic clinical consequences, we have evaluated the capacity of the vangcd cluster to confer resistance. we showed that expression of vangcd is inducible by vancomycin and that vangcd , vanxycd and vantcd are functional, exhibiting d-ala : d-ser ligase, d,d-dipeptidase and d-ser racemase activities res ...201323782343
diagnosis of clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories.clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. since the early 2000s, the incidence of c. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. for many years, the mainstay of c. difficile disease diagnosis was enzyme immunoassays for detection of the c. difficile to ...201323824374
clinical features and treatment responses in pediatric lymphocytic and collagenous colitis.microscopic colitis (mc) is prevalent in adults investigated for chronic watery diarrhea, yet characterization of pediatric mc is limited.201323820404
epidemiology of clostridium difficile infection in asia.while clostridium difficile infection (cdi) has come to prominence as major epidemics have occurred in north america and europe over the recent decade, awareness and surveillance of cdi in asia have remained poor. limited studies performed throughout asia indicate that cdi is also a significant nosocomial pathogen in this region, but the true prevalence of cdi remains unknown. a lack of regulated antibiotic use in many asian countries suggests that the prevalence of cdi may be comparatively high ...201323816346
a unique strain of community-acquired clostridium difficile in severe complicated infection and death of a young adult.clostridium difficile is the major cause of nosocomial antibiotic-associated diarrhoea with the potential risk of progressing to severe clinical outcomes including death. it is not unusual for clostridium difficile infection to progress to complications of toxic megacolon, bowel perforation and even gram-negative sepsis following pathological changes in the intestinal mucosa. these complications are however less commonly seen in community-acquired clostridium difficile infection than in hospital ...201323815405
community-acquired clostridium difficile infection: awareness and clinical implications.the epidemiology of clostridium difficile infection (cdi) is changing. cdi, usually depicted as a nosocomial infection in the elderly, is now occurring in community-dwelling persons who are younger and otherwise dissimilar. a more virulent isolate (north american pulsed field type 1 (nap1) associated with increased morbidity and mortality, has been identified. in 2005, similar strains were associated with severe disease in community-dwelling patients at a rate of 7.6/100,000. screening patients ...201323814528
an investigation into the association between cpb2-encoding clostridium perfringens type a and diarrhea in neonatal piglets.to investigate the possible role of cpb2-positive type a clostridium perfringens in neonatal diarrheal illness in pigs, the jejunum and colon of matched normal and diarrheic piglets from 10 farms with a history of neonatal diarrhea were examined grossly and by histopathology, and tested for c. perfringens, for c. perfringens beta2 (cpb2) toxin, as well as for clostridium difficile toxins, salmonella, enterotoxigenic escherichia coli, rotavirus, transmissible gastroenteritis (tge) virus, and cocc ...201323814355
nutritional and microbial analysis of bully sticks and survey of opinions about pet treats.the objectives of this study were to measure the caloric density of bully sticks, to analyze the bully sticks for bacterial contamination, and to assess owner opinions about these and other pet treat products. mean caloric density was 15 kcal/inch (38 kcal/cm) [range: 9 to 22 kcal/inch (23 to 56 kcal/cm), 2.96 to 3.07 kcal/g]. of 26 bully sticks that were tested for bacterial contamination 1 (4%) was contaminated with clostridium difficile, 1 was contaminated with methicillin-resistant staphyloc ...201323814301
pre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients.patients requiring mechanical ventilation (mv) for >48 h after major heart surgery (mhs) are at a high risk of acquiring ventilator-associated pneumonia (vap) and tracheobronchitis (vat). most non-pharmacological interventions to prevent vap in such patients are usually already implemented. the objective of this study was to evaluate the efficacy in preventing lower respiratory infections of antibiotics active against multidrug-resistant pathogens in this very high-risk population.201323812339
clostridium difficile infection associated with antituberculous agents in a patient with tuberculous pericarditis.clostridium difficile can cause pseudomembranous colitis (pmc). antimicrobial agent exposure is a risk factor for clostridium difficile-associated disease, whereas the use of antituberculous (anti-tb) agents is not. we herein report a case of pmc-associated with antituberculous therapy. a 63-year-old woman with tuberculous pericarditis treated with anti-tb agents was admitted for abdominal pain and diarrhea. on colonoscopy, mucoid exudate and yellowish plaque lesions were observed. the anti-tb a ...201323812197
unusual case of prosthetic shoulder joint infection due to clostridium difficile.extraintestinal manifestatation such as prosthetic joint infection due to clostridium difficile is a rare diagnosis. a 47-year-old female patient presented with chronic pain in left shoulder prosthetic joint. plain roentgenogram of left shoulder prosthetic joint revealed anterior dislocation and loosening of prosthesis. the synovial fluid cultures and intraoperative deep joint cultures repeatedly grew clostridium difficile. patient was treated with antimicrobial therapy and surgical debridement ...201323811577
clostridium difficile infection.clostridium difficile is emerging as a common cause of infectious diarrhea. incidence has increased dramatically since 2000, associated with a new strain that features both increased toxin production and increased resistance to antibiotics. for patients with mild to moderate disease, oral metronidazole is usually the first choice of treatment, and those with severe disease should be treated with vancomycin, with additional intravenous metronidazole in some cases. fecal microbiota transplantation ...201323809712
clostridium difficile infection among hematopoietic stem cell transplant recipients: beyond colitis.to review the most recent data regarding the epidemiology, risks factors, and outcomes among hematopoietic stem cell transplant recipients with clostridium difficile infection (cdi).201323806895
clostridium difficile infection increases mortality risk in lung transplant recipients.clostridium difficile infection (cdi) and associated mortality in solid organ transplant recipients is rising, but data are scarce in lung transplant recipients. we aimed to characterize cdi and its effect on mortality in a large cohort of lung transplant recipients.201323891145
risk factors associated with clostridium difficile infection after kidney and pancreas transplantation.clostridium difficile infection (cdi) is a common cause of nosocomial antibiotic-associated diarrhea with an increased incidence reported in solid organ transplant recipients. we sought to determine if kidney and/or pancreas transplant recipients possess unique risk factors for cdi.201323890202
the effects of statins on the clinical outcomes of clostridium difficile infection in hospitalised patients.an association between exposure to statin drugs and favourable treatment outcomes for various types of infections has been established.201323888883
the anticancer drug tirapazamine has antimicrobial activity against escherichia coli, staphylococcus aureus and clostridium difficile.rapidly increasing bacterial resistance to existing therapies creates an urgent need for the development of new antibacterials. tirapazamine (tpz, 3-amino-1,2,4-benzotriazine 1,4 dioxide) is a prodrug undergoing clinical trials for various types of cancers. in this study, we showed that tpz has antibacterial activity, particularly at low oxygen levels. with escherichia coli, tpz was bactericidal under both aerobic and anaerobic conditions. escherichia coli mutants deficient in homologous recombi ...201323888874
reducing clostridium difficile incidence, colectomies, and mortality in the hospital setting: a successful multidisciplinary approach.health care associated clostridium difficile infections are a major cause of morbidity and mortality in hospitals. in the united states, from 2000 through 2009, discharge diagnoses from hospitals in the united states that included c. difficile increased from 139,000 to 336,600, and the yearly national excess hospital cost associated with hospital-onset c. difficile is estimated to be upwards of $1.3 billion.201323888639
molecular test to determine toxigenic capabilities in gdh-positive, toxin-negative samples: evaluation of the portrait toxigenic c. difficile assay.new recommendations for testing and reporting of clostridium difficile were introduced in the nhs in 2012. these guidelines have improved identification of potential c. difficile infection (cdi) cases, but questions remain around the management of glutamate dehydrogenase (gdh)-positive, toxin-negative patients. this study aims to assess the introduction of the portrait c. difficile assay as the third step to identify the presence of the toxigenic c. difficile b (tcdb) gene and thus determine tox ...201323888607
presumably hospital-transmitted clostridium difficile infections based on epidemiological linkage.given the traditionally low cdad (clostridium difficile associated diarrhoea) prevalence in switzerland, cdad patients are not routinely contact-isolated in our institution. in light of the globally changing c. difficile epidemiology, we sought to determine our institutional cdad rate and to detect possible hospital transmission by means of epidemiological linkage.201323888435
candidemia subsequent to severe infection due to clostridium difficile: is there a link? 201323723197
diversity of cwp loci in clinical isolates of clostridium difficile.an increased incidence of clostridium difficile infection (cdi) is associated with the emergence of epidemic strains characterized by high genetic diversity. among the factors that may have a role in cdi is a family of 29 paralogues, the cell-wall proteins (cwps), which compose the outer layer of the bacterial cell and are likely to be involved in colonization. previous studies have shown that 12 of the 29 cwp genes are clustered in the same region, named after slpa (cwp1), the slpa locus, where ...201323722432
mortality in patients with clostridium difficile infection correlates with host pro-inflammatory and humoral immune responses.host anti-toxin immune responses play important roles in clostridium difficile disease and outcome. the relationship between host immune and inflammatory responses during severe c. difficile infection (cdi) and the risk of mortality has yet to be defined. we aimed to investigate the host systemic igg anti-toxin immune responses, the in vitro cytotoxicity of the infecting c. difficile ribotyped strain, and the host inflammatory markers and their relationship to cdi disease severity and risk of mo ...201323722431
evaluating the impact of a pharmacist's absence from an antimicrobial stewardship team.results of a study to determine the impact of a clinical pharmacist's temporary absence from a hospital's antimicrobial stewardship team are presented.201323719885
duodenal infusion of feces for recurrent clostridium difficile. 201323718172
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