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clostridium difficile: the anaerobe that made the grade.unlike other anaerobic bacteria of clinical importance, clostridium difficile has managed to enter into the realm of public awareness. following the trail blazed by methicillin-resistant staphylococcus aureus (mrsa), c. difficile has made the transition from being an obscure anaerobic bacterium, mainly of interest to specialist anaerobic microbiologists, to that of an infamous "superbug" responsible for outbreaks of hospital-acquired infection that commonly result in serious disease and death. t ...201222293217
prediction tools for unfavourable outcomes in clostridium difficile infection: a systematic review.identifying patients at risk for adverse outcomes of clostridium difficile infection (cdi), including recurrence and death, will become increasingly important as novel therapies emerge, which are more effective than traditional approaches but very expensive. clinical prediction rules (cprs) can improve the accuracy of medical decision-making. several cprs have been developed for cdi, but none has gained a widespread acceptance.201222291926
mathematical model of the impact of a nonantibiotic treatment for clostridium difficile on the endemic prevalence of vancomycin-resistant enterococci in a hospital setting.clostridium difficile-associated disease (cdad) is treated using antibiotics, which often leads to the emergence of antibiotic-resistant bacteria such as vancomycin-resistant enterococci (vre). this study estimated the impact of a non antibiotic treatment for cdad on vre prevalence.201222291852
comparative in vitro activities of lff571 against clostridium difficile and 630 other intestinal strains of aerobic and anaerobic bacteria.the in vitro activities of lff571, a novel analog of ge2270a that inhibits bacterial growth by binding with high affinity for protein synthesis elongation factor tu, fidaxomicin, and 10 other antimicrobial agents were determined against 50 strains of clostridium difficile and 630 other anaerobic and aerobic organisms of intestinal origin. lff571 possesses potent activity against c. difficile and most other gram-positive anaerobes (mic(90), ≤ 0.25 μg/ml), with the exception of bifidobacteria and ...201222290948
standardized frozen preparation for transplantation of fecal microbiota for recurrent clostridium difficile infection.while fecal microbiota transplantation (fmt) is historically known to be an effective means to treat recurrent clostridium difficile infection (cdi) refractory to standard antibiotic therapies, the procedure is rarely performed. at least some of the reasons for limited availability are those of practicality, including aesthetic concerns and costs of donor screening. the objective of this study was to overcome these barriers in our clinical fmt program.201222290405
gastric acid suppression and clostridium difficile infection: is there a causal connection? 201222289872
assessing colectomies due to clostridium difficile infection: increases in the community, but not in the referral center.to investigate an increase in cdi-related colectomies, electronically available data were used to identify patients who underwent colectomy and were diagnosed with clostridium difficile infection (cdi), with chart review to determine whether the colectomy was for cdi. the investigation found an increase in cdi-related colectomies for cdi not associated with the study institution. electronically available data facilitated surveillance for severe cdi.201222285711
fidaxomicin: the newest addition to the armamentarium against clostridium difficile infections.fidaxomicin, a macrolide antibiotic, was the first medication for the management of clostridium difficile infections (cdi) to be approved by the us food and drug administration in more than 20 years.201222284993
[adverse effects of proton pump inhibitors: should we worry about long-term exposure?].long-term treatment with proton pump inhibitors (ppi) is becoming more prevalent. although they are well tolerated in the short term, serious concerns about long-term use have arisen. recent data suggest that the latter is associated with an increased risk for osteoporotic fracture (especially vertebral), clostridium difficile infection and rebound acid hypersecretion after treatment discontinuation. acute interstitial nephritis is rare but may progress to chronic renal failure. an increased ris ...201222284952
clostridium difficile infection prevention: biotherapeutics, immunologics, and vaccines.we are in the midst of a resurgence of clostridium difficile infection (cdi) in north america and europe for which morbidity and mortality are higher than ever seen. c. difficile has risen in frequency to become the most common healthcare-associated infection pathogen, exceeding methicillin-resistant staphylococcus aureus in many hospitals. protection against cdi is thought to be mediated first by the normal bacterial microbiota, supplemented by an adaptive immune antibody response directed prim ...201222284786
non-steroidal anti-inflammatory drugs and the risk of clostridium difficile-associated disease.several case reports have linked diclofenac, a non-steroidal anti-inflammatory drug (nsaid), with clostridium difficile associated disease (cdad). we assessed whether nsaid use in general, and diclofenac use in particular, is associated with an increased risk of cdad.201222283873
considerations for the use of proton-pump inhibitors in older adults.to investigate current concerns regarding the use of proton-pump inhibitors (ppis) in older adults.201222330952
clinical and laboratory evaluation of a real-time pcr for clostridium difficile toxin a and b genes.many laboratories use enzyme immunoassays (eias) for the diagnosis of clostridium difficile infection (cdi). more recently, polymerase chain reaction (pcr)-based diagnosis has been described as a sensitive test. real-time pcr for the detection of c. difficile toxin a and b genes was evaluated. a prospective evaluation was performed on stool samples from 150 hospitalized adult patients and 141 healthy volunteers. pcr was compared to toxigenic culture (tc), direct cytotoxicity test (ctt), immunoca ...201222327373
fidaxomicin versus vancomycin for infection with clostridium difficile in europe, canada, and the usa: a double-blind, non-inferiority, randomised controlled trial.infection with clostridium difficile is the primary infective cause of antibiotic-associated diarrhoea. we aimed to compare efficacy and safety of fidaxomicin and vancomycin to treat patients with c difficile infection in europe, canada, and the usa.201222321770
u.k. laboratory diagnosis of clostridium difficile infection: in a state of transition, confusion, or both? 201222321724
fidaxomicin for the treatment of clostridium difficile infections.to evaluate the pharmacology, microbiology, safety, and efficacy of fidaxomicin for treatment of clostridium difficile infections (cdi).201222318930
discovery of lff571: an investigational agent for clostridium difficile infection.clostridium difficile (c. difficile) is a gram positive, anaerobic bacterium that infects the lumen of the large intestine and produces toxins. this results in a range of syndromes from mild diarrhea to severe toxic megacolon and death. alarmingly, the prevalence and severity of c. difficile infection are increasing; thus, associated morbidity and mortality rates are rising. 4-aminothiazolyl analogues of the antibiotic natural product ge2270 a (1) were designed, synthesized, and optimized for th ...201222315981
clostridium difficile o27 colitis: hospital-onset but community-acquired.large outbreaks of clostridium difficile (cd) associated colitis in north america and europe have been attributed to the emergence of the epidemic/toxin pcr ribotype o27 cd strain (cd027). due to the increased virulence of this epidemic strain and its propension for causing outbreaks, we performed a structured risk-assessment approach in order to determine the risks associated with the introduction of this strain within our university hospital. from february 2009 to january 2010, we identified 3 ...201222314411
implementing automated surveillance for tracking clostridium difficile infection at multiple healthcare facilities.automated surveillance using electronically available data has been found to be accurate and save time. an automated clostridium difficile infection (cdi) surveillance algorithm was validated at 4 centers for disease control and prevention epicenter hospitals. electronic surveillance was highly sensitive, specific, and showed good to excellent agreement for hospital-onset; community-onset, study facility-associated; indeterminate; and recurrent cdi.201222314071
a meta-analysis and systematic review on the effect of probiotics in acute diarrhea.diarrhea the second leading cause of death in childhood is caused by a variety of organisms. rehydration reduces the risk of death but it is not effective in shortening duration of disease. recently, probiotics have been recommended for prevention or treatment of gastrointestinal disorders including diarrhea. considering existing documents from different aspects, it seems that results are somehow controversial or non-conclusive. thus, we aimed to meta-analyze clinical trials to show actual benef ...201222309079
assessment of administrative data for evaluating the shifting acquisition of clostridium difficile infection in england.little is known about the acquisition of clostridium difficile infection (cdi) and whether it represents hospital- or community-acquired infection.201222306443
phase i dose finding studies of an adjuvanted clostridium difficile toxoid vaccine.fifty healthy adult (18-55 years) and 48 elderly (≥ 65 years) volunteers were randomized to receive a candidate clostridium difficile toxoid vaccine (2 μg, 10 μg, or 50 μg) or placebo on days 0, 28, and 56. no volunteer receiving placebo seroconverted. for toxin a, seroconversion by day 56 (post-dose 2) was observed in 100% of volunteers aged 18-55 years in all dose groups and in 50%, 89%, and 100% of elderly participants in the 2 μg, 10 μg, and 50 μg dose groups, respectively. for both age grou ...201222306375
mycotic abdominal aortic aneurysm caused by toxigenic clostridium difficile.extra-intestinal infections caused by clostridium difficile are uncommon. we report a case of a mycotic abdominal aortic aneurysm in an 86-year old male. tissue and pus swabs from the aneurysmal sac grew a pure growth of c. difficile. the identity of the isolate was determined by phenotypic methods and confirmed by dna sequencing. he was treated successfully with an aorta-bifemoral bypass and a 4-week course of intravenous and oral antibiotics.201222306098
determining mortality rates attributable to clostridium difficile infection.to determine accuracy of measures of deaths attributable to clostridium difficile infection, we compared 3 measures for 2007-2008 in ontario, canada: death certificate; death within 30 days of infection; and panel review. data on death within 30 days were more feasible than panel review and more accurate than death certificate data.201222305427
cryptosporidium enteritis in solid organ transplant recipients: multicenter retrospective evaluation of 10 cases reveals an association with elevated tacrolimus concentrations.cryptosporidial enteritis, a diarrheal infection of the small intestine caused by the apicomplexan protozoa cryptosporidium, is infrequently recognized in transplant recipients from developed countries.201222340660
detection of clostridium difficile as a routine diagnosis: comparison of real-time pcr and enzyme immunoassay. 201222338064
an evaluation of repeat stool testing for clostridium difficile infection by polymerase chain reaction.to evaluate the yield of repeat stool polymerase chain reaction (pcr) testing in patients with suspected clostridium difficile infection (cdi).201222334221
environmental decontamination with ultraviolet radiation to prevent recurrent clostridium difficile infection in 2 roommates in a long-term care facility. 201222476286
comparison of the microbiological efficacy of hydrogen peroxide vapor and ultraviolet light processes for room decontamination.to compare the microbiological efficacy of hydrogen peroxide vapor (hpv) and ultraviolet radiation (uvc) for room decontamination.201222476278
use of a structured panel process to define quality metrics for antimicrobial stewardship programs.antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, clostridium difficile infection, and antimicrobial resistance. there is no standardized approach to evaluate the impact of these programs.201222476277
a multicenter study of clostridium difficile infection-related colectomy, 2000-2006.to assess clostridium difficile infection (cdi)-related colectomy rates by cdi surveillance definitions and over time at multiple healthcare facilities.201222476273
polymerase chain reaction testing for clostridium difficile. 201222475569
a meta-analysis of probiotic efficacy for gastrointestinal diseases.meta-analyses on the effects of probiotics on specific gastrointestinal diseases have generally shown positive effects on disease prevention and treatment; however, the relative efficacy of probiotic use for treatment and prevention across different gastrointestinal diseases, with differing etiology and mechanisms of action, has not been addressed.201222529959
a prospective cohort study on hospital mortality due to clostridium difficile infection.although an increase in burden of disease has frequently been reported for clostridium difficile infection (cdi), specific data on the effect of cdi on a patient's risk of death or overall hospital mortality are scarce. therefore, we performed a prospective cohort study to analyse the effect of cdi on the risk of pre-discharge all-cause death in all inpatients with cdi compared to all inpatients without cdi during 2009 in a single hospital.201222527876
generation of an actagardine a variant library through saturation mutagenesis.the lantibiotic actagardine a is nineteen amino acids in length and comprises three intertwined c-terminal methyllanthionine-bridged rings and an n-terminal lanthionine-bridged ring. produced by the actinomycete actinoplanes garbadinensis atcc 31049, actagardine a demonstrates antibacterial activity against important gram-positive pathogens. this activity combined with its ribosomal synthesis makes it an attractive target for the generation of lantibiotic variants with improved biological activi ...201222526797
risk of clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis.several studies have raised concern regarding the possible association between proton-pump inhibitors (ppis) and clostridium difficile infection (cdi). we aimed to perform a systematic review of incident and recurrent cdi in ppi users, and to evaluate the relative impact of concurrent antibiotic use, or switching acid suppression to histamine-2-receptor antagonists (h2ras).201222525304
decreased cure and increased recurrence rates for clostridium difficile infection caused by the epidemic c. difficile bi strain.an epidemic strain of clostridium difficile designated by restriction endonuclease analysis (rea) as group bi has caused multiple outbreaks of severe c. difficile infection (cdi). the treatment response of patients infected with this strain is uncertain.201222523271
cyclic diguanylate inversely regulates motility and aggregation in clostridium difficile.clostridium difficile-associated disease is increasing in incidence and is costly to treat. our understanding of how this organism senses its entry into the host and adapts for growth in the large bowel is limited. the small-molecule second messenger cyclic diguanylate (c-di-gmp) has been extensively studied in gram-negative bacteria and has been shown to modulate motility, biofilm formation, and other processes in response to environmental signals, yet little is known about the functions of thi ...201222522894
precise manipulation of the clostridium difficile chromosome reveals a lack of association between the tcdc genotype and toxin production.clostridium difficile causes a potentially fatal diarrheal disease through the production of its principal virulence factors, toxin a and toxin b. the tcdc gene is thought to encode a negative regulator of toxin production. therefore, increased toxin production, and hence increased virulence, is often inferred in strains with an aberrant tcdc genotype. this report describes the first allele exchange system for precise genetic manipulation of c. difficile, using the coda gene of escherichia coli ...201222522680
antimicrobial resistance, toxinotype, and genotypic profiling of clostridium difficile isolates of swine origin.the occurrence of clostridium difficile infections in patients that do not fulfill the classical risk factors prompted us to investigate new risk factors of disease. the goal of this study was to characterize strains and associated antimicrobial resistance determinants of c. difficile isolated from swine raised in ohio and north carolina. genotypic approaches used include pcr detection, toxinotyping, dna sequencing, and pulsed-field gel electrophoresis (pfge) dna fingerprinting. thirty-one perce ...201222518873
acp journal club. review: fidaxomicin is better than vancomycin for clostridium difficile recurrence. 201222508749
fk506-binding protein 51 interacts with clostridium botulinum c2 toxin and fk506 inhibits membrane translocation of the toxin in mammalian cells.the binary clostridium botulinum c2 toxin consists of the binding/translocation component c2iia and the separate enzyme component c2i. c2iia delivers c2i into the cytosol of eukaryotic target cells where c2i adp-ribosylates actin. after receptor-mediated endocytosis of the c2iia/c2i complex, c2iia forms pores in membranes of acidified early endosomes and unfolded c2i translocates through the pores into the cytosol. membrane translocation of c2i is facilitated by the activities of host cell chape ...201222420783
audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis.we aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum antimicrobial use among critical care patients.201222418630
epidemiology and outcomes of clostridium difficile infections in hematopoietic stem cell transplant recipients.background. clostridium difficile is the leading cause of infectious diarrhea among hospitalized patients and is a major concern for patients undergoing hematopoietic stem cell transplantation (hsct). risk factors and the natural history of c. difficile infection (cdi) are poorly understood in this population. methods. we performed a retrospective nested case-control study to describe the epidemiology, timing, and risk factors for cdi among adult patients who received hscts at our center from ja ...201222412059
antimicrobial-resistant strains of clostridium difficile from north america.a total of 316 toxigenic clostridium difficile clinical isolates of known pcr ribotypes from patients in north america were screened for resistance to clindamycin, metronidazole, moxifloxacin, and rifampin. clindamycin resistance was observed among 16 different ribotypes, with ribotypes 017, 053, and 078 showing the highest proportions of resistance. all isolates were susceptible to metronidazole. moxifloxacin resistance was present in >90% of pcr-ribotype 027 and 053 isolates but was less commo ...201222411613
induction of cytokines in a macrophage cell line by proteins of clostridium difficile.clostridium difficile is a major cause of nosocomial diarrhoea. the toxins produced by c. difficile are responsible for the characteristic pathology observed in c. difficile disease, but several surface-associated proteins of c. difficile are also recognized by the immune system and could modulate the immune response in infection. the aim of this study was to assess the induction of cytokines in a macrophage cell line in response to different antigens prepared from five c. difficile strains: the ...201222409477
distribution of the vang-like gene cluster in clostridium difficile clinical isolates.treatment of clostridium difficile infections generally requires cessation of their causative antibiotic and subsequent administration of metronidazole or vancomycin. intriguingly, the genome of c. difficile 630 contains a cryptic gene cluster homologous to the vang-type operon of enterococcus faecalis bm4518. we detected this cluster by pcr in 35 out of 41 clinical isolates, confirming its large prevalence in this species. the cluster was found to be located in a unique locus. comparison of thi ...201222409319
identification and characterization of a bacterial hydrosulphide ion channel.the hydrosulphide ion (hs(-)) and its undissociated form, hydrogen sulphide (h(2)s), which are believed to have been critical to the origin of life on earth, remain important in physiology and cellular signalling. as a major metabolite in anaerobic bacterial growth, hydrogen sulphide is a product of both assimilatory and dissimilatory sulphate reduction. these pathways can reduce various oxidized sulphur compounds including sulphate, sulphite and thiosulphate. the dissimilatory sulphate reductio ...201222407320
clostridium difficile colitis: a review.clostridium difficile has become an increasingly important nosocomial pathogen and is one of the most common causes of hospital-acquired diarrhea. the incidence of c difficile infection (cdi) is increasing worldwide. overuse of antibiotics is felt to be a major contributing factor leading to the increased incidence of cdi. the clinical manifestations of cdi vary from a mild form of the disease to fulminant diarrhea, leading to significant patient morbidity and mortality. the increasing incidence ...201222406889
nosocomial diarrhea: a review of pathophysiology, etiology, and treatment strategies.diarrhea is a frequent complication among hospitalized patients. nosocomial diarrhea is generally diagnosed as increased frequency and decreased consistency of stools developing after 72 hours of hospitalization. the causes of nosocomial diarrhea may be infectious or noninfectious. noninfectious etiologies occur most commonly, and are often adverse effects of medications or enteral nutrition therapies. infectious etiologies are most concerning and include clostridium difficile and norovirus. pat ...201222406888
an overview of the diagnosis and management of clostridium difficile infection.the diagnosis and treatment of clostridium difficile infection are becoming increasingly complex with the introduction of novel diagnostic techniques and new pharmacologic and nonpharmacologic treatments. the integration of these new approaches with older, established methods is a challenge to individual clinicians and hospital systems. this article provides an overview of the current methods for the diagnosis and treatment of c difficile infection.201222406887
antimicrobial prophylaxis in noncardiac prosthetic device recipients.secondary antimicrobial prophylaxis involves the use of ≥ 1 antimicrobial agent just prior to the time when a diagnostic/therapeutic procedure, which may induce infection, is to be performed. in the context of this article, antimicrobial agent(s) are administered to patients with ≥ 1 implanted prosthetic device in order to prevent metastatic seeding of the device(s) during bacteremia induced by a diagnostic/therapeutic procedure. antimicrobial agents used in this context are only administered pe ...201222406882
high resolution melt analysis to track infections due to ribotype 027 clostridium difficile.the increased prevalence of hypervirulent ribotype 027 clostridium difficile requires rapid identification of isolates in order to implement timely infection control strategies. high resolution melt (hrm) analysis of pcr products can identify strain variation amongst genera of bacteria. the intergenic (16s-23s rdna) spacer region contains sequence regions conserved within genera and other sequence region variables between species within genera. we wished to investigate whether hrm analysis of pc ...201222406296
clostridium difficile infection is associated with worse long term outcome in patients with ulcerative colitis.clostridium difficile infection (cdi) is becoming prevalent in general population as well as in patients with inflammatory bowel disease (ibd).201222405170
diagnosing toxigenic clostridium difficile: new confidence bounds show culturing increases sensitivity of the toxin a/b enzyme immunoassay and refute gold standards.to scrutinize published sensitivity estimates obtained using questionable gold standards by comparing sensitivities of culturing clostridium difficile in commercially available media followed by enzyme immunoassay (eia) toxin a or b detection (culture test) with applying the eia to stool samples alone (direct test).201222404319
a new rapid method for clostridium difficile dna extraction and detection in stool: toward point-of-care diagnostic testing.we describe a new method for the rapid diagnosis of clostridium difficile infection, with stool sample preparation and dna extraction by heat and physical disruption in a single-use lysis microreactor (lmr), followed by a rapid pcr amplification step. all steps can be accomplished in <20 minutes overall. gel electrophoresis is currently used to detect the amplification product, pending real-time availability with an ultra-rapid thermocycler. compared with the dual enzyme immunoassay (eia) screen ...201222402170
secretome analysis of clostridium difficile strains.clostridium difficile causes infections ranging from mild c. difficile-associated diarrhea to severe pseudomembranous colitis. since 2003 new hypervirulent c. difficile strains (pcr ribotype 027) emerged characterized by a dramatically increased mortality. the secretomes of the three c. difficile strains cdr20291, cd196, and cd630 were analyzed and compared. proteins were separated and analyzed by means of sds--page and lc-ms. ms data were analyzed using mascot and proteins were checked for expo ...201222398929
vital signs: preventing clostridium difficile infections.clostridium difficile infection (cdi) is a common and sometimes fatal health-care-associated infection; the incidence, deaths, and excess health-care costs resulting from cdis in hospitalized patients are all at historic highs. meanwhile, the contribution of nonhospital health-care exposures to the overall burden of cdi, and the ability of programs to prevent cdis by implementing cdc recommendations across a range of hospitals, have not been demonstrated previously.201222398844
double trouble: how big a problem is redundant anaerobic antibiotic coverage in veterans affairs medical centres?to assess the prevalence of, and the variation in, avoidable use of metronidazole in the veterans affairs (va) healthcare system201222398652
treatment failure and recurrence of clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence.the objective of this review was to evaluate the frequency of treatment failure and recurrence of clostridium difficile infection (cdi) following treatment with vancomycin or metronidazole in recently performed studies (last 10 years). searches in pubmed and scopus were performed by two reviewers independently. data regarding treatment failure and recurrence following metronidazole and vancomycin treatment were extracted and analysed. in total, 39 articles (7005 patients) were selected for inclu ...201222398198
macro and micro diversity of clostridium difficile isolates from diverse sources and geographical locations.clostridium difficile has emerged rapidly as the leading cause of antibiotic-associated diarrheal disease, with the temporal and geographical appearance of dominant pcr ribotypes such as 017, 027 and 078. despite this continued threat, we have a poor understanding of how or why particular variants emerge and the sources of strains that dominate different human populations. we have undertaken a breadth genotyping study using multilocus sequence typing (mlst) analysis of 385 c. difficile strains f ...201222396735
quantitative analysis of intestinal bacterial populations from term infants fed formula supplemented with fructo-oligosaccharides.previous studies of infant formulas supplemented with oligosaccharides reported mixed results regarding the impact on intestinal microbial populations. the objective of this study was to examine the effect of supplementation of an infant formula with fructo-oligosaccharides (fos) on select groups of intestinal bacteria in term infants.201222395187
a real-world evaluation of oral vancomycin for severe clostridium difficile infection: implications for antibiotic stewardship programs.to assess antibiotic treatment patterns and clinical outcomes of patients with clostridium difficile infection (cdi) based on underlying severity of cdi disease.201222392421
activity of a novel cyclic lipopeptide, cb-183,315, against resistant clostridium difficile and other gram-positive aerobic and anaerobic intestinal pathogens.we evaluated the activity of cb-183,315 against clostridium difficile, including strains that are resistant to fluoroquinolones and metronidazole and with elevated mics to vancomycin as well as other gram-positive intestinal pathogens. the mics of cb-183,315 against all c. difficile isolates were ≤ 1 μg/ml. cb-183,315 had greater activity than vancomycin and metronidazole against c. difficile isolates and was more active than the comparators against vancomycin-resistant enterococcus (vre). cb-18 ...201222391542
clostridium difficile infection after allogeneic hematopoietic stem cell transplantation: incidence, risk factors, and outcome.clostridium difficile (c. difficile) infection was observed in 13% of recipients after hematopoietic stem cell transplantation (hsct), mainly in the first month posttransplantation. risk factors were cord blood as the source of stem cells, acute graft-versus-host disease (gvhd), and total body irradiation (tbi). no association was found with an increased risk of mortality. the purpose of this study was to evaluate the incidence, risk factors, and outcome of c. difficile infection (cdi) after hsc ...201222387347
clostridium difficile: a new look at an old but increasingly deadly infection. 201222384754
fidaxomicin, a new treatment for clostridium difficile infections.clostridium difficile is currently the most important cause of infectious diarrhea in the united states. fidaxomicin, a macrolide antibiotic, was recently approved for treatment of c. difficile infections (cdis). in vitro studies demonstrate that fidaxomicin has a narrow spectrum of activity against c. difficile with minimal effect on the gut flora. clinical trials indicate that fidaxomicin is as effective as vancomycin for treatment of cdi with fewer recurrences. additionally, fidaxomicin has m ...201222384450
spores of clostridium difficile clinical isolates display a diverse germination response to bile salts.clostridium difficile spores play a pivotal role in the transmission of infectious diarrhoea, but in order to cause disease spores must complete germination and return to vegetative cell growth. while the mechanisms of spore germination are well understood in bacillus, knowledge of c. difficile germination remains limited. previous studies have shown that bile salts and amino acids play an important role in regulating the germination response of c. difficile spores. taurocholate, in combination ...201222384234
association between appendectomy and clostridium difficile infection.recent theory proposes that the appendix functions as a reservoir for commensal bacteria, and serves to re-inoculate the colon with normal flora in the event of pathogen exposure or purging of intestinal flora. if true, we reasoned that flora from a normal appendix could provide protection against clostridium difficile. we conducted this investigation to examine the protective effect of an intact appendix and test the hypothesis that prior appendectomy will be more common among patients with a p ...201222383922
diarrhoeagenic escherichia coli as a predominant cause of paediatric nosocomial diarrhoea in india.intestinal nosocomial infections remain a major concern in paediatric wards leading to increased morbidity and mortality. this study determined the aetiological and epidemiological profile of nosocomial diarrhoea (nd) among children admitted to a hospital in india. during the period of january 2008 to june 2009, we consecutively enrolled 100 children between the age of 2 months and 14 years who developed nd as defined by the centers for disease control and prevention. a control group of patients ...201222383443
[current management of toxic megacolon].toxic megacolon is a rare and life-threatening complication of severe colitis, defined as a dilatation of the colon > 6 cm in the absence of distal obstruction in combination with signs of systemic toxicity (major criteria: fever, tachycardia, leukocytosis, anaemia). various triggers are known and the most common causes are underlying ulcerative colitis and clostridium difficile. diagnosis can easily be made by clinical examination, routine laboratory parameters and a plain x-ray of the abdomen. ...201222383287
certification in infection control matters: impact of infection control department characteristics and policies on rates of multidrug-resistant infections.the study objective is to describe infection control policies aimed at multidrug-resistant organisms (mdro) in california hospitals and assess the relationship among these policies, structural characteristics, and rates of methicillin-resistant staphylococcus aureus (mrsa) or vancomycin-resistant enterococcus (vre) bloodstream infections and clostridium difficile infections.201222381222
signal transducer and activator of transcription-5 mediates neuronal apoptosis induced by inhibition of rac gtpase activity.in several neuronal cell types, the small gtpase rac is essential for survival. we have shown previously that the rho family gtpase inhibitor clostridium difficile toxin b (toxb) induces apoptosis in primary rat cerebellar granule neurons (cgns) principally via inhibition of rac gtpase function. in the present study, incubation with toxb activated a proapoptotic janus kinase (jak)/signal transducer and activator of transcription (stat) pathway, and a pan-jak inhibitor protected cgns from rac inh ...201222378792
community-associated clostridium difficile infections, monroe county, new york, usa.we conducted active sentinel surveillance in monroe county, new york, usa, to compare incidence of community-associated clostridium difficile infections (ca-cdis) with that of health care-associated infections (ha-cdis) and identify exposure and strain type differences between ca and ha cases. patients positive for c. difficile toxin and with no documented health care exposure in the previous 12 weeks were defined as possible ca case-patients. patients with onset in a health care setting or rece ...201222377231
tcdb from hypervirulent clostridium difficile exhibits increased efficiency of autoprocessing.tcdb, an intracellular bacterial toxin that inactivates small gtpases, is a major clostridium difficile virulence factor. recent studies have found that tcdb produced by emerging/hypervirulent strains of c. difficile is more potent than tcdb from historical strains, and in the current work, studies were performed to investigate the underlying mechanisms for this change in tcdb toxicity. using a series of biochemical analyses we found that tcdb from a hypervirulent strain (tcdb(hv) ) was more eff ...201222372854
in vivo selection of moxifloxacin-resistant clostridium difficile. 201222371889
clostridium difficile toxin a inhibits the kinase activity of extracellular signal-related kinases 1 and 2 through direct binding.clostridium difficile toxin a glucosylates rho family proteins, resulting in actin filament disaggregation and cell rounding in cultured colonocytes. given that the cellular toxicity of toxin a is dependent on its receptor binding and subsequent entry into the cell, we herein sought to identify additional colonocyte proteins that might bind to toxin a following its internalization. our results revealed that toxin a interacted with erk1 and erk2 in two human colonocyte cell lines (ncm460 and ht29 ...201222370345
preliminary investigation of environmental prevalence of clostridium difficile affecting inpatients in a north indian hospital.a preliminary study was conducted to see the prevalence of clostridium difficile in patients and their environment in a tertiary care hospital. seventy-nine fecal specimens from hospitalized patients, 176 swab samples from beds and 48 from hands of hospital personnel were investigated. sixty-three patients received antibiotics and 14 proton pump inhibitors. abdominal pain was observed in 16 patients with fever in 15 of them. c. difficile culture was positive in 12.6% patients at initial sampling ...201222361768
high-resolution melting analysis of the single nucleotide polymorphism hot-spot region in the rpob gene as an indicator of reduced susceptibility to rifaximin in clostridium difficile.clostridium difficile, a gram-positive, spore-forming, anaerobic bacterium, is the main causative agent of hospital-acquired diarrhoea worldwide. in addition to metronidazole and vancomycin, rifaximin, a rifamycin derivative, is a promising antibiotic for the treatment of recurring c. difficile infections (cdi). however, exposure of c. difficile to this antibiotic has led to the development of rifaximin-resistance due to point mutations in the β-subunit of the rna polymerase (rpob) gene. in the ...201222361457
systematic review: faecal transplantation for the treatment of clostridium difficile-associated disease.management of recurrent clostridium difficile-associated disease (cdad), particularly in elderly patients, remains clinically challenging. faecal transplantation (ft) may restore normal microbiota and break the cycle of recurrent cdad.201222360412
predictors of severe outcomes associated with clostridium difficile infection in patients with inflammatory bowel disease.the increasing incidence of clostridium difficile (c. difficile) infection (cdi) among patients with inflammatory bowel disease is well recognised. however, most studies have focused on demonstrating that cdi is associated with adverse outcomes in ibd patients. few have attempted to identify predictors of severe outcomes associated with cdi among ibd patients.201222360370
risk factors for mortality in patients with clostridium difficile infection. 201222354921
clostridium difficile in piglets in the czech republic. 201222354381
monitoring clostridium difficile infection in an acute hospital: prevalence or incidence studies?surveillance of clostridium difficile infection (cdi) is an essential component of a cdi preventative programme.201222350440
characterisation of clostridium difficile hospital ward-based transmission using extensive epidemiological data and molecular typing.clostridium difficile infection (cdi) is a leading cause of antibiotic-associated diarrhoea and is endemic in hospitals, hindering the identification of sources and routes of transmission based on shared time and space alone. this may compromise rational control despite costly prevention strategies. this study aimed to investigate ward-based transmission of c. difficile, by subdividing outbreaks into distinct lineages defined by multi-locus sequence typing (mlst).201222346738
comparison of two capillary gel electrophoresis systems for clostridium difficile ribotyping, using a panel of ribotype 027 isolates and whole-genome sequences as a reference standard.pcr ribotyping is the most commonly used clostridium difficile genotyping method, but its utility is limited by lack of standardization. in this study, we analyzed four published whole genomes and tested an international collection of 21 well-characterized c. difficile ribotype 027 isolates as the basis for comparison of two capillary gel electrophoresis (cge)-based ribotyping methods. there were unexpected differences between the 16s-23s rrna intergenic spacer region (isr) allelic profiles of t ...201222692737
chemotherapy patients with c. difficile colitis have outcomes similar to immunocompetent c. difficile patients.clostridium difficile colitis (cdc) patients receiving chemotherapy for hematologic malignancies are anticipated to have worse outcomes than immunocompetent cdc patients.201222692587
critical role for myd88-mediated neutrophil recruitment during clostridium difficile colitis.clostridium difficile can infect the large intestine and cause colitis when the normal intestinal microbiota is altered by antibiotic administration. little is known about the innate immune signaling pathways that marshal inflammatory responses to c. difficile infection and whether protective and pathogenic inflammatory responses can be dissociated. toll-like receptors predominantly signal via the myd88 adaptor protein and are important mediators of innate immune signaling in the intestinal muco ...201222689818
incidence of clostridium difficile infection in children with inflammatory bowel disease compared to oncology and immunocompetent patients.the aim of this study was to determine the incidence of clostridium difficile infection in hospitalized children with inflammatory bowel disease (ibd) and to compare it to other immunosuppressed patients at risk (oncology patients) as well as to immunocompetent patients.201222688504
secretion of clostridium difficile toxins a and b requires the holin-like protein tcde.the pathogenesis of clostridium difficile, the major cause of antibiotic-associated diarrhea, is mainly associated with the production and activities of two major toxins. in many bacteria, toxins are released into the extracellular environment via the general secretion pathways. c. difficile toxins a and b have no export signature and their secretion is not explainable by cell lysis, suggesting that they might be secreted by an unusual mechanism. the tcde protein encoded within the c. difficile ...201222685398
fda drug safety communications: a narrative review and clinical considerations for older adults.the us food and drug administration (fda) has new regulatory authorities intended to enhance drug safety monitoring in the postmarketing period. this has resulted in an increase in communication from the fda in recent years about the safety profile of certain drugs. it is important to stay abreast of the current literature on drug risks to effectively communicate these risks to patients, other health care providers, and the general public.201222683398
a year in review: new drugs for older adults in 2011.new drugs approved by the food and drug administration (fda) may offer tremendous clinical advances by providing health care providers with new treatment strategies. however, additional care must be taken for safe and effective use of these new agents by older adults.201222682643
clostridium difficile: development of a novel candidate vaccine.clostridium difficile has become the most frequent hospital-acquired infection in north america and the eu. c. difficile infection (cdi) is present worldwide and disease awareness is increasing. in the us, eu, and canada, in addition to hospital diagnosed disease, cdi has also been reported with increasing frequency in the community. hypervirulent strains have increased the morbidity and mortality associated with cdi. current treatment options are suboptimal. of all patients treated for cdi, 20% ...201222682287
vermin on pig farms are vectors for clostridium difficile pcr ribotypes 078 and 045.clostridium difficile is a gram positive, spore forming, toxin producing, anaerobic bacteria and an opportunistic pathogen for man and many animal species, causing diarrhea in young piglets. piglets probably become colonized from the environment. to investigate the possible spread and transmission of c. difficile by vermin, vermin samples were collected on a pig farm in the netherlands and investigated for the presence of c. difficile. samples of house mice (n=53), drain flies (n=39), lesser hou ...201222682200
in vitro evaluation of single- and multi-strain probiotics: inter-species inhibition between probiotic strains, and inhibition of pathogens.many studies comparing the effects of single- and multi-strain probiotics on pathogen inhibition compare treatments with different concentrations. they also do not examine the possibility of inhibition between probiotic strains with a mixture. we tested the ability of 14 single-species probiotics to inhibit each other using a cross-streak assay, and agar spot test. we then tested the ability of 15 single-species probiotics and 5 probiotic mixtures to inhibit clostridium difficile, escherichia co ...201222677262
fecal transplantation for the treatment of clostridium difficile infection. 201222675283
a pilot study of rapid benchtop sequencing of staphylococcus aureus and clostridium difficile for outbreak detection and surveillance.to investigate the prospects of newly available benchtop sequencers to provide rapid whole-genome data in routine clinical practice. next-generation sequencing has the potential to resolve uncertainties surrounding the route and timing of person-to-person transmission of healthcare-associated infection, which has been a major impediment to optimal management.201222674929
[clostridium difficile-associated diarrhea infection: is it time for us to start worrying in mexico?]. 201222672852
[intrahospital mortality in patients with clostridium difficile-associated diarrhea infection].clostridium difficile (c. difficile) is a gram-positive anaerobic bacillus capable of producing diarrhea or colitis in the hospitalized patient, particularly in those exposed to the use of antibiotics, and 6% to 38% mortality in patients with c. difficile-associated diarrhea (cdad) has been described.201222672850
antimicrobial susceptibility testing of clostridium difficile using eucast epidemiological cut-off values and disk diffusion correlates.with the emergence of reduced susceptibility of clostridium difficile to metronidazole and vancomycin the value of antimicrobial susceptibility testing has increased. the aim of our study was to evaluate disk diffusion for susceptibility testing of c. difficile by comparing disk diffusion results with mics from gradient tests and to propose zone diameter breakpoint correlates for the eucast epidemiological cut-off values (ecoffs) recently published. we tested 211 clinical isolates of c. difficil ...201222672504
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