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procalcitonin levels associate with severity of clostridium difficile infection.clostridium difficile infection (cdi) is a major cause of morbidity and biomarkers that predict severity of illness are needed. procalcitonin (pct), a serum biomarker with specificity for bacterial infections, has been little studied in cdi. we hypothesized that pct associated with cdi severity.201323505476
clostridium difficile contamination of public tap water distribution system during a waterborne outbreak in finland.in november through december 2007, the drinking water distribution system in the town of nokia, finland, was contaminated with treated sewage effluent that resulted in a large gastroenteritis outbreak in the community. the aim of the present study was to investigate if the contaminated water in this outbreak was also a potential source of clostridium difficile infections.201323503193
clinical and microbiological features of clostridium difficile infections in france: the icd-raisin 2009 national survey.the surveillance of clostridium difficile infections (cdi) in france was reinforced after the emergence of the pcr-ribotype 027 epidemic clone in 2006; notification of case clusters or severe cases by healthcare facilities (hcf) became mandatory. the french public health surveillance institute (invs) and the c. difficile national reference center (nrc) launched a national, prospective, multicentric survey to complete available data, in 2009. the survey had for objectives to assess cdi incidence ...201323498135
clostridium difficile in faeces from healthy dogs and dogs with diarrhea.this study was conducted to evaluate the faecal occurrence and characterization of clostridium difficile in clinically healthy dogs (n = 50) and in dogs with diarrhea (n = 20) in the stockholm-uppsala region of sweden.201323497714
current role of surgery for the treatment of fulminant clostridium difficile colitis.this review discusses the current status and progress in studies on fulminant clostridium difficile colitis (fcdc), including the definition, risk factor, diagnostic role of ct, surgical treatment, postoperative mortality, and new therapeutic strategy.201323489808
understanding factors that impact on health care professionals' risk perceptions and responses toward clostridium difficile and meticillin-resistant staphylococcus aureus: a structured literature review.clostridium difficile is the most common health care-associated infection. despite considerable efforts to prevent and manage c difficile, poor clinical practice and nonadherence to policy continues to compromise patient safety. risk perception research is essential in gaining understanding about how health care professionals respond.201323489738
the role of gut inflammation in recurrent clostridium difficile-associated disease. 201323487370
markers of intestinal inflammation, not bacterial burden, correlate with clinical outcomes in clostridium difficile infection.clostridium difficile is a leading hospital-acquired infection. many patients remain symptomatic for several days on appropriate antibiotic therapy. to assess the contribution of ongoing infection vs persistent inflammation, we examined the correlation between fecal cytokine levels, fecal c. difficile burden, and disease outcomes in c. difficile infection (cdi).201323487367
a segment of 97 amino acids within the translocation domain of clostridium difficile toxin b is essential for toxicity.clostridium difficile toxin b (tcdb) intoxicates target cells by glucosylating rho gtpases. tcdb (269 kda) consists of at least 4 functional domains including a glucosyltransferase domain (gtd), a cysteine protease domain (cpd), a translocation domain (td), and a receptor binding domain (rbd). the function and molecular mode of action of the td, which is the largest segment of tcdb and comprises nearly 50% of the protein, remain largely unknown. here we show that a 97-amino-acid segment (aa1756 ...201323484044
[infusion of donor feces in recurrent clostridium difficile infection? - infusion of donor feces: promising intervention with several question marks]. 201323483414
clostridium difficile colitis in patients undergoing lower-extremity arthroplasty: rare infection with major impact.the prevalence of clostridium difficile colitis is reportedly increasing in surgical patients and can negatively impact their outcome. however, as yet there are no clear estimates of the c difficile infection colitis rate and its consequences among patients undergoing total joint arthroplasty (tja).201323479237
meta-analysis of antibiotics and the risk of community-associated clostridium difficile infection.the rising incidence of clostridium difficile infection (cdi) could be reduced by lowering exposure to high-risk antibiotics. the objective of this study was to determine the association between antibiotic class and the risk of cdi in the community setting. the embase and pubmed databases were queried without restriction to time period or language. comparative observational studies and randomized controlled trials (rcts) considering the impact of exposure to antibiotics on cdi risk among nonhosp ...201323478961
health care burden of clostridium difficile infection in hospitalized children with inflammatory bowel disease.children with inflammatory bowel disease (ibd), similar to adults, are at increased risk of acquiring a clostridium difficile infection (cdi). our objective was to characterize the health care burden associated with cdi in hospitalized pediatric patients with ibd.201323478808
trends in clostridium difficile infection and risk factors for hospital acquisition of clostridium difficile among children with cancer.to study the trend of clostridium difficile infection (cdi) and risk factors for hospital acquired cdi (ha-cdi) among children with cancer.201323477996
the clostridium difficile problem: a south african tertiary institution's prospective perspective.the aim of this study is to report the incidence of clostridium difficile-associated disease (cdad) in a tertiary-care hospital in south africa and to identify risk factors, assess patient outcomes and determine the impact of the hypervirulent strain of the organism referred to as north american pulsed-field type 1 (nap1).201323472693
analysis of nosocomial acquired clostridium difficile infection in an italian research and teaching hospital.clostridium difficile (cd) infection is a nosocomial plague which is correlated with several clinical and medical factors such as antibiotics intake. it is known that prevention is possible through infection control measures both clinical and epidemiological.201323471449
effectiveness of supportive care measures to reduce infections in pediatric aml: a report from the children's oncology group.objective was to describe the effect of antibiotic and granulocyte colony-stimulating factor (g-csf) prophylaxis and discharge policy on infection risk and nonrelapse-related mortality (nrm) during chemotherapy for children with acute myeloid leukemia. patients were non-down syndrome children enrolled on children's oncology group (cog) trial aaml0531. we surveyed sites to determine institutional standards for systemic antibacterial, antifungal, and g-csf prophylaxis, and mandatory hospitalizatio ...201323471307
do statins protect against the development of clostridium difficile-associated diarrhoea?to assess whether prior statin use protects against the development of clostridium difficile-associated diarrhoea (cdad) in hospitalized patients.201323563740
emergence of a highly resistant clostridium difficile strain (nap/bi/027) in a tertiary care center in saudi arabia. 201323563012
carbohydrate-based clostridium difficile vaccines.clostridium difficile is responsible for thousands of deaths each year and a vaccine would be welcomed, especially one that would disrupt bacterial maintenance, colonization and persistence in carriers and convalescent patients. structural explorations at the university of guelph (on, canada) discovered that c. difficile may express three phosphorylated polysaccharides, named psi, psii and psiii; this review captures our recent efforts to create vaccines based on these glycans, especially psii, ...201323560922
intracolonic vancomycin for severe clostridium difficile colitis.clostridium difficile colitis is associated with increased age, antibiotic usage, and hospitalization. severe c. difficile colitis refractory to medical therapy may require surgical intervention including subtotal colectomy. we initiated an adjuvant intracolonic vancomycin (icv) enema protocol for inpatients with severe c. difficile colitis and compared the response to this therapy in patients from the community and nursing homes.201323560732
impact of ribotype 027 on clostridium difficile infection in a geriatric department.the purposes of this study were to describe the epidemiology (2001-2009) of clostridium difficile infections (cdi) in a geriatric department and to compare the clinical data of patients infected with a 027 or non-027 strain. we retrospectively identified all geriatric patients with cdi and analysed the clinical and microbiological data of 133 patients for whom a ribotype was available between march 2003 and december 2009. the incidence of cdi in our geriatric department increased from 0.2 per 10 ...201323558363
cellular uptake of clostridium difficile tcda and truncated tcda lacking the receptor binding domain.the combined repetitive oligopeptides (crops) of clostridium difficile toxins a (tcda) and b (tcdb) induce clathrin-mediated endocytosis of the toxins. inconsistently, crop-truncated tcda(1-1874) is also capable of entering host cells and displaying full cytotoxic properties although with less potency. pre-incubation of cells with isolated crops, however, reconstitutes the reduced uptake of tcda(1-1874) to the level of the full-length toxin. we believe that tcda exhibits an additional binding mo ...201323558138
two cases of fulminant colitis due to binary toxin-positive clostridium difficile that are not pcr ribotype 027 or type 078.two cases of fulminant colitis due to clostridium difficile occurred within ten weeks of each other on the same ward of a hospital in japan. the patients died 2 and 4 days after the onset of colitis. c. difficile isolates obtained from both patients were toxin a-positive, toxin b-positive and binary toxin-positive. these isolates yielded identical results by both pcr ribotyping and slpa sequence typing. however, the banding patterns and slpa sequences of the isolates differed from those of pcr r ...201323558137
evaluation of antimicrobial activity of ceftaroline against clostridium difficile and propensity to induce c. difficile infection in an in vitro human gut model.to examine the effects of exposure to ceftaroline or ceftriaxone on the epidemic clostridium difficile strain pcr ribotype 027 and the indigenous gut microflora in an in vitro human gut model. additionally, the mics of ceftriaxone and ceftaroline for 60 c. difficile isolates were determined.201323557928
clostridium difficile enteritis: a report of two cases and systematic literature review.clostridium difficile (c. difficile) is the most common cause of healthcare associated infectious diarrhea. in the last decade, the incidence of c. difficile infection has increased dramatically. the virulence of c. difficile has also increased recently with toxigenic strains developing. c. difficile is generally a disease of the colon and presents with abdominal pain and diarrhea due to colitis. however, c. difficile enteritis has been reported rarely. the initial reports suggested mortality ra ...201323556059
low cost extraction and isothermal amplification of dna for infectious diarrhea diagnosis.in order to counter the common perception that molecular diagnostics are too complicated to work in low resource settings, we have performed a difficult sample preparation and dna amplification protocol using instrumentation designed to be operated without wall or battery power. in this work we have combined a nearly electricity-free nucleic acid extraction process with an electricity-free isothermal amplification assay to detect the presence of clostridium difficile (c. difficile) dna in the st ...201323555883
clostridium difficile ribotype diversity at six health care institutions in the united states.capillary-based pcr ribotyping was used to quantify the presence/absence and relative abundance of 98 clostridium difficile ribotypes from clinical cases of disease at health care institutions in six states of the united states. regionally important ribotypes were identified, and institutions in close proximity did not necessarily share more ribotype diversity than institutions that were farther apart.201323554188
appendectomy is not associated with adverse outcomes in clostridium difficile infection: a population-based study. 201323552320
nisin and clostridium difficile: a potentially effective treatment for an increasingly problematic disease. 201323552318
fecal bacteriotherapy for recurrent clostridium difficile infection: what's old is new again?in recent years, effective management of recurrent clostridium difficile infection (cdi) has emerged as an important issue for those clinicians who treat patients with cdi. in addition to antibiotic-based therapies, including alternating use, chaser, and tapering protocols, interest has increased in the potential utility of a variety of nonantibiotic forms of adjunctive therapy. among these alternative forms of treatment, the concept of transferring extracts of a stool from donors to patients wi ...201323549617
clostridium difficile infection in the hospitalized pediatric population: increasing trend in disease incidence.to determine whether the incidence of clostridium difficile infection continues to increase in hospitalized pediatric patients, we evaluated data from a united states national inpatient database. for the period of 2003 to 2009, we found an increasing trend in the incidence of c. difficile infection. these data suggest greater effort be given to prevent and treat this infection in children.201323546535
new opportunities for improved ribotyping of c. difficile clinical isolates by exploring their genomes.clostridium difficile causes outbreaks of infectious diarrhoea, most commonly occurring in healthcare institutions. recently, concern has been raised with reports of c. difficile disease in those traditionally thought to be at low risk i.e. community acquired rather than healthcare acquired. this has increased awareness for the need to track outbreaks and pcr-ribotyping has found widespread use to elucidate epidemiologically linked isolates. pcr-ribotyping uses conserved regions of the 16s rrna ...201323545446
toll-like receptor 5-dependent immunogenicity and protective efficacy of a recombinant fusion protein vaccine containing the nontoxic domains of clostridium difficile toxins a and b and salmonella enterica serovar typhimurium flagellin in a mouse model of clostridium difficile disease.clostridium difficile is a spore-forming bacillus that produces toxin-mediated enteric disease. c. difficile expresses two major virulence factors, toxin a (tcda) and toxin b (tcdb). human and animal studies demonstrate a clear association between humoral immunity to these toxins and protection against c. difficile infection (cdi). the receptor binding-domains (rbds) of tcda and tcdb are known to be immunogenic. here, we tested the immunoadjuvant properties of salmonella enterica serovar typhimu ...201323545305
the clostridium difficile cpr locus is regulated by a noncontiguous two-component system in response to type a and b lantibiotics.the intestinal pathogen clostridium difficile is known to grow only within the intestines of mammals, yet little is known about how the bacterium subsists in this environment. in the intestine, c. difficile must contend with innate defenses within the host, such as cationic antimicrobial peptides (camps) produced by the host and the indigenous microbiota. in this study, we investigated the mechanism of activation and regulation of the cprabc transporter system, which provides resistance to multi ...201323543720
diagnosis and management of clostridium difficile infection.clostridium difficile infection (cdi) is increasing in frequency and severity in and out of the hospital, with a high probability of recurrence after treatment. the recent literature on cdi was reviewed using pubmed to include recent publications dealing with diagnosis and therapy. real-time polymerase chain reaction is a sensitive and useful diagnostic test for cdi but there are growing concerns of false-positive test results if the rate of cdi is low in the patient population providing samples ...201323542332
protective effect of a mixture of kefir-isolated lactic acid bacteria and yeasts in a hamster model of clostridium difficile infection.the objective of this work was to test the protective effect of a mixture (mm) constituted by kefir-isolated microorganisms (lactobacillus plantarum, lactobacillus kefir, lc. lactis, kluyveromyces marxianus and saccharomyces cerevisiae) in a hamster model of infection with clostridium difficile, an anaerobic gram-positive bacterium that causes diarrhoea. placebo or mm was administered ad libitum in drinking water from day 0 to the end of treatment. hamsters received orally 200 μg of clyndamicin ...201323542116
adjuvant vancomycin for antibiotic prophylaxis and risk of clostridium difficile infection after coronary artery bypass graft surgery.the incidence of hospital-acquired clostridium difficile infection (cdi) has increased rapidly over the past decade; patients undergoing major surgery, including coronary artery bypass grafting (cabg), are at particular risk. intravenous vancomycin exposure has been identified as an independent risk factor for cdi, but this is controversial. it is not known whether vancomycin administered for surgical site infection prophylaxis increases the risk of cdi.201323541855
advances in molecular surveillance of clostridium difficile in bulgaria.the increasing incidence of clostridium difficile infection (cdi) in bulgaria has indicated the need to implement better surveillance approaches. the aim of the present work was to improve the current surveillance of cdi in bulgaria by introducing innovative methods for identification and typing. one hundred and twenty stool samples obtained from 108 patients were studied over 4 years from which 32 c. difficile isolates were obtained. an innovative duplex evagreen real-time pcr assay based on si ...201323598377
clostridium difficile psi polysaccharide: synthesis of pentasaccharide repeating block, conjugation to exotoxin b subunit, and detection of natural anti-psi igg antibodies in horse serum.clostridium difficile is the most common cause of antimicrobial-associated diarrhea in humans and may cause death. previously, we discovered that c. difficile expresses three polysaccharides, named psi, psii, and psiii. it has now been established that psii is a conserved antigen abundantly present on the cell-surface and biofilm of c. difficile. in contrast, the expression of psi and psiii appears to be stochastic processes. in this work, the total chemical synthesis of the psi pentasaccharide ...201323597587
clostridium difficile vertebral osteomyelitis.clostridium difficile is the most common cause of antibiotic-associated diarrhea, and it occasionally causes extraintestinal infections. we present a case of c. difficile-associated diarrhea that led to vertebral osteomyelitis associated with hardware. the osteomyelitis became symptomatic 2 years after the initial diarrheal event. c. difficile recovered from internal hardware sites cannot simply be regarded as a contaminant but should be treated.201323594589
prebiotics, faecal transplants and microbial network units to stimulate biodiversity of the human gut microbiome.accumulating evidence demonstrates the intimate association between human hosts and the gut microbiome. starting at birth, the sterile gut of the newborn acquires a diverse spectrum of microbes, needed for immunological priming. however, current practices (caesarean sections, use of formula milk) deprive newborns from being exposed to this broad spectrum of microbes. unnecessary use of antibiotics and excessive hygienic precautions (e.g. natural versus chlorinated drinking water) together with t ...201323594389
reply to "comparison of detection methods for clostridium difficile". 201323592855
comparison of detection methods for clostridium difficile. 201323592854
effect of occurrence of infection-related never events on length of stay and hospital charges in patients undergoing radical neck dissection for head and neck cancer.to estimate the impact of infection-related never events (postoperative pneumonia, clostridium difficile infection, infection with microorganisms resistant to penicillin, postoperative infections, and decubitus ulcers) following radical neck dissections for head and neck cancers.201323591100
specialty care delivery: bringing infectious disease expertise to the residents of a veterans affairs long-term care facility.to initiate a long-term care facility (ltcf) infectious disease (lid) service that provides on-site consultations to ltcf residents to improve the care of residents with possible infections.201323590125
what is hot in the anaerobe literature? clostridium difficile infections. 201323587754
evaluation of multiplex pcr with enhanced spore germination for detection of clostridium difficile from stool samples of the hospitalized patients.clostridium difficile poses as the most common etiologic agent of nosocomial diarrhea. although there are many diagnostic methods to detect c. difficile directly from stool samples, the nucleic acid-based approach has been largely performed in several laboratories due to its high sensitivity and specificity as well as rapid turnaround time. in this study, a multiplex pcr was newly designed with recent accumulated nucleotide sequences. the pcr testing with various c. difficile ribotypes, other cl ...201323586062
clostridium septicum gas gangrene in a previously healthy 8-year-old female with survival.we present the only reported case of an immunocompetent pediatric patient in the literature to have fulminate gas gangrene of the lower extremity and concomitant gastrointestinal tract infection due to clostridium septicum coinfected with clostridium difficile colitis respectively. the patient survived with aggressive medical and surgical treatment.201323583163
isolation of clostridium difficile from faecal specimens--a comparison of chromid c. difficile agar and cycloserine-cefoxitin-fructose agar.the culture of toxigenic clostridium difficile from stool specimens is still seen as the gold standard for the laboratory diagnosis of c. difficile infection (cdi). biomérieux have released chromid cdiff chromogenic agar (cdif) for the isolation and identification of c. difficile in 24 h. in this study, we compared cdif to pre-reduced cycloserine-cefoxitin-fructose agar with sodium taurocholate (tccfa) in the examination of glutamate dehydrogenase-positive faecal specimens that were either geneo ...201323579394
if microbial ecosystem therapy can change your life, what's the problem?the increased incidence of morbidity and mortality due to clostridium difficile infection, had led to the emergence of fecal microbial transplantation (fmt) as a highly successful treatment. from this, a 32 strain stool substitute has been derived, and successfully tested in a pilot human study. these approaches could revolutionize not only medical care of infectious diseases, but potentially many other conditions linked to the human microbiome. but a second revolution may be needed in order for ...201323575749
longitudinal study of clostridium difficile and methicillin-resistant staphylococcus aureus associated with pigs from weaning through to the end of processing.there has been a recent increase in community-associated infections linked to methicillin-resistant staphylococcus aureus (mrsa) and clostridium difficile. it is established that both pathogens can be recovered from retail pork, although it is unclear to what degree contamination is acquired at the farm in comparison to that acquired during processing. to address this gap, the following study reports on the carriage of mrsa and c. difficile on pigs from birth through to the end of processing. c. ...201323575124
diagnosing clostridial enteric disease in poultry.the world's poultry industry has grown into a multibillion-dollar business, the success of which hinges on healthy intestinal tracts, which result in effective feed conversion. enteric disease in poultry can have devastating economic effects on producers, due to high mortality rates and poor feed efficiency. clostridia are considered to be among the most important agents of enteric disease in poultry. diagnosis of enteric diseases produced by clostridia is usually challenging, mainly because man ...201323572451
impact of preoperative organ failures on survival in intensive care unit patients with colectomy.the present study aimed to evaluate the prognostic value of preoperative changes in sequential organ failure assessment (sofa) score, daily norepinephrine (ne) dose, lactate, c-reactive protein, and white blood cell count among patients with colectomy in the intensive care unit (icu).201323571867
total colectomy for ulcerative colitis in children: when are we operating?ulcerative colitis (uc) in children is frequently severe and treatment-refractory. while medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric uc patients.201323571824
analysis of anti-clostridium difficile activity of thuricin cd, vancomycin, metronidazole, ramoplanin, and actagardine, both singly and in paired combinations.due to the ongoing problem of recurrence of clostridium difficile-associated diarrhea following antibiotic treatment, there is an urgent need for alternative treatment options. we assessed the mics of five antimicrobials singly and in combinations against a range of c. difficile clinical isolates. ramoplanin-actagardine combinations were particularly effective, with partial synergistic/additive effects observed against 61.5% of c. difficile strains tested.201323571539
rapid hospital room decontamination using ultraviolet (uv) light with a nanostructured uv-reflective wall coating.we tested the ability of an ultraviolet c (uv-c)-reflective wall coating to reduce the time necessary to decontaminate a room using a uv-c-emitting device (tru-d smartuvc). the reflective wall coating provided the following time reductions for decontamination: for methicillin-resistant staphylococcus aureus, from 25 minutes 13 seconds to 5 minutes 3 seconds ([formula: see text]), and for clostridium difficile spores, from 43 minutes 42 seconds to 9 minutes 24 seconds ([formula: see text]).201323571373
beyond the hawthorne effect: reduction of clostridium difficile environmental contamination through active intervention to improve cleaning practices.education and passive observation resulted in a significant improvement in housekeeper disinfection of nontoxigenic clostridium difficile spores artificially inoculated onto surfaces in c. difficile infection rooms. a further significant reduction occurred with direct supervision and real-time feedback, suggesting that optimal disinfection is achieved by working closely with housekeepers.201323571372
decontamination of targeted pathogens from patient rooms using an automated ultraviolet-c-emitting device.objective. to determine the effectiveness of an automated ultraviolet-c (uv-c) emitter against vancomycin-resistant enterococci (vre), clostridium difficile, and acinetobacter spp. in patient rooms. design. prospective cohort study. setting. two tertiary care hospitals. participants. convenience sample of 39 patient rooms from which a patient infected or colonized with 1 of the 3 targeted pathogens had been discharged. intervention. environmental sites were cultured before and after use of an au ...201323571362
an environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of clostridium difficile isolation rooms.objective. effective disinfection of hospital rooms after discharge of patients with clostridium difficile infection (cdi) is necessary to prevent transmission. we evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in cdi rooms after cleaning. design. prospective intervention. setting. a veterans affairs hospital. interventions. during a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide ...201323571361
nanolitre real-time pcr detection of bacterial, parasitic, and viral agents from patients with diarrhoea in nunavut, canada.little is known about the microbiology of diarrhoeal disease in canada's arctic regions. there are a number of limitations of conventional microbiology testing techniques for diarrhoeal pathogens, and these may be further compromised in the arctic, given the often long distances for specimen transport.201323570023
detection of clostridium difficile in small and medium-sized wild mammals in southern ontario, canada.we sampled 325 small and medium-sized wild mammals in ontario, canada in 2007 and 2010 to determine the prevalence and characteristics of clostridium difficile in wild mammals living in proximity to captive wildlife and livestock. clostridium difficile was isolated from five of 109 animals (4.6%) on four of 25 farms (16%), but was not isolated from any of the 216 samples from raccoons (procyon lotor) living on the grounds of the toronto zoo. the positive animals included two raccoons from one be ...201323568920
antimicrobial susceptibility profiles of human and piglet clostridium difficile pcr-ribotype 078.in the last decade, outbreaks of nosocomial clostridium difficile infections (cdi) occurred worldwide. a new emerging type, pcr-ribotype 027, was the associated pathogen. antimicrobial susceptibility profiles of this type were extensively investigated and used to partly explain its spread. in europe, the incidence of c. difficile pcr-ribotype 078 recently increased in humans and piglets. using recommendations of the european committee on antimicrobial susceptibility testing (eucast) and the clin ...201323566553
calcineurin inhibitors and clostridium difficile infection in adult lung transplant recipients: the effect of cyclosporine versus tacrolimus.tacrolimus (fk506) has a superior immunosuppressive effect compared with cyclosporine (csa) without a significant increase in generalized infectious complications. differences in specific infections such as clostridium difficile (cdi) have not been reported. we investigated the relationship between calcineurin inhibitors and cdi, hypothesizing that choice of calcineurin inhibitor (csa or fk506) after lung transplantation would have no effect on the incidence of cdi.201323566442
diarrhea-associated pathogens, lactobacilli and cellulolytic bacteria in equine feces: responses to antibiotic challenge.antibiotics are important to equine medicine, but antibiotic-associated diarrhea (aad) can lead to poor performance and even mortality. aad is attributed to disruption of the hindgut microbiota, which permits proliferation of pathogenic microbes. the goal of this study was to evaluate the effects of common antibiotics on cellulolytic bacteria, lactobacilli, and aad-associated pathogens in the feces of healthy horses. fifteen horses were assigned to three treatment groups (blocked by age and sex) ...201323769300
declining cephalosporin and fluoroquinolone non-susceptibility among bloodstream enterobacteriaceae from the uk: links to prescribing change?the uk saw major increases in cephalosporin and quinolone resistance amongst enterobacteriaceae from 2001 to 2006, with cephalosporin resistance largely reflecting dissemination of ctx-m extended-spectrum β-lactamases (esbls). we review subsequent trends.201323766490
clostridium difficile infection. 201323764494
characterization of swine isolates of clostridium difficile in spain: a potential source of epidemic multidrug resistant strains?clostridium difficile is an emerging pathogen for humans and animals and there is concern about the possibility that livestock might serve as a reservoir of epidemic strains. in spain, ribotype 078 is one of the most prevalent in human episodes of c. difficile infection, but the distribution of this and other ribotypes in animals is yet unknown. we present the first report on the ribotype distribution and antimicrobial susceptibility of c. difficile in swine in spain. a total of 144 isolates wer ...201323764416
clostridium difficile infection: the importance of accurate diagnosis. 201323763047
effect of ribotype on all-cause mortality following clostridium difficile infection.clostridium difficile infection (cdi) is significantly associated with subsequent all-cause mortality. although a number of studies have investigated mortality associated with cdi, few have compared all-cause mortality between ribotypes.201323759667
evaluation of the effect of oritavancin on clostridium difficile spore germination, outgrowth and recovery.previous work suggests oritavancin may be inhibitory to clostridium difficile spores. we have evaluated the effects of oritavancin exposure on c. difficile spore germination, outgrowth and recovery.201323759507
acid suppression and the risk of clostridium difficile infection. 201323759424
epidemiology of community-associated clostridium difficile infection, 2009 through 2011.clostridium difficile infection (cdi) has been increasingly reported among healthy individuals in the community. recent data suggest that community-associated cdi represents one-third of all c difficile cases. the epidemiology and potential sources of c difficile in the community are not fully understood.201323780507
clostridium difficile leaves the hospital--what's next? 201323778358
clinical utility of retrograde terminal ileum intubation in the evaluation of chronic non-bloody diarrhea.the aims of this study were to investigate the frequency and factors involved in the terminal ileum intubation of patients with chronic, non-bloody diarrhea and to compare diagnostic yields of colonoscopy and ileocolonoscopy.201323777610
role of interleukin 23 signaling in clostridium difficile colitis.clostridium difficile is currently the leading cause of hospital-acquired infections in the united states. here, we observed increased interleukin 23 (il-23) protein levels in human colon biopsy specimens positive for c. difficile toxins, compared with levels in negative controls (p = .008) we also investigated the role of il-23 during c. difficile infection, using 2 distinct murine models. mice lacking il-23 signaling had a significant increase in survival (100% [12 mice]), compared with contro ...201323776194
clostridium difficile infection in the elderly.the incidence of c. difficile infections (cdi) in the elderly continues to rise and infection is associated with increased morbidity and mortality when compared to those affected in younger age-groups. immunosenescence may be a contributory factor yet the exact immune responses that may protect against cdi are incompletely understood. increased exposure to antibiotics, frequent and/or prolonged hospital admissions and residing in long-term care facilities provide multiple opportunities for host ...201323774972
clostridium difficile: restoring the balance--microbes for the management of clostridium difficile infection? 201323774772
therapy: probiotics do not reduce antibiotic-associated or clostridium difficile diarrhoea in older hospitalized patients. 201323982682
new developments in chemotherapeutic options for clostridium difficile colitis.clostridium difficile infections (cdis) are of increasing concern in healthcare due to increasing incidence as well as suboptimal response to standard therapies. this review focuses on current updates in chemotherapeutic treatment options for primary cdi as well as for relapse.201323982237
clostridium difficile: biological therapies.biological therapies for clostridium difficile infection (cdi) include probiotics and faecal microbiota transplant (fmt). there is significant interest in their use in treating refractory/recurrent cdi. this review summarizes the latest evidence for these approaches.201323982236
recent insights into clostridium difficile pathogenesis.clostridium difficile infection (cdi) is the leading cause of antibiotic-associated diarrhea and pseudomembranous colitis in the healthcare setting. an emerging consensus suggests that cdi is caused by pathogenic toxin production, gut microbial dysbiosis and altered host inflammatory responses. the aim of this review is to summarize and highlight recent advances focused on cdi pathogenic mechanisms.201323982235
[the intestinal microbiota and human disease].advances in sequencing technology and the development of metagenomics have opened up new ways to investigate the microorganisms inhabiting the human gut. the intestinal microbiota confer protection against pathogens, contribute to the maturation of the immune system, and regulate host metabolism. the composition of gut microbiota in early life is influenced by mode of birth, diet, and antibiotics. decreased biodiversity and alterations in the composition of the intestinal microbiota have been ob ...201323981941
moving fecal microbiota transplantation into the mainstream.in recent years, fecal microbiota transplantation (aka fecal transplantation, fecal bacteriotherapy, fmt) has become increasing utilized to treat recurrent and refractory clostridium difficile infection (cdi). almost 600,000 cases of cdi occur each year in the united states. of these, an estimated 15,000 patients have a recurrence. the management of recurrent disease has been challenging for patients and clinicians. increasingly, fmt has been recognized as an effective option for these patients. ...201323979974
challenges and opportunities for faecal microbiota transplantation therapy.the incidence, morbidity, and mortality associated with clostridium difficile gastrointestinal infections has increased greatly over recent years, reaching epidemic proportions; a trend due, in part, to the emergence of hypervirulent and antibiotic-resistant strains. the need to identify alternative, non-antibiotic, treatment strategies is therefore urgent. the ability of bacteria in faecal matter transplanted from healthy individuals to displace pathogen populations is well recognized. further, ...201323735045
hospital-acquired clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards.clostridum difficile (c. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. we aimed to determine the rate and characteristics of hospital-acquired c. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards.201323734349
clostridium difficile: a cause of diarrhea in children. 201323733223
expression and cytoprotective activity of the small gtpase rhob induced by the escherichia coli cytotoxic necrotizing factor 1.rhob is the only member of the rho subfamily of small gtpases, which is classified as an immediate early gene product. rhob is up-regulated in response to growth factors as well as cytotoxic and genotoxic agents. clostridial glucosylating toxins have been reported to evoke pronounced rhob expression, based on the inactivation of rho/ras proteins. in this study, we report on a long lasting expression of rhob in cultured cells upon activation of rho proteins by the cytotoxic necrotizing factor 1 ( ...201323732113
impact of toxigenic clostridium difficile polymerase chain reaction testing on the clinical microbiology laboratory and inpatient epidemiology.conversion from clostridium difficile toxin a/b eia to tcdb polymerase chain reaction for diagnosis of c. difficile infection (cdi) resulted in significant decreases in laboratory testing volume and largely unchanged c. difficile toxin detection rates. decreases in healthcare-associated cdi rates (p ≤ 0.05) reflected a clinical practice benefit of this conversion.201323731555
improved bacterial mutagenesis by high-frequency allele exchange, demonstrated in clostridium difficile and streptococcus suis.here we show that the frequency of mutant isolation by two-step allele exchange can be improved by increasing the length of homologous dna and the opportunity for recombination, obviating the need for counterselection markers. these principles are demonstrated in clostridium difficile and streptococcus suis but are likely to be generally applicable.201323728809
probiotics for the prevention of clostridium difficile-associated diarrhea in adults and children.antibiotics are widely prescribed; however they can cause disturbances in gastrointestinal flora which may lead to reduced resistance to pathogens such as clostridium difficile (c. difficile). probiotics are live organisms thought to balance the gastrointestinal flora.201323728658
[antimicrobial therapy of clostridium difficile infection. systematic review and meta-analysis of the scientific evidence].clostridium difficile is the leading cause of antibiotic associated infectious nosocomial diarrhoea. limited number of new pharmaceutical products have been developed and registered in the past decades for the treatment of clostridium difficile infection. the available scientific evidence is limited and hardly comparable.201323728312
a clinical and epidemiological review of non-toxigenic clostridium difficile.clostridium difficile is a significant nosocomial threat to human health and is the most commonly identified cause of antibiotic-associated diarrhea. the development of c. difficile colitis requires production of toxins a and/or b, but some strains do not express these proteins. these non-toxigenic c. difficile (ntcd) have garnered attention for their capacity to colonize humans and potentially reduce the risk for symptomatic colitis caused by toxigenic strains. isolates of ntcd have been obtain ...201323727391
effect of an oxygen-tolerant bifurcating butyryl coenzyme a dehydrogenase/electron-transferring flavoprotein complex from clostridium difficile on butyrate production in escherichia coli.the butyrogenic genes from clostridium difficile dsm 1296(t) have been cloned and expressed in escherichia coli. the enzymes acetyl-coenzyme a (coa) c-acetyltransferase, 3-hydroxybutyryl-coa dehydrogenase, crotonase, phosphate butyryltransferase, and butyrate kinase and the butyryl-coa dehydrogenase complex composed of the dehydrogenase and two electron-transferring flavoprotein subunits were individually produced in e. coli and kinetically characterized in vitro. while most of these enzymes wer ...201323772070
the agr locus regulates virulence and colonization genes in clostridium difficile 027.the transcriptional regulator agra, a member of the lyttr family of proteins, plays a key role in controlling gene expression in some gram-positive pathogens, including staphylococcus aureus and enterococcus faecalis. agra is encoded by the agracdb global regulatory locus, and orthologues are found within the genome of most clostridium difficile isolates, including the epidemic lineage 027/bi/nap1. comparative rna sequencing of the wild type and otherwise isogenic agra null mutant derivatives of ...201323772065
extraintestinal clostridium difficile infections.clostridium difficile causes diarrhea that ranges from a benign, self-limiting antibiotic use-associated disease to a life-threatening pseudomembranous colitis. clostridium difficile has rarely been isolated in extraintestinal infections. our objective was to characterize clinical features and risk factors of these infections. methods extraintestinal c. difficile infections (cdis) were searched for in an electronic database of all c. difficile-positive isolates found during a 10-year period. the ...201323771984
elevated lactoferrin is associated with moderate to severe clostridium difficile disease, stool toxin, and 027 infection.we evaluated blood and fecal biomarkers as indicators of severity in symptomatic patients with confirmed clostridium difficile infection (cdi). recruitment included patients with cdi based on clinical symptoms and supporting laboratory findings. disease severity was defined by physician's assessment and blood and fecal biomarkers were measured. toxigenic culture done using spore enrichment and toxin b detected by tissue culture were done as confirmatory tests. polymerase chain reaction (pcr) rib ...201323771554
clostridium difficile infection in hospitalized cancer patients in beijing, china is facilitated by receipt of cancer chemotherapy.the purpose of this study was to determine the presence of clostridium difficile infection (cdi) and risk factors for infection in hospitalized patients with diarrhea in a cancer hospital in beijing, china. a total of 277 patients with hospital-associated diarrhea (had) were studied of which 41 (15%) were positive for fecal c. difficile toxin a/b. for each cdi case identified, a control with had but negative c. difficile specimen was enrolled to look for cdi risk factors. receipt of cancer chemo ...201323770543
in vitro selective inhibitory effect of 8-hydroxyquinoline against bifidobacteria and clostridia.8-hydroxyquinoline (8hq) inhibited clostridium tertium, clostridium clostridioforme, clostridium difficile and clostridium perfringens in vitro with mics of 8, 16, 32 and 32 μg/ml, respectively. in contrast, mics of most bifidobacteria (84%) were 512 μg/ml or higher. thus, 8hq could be used as anti-clostridial agent or in selective media for bifidobacteria isolation.201323770542
diagnostic testing for clostridium difficile infection in patients with inflammatory bowel disease. 201323751851
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