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control of clostridium difficile-associated diarrhea by antibiotic stewardship in a small community hospital. 201223730314
[a case of diarrhoea by clostridium difficile].we present a patient who developed a pseudomembranous colitis due to clostridium difficile with a prolonged course. the diarrhoea symptoms worsened after two hospitalisations, but there was an improvement with outpatient treatment. the first diagnosis was made in primary care. we summarise the preventive measures, and present the severity criteria of this condition, as well as the failure antibiotic treatment with metronidazole and the possible aggravation by the use of other antibiotics in thes ...201223726735
clostridium difficile infection in children: current state and unanswered questions.the incidence of clostridium difficile infection (cdi) in children has increased over the past decade. in recent years, new and intriguing data on pediatric cdi have emerged. community-onset infections are increasingly recognized, even in children who have not previously received antibiotics. a hypervirulent strain is responsible for up to 20% of pediatric cdi cases. unique risk factors for cdi in children have been identified. advances in diagnostic testing strategies, including the use of nucl ...201223687578
effects of nisin and reutericyclin on resistance of endospores of clostridium spp. to heat and high pressure.the effects of high pressure, temperature, and antimicrobial compounds on endospores of clostridium spp. were examined. minimal inhibitory concentrations (mic) of nisin and reutericyclin were determined for vegetative cells and endospores of clostridium sporogenes atcc 7955, clostridium beijerinckii atcc 8260, and clostridium difficile 3195. endospores of c. sporogenes atcc 7955 and c. beijerinckii atcc 8260 were exposed to 90 °c and 90 °c/600 mpa in the presence of 16 mg l(-1) nisin or 6.4 mg l ...201223498177
portal vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity.portal vein thrombosis has been documented after laparoscopic general surgery and has been uncommonly observed after laparoscopic bariatric surgery. among bariatric operations, the sleeve gastrectomy is being performed with ever-increasing frequency. here we report the case of a man who presented with portal vein thrombosis after laparoscopic sleeve gastrectomy.201223484577
glutamine and alanyl-glutamine increase rhoa expression and reduce clostridium difficile toxin-a-induced intestinal epithelial cell damage.clostridium difficile is a major cause of antibiotic-associated colitis and is associated with significant morbidity and mortality. glutamine (gln) is a major fuel for the intestinal cell population. alanyl-glutamine (ala-gln) is a dipeptide that is highly soluble and well tolerated. iec-6 cells were used in the in vitro experiments. cell morphology was evaluated by atomic force microscopy (afm) and scanning electron microscopy (sem). cell proliferation was assessed by wst-1 and ki-67 and apopto ...201223484083
clostridium difficile infection in patients with inflammatory bowel disease. 201223483861
deadly diarrhea: clostridium difficile infection.diarrhea is often only a minor inconvenience, but sometimes it can be deadly--especially if it results from a clostridium difficile infection. clostridium difficile colitis is becoming increasingly common and more virulent, and patients with kidney failure are at increased risk for development of a clostridium disfficile infection. this article provides information about clostridium difficile infection, its incidence, diagnosis, and treatment. in addition, the article discusses how to combat the ...201223469412
detection of clostridium difficile in retail ground meat products in manitoba.the aim of the present study was to determine whether clostridium difficile was present in uncooked retail ground beef and ground pork products sold in winnipeg, manitoba. using an alcohol treatment protocol and inoculation of cultures on c difficile moxalactam norfloxacin (cdmn), toxigenic c difficile was found in 6.3% of 48 meat samples. the c difficile isolates belonged to different pulsotypes, all of which had been previously isolated from the stool of manitoba patients with c difficile dise ...201223450202
analysis of a clostridium difficile pcr ribotype 078 100 kilobase island reveals the presence of a novel transposon, tn6164.clostridium difficile is the main cause of antibiotic associated diarrhea. in the past decade, the number of c. difficile patients has increased dramatically, coinciding with the emergence of two pcr ribotypes 027 and 078. pcr ribotype 078 is also frequently found during c. difficile outbreaks in pigfarms. previously, the genome of the pcr ribotype 078 strain m120, a human isolate, was described to contain a unique insert of 100 kilobases.201222747711
effects of probiotics and antibiotics on the intestinal homeostasis in a computer controlled model of the large intestine.antibiotic associated diarrhea and clostridium difficile infection are frequent complications of broad spectrum antibiotic therapy. probiotic bacteria are used as therapeutic and preventive agents in these disorders, but the exact functional mechanisms and the mode of action are poorly understood. the effects of clindamycin and the probiotic mixture vsl#3 (containing the 8 bacterial strains streptococcus thermophilus, bifidobacterium breve, bifidobacterium longum, bifidobacterium infantis, lacto ...201222452835
microevolutionary analysis of clostridium difficile genomes to investigate transmission.the control of clostridium difficile infection is a major international healthcare priority, hindered by a limited understanding of transmission epidemiology for these bacteria. however, transmission studies of bacterial pathogens are rapidly being transformed by the advent of next generation sequencing.201223259504
hemolytic uremic syndrome and clostridium difficile colitis.hemolytic uremic syndrome (hus) can be associated with different infectious etiologies, but the relationship between pseudomembranous colitis and hus was first described in the 1970s in some childhood patients. there is very limited published literature on clostridium difficile-associated hus. we report a case of c. difficile-related hus in an adult patient and provide a review of the literature.201223882375
modulation of toxin production by the flagellar regulon in clostridium difficile.we show in this study that toxin production in clostridium difficile is altered in cells which can no longer form flagellar filaments. the impact of inactivation of flic, cd0240, flif, flig, flim, and flhb-flir flagellar genes upon toxin levels in culture supernatants was assessed using cell-based cytotoxicity assay, proteomics, immunoassay, and immunoblotting approaches. each of these showed that toxin levels in supernatants were significantly increased in a flic mutant compared to that in the ...201222851750
amixicile, a novel inhibitor of pyruvate: ferredoxin oxidoreductase, shows efficacy against clostridium difficile in a mouse infection model.clostridium difficile infection (cdi) is a serious diarrheal disease that often develops following prior antibiotic usage. one of the major problems with current therapies (oral vancomycin and metronidazole) is the high rate of recurrence. nitazoxanide (ntz), an inhibitor of pyruvate:ferredoxin oxidoreductase (pfor) in anaerobic bacteria, parasites, helicobacter pylori, and campylobacter jejuni, also shows clinical efficacy against cdi. from a library of ∼250 analogues of ntz, we identified lead ...201222585229
automated detection of toxigenic clostridium difficile in clinical samples: isothermal tcdb amplification coupled to array-based detection.clostridium difficile can carry a genetically variable pathogenicity locus (paloc), which encodes clostridial toxins a and b. in hospitals and in the community at large, this organism is increasingly identified as a pathogen. to develop a diagnostic test that combines the strengths of immunoassays (cost) and dna amplification assays (sensitivity/specificity), we targeted a genetically stable paloc region, amplifying tcdb sequences and detecting them by hybridization capture. the assay employs a ...201222675134
antimicrobial activities of fidaxomicin.fidaxomicin is bactericidal against clostridium difficile. the combined results of 8 in vitro studies of 1323 c. difficile isolates showed the minimum inhibitory concentration (mic) range of fidaxomicin to be ≤ 0.001-1 μg/ml, with a maximum mic for inhibition of 90% of organisms (mic(90)) of 0.5 μg/ml. isolates from 2 phase iii clinical trials demonstrated that fidaxomicin mics of baseline isolates did not predict clinical cure, failure, or recurrence of c. difficile infections. no resistance to ...201222752863
clinical importance and representation of toxigenic and non-toxigenic clostridium difficile cultivated from stool samples of hospitalized patients.the aim of this study was to fortify the clinical importance and representation of toxigenic and non-toxigenic clostridium difficile isolated from stool samples of hospitalized patients. this survey included 80 hospitalized patients with diarrhea and positive findings of clostridium difficile in stool samples, and 100 hospitalized patients with formed stool as a control group. bacteriological examination of a stool samples was conducted using standard microbiological methods. stool sample were i ...201224031820
in silico analysis of sequenced strains of clostridium difficile reveals a related set of conjugative transposons carrying a variety of accessory genes.the human gut pathogen clostridium difficile contains many conjugative transposons that have an array of accessory genes. in the current study, recently sequenced genomes were analyzed to identify new putative conjugative transposons. eleven new elements in 5 c. difficile strains were identified and all had a similar structure to the previously described elements ctn1, ctn5 and ctn7 in c. difficile strain 630. each element identified did however contain a new set of accessory genes compared with ...201222754747
clostridium difficile mazf toxin exhibits selective, not global, mrna cleavage.clostridium difficile is an important, emerging nosocomial pathogen. the transition from harmless colonization to disease is typically preceded by antimicrobial therapy, which alters the balance of the intestinal flora, enabling c. difficile to proliferate in the colon. one of the most perplexing aspects of the c. difficile infectious cycle is its ability to survive antimicrobial therapy and transition from inert colonization to active infection. toxin-antitoxin (ta) systems have been implicated ...201222544268
fidaxomicin is an inhibitor of the initiation of bacterial rna synthesis.fidaxomicin was recently approved for the treatment of clostridium difficile infection. it inhibits transcription by bacterial rna polymerase. because transcription is a multistep process, experiments were conducted in which fidaxomicin was added at different stages of transcriptional initiation to identify the blocked step. dna footprinting experiments were also conducted to further elucidate the stage inhibited. fidaxomicin blocks initiation only if added before the formation of the "open prom ...201222752861
biocidal activity of metalloacid-coated surfaces against multidrug-resistant microorganisms. 201223148568
activity of the thiopeptide antibiotic nosiheptide against contemporary strains of methicillin-resistant staphylococcus aureus.the rapid rise in antimicrobial resistance in bacteria has generated an increased demand for the development of novel therapies to treat contemporary infections, especially those caused by methicillin-resistant staphylococcus aureus (mrsa). however, antimicrobial development has been largely abandoned by the pharmaceutical industry. we recently isolated the previously described thiopeptide antibiotic nosiheptide from a marine actinomycete strain and evaluated its activity against contemporary cl ...201223047246
implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital. 201223043720
use of uv-c radiation to disinfect non-critical patient care items: a laboratory assessment of the nanoclave cabinet.the near-patient environment is often heavily contaminated, yet the decontamination of near-patient surfaces and equipment is often poor. the nanoclave cabinet produces large amounts of ultraviolet-c (uv-c) radiation (53 w/m2) and is designed to rapidly disinfect individual items of clinical equipment. controlled laboratory studies were conducted to assess its ability to eradicate a range of potential pathogens including clostridium difficile spores and adenovirus from different types of surface ...201222856652
the potential economic value of screening hospital admissions for clostridium difficile.asymptomatic clostridium difficile carriage has a prevalence reported as high as 51-85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. accurately identifying carriers may limit the spread of clostridium difficile. since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for clostridium difficile from the hospital and third party payer perspective ...201222752150
national institute of allergy and infectious disease (niaid) funding for studies of hospital-associated bacterial pathogens: are funds proportionate to burden of disease? 201222958856
the impact of infection on population health: results of the ontario burden of infectious diseases study.evidence-based priority setting is increasingly important for rationally distributing scarce health resources and for guiding future health research. we sought to quantify the contribution of a wide range of infectious diseases to the overall infectious disease burden in a high-income setting.201222962601
prospective evaluation of the meridian illumigene™ loop-mediated amplification assay and the gen probe progastro™ cd polymerase chain reaction assay for the direct detection of toxigenic clostridium difficile from fecal samples.clostridium difficile is the most common and important cause of toxigenic colitis in the health care setting. laboratory diagnostics have included bacterial culture with further identification of toxigenic stains, or more commonly, direct detection of preformed toxin in stool samples using biological or immunochemistry assays. recently, molecular amplification assays for the direct detection of toxin-encoding genes have become available commercially. we prospectively evaluated 2 fda-cleared mole ...201222015321
activity in vitro of hydrogen peroxide vapour against clostridium difficile spores.clostridium difficile spores are shed in high numbers by infected patients and are resistant to desiccation and some disinfectants. we explored the in vitro activity of hydrogen peroxide vapour (hpv) against several strains of c. difficile spores using a spore-carrier test. spores were dried on polyvinyl chloride or laminate carriers at mean concentrations of 4.7-6.9 log(10) spores/carrier, which were then decontaminated using hpv. c. difficile was completely eradicated from the exposed carriers ...201222099497
evaluation of vaporized hydrogen peroxide, citrox and ph neutral ecasol for decontamination of an enclosed area: a pilot study.hydrogen peroxide, ecasol and citrox aerosols were each tested for their ability to kill a range of nosocomial pathogens. hydrogen peroxide had the broadest microbicidal activity but operational issues limit its use. ecasol was effective against all micro-organisms, except clostridium difficile, while citrox aerosols were not effective against gram-negative bacilli.201222130097
evaluation of stethoscopes as vectors of clostridium difficile and methicillin-resistant staphylococcus aureus. 201222173532
vaccination with parenteral toxoid b protects hamsters against lethal challenge with toxin a-negative, toxin b-positive clostridium difficile but does not prevent colonization.toxin a has historically been regarded as the primary virulence determinant in clostridium difficile infection, but naturally occurring toxin a-negative, toxin b-positive (a-/b+) c. difficile strains are known to be virulent. to determine the role of toxin b in these strains, we immunized hamsters with a toxoid prepared from purified toxin b to determine whether they would be protected from lethal challenge with an a-/b+ strain of c. difficile.201222124129
Verification of Performance Specifications for a US Food and Drug Administration-Approved Molecular Microbiology Test: Clostridium difficile Cytotoxin B Using the Becton, Dickinson and Company GeneOhm Cdiff Assay.Context.-US Food and Drug Administration (FDA)-approved diagnostic tests based on molecular genetic technologies are becoming available for an increasing number of microbial pathogens. Advances in technology and lower costs have moved molecular diagnostic tests formerly performed for research purposes only into much wider use in clinical microbiology laboratories. Objective.-To provide an example of laboratory studies performed to verify the performance of an FDA-approved assay for the detecti ...201222208483
Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer.Backgound The number of patients with chronic gastrointestinal (GI) symptoms after cancer therapies which have a moderate or severe impact on quality of life is similar to the number diagnosed with inflammatory bowel disease annually. However, in contrast to patients with inflammatory bowel disease, most of these patients are not referred for gastroenterological assessment. Clinicians who do see these patients are often unaware of the benefits of targeted investigation (which differ from those r ...201222057051
retargeting clostridium difficile toxin b to neuronal cells as a potential vehicle for cytosolic delivery of therapeutic biomolecules to treat botulism.botulinum neurotoxins (bonts) deliver a protease to neurons which can cause a flaccid paralysis called botulism. development of botulism antidotes will require neuronal delivery of agents that inhibit or destroy the bont protease. here, we investigated the potential of engineering clostridium difficile toxin b (tcdb) as a neuronal delivery vehicle by testing two recombinant tcdb chimeras. for agt-tcdb chimera, an alkyltransferase (agt) was appended to the n-terminal glucosyltransferase (gt) of t ...201221941543
need for clinicopathologic correlation of clostridium difficile colitis in view of molecular diagnosis. 201222187416
A two-stage algorithm for Clostridium difficile including PCR: can we replace the toxin EIA?A two step, three-test algorithm for Clostridium difficile infection (CDI) was reviewed. Stool samples were tested by enzyme immunoassays for C. difficile common antigen glutamate dehydrogenase (G) and toxin A/B (T). Samples with discordant results were tested by polymerase chain reaction detecting the toxin B gene (P). The algorithm quickly identified patients with detectable toxin A/B, whereas a large group of patients excreting toxigenic C. difficile but with toxin A/B production below detect ...201222104474
Pathology Consultation on Detection of Clostridium difficile.Laboratory methods for detecting Clostridium difficile have undergone considerable evolution since the organism's etiologic association with antibiotic-associated diarrhea and colitis was established. Clearly, familiarity with the advantages and shortcomings of the various assays is essential for the laboratory director when choosing among these tests. For the consulting pathologist, furthermore, an understanding of the laboratory's role in securing a diagnosis of C difficile infection (CDI) is ...201222180472
Clostridium difficile Mixed Infection and Reinfection.Isolates from consecutive Clostridium difficile infection (CDI) fecal samples underwent multilocus sequence typing. Potential reinfections with different genotypes were identified in 88/560 (16%) sample pairs taken 1 to 1,414 days (median, 24; interquartile range [IQR], 1 to 52 days) apart; odds of reinfection increased by 58% for every doubling of time between samples. Of 109 sample pairs taken on the same day, 3 (3%) had different genotypes. Considering samples 0 to 7 days apart as the same CD ...201222075589
macrocyclic antibiotics: a novel class of drug for the treatment of clostridium difficile infection. 201222142153
emergence of new pcr ribotypes from the hypervirulent clostridium difficile 027 lineage.clostridium difficile is the most common cause of antibiotic-associated diarrhoea worldwide. over the past 10 years, the incidence and severity of disease have increased in north america and europe due to the emergence of a hypervirulent clone designated pcr ribotype 027. in this study, we sought to identify phenotypic differences among a collection of 26 presumed pcr ribotype 027 strains from the us and the uk isolated between 1988 and 2008 and also re-evaluated the pcr ribotype. we demonstrate ...201221903827
Clostridium difficile infection ward rounds. 201222099499
approach to the patient with infectious colitis.to provide current recommendations for evaluation and treatment of patients with infectious colitis. infectious colitis is diagnosed in someone with diarrhea and one or more of the following: fever and/or dysentery, stools containing inflammatory markers such as leukocytes, lactoferrin, or calprotectin, or positive stool culture for an invasive or inflammatory bacterial enteropathogen including shigella, salmonella, campylobacter, shiga toxin-producing escherichia coli (stec) or clostridium diff ...201222080825
Profound Alterations of Intestinal Microbiota following a Single Dose of Clindamycin Results in Sustained Susceptibility to Clostridium difficile-Induced Colitis.Antibiotic-induced changes in the intestinal microbiota predispose mammalian hosts to infection with antibiotic-resistant pathogens. Clostridium difficile is a Gram-positive intestinal pathogen that causes colitis and diarrhea in patients following antibiotic treatment. Clindamycin predisposes patients to C. difficile colitis. Here, we have used Roche-454 16S rRNA gene pyrosequencing to longitudinally characterize the intestinal microbiota of mice following clindamycin treatment in the presence ...201222006564
Gastrointestinal infection as a trigger for inflammatory bowel disease.There is accumulating evidence on the importance of microbes in the development and maintenance of both the intestinal and immune systems. This review focuses on the current findings on the role of gastrointestinal pathogens in the cause of chronic inflammatory bowel disease.201222080823
Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options.The incidence and severity of Clostridium difficile infection (CDI) around the world has increased over the past 20 years due to the emergence of hypervirulent strains, increased use and misuse of antibiotics, and the increase of susceptible at-risk populations. Treatments currently available for CDI are inadequate to impede the increasing spread and virulence of the infection, avoid recurrence in chronic patients or prevent infection in at-risk populations.201222134217
Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk.Toilet facilities in healthcare settings vary widely, but patient toilets are commonly shared and do not have lids. When a toilet is flushed without the lid closed, aerosol production may lead to surface contamination within the toilet environment.201222137761
release of tcda and tcdb from clostridium difficile cdi 630 is not affected by functional inactivation of the tcde gene.the small open reading frame tcde is located between the genes tcda and tcdb which encode toxin a (tcda) and b (tcdb), respectively, within the pathogenicity locus of clostridium difficile. sequence and structure similarities to bacteriophage-encoded holins have led to the assumption that tcde mediates the release of the toxins from c. difficile into the extracellular environment. a tcde-deficient c. difficile 630 strain was generated by insertional inactivation of the tcde gene. data revealed t ...201222107906
effects of adenosine a2a receptor activation and alanyl-glutamine in clostridium difficile toxin-induced ileitis in rabbits and cecitis in mice.abstract: background: severe clostridium difficile toxin-induced enteritis is characterized by exuberant intestinal tissue inflammation, epithelial disruption and diarrhea. adenosine, through its action on the adenosine a2a receptor, prevents neutrophillic adhesion and oxidative burst and inhibits inflammatory cytokine production. alanyl-glutamine enhances intestinal mucosal repair and decreases apoptosis of enterocytes. this study investigates the protection from enteritis by combination thera ...201222264229
characterization of shiga toxin producing (stec) and enteropathogenic escherichia coli (epec) in raw yak (poephagus grunniens) milk and milk products.thirty-one shiga toxin-producing (stec) and 6 enteropathogenic escherichia coli (epec) were isolated from 87 raw yak milk and 63 'churpi' samples. of 18 stx(1) positive isolates (48.6%), 14 carried stx(1c) (77.7%). subtyping of 28 stx(2) positive isolates (75.7%) revealed the presence of stx(2c) (9, 32.1%), stx(2d) (3, 10.7%), stx(2e) (1, 3.57%) and stx(2f) (3, 10.7%) variants. furthermore, intimin (eaea), enterohaemolysin (ehxa), autoagglutinating adhesin (saa), iha (adherence conferring protei ...201222226073
editorial: not so nosocomial anymore: the growing threat of community-acquired clostridium difficile.clostridium difficile infection is widely accepted to be the leading cause of nosocomial infection-related morbidity and mortality, outpacing both antibiotic-resistant staphylococcus and enterococcus. the existence and prevalence of community-acquired clostridium difficile infection, on the other hand, is much less well appreciated. growing evidence now suggests that community-acquired clostridium difficile infection may account for more than a third of clostridium difficile-associated diarrhea ...201222218031
systems analysis of the transcriptional response of human ileocecal epithelial cells to clostridium difficile toxins and effects on cell cycle control.abstract:201222225989
clostridium difficile infection in older adults: a review and update on its management.background: clostridium difficile is a main cause of health care-associated infections. the incidence and severity have been increasing. elderly persons are at an increased risk of morbidity and mortality from c. difficile infection (cdi). relatively few advances have been made in the treatment of cdi since it was first identified as a cause of antibiotic-associated diarrhea more than 30 years ago. objective: this article reviews cdi and provides an update on its treatment, including recently pu ...201222260856
fecal transplant via retention enema for refractory or recurrent clostridium difficile infection. 201222271132
gef-h1/rhoa signalling pathway mediates lipopolysaccharide-induced intercellular adhesion molecular-1 expression in endothelial cells via activation of p38 and nf-κb.the purpose of study is to investigate the effects of gef-h1/rhoa pathway in regulating intercellular adhesion molecule-1 (icam-1) expression in lipopolysaccharide (lps)-activated endothelial cells. exposure of human umbilical vein endothelial cells (huvecs) to lps induced gef-h1 and icam-1 expression in dose- and time-dependent up-regulating manners. pretreatment with clostridium difficile toxin b-10463 (tcdb-10463), an inhibitor of rho activity, reduced lps-related phosphorylation of p65 at se ...201222226621
hospital-acquired infections.health-acquired infection (hai) is defined as a localized or systemic condition resulting from an adverse reaction to the presence of infectious agents or its toxins. this article focuses on hais that are well studied, common, and costly (direct, indirect, and intangible). the hais reviewed are catheter-related bloodstream infection, ventilator-associated pneumonia, surgical site infection, and catheter-associated urinary tract infection. this article excludes discussion of clostridium difficile ...201222269261
identification of the cellular receptor of clostridium spiroforme toxin.clostridium spiroforme produces the binary actin-adp-ribosylating toxin cst (c. spiroforme toxin), which has been proposed to be responsible for diarrhea, enterocolitis and, eventually, death especially in rabbits. here, we report on the recombinant production of the enzyme component (csta) and the binding component (cstb) of c. spiroforme toxin in bacillus megaterium. by using the recombinant toxin components we show that cst enters target cells via the lipolysis-stimulated lipoprotein receptor ...201222252869
high proportion of false-positive clostridium difficile enzyme immunoassays for toxin a and b in pediatric patients.objectives. to determine the frequency of false-positive clostridium difficile toxin enzyme immunoassay (eia) results in hospitalized children and to examine potential reasons for this false positivity. design. nested case-control. setting. two tertiary care pediatric hospitals. methods. as part of a natural history study, prospectively collected eia-positive stools were cultured for toxigenic c. difficile, and characteristics of children with false-positive and true-positive eia results were ...201222227987
epidemiology of clostridium difficile-associated disease in internal medicine wards in northern italy.clostridium difficile-associated disease (cdad) is a growing health care problem. elderly patients with multiple comorbidities and repeated hospitalization are at high risk for developing the disease. few data are available on epidemiology of cdad in italy and no studies have focused on cdad burden in internal medicine wards. we retrospectively analysed all cdad cases in four internal medicine wards of a city hospital in northern italy and reviewed the medical records of patients who developed c ...201222249916
health care and socioeconomic impact of falls in the elderly.background: elderly falls are associated with long hospital stays, major morbidity, and mortality. we sought to examine the fate of patients ≥75 years of age admitted after falls. methods: we reviewed all fall admissions in 2008. causes, comorbidities, injuries, procedures, mortality, readmission, and costs were analyzed. results: seven hundred eight patients ≥75 years old were admitted after a fall, with 89% being simple falls. short-term mortality was 6%. male sex, atrial fibrillation, acute m ...201222257741
structural determinants of the clostridium difficile toxin a glucosyltransferase activity.the principle virulence factors in clostridium difficile pathogenesis are tcda and tcdb, homologous glucosyltransferases capable of inactivating small gtpases within the host cell. we present crystal structures of the tcda glucosyltransferase domain (gtd) in the presence and absence of the co-substrate udp-glucose. while the enzymatic core is similar to that of tcdb, the proposed gtpase-binding surface differs significantly. we show that tcda is comparable to tcdb in its modification of rho-fa ...201222267739
risk factors associated with clostridium difficile infection in adult oncology patients with a history of recent hospitalization for febrile neutropenia. 201222221036
behaviour and target site selection of the conjugative transposon tn916 in two different strains of toxigenic clostridium difficile.the insertion sites of the conjugative transposon tn916 in the anaerobic pathogen clostridium difficile were determined using illumina solexa high-throughput dna sequencing of tn916 insertion libraries in two different clinical isolates: 630δe, an erythromycin-sensitive derivative of 630 (ribotype 012) and the ribotype 027 isolate r20291 which was responsible for a severe outbreak of c. difficile disease. a consensus fifteen base pair tn916 insertion sequence was identified which was similar in ...201222267673
clostridium difficile toxins: mediators of inflammation.clostridium difficile is a significant problem in hospital settings as the most common cause of nosocomial diarrhea worldwide. c. difficile infections (cdis) are characterized by an acute intestinal inflammatory response with neutrophil infiltration. these symptoms are primarily caused by the glucosylating toxins, tcda and tcdb. in the past decade, the frequency and severity of cdis have increased markedly due to the emergence of so-called hypervirulent strains that overproduce cytotoxic glucosy ...201222237401
the patient presenting with acute dysentery - a systematic review.objectives: the etiologies, clinical presentations and diagnosis of acute pathogen-specific dysentery in children and adults in industrialized and developing regions is described to help develop recommendations for therapy. methods: we conducted a systematic review of literature published between january 2000 and june 2011 to determine the frequency of occurrence of pathogen-specific dysentery. results: shigella, salmonella, and campylobacter remain the most frequent bacterial causes of dysenter ...201222266388
high prevalence of clostridium difficile colonization among nursing home residents in hesse, germany.clostridium difficile is the most common cause of antibiotic-associated diarrhoea in hospitals and other healthcare facilities. the elderly are particularly susceptible and at increased risk for adverse outcome as a result of c. difficile infection. the aim of this study was to determine the prevalence of c. difficile colonization among residents of nursing homes in hesse and to compare it with the prevalence in the general population living outside long-term care facilities (ltcf). we assessed ...201222253917
high occurrence of various clostridium difficile pcr ribotypes in pigs arriving at the slaughterhouse.background: clostridium difficile is recognized as an important cause of nosocomial diarrhoea in humans, especially in association with the administration of antibiotics. furthermore, c. difficile can not only cause neonatal enteritis in pigs but can also be found in pigs without any clinical disease symptoms. clostridium difficile had been found on pork samples destined for human consumption. however, little is known about the risk of food-borne transmission. objective: to elaborate the risk ...201222235856
clostridium difficile infection is associated with poor outcomes in end-stage renal disease.to investigate the association of clostridium difficile infection (cdi) with the outcomes of hospitalized patients with end-stage renal disease (esrd).201222222233
outpatient parenteral antimicrobial therapy with ceftriaxone, a review.more than 30 years since it was developed for clinical use, the third-generation cephalosporin ceftriaxone remains the most commonly used agent for outpatient parental antimicrobial therapy (opat). recent antimicrobial stewardship programmes have tended to restrict ceftriaxone use in hospitals to control antibiotic resistance and outbreaks of clostridium difficle infection (cdi). considering the expansion of opat programmes both in the uk and worldwide, revisiting the role of ceftriaxone in opat ...201222527482
multidrug-resistant north american pulsotype 2 clostridium difficile was the predominant toxigenic hospital-acquired strain in the province of manitoba, canada, in 2006-2007.the objective of the current study was to determine whether the antimicrobial susceptibility profile or genotype of hospital-acquired isolates of clostridium difficile differed from isolates causing community-acquired disease. five hundred diarrhoeal stool samples (one >2 ml sample per patient) from patients across manitoba, canada, in 2006-2007 that were reported as c. difficile toxin positive were cultured, resulting in 432 isolates of toxin-positive c. difficile for analysis. of these 432 iso ...201222301615
guanine-nucleotide exchange factor h1 mediates lipopolysaccharide-induced interleukin 6 and tumor necrosis factor α expression in endothelial cells via activation of nuclear factor κb.the development of sepsis is multifactorial. tissue damage and organ dysfunction may be caused not only by the microorganisms but also by the inflammatory mediators released in response to the infection. interleukin 6 (il-6) and tumor necrosis factor α (tnf-α) levels in serum are well known to be upregulated in humans with sepsis and can be used to predict outcome. using human umbilical vein endothelial cells, we analyzed the role of guanine-nucleotide exchange factor h1 (gef-h1) on lipopolysacc ...201222301607
glutamate dehydrogenase is highly conserved among clostridium difficile ribotypes.glud was highly conserved and glutamate dehydrogenase (gdh) was readily expressed in vitro by all 77 clostridium difficile ribotypes assayed. all ribotypes, including arl 002, arl 027, and arl 106, were reactive in assays that detect c. difficile gdh.201222301027
frequency of outbreak investigations in us hospitals: results of a national survey of infection preventionists.a survey of infection preventionists was conducted to determine the frequency of outbreak investigations in us hospitals.201222300590
[segmental necrotizing colitis in a patient with e. coli o104:h4 infection].a 29-year-old man presented with abdominal cramps and bloody diarrhoea. blood tests revealed elevated c-reactive protein (21.3 mg/dl; normal range 0.01 - 0. 82 mg/dl) and white blood cells (28200/μl, normal range 4000 - 10000/μl). stool tests were negative for enteropathogenic bacteria and clostridium difficile toxins a/b. ultrasound and computed tomography showed massive swelling of the transverse colon and right colonic flexure. at endoscopy, circular necrosis of the mucosa was encountered in ...201222298100
co-amoxiclav induces proliferation and cytotoxin production of clostridium difficile ribotype 027 in a human gut model.co-amoxiclav is widely prescribed in hospitals. although reports have suggested it may be linked to onset of clostridium difficile infection (cdi), data on the risk of cdi associated with specific antibiotics is difficult to obtain, due to confounding clinical factors. we have examined the propensity of co-amoxiclav to induce cdi using a human gut model.201222279183
detection of toxigenic clostridium difficile: comparison of the cell culture neutralization, xpert c. difficile, xpert c. difficile/epi, and illumigene c. difficile assays.clostridium difficile is the most important cause of nosocomial diarrhea. several laboratory techniques are available to detect c. difficile toxins or the genes that encode them in fecal samples. we evaluated the xpert c. difficile and xpert c. difficile/epi (cepheid, ca) that detect the toxin b gene (tcdb) and tcdb, cdt, and a deletion in tcdc associated with the 027/nap1/bi strain, respectively, by real-time pcr, and the illumigene c. difficile (meridian bioscience, inc.) that detects the toxi ...201222278839
outbreak of abdominal distension and obstipation in a c57bl/6j experimental autoimmune encephalomyelitis study.seventy-four 9-week old female c57bl/6j mice housed in a conventional facility were manipulated to induce experimental autoimmune encephalomyelitis, among which 26 developed clinical signs including lethargy, absence of defecation, and abdominal distension. by gross necropsy examination, there was distension of the cecum and colon with fecal impaction. by histologic examination, there was severe ulcerative and proliferative typhlocolitis. fecal elisa confirmed the presence of toxins a and b of c ...201222262350
clostridium difficile testing algorithms using glutamate dehydrogenase antigen and c. difficile toxin enzyme immunoassays with c. difficile nucleic acid amplification testing increase diagnostic yield in a tertiary pediatric population.we evaluated the performance of the rapid c. diff quik chek complete's glutamate dehydrogenase antigen (gdh) and toxin a/b (cdt) tests in two algorithmic approaches for a tertiary pediatric population: algorithm 1 entailed initial testing with gdh/cdt followed by loop-mediated isothermal amplification (lamp), and algorithm 2 entailed gdh/cdt followed by cytotoxicity neutralization assay (ccna) for adjudication of discrepant gdh-positive/cdt-negative results. a true positive (tp) was defined as p ...201222259201
genomic analysis uncovers a phenotypically diverse but genetically homogeneous escherichia coli st131 clone circulating in unrelated urinary tract infections.to determine variation at the genome level in escherichia coli st131 clinical isolates previously shown to be phenotypically diverse.201222258927
rhabdomyolysis: rare complications with a difficult prognosis in the course of anticancer treatment.rhabdomyolysis refers to a number of clinical and biochemical symptoms, which result from the destruction of skeletal muscles. the following triad of symptoms is considered typical: myalgia, muscle weakness, and dark urine. the most common reasons for rhabdomyolysis in children are infections. it has also been reported that rhabdomyolysis may be caused by chemotherapy drugs. the most difficult complication of rhabdomyolysis is renal failure. the authors present a 17-year-old boy diagnosed with e ...201222258346
clostridium difficile infection and colonization. 201222256813
prospective observational study comparing three different treatment regimes in patients with clostridium difficile infection.in a hospital-based, prospective cohort study, the effects of the three standard treatment regimens for mild clostridium difficile infection (cdi), oral (p.o.) metronidazole at 500 mg three times/day, intravenous (i.v.) metronidazole at 500 mg three times/day, and oral (p.o.) vancomycin at 250 mg four times/day, were compared with respect to the risk of occurrence of complications, sequelae, and all-cause death within 30 days after the date of starting treatment. differences in the incidence of ...201222252830
synbiotics and probiotics in the critically ill after the propatria trial.recent clinical trials have furthered our understanding of the role of probiotic and synbiotic therapy across a variety of diverse diseases including antibiotic-associated diarrhea, clostridium difficile associated diarrhea, acute pancreatitis, ventilator-associated pneumonia, and sepsis among others. although each of these conditions has implications for critically ill patients, relatively few studies have specifically studied this vulnerable population.201222248590
effects of prebiotic-containing infant formula on gastrointestinal tolerance and fecal microbiota in a randomized controlled trial.prebiotic-containing infant formula may beneficially affect gastrointestinal tolerance and commensal microbiota composition.201222237884
inulin and fructo-oligosaccharides have divergent effects on colitis and commensal microbiota in hla-b27 transgenic rats.modulation of intestinal microbiota by non-digestible carbohydrates may reduce inflammation in inflammatory bowel disease (ibd). the aim of the present study was to assess the effects of inulin and fructo-oligosaccharides (fos) on intestinal microbiota and colitis in hla-b27 transgenic rats, a well-validated rodent model for ibd. in this study, 4-week-old rats were fed 8 g/kg body weight inulin or fos for 12 weeks, or not. faeces were collected at 4 and 16 weeks of age; and caecal samples were c ...201222243836
clinical and laboratory characteristics of clostridium difficile infection in patients with discordant diagnostic test results.the aim of this study was to compare the clinical and laboratory characteristics of clostridium difficile infection (cdi) in patients with discordant test results for the cytotoxin assay (cyt) and pcr assays. a retrospective study from may to august 2008 and march to may 2010 was performed. cdi was diagnosed in 128 patients. pcr increased the yield of c. difficile cases by 2-fold compared to that of the cyt assay. fifty-six cases (44%) were detected by pcr only (cyt negative). forty-nine percent ...201222238444
enveloped virus but not bacteria block il-13 responses in human cord blood t cells in vitro.infections that occur early in life may have a beneficial effect on the immune system and thereby reduce the risk of allergen sensitization and/or allergic disease. it is not yet clear to what extent specific virus and/or bacteria can mediate this effect. the purpose of this study was to assess the role of virus and bacteria in cd4(+) t cell-derived cytokine production in newborns. we compared the effects of five bacteria (staphlococcus aureus, escherichia coli, clostridium difficile, lactobacil ...201222229804
outcomes in community-acquired clostridium difficile infection.community-acquired clostridium difficile infection (ca-cdi) is an increasingly appreciated condition. it is being described in populations lacking traditional predisposing factors that have been previously considered at low-risk for this infection. as most studies of cdi are hospital-based, outcomes in these patients are not well known.201222229532
risk of secondary cases of clostridium difficile infection among household contacts of index cases.we aimed to estimate the risk of secondary cases of clostridium difficile infection (cdi) among household contacts of index cases.201222227466
gef-h1-rhoa signaling pathway mediates lps-induced nf-κb transactivation and il-8 synthesis in endothelial cells.secretion of proinflammatory cytokines by lps activated endothelial cells contributes substantially to the pathogenesis of sepsis. however, the mechanism involved in this process is not well understood. in the present study, we determined the roles of gef-h1 (guanine-nucleotide exchange factor-h1)-rhoa signaling in lps-induced interleukin-8 (il-8, cxcl8) production in endothelial cells. first, we observed that gef-h1 expression was upregulated in a dose- and time-dependent manner as consistent w ...201222226472
epidemiology and pathogenesis of c. difficile and mrsa in the light of current nhs control policies: a policy review.healthcare associated infections (hcais) cause significant morbidity and mortality, and are estimated to cost the united kingdom national health service £1 billion annually. the current health care infection rates suggest that the level of performance to avoid hcais is not maintained consistently. increasing screening, improving local accountability and performance management, careful use of antibiotics in the management of emergency patients, health economy wide approaches, and improved hand wa ...201226257907
metronidazole-induced encephalopathy in a patient with end-stage liver disease.purpose. metronidazole-induced encephalopathy (mie) has been rarely reported. we report a case in a patient with end-stage liver disease (esld). summary. a 63-year-old male with esld secondary to hepatitis c virus presented with progressively worsening fatigue, slurred speech, aphasia, vomiting, and left-sided facial droop after completing a 2-week course of metronidazole for recurrent clostridium difficile-associated diarrhea. he completed a previous course of metronidazole 3 weeks prior to pre ...201225374704
proton pump inhibitor use in hospitalized patients: is overutilization becoming a problem?proton pump inhibitors (ppis) are among the most common classes of medications prescribed. though they were previously thought of as safe, recent literature has shown risks associated with their use including increased risk for clostridium difficile infection, pneumonia, and fractures. due to these risks, it is important to determine if ppis are being used appropriately. this review evaluates seven studies in hospitalized patients. additionally, this review evaluates literature pertaining to rec ...201224833936
duration and cessation of antimicrobial treatment.shortening the duration of antimicrobial therapy is an important strategy for optimizing patient care and reducing the spread of antimicrobial resistance. it is best used in the context of an overall approach to infection management that includes a focus on selecting the right initial drug and dosing regimen for empiric therapy, and de-escalation to a more narrowly focused drug regimen (or termination) based on subsequent culture results and clinical data. in addition to reducing resistance, oth ...201223737335
antimicrobial de-escalation strategies in hospitalized patients with pneumonia, intra-abdominal infections, and bacteremia.increasing numbers of serious hospital/healthcare- or community-acquired infections are caused by resistant (often multi-drug resistant) bacterial pathogens. because delayed or ineffective initial therapy can have severe negative consequences, patients at risk for these types of infections typically receive initial empiric antibiotic therapy with a broad-spectrum regimen covering the most likely pathogens, based on local surveillance data and risk factors for infection with a resistant microorga ...201223737333
duration and cessation of antimicrobial treatment.shortening the duration of antimicrobial therapy is an important strategy for optimizing patient care and reducing the spread of antimicrobial resistance. it is best used in the context of an overall approach to infection management that includes a focus on selecting the right initial drug and dosing regimen for empiric therapy, and de-escalation to a more narrowly focused drug regimen (or termination) based on subsequent culture results and clinical data. in addition to reducing resistance, oth ...201223677632
antimicrobial de-escalation strategies in hospitalized patients with pneumonia, intra-abdominal infections, and bacteremia.increasing numbers of serious hospital/healthcare- or community-acquired infections are caused by resistant (often multi-drug resistant) bacterial pathogens. because delayed or ineffective initial therapy can have severe negative consequences, patients at risk for these types of infections typically receive initial empiric antibiotic therapy with a broad-spectrum regimen covering the most likely pathogens, based on local surveillance data and risk factors for infection with a resistant microorga ...201223677630
using machine-learned bayesian belief networks to predict perioperative risk of clostridium difficile infection following colon surgery.clostridium difficile (c-diff) infection following colorectal resection is an increasing source of morbidity and mortality.201223611947
cells transformed by plc-gamma 1 overexpression are highly sensitive to clostridium difficile toxin a-induced apoptosis and mitotic inhibition.phospholipase c-γl (plc-γl) expression is associated with cellular transformation. notably, plc-gamma is up-regulated in colorectal cancer tissue and breast carcinoma. because exotoxins released by clostridium botulinum have been shown to induce apoptosis and promote growth arrest in various cancer cell lines, we examined here the potential of clostridium difficile toxin a to selectively induce apoptosis in cells transformed by plc-γl overexpression. we found that plc-γl-transformed cells, but n ...201222297219
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