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clinical negligence, litigation and healthcare-associated infections.litigation costs resulting from clinical negligence claims involving healthcare-associated infections are a significant but underappreciated cost to healthcare organizations. in england these claims are handled on behalf of the national health service (nhs) organizations by the nhs litigation authority (nhsla). the total number of claims and the amounts awarded have increased significantly in recent years.201222658237
clostridium difficile and entamoeba histolytica infections in patients with colitis in the philippines.amoebiasis is a common cause of non-specific colitis in the philippines. the prevalence of clostridium difficile infection with colitis is unknown. empiric use of metronidazole for colitis treatment is widely practiced. we investigated the association of c. difficile or entamoeba histolytica infection with endoscopically/histopathologically proven colitis among adults in the philippines. two hundred and ten patients undergoing colonoscopy were enrolled. demographic and clinical data were reviewe ...201222657531
fidaxomicin for clostridium difficile-associated diarrhoea: epidemiological method for estimation of warranted price.fidaxomicin is a macrocyclic antibiotic approved in 2011 by the us food and drug administration for treatment of clostridium difficile-associated diarrhoea (cdad).201222708825
[clostridium difficile infection in children--experience of clinical centre in bydgoszcz].clostridium difficile (cd) is one of the main factors of nosocomial infections both in children and adults and the number these infections is still growing. there is an increasing number of community-associated cdad and cdis with no exposure to antibiotics. tests for cd among children are not routinely conducted because of high rate of carrying (from 13 to 70% infants). the objective of a study was to assess the frequency cdi among children with diarrhea, analysis of the risk factors of cdi and ...201222708301
[clostridium difficile as etiological agent of pseudomembranous colitis]. 201222708300
evaluation of three enzyme immunoassays and a loop-mediated isothermal amplification test for the laboratory diagnosis of clostridium difficile infection.the laboratory diagnosis of clostridium difficile infection (cdi) consists of the detection of toxigenic clostridium difficile, and/or its toxins a or b in stool preferably in a two-step algorithm. in a prospective study, we compared the performance of three toxin enzyme immunoassays (eias)-immunocard toxins a & b, premier toxins a & b and c. diff quik chek complete, which combines a toxins test and a glutamate dehydrogenase (gdh) antigen eia in one device -and the loop-mediated isothermal ampli ...201222706512
prophage carriage and diversity within clinically relevant strains of clostridium difficile.prophages are encoded in most genomes of sequenced clostridium difficile strains. they are key components of the mobile genetic elements and, as such, are likely to influence the biology of their host strains. the majority of these phages are not amenable to propagation, and therefore the development of a molecular marker is a useful tool with which to establish the extent and diversity of c. difficile prophage carriage within clinical strains. to design markers, several candidate genes were ana ...201222706062
comparative analysis of an expanded clostridium difficile reference strain collection reveals genetic diversity and evolution through six lineages.clostridium difficile is an anaerobic bacillus that resides in the gut and has rapidly emerged as a leading cause of antibiotic associated diarrheal disease in humans. the genetic basis of the pathogenicity of c. difficile remains poorly understood. in this study we aimed at characterizing the genetic diversity of c. difficile strains by three different methods (pcr ribotyping, multilocus sequence typing and genetic markers) to improve the typing of c. difficile. our study was performed on a ref ...201222705462
you can teach old pathogens new tricks: the zoonotic potential of escherichia coli, clostridium difficile, staphylococcus aureus, and enterococci, or from noah's ark to pandora's box. 201222703445
efficacy and safety of fidaxomicin compared with oral vancomycin for the treatment of adults with clostridium difficile-associated diarrhea: data from the opt-80-003 and opt-80-004 studies.clostridium difficile is emerging as one of the most important and devastating pathogens affecting hospitalized populations around the world. the incidence of c. difficile infection is increasing and disease severity is worsening. thus, an effective alternative to metronidazole and oral vancomycin is urgently needed. two phase iii trials, opt-80-003 and opt-80-004, showed that oral fidaxomicin for 10 days was noninferior compared with treatment with oral vancomycin among adult patients with toxi ...201222702523
inappropriate use of gastric acid suppression therapy in hospitalized patients with clostridium difficile-associated diarrhea: a ten-year retrospective analysis.purpose. the incidence of clostridium difficile-associated diarrhea (cdad) has steadily increased over the past decade. a multitude of factors for this rise in incidence of cdad have been postulated, including the increased use of gastric acid suppression therapy (gast). despite the presence of practice guidelines for use of gast, studies have demonstrated widespread inappropriate use of gast in hospitalized patients. we performed a retrospective analysis of inpatients with cdad, with special em ...201222701180
diarrhea etiology in a pediatric emergency department: a case control study.the etiology of childhood diarrhea is frequently unknown.201222700832
implementation of standardised surveillance for clostridium difficile infections in australia: initial report from the victorian healthcare associated infection surveillance system.detection of a hypervirulent strain of clostridium difficile in victoria led to commencement of targeted surveillance for c. difficile infection in 2010. cases were reported through the victorian healthcare associated infection surveillance system. between 1 october 2010 and 31 march 2011, 477 cases of c. difficile infection were identified; 11 (2.3%) secondary to a hypervirulent strain. three hundred and seventy (1.7 per 10,000 occupied bed days) were healthcare associated. data reflect success ...201222697155
clostridium difficile infection: managing the risks. 201222712142
clostridium difficile-associated diarrhea and proton pump inhibitor therapy: a meta-analysis.clostridium difficile-associated diarrhea (cdad) is a major cause of morbidity and increasing health-care costs among hospitalized patients. although exposure to antibiotics remains the most documented risk factor for cdad, attention has recently been directed toward a plausible link with proton pump inhibitors (ppis). however, the results of studies on the association between cdad and ppis remain controversial. we have conducted a meta-analysis to summarize the association between ppis and cdad ...201222710578
high prevalence and resistance rates to antibiotics in anaerobic bacteria in specimens from patients with chronic balanitis.aim of the study was to assess both prevalence and antibiotic resistance in anaerobic bacteria from glans penis skin of 70 adults. strain susceptibility was determined by breakpoint susceptibility test or e test. in 9 asymptomatic, 48 untreated and 13 treated symptomatic patients, anaerobes were found in 22.2%, 70.8% and 53.3%, respectively. gram-positive strains (gpas) were 2.2-fold more common than gram-negative ones. prevalent gram-negative (gnas) and gpas were prevotella spp. and anaerobic c ...201222710106
moxifloxacin safety: an analysis of 14 years of clinical data.moxifloxacin, a fluoroquinolone antibiotic, is used for the treatment of respiratory tract, pelvic inflammatory disease, skin, and intra-abdominal infections. its safety profile is considered favorable in most reviews but has been challenged with respect to rare but potentially fatal toxicities (e.g. hepatic, cardiac, or skin reactions).201222715866
fecal microbiota transplantation for treating recurrent clostridium difficile infection. 201222937601
enteric pathogens through life stages.enteric infections and diarrheal diseases constitute pervasive health burdens throughout the world, with rates being highest at the two ends of life. during the first 2-3 years of life, much of the disease burden may be attributed to infection with enteric pathogens including salmonella, rotavirus, and many other bacterial, viral, and protozoan organisms; however, infections due to clostridium difficile exhibit steady increases with age. still others, like campylobacter infections in industriali ...201222937528
clostridium difficile. a super serious bug. 201222649818
identification of ligand analogues that control c-di-gmp riboswitches.riboswitches for the bacterial second messenger c-di-gmp control the expression of genes involved in numerous cellular processes such as virulence, competence, biofilm formation, and flagella synthesis. therefore, the two known c-di-gmp riboswitch classes represent promising targets for developing novel modulators of bacterial physiology. here, we examine the binding characteristics of circular and linear c-di-gmp analogues for representatives of both class i and ii c-di-gmp riboswitches derived ...201222646696
mechanism of action of and mechanism of reduced susceptibility to the novel anti-clostridium difficile compound lff571.lff571 is a novel semisynthetic thiopeptide and potent inhibitor of gram-positive bacteria. we report that the antibacterial activity of lff571 against clostridium difficile is due to inhibition of translation. single-step mutants of c. difficile with reduced susceptibility to lff571 were selected at frequencies of <4.5 × 10(-11) to 1.2 × 10(-9). sequencing revealed a g260e substitution in the thiopeptide-binding pocket of elongation factor tu. importantly, this mutation did not confer cross-res ...201222644023
efficacy of lff571 in a hamster model of clostridium difficile infection.lff571 is a novel semisynthetic thiopeptide antibiotic with potent activity against a variety of gram-positive pathogens, including clostridium difficile. in vivo efficacy of lff571 was compared to vancomycin in a hamster model of c. difficile infection (cdi). infection was induced in golden syrian hamsters using a toxigenic strain of c. difficile. treatment started 24 h postinfection and consisted of saline, vancomycin, or lff571. cox regression was used to analyze survival data from a cohort o ...201222644020
mechanisms of constitutive and atp-evoked atp release in neonatal mouse olfactory epithelium.atp is an extracellular signaling molecule with many ascribed functions in sensory systems, including the olfactory epithelium. the mechanism(s) by which atp is released in the olfactory epithelium has not been investigated. quantitative luciferin-luciferase assays were used to monitor atp release, and confocal imaging of the fluorescent atp marker quinacrine was used to monitor atp release via exocytosis in swiss webster mouse neonatal olfactory epithelial slices.201222640172
fecal transplant for clostridium difficile. 201222636832
uk laboratory diagnosis of clostridium difficile infection: in a state of transition, confusion, or both? 201222633279
epidemiological survey of clostridium difficile ribotypes in the north east of england during an 18-month period.during an 18-month period, 1606 stool specimens from laboratory-confirmed cases of clostridium difficile infection in the north east of england were ribotyped using unrestricted polymerase chain reaction. of these, 87.6% grew c. difficile on culture; 70% had one of 10 recognizable ribotypes of which 001, 106 and 027 were the most prevalent. the proportions of ribotypes 002 and 015 declined during the study period, whereas ribotypes 016 and 023 increased. ribotype 005 was significantly more numer ...201222633277
protection from clostridium difficile toxin b-catalysed rac1/cdc42 glucosylation by tauroursodeoxycholic acid-induced rac1/cdc42 phosphorylation.toxin a (tcda) and toxin b (tcdb) are the major virulence factors of clostridium difficile-associated diarrhoea (cdad). tcda and tcdb mono-glucosylate small gtpases of the rho family, thereby causing actin re-organisation in colonocytes, resulting in the loss of colonic barrier function. the hydrophilic bile acid tauroursodeoxycholic acid (tudca) is an approved drug for the treatment of cholestasis and biliary cirrhosis. in this study, tudca-induced activation of akt1 is presented to increase ce ...201222628301
diverse temperate bacteriophage carriage in clostridium difficile 027 strains.the hypervirulent clostridium difficile ribotype 027 can be classified into subtypes, but it unknown if these differ in terms of severity of c. difficile infection (cdi). genomic studies of c. difficile 027 strains have established that they are rich in mobile genetic elements including prophages. this study combined physiological studies, electron microscopy analysis and molecular biology to determine the potential role of temperate bacteriophages in disease and diversity of c. difficile 027.201222624004
phosphorylation of the synthetic hexasaccharide repeating unit is essential for the induction of antibodies to clostridium difficile psii cell wall polysaccharide.clostridium difficile is emerging worldwide as a major cause of nosocomial infections. the negatively charged psii polysaccharide has been found in different strains of c. difficile and, thereby, represents an important target molecule for a possible carbohydrate-based vaccine. in order to identify a synthetic fragment that after conjugation to a protein carrier could be able to induce anti-psii antibodies, we exploited a combination of chemical synthesis with immunochemistry, confocal immunoflu ...201222620974
proton pump inhibitors and diarrhoea related to clostridium difficile infection in hospitalised patients: a case-control study.the incidence and disease severity of clostridium difficile infection are rising. there is increasing evidence of a potential association between proton-pump inhibitors (ppi) and c. difficile infection. we performed a case-control study to examine the relationship between ppi and polymerase chain reaction (pcr)-proven c. difficile infection in 137 hospitalised patients in a tertiary hospital in western australia. only antibiotic exposure within 3 months prior to onset of diarrhoea was associated ...201222616966
sustained clinical response as an endpoint in treatment trials of clostridium difficile-associated diarrhea. 201222615287
the clostridium difficile spo0a gene is a persistence and transmission factor.clostridium difficile is a major cause of chronic antibiotic-associated diarrhea and a significant health care-associated pathogen that forms highly resistant and infectious spores. spo0a is a highly conserved transcriptional regulator that plays a key role in initiating sporulation in bacillus and clostridium species. here, we use a murine model to study the role of the c. difficile spo0a gene during infection and transmission. we demonstrate that c. difficile spo0a mutant derivatives can cause ...201222615253
clostridium difficile: novel insights on an incessantly challenging disease.this review comprises recent insights on epidemiology, risk factors, diagnostic approaches, pathophysiologic mechanisms, novel treatment options and prevention strategies of clostridium difficile infection (cdi).201222614522
fidaxomicin failures in recurrent clostridium difficile infection: a problem of timing. 201222610922
fidaxomicin: a novel macrocyclic antibiotic for the treatment of clostridium difficile infection.the pharmacology, clinical efficacy, safety, dosage and administration, and place in therapy of fidaxomicin for the treatment of clostridium difficile infection (cdi) are reviewed.201222610025
[improving the diagnosis of toxigenic clostridium difficile infection]. 201222608489
occurrence of toxigenic clostridium difficile in edible bivalve molluscs.clostridium difficile is an anaerobic bacterium commonly considered to be responsible for antibiotic-associated gastrointestinal diseases, ranging from diarrhea of varying severity to pseudomembranous colitis. the aim of this study was to assess the occurrence of c. difficile in marine edible bivalve molluscs, which, as filter feeding organisms, are able to accumulate particles suspended in water, including microorganisms. samples of mytilus galloprovincialis, tapes philippinarum, and venus verr ...201222608238
clostridium difficile infection, colorado and the northwestern united states, 2007.to determine the incidence of clostridium difficile infection during 2007, we examined infection in adult inpatient and outpatient members of a managed-care organization. incidence was 14.9 c. difficile infections per 10,000 patient-years. extrapolating this rate to us adults, we estimate that 284,875 c. difficile infections occurred during 2007.201222608207
accuracy of icd-10 codes for surveillance of clostridium difficile infections, france.the sensitivity and specificity of surveillance for clostridium difficile infections according to international classification of diseases, 10th revision, codes were compared with laboratory results as standard. sensitivity was 35.6%; specificity was 99.9%. concordance between the 2 methods was moderate. surveillance based on icd-10 codes underestimated the rate based on laboratory results.201222607707
intravenous immunoglobulin in treatment of clostridium difficile colitis.clostridium difficile infection is the most common infectious cause of healthcare-acquired diarrhoea. severe infections cause therapeutic challenges for healthcare providers. various novel treatment modalities are currently being explored for treatment of severe disease. the authors report a 70-year-old female who presented to the emergency room with 1 week history of fever, watery diarrhoea, diffuse abdominal pain and weakness. c difficile toxin was detected in the stool and abdominal cat scan ...201222605853
saccharomyces boulardii fungemia caused by treatment with a probioticum.saccharomyces cerevisiae, known as baker's yeast, is normally considered a non-pathogenic yeast. a genetically very similar subtype, s boulardii, is used in a probioticum (sacchaflor) to prevent antibiotic-associated diarrhoea and in the treatment of recurrent clostridium difficile associated diarrhoea. the authors present a case report of a 79-year-old woman with rheumatoid arthritis, who after a bowel resection developed s boulardii fungemia. her postoperative course was complicated by nutriti ...201222605806
adherence of clostridium difficile spores to caco-2 cells in culture.clostridium difficile is the causative agent of the majority of antibiotic associated diarrhoea cases. c. difficile spores are recognized as the persistent and infectious morphotype as well as the vehicle of transmission of cdi. however, there is a lack of knowledge on how c. difficile spores interact with the host's epithelial surfaces. in this context, we have characterized the ability of c. difficile spores to adhere to human caco-2 cells. despite the similarities in spore-surface hydrophobic ...201222595914
interaction between the intestinal microbiota and host in clostridium difficile colonization resistance.clostridium difficile infection (cdi) has become one of the most prevalent and costly nosocomial infections. in spite of the importance of cdi, our knowledge of the pathogenesis of this infection is still rudimentary. although previous use of antibiotics is generally considered to be the sine qua non of cdi, the mechanisms by which antibiotics render the host susceptible to c. difficile are not well defined. in this review, we will explore what is known about how the indigenous microbiota acts i ...201222595318
a 5-year retrospective review of experience with clostridium difficile-associated diarrhea.the incidence and virulence of clostridium difficile-associated diarrhea (cdad) has increased dramatically from the mid 1990s to the mid 2000s. this research assessed recent cdad patterns at a major military medical center from 2005 to 2009, by retrospectively reviewing clinical data of each cdad case identified using the center's electronic medical record system. two hundred and thirty-two cases were identified. there was a stable incidence rate for both inpatient (2.6-4.3/1000) and outpatient ...201222594138
treatment with histamine-type 2 receptor antagonists and omeprazole increase the risk of diarrhoea in neonatal foals treated in intensive care units.the use of anti-ulcer medication in the neonatal intensive care unit (icu) is common due to the concern for development of catastrophic gastric ulcerdisease. in man, however, the use of acid-suppressive medication has been shown in some studies to be a substantial riskfactorfor the development of clostridium difficile-associated diarrhoea (cdad), bacteraemia and neonatal sepsis.201222594032
fecal bacteriotherapy: a case report in an immunosuppressed patient with ulcerative colitis and recurrent  clostridium difficile infection.we report a case of ulcerative colitis (uc) and recurrent clostridium difficile infection (cdi) where the patient was on immunomodulatory therapy and had successful cdi eradication after fecal transplantation. this is the first case report in the literature documenting successful c. difficile eradication in an immunosuppressed patient. we feel that fecal transplantation should be studied as a treatment option in these patients.201222593832
evaluation of a hand-held far-ultraviolet radiation device for decontamination of clostridium difficile and other healthcare-associated pathogens.environmental surfaces play an important role in transmission of healthcare-associated pathogens. there is a need for new disinfection methods that are effective against clostridium difficile spores, but also safe and rapid. the sterilray™ disinfection wand device is a hand-held room decontamination technology that utilizes far-ultraviolet radiation (185-230 nm) to kill pathogens.201222591268
[fever of unknown origin in the intensive care unit].fever is common in patients in intensive care units. sources of fever can be infectious or non-infectious. the most common sources of infectious fever include ventilator-associated pneumonia, intravascular catheter-related infections, infection with clostridium difficile or sinusitis. typical examples of non-infectious fever include thromboembolic events, myocardial infarction, autoimmune disease, withdrawal symptoms or a drug-fever. every new onset of fever prompts diagnostic decisions, treatme ...201222588658
mycobacterium tuberculosis and clostridium difficille interactomes: demonstration of rapid development of computational system for bacterial interactome prediction.protein-protein interaction (ppi) networks (interactomes) of most organisms, except for some model organisms, are largely unknown. experimental methods including high-throughput techniques are highly resource intensive. therefore, computational discovery of ppis can accelerate biological discovery by presenting "most-promising" pairs of proteins that are likely to interact. for many bacteria, genome sequence, and thereby genomic context of proteomes, is readily available; additionally, for some ...201222587966
identifying patients at risk of severe clostridium difficile-associated disease.clostridium difficile infection is responsible for a wide spectrum of clinical presentations, ranging from mild diarrhoea to fatal toxic colitis. this article reviews factors which may identify individuals who are at high risk of severe c. difficile-associated disease, and aims to help clinicians predict patients at risk of severe disease.201222585325
stool transplants: ready for prime time?clostridium difficile infection (cdi) is a leading cause of antibiotic- and healthcare-related diarrhea. predisposing factors for infection include antimicrobial use, exposure to healthcare settings, inflammatory bowel disease, chemotherapy and advanced age, although cdi is now seen in patients without traditional risk factors. the gut microbiome may hold clues to the pathophysiology of cdi and promoting a 'healthy' microbiome has become a focus for cdi therapy. stool transplant or fecal microbi ...201222585070
acute fulminant pseudomembranous colitis which developed after ileostomy closure and required emergent total colectomy: a case report.pseudomembranous colitis is known to be caused by clostridium difficile; and, in 3% to 8% of patients, it lapses into an aggressive clinical course that is described as fulminant. we present here a case of extremely rapid and fatal fulminant pseudomembranous colitis that developed after ileostomy closure, a minor surgical procedure. to the best of our knowledge, this is the first case report of fatal fulminant pseudomembranous colitis after closure of a diversion ileostomy in an adult.201222583397
sensitive quantification of clostridium difficile cells by reverse transcription-quantitative pcr targeting rrna molecules.we established a sensitive and accurate quantification system for clostridium difficile in human intestines, based on rrna-targeted reverse transcription-quantitative pcr (rt-qpcr). we newly developed a species-specific primer set for c. difficile targeting 23s rrna gene sequences. both the vegetative cells and the spores of c. difficile in human feces were quantified by rt-qpcr, with a lower detection limit of 10(2.4) cells/g of feces. in an analysis of the feces of residents (n = 83; age, 85 ± ...201222582062
carriage of clostridium difficile in outpatients with irritable bowel syndrome.irritable bowel syndrome (ibs) is a common, typically chronic and sometimes disabling gastrointestinal condition of uncertain aetiology. recently, a variety of links to gastrointestinal infections have been described including the onset of ibs following exposure to enteric pathogens and an apparent predisposition to gastrointestinal infection. the prevalence of clostridium difficile in a population of ibs outpatients (n = 87) in the absence of established risk factors for the acquisition of c. d ...201222580916
probiotics in the intensive care unit.probiotics are living microorganisms that, when ingested in adequate amounts, provide benefits to the host. the benefits include either a shortened duration of infections or decreased susceptibility to pathogens. proposed mechanisms of beneficial effects include improving gastrointestinal barrier function, modification of the gut flora by inducing host cell antimicrobial peptides and/or local release of probiotic antimicrobial factors, competition for epithelial adherence, and immunomodulation. ...201222473797
saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in adult hospitalized patients: a single-center, randomized, double-blind, placebo-controlled trial.antibiotic-associated diarrhea (aad) and clostridium difficile-associated diarrhea (cdad) are common complications of antibiotic use. probiotics were effective in preventing aad and cdad in several randomized controlled trials. this study was aimed at testing the effect of saccharomyces boulardii on the occurrence of aad and cdad in hospitalized patients.201222472744
prevalence of clostridium difficile in excluded colons.clostridium difficile infection is associated with substantial morbidity and mortality, increased duration of hospitalization, and a marked economic impact. several case reports and case series have described c. difficile infection in excluded bowels or immediately after reversal of defunctioning ileostomy. the aim of this prospective study is to detect whether the excluded colon is associated with a higher rate of c. difficile colonization than the normal population, which may increase the risk ...201222472396
the long-term clinical course of pouchitis after total proctocolectomy and ipaa for ulcerative colitis.pouchitis is the most common long-term complication after restorative total proctocolectomy and ipaa for ulcerative colitis.201222469801
fecal transplant against relapsing clostridium difficile-associated diarrhea in 32 patients.clostridium difficile-associated disease (cdad) with frequent watery stools, sometimes with painful bowel movements, fever and sickness, is probably the major known cause of antibiotic-associated diarrhea and colitis, most probably depending on a disruption of the normal intestinal balance in the microbiome. in this study, we have inoculated a mixture of fecal microbes--as an enema--originating from a healthy scandinavian middle-aged donor, regularly re-cultivated under strict anaerobic conditio ...201222468996
discrepancies in testing recommendations for clostridium difficile infection: updated review favors amplification test systems. 201222468811
polymerase chain reaction testing for clostridium difficile. 201222463792
draft genome sequence of the nontoxigenic clostridium difficile strain cd37.here we report the draft genome sequence of clostridium difficile strain cd37, the first nontoxigenic strain sequenced. every sequenced strain of clostridium difficile has been shown to contain multiple different mobile genetic elements. the draft genome sequence of strain cd37 reveals the presence of two putative conjugative transposons.201222461557
clostridium difficile infection in gastroenterology settings: more frequent or better diagnosed? 201222457871
prevalence and molecular characterization of clostridium difficile isolated from feedlot beef cattle upon arrival and mid-feeding period.the presence of indistinguishable strains of clostridium difficile in humans, food animals and food, as well as the apparent emergence of the food-animal-associated ribotype 078/toxinotype v as a cause of community-associated c. difficile infection have created concerns about the potential for foodborne infection. while studies have reported c. difficile in calves, studies of cattle closer to the age of harvest are required. four commercial feedlots in alberta (canada) were enrolled for this stu ...201222455611
clostridium difficile genotypes other than ribotype 078 that are prevalent among human, animal and environmental isolates.characterising the overlap of c. difficile genotypes in different reservoirs can improve our understanding of possible transmission routes of this pathogen. most of the studies have focused on a comparison of the pcr ribotype 078 isolated from humans and animals. here we describe for the first time a comparison of c. difficile genotypes isolated during longer time intervals from different sources including humans, animals and the non-hospital environment.201222452857
underestimation of clostridium difficile infection among clinicians: an international survey.the objective of this investigation was to document clinicians' awareness regarding the incidence and severity of clostridium difficile-associated diarrhea (cdad). an international electronic survey was conducted among corresponding authors of articles indexed by pubmed and published during the last 10 years in 'core clinical journals'. a total of 1,163 clinicians answered (response rate 59%); most of the responses were submitted from north america (54.6%), europe (32.2%), and asia/pacific (11.6 ...201222450740
long-term follow-up of colonoscopic fecal microbiota transplant for recurrent clostridium difficile infection.clostridium difficile infection (cdi) has increased to epidemic proportions over the past 15 years, and recurrence rates of 30-65% with failure to respond to multiple courses of antimicrobials are common. the aim of this study was to report the efficacy of fecal microbiota transplantation (fmt) in patients with recurrent cdi in five geographically disparate medical centers across the united states.201222450732
successful colonoscopic fecal transplant for severe acute clostridium difficile pseudomembranous colitis.clostridium difficile-associated diarrhea has become one of the most common healthcare-associated infections, with significant morbidity and mortality, especially among the elderly in the inpatient setting. the standard approach with metronidazole and vancomycin is not very effective in treating patients with severe colitis and hence other alternatives have been explored. we herein describe the first successful experience of colonoscopic fecal transplant in a case of severe refractory c. diffici ...201222450020
potential protective role of linezolid against clostridium difficile infection.clostridium difficile infection (cdi) is one of the main causes of diarrhoea associated with antimicrobial therapy. antibiotics with good 'in vitro' activity against c. difficile could protect patients from developing cdi. in this study, the potential of linezolid to protect patients with ventilator-associated pneumonia (vap) from developing cdi was assessed. over a 4-year period, a cohort of patients who developed vap following major heart surgery (mhs) in gregorio marañón general hospital (mad ...201222445203
biofilm-growing intestinal anaerobic bacteria.sessile growth of anaerobic bacteria from the human intestinal tract has been poorly investigated, so far. we recently reported data on the close association existing between biliary stent clogging and polymicrobial biofilm development in its lumen. by exploiting the explanted stents as a rich source of anaerobic bacterial strains belonging to the genera bacteroides, clostridium, fusobacterium, finegoldia, prevotella, and veillonella, the present study focused on their ability to adhere, to grow ...201222444687
statin use and the risk of clostridium difficile in academic medical centres.to estimate the possible relationship between statin use and the risk of healthcare facility onset clostridium difficile.201222442166
risk factors for clostridium difficile toxin-positive diarrhea: a population-based prospective case-control study.increased incidence and severity of clostridium difficile infections (cdis) is of major concern. however, by minimizing known risk factors, the incidence can be decreased. the aim of this investigation was to calculate the incidence and assess risk factors for cdi in our population. a 1-year prospective population-based nationwide study in iceland of cdis was carried out. for risk factor evaluation, each case was matched with two age- and sex-matched controls that tested negative for c. difficil ...201222441775
clostridium difficile colitis: increasing incidence, risk factors, and outcomes in solid organ transplant recipients.clostridium difficile-associated diarrhea (cdad) is an increasingly important diagnosis in solid organ transplant recipients, with rising incidence and mortality. we describe the incidence, risk factors, and outcomes of colectomy for cdad after solid organ transplantation.201222441318
clostridium difficile infection in an iranian hospital.clostridium difficile infection (cdi) is an important cause of morbidity and mortality internationally, yet there are important regional differences in the epidemiology and microbiology of disease. most reports have come from north america and europe, with limited information from other regions, including the middle east. given the changes in the epidemiology of cdi in developed countries, particularly associated with the dissemination of hypervirulent epidemic clones, an understanding of the ep ...201222436392
detection, treatment, and prevention of clostridium difficile infection.clostridium difficile is a gram-positive anaerobic bacillus responsible for approximately 1 of 5 cases of antibiotic-associated diarrhea. c difficile infection (cdi) is defined by at least 3 unformed stools in a 24-hour period and stool, endoscopic, or histopathologic test results that indicate the presence of this bacteria. the history of cdi research can be divided into early (before 2000) and modern eras (after 2000). c difficile was first described in 1935, and the characteristics and causes ...201222433924
prospective observational study on antibiotic-associated bloody diarrhea: report of 21 cases with a long-term follow-up from turkey.antibiotic-associated hemorrhagic colitis is a distinct form of antibiotic-associated bloody diarrhea (aabd) in which clostridium difficile is absent. although the cause is not exactly known, reports have suggested the role of klebsiella oxytoca and/or c. difficile.201222433794
current strategies for management of initial clostridium difficile infection.in the past decade, an epidemic strain of clostridium difficile has led to increased incidence and severity of nosocomial c. difficile infections (cdi). responsiveness to standard antimicrobial care for this strain is declining, and the morbidity and mortality of cdi and recurrent cdi are rising. effective management requires a coordinated effort among all members of the healthcare team to facilitate early identification of patients at risk for cdi, early recognition of disease onset and confirm ...201222407996
strategies for prevention of clostridium difficile infection.infection control is the most essential component of an effective overall management strategy for prevention of nosocomial clostridium difficile infection (cdi). the cornerstones of cdi prevention are appropriate contact precautions and strict hand hygiene. other important tactics are effective environmental cleaning, identification and removal of environmental sources of c. difficile, and antibiotic stewardship. hospitalists, as coordinators of care for each patient and advocates for quality ca ...201222407995
meeting the challenge of recurrent clostridium difficile infection.recurrent clostridium difficile infection (cdi) is a growing problem that poses significant management challenges. there is no strong evidence to support a particular treatment strategy for recurrent cdi, especially those with multiple recurrences. however, a key strategy for reducing recurrent cdi is prompt diagnosis and treatment, facilitated by early recognition of patients at risk for recurrence.201222407994
clostridium difficile infection: the scope of the problem.clostridium difficile infection (cdi) is increasingly common, and it is associated with significant morbidity, mortality, and cost burden for patients and the healthcare system. the severity and rates of recurrent cdi and associated mortality are also increasing. this article is an overview of the changes in cdi epidemiology that have occurred since the turn of the century and the current scope of the problem. the 3 articles that follow in this supplement address the diagnosis and treatment of i ...201222407993
genomic sequence of bacteriophage atcc 8074-b1 and activity of its endolysin and engineered variants against clostridium sporogenes.lytic bacteriophage atcc 8074-b1 produces large plaques on its host clostridium sporogenes. sequencing of the 47,595-bp genome allowed the identification of 82 putative open reading frames, including those encoding proteins for head and tail morphogenesis and lysis. however, sequences commonly associated with lysogeny were absent. orf 22 encodes an endolysin, cs74l, that shows homology to n-acetylmuramoyl-l-alanine amidases, and when expressed in escherichia coli, the protein causes effective ly ...201222427494
clostridium difficile of the ileum following total abdominal colectomy, with or without proctectomy: who is at risk?clostridium difficile enteritis is considered a rare entity, although recent data suggest a significant increase in prevalence and incidence. there is paucity of data evaluating risk factors of c difficile enteritis following total colectomy.201222426266
comparison of eight commercial enzyme immunoassays for the detection of clostridium difficile from stool samples and effect of strain type.we compared the performance of 8 clostridium difficile enzyme immunoassays to cell cytotoxicity neutralization assay and toxigenic culture. the effect of strain type on assay performance was also examined. there were a total of 71 (14.4%) samples in which c. difficile was recovered; 58 (81.7%) of 71 were toxigenic. compared to a composite reference standard of either c. difficile cytotoxin assay positive or toxigenic c. difficile culture positive, the sensitivities of these assays varied from 31 ...201222424900
characterizations of clinical isolates of clostridium difficile by toxin genotypes and by susceptibility to 12 antimicrobial agents, including fidaxomicin (opt-80) and rifaximin: a multicenter study in taiwan.a total of 403 nonduplicate isolates of clostridium difficile were collected at three major teaching hospitals representing northern, central, and southern taiwan from january 2005 to december 2010. of these 403 isolates, 170 (42.2%) were presumed to be nontoxigenic due to the absence of genes for toxins a or b or binary toxin. the remaining 233 (57.8%) isolates carried toxin a and b genes, and 39 (16.7%) of these also had binary toxin genes. the mic(90) of all isolates for fidaxomicin and rifax ...201222508299
acute and chronic pouchitis--pathogenesis, diagnosis and treatment.restorative proctocolectomy with ileal pouch-anal anastomosis has become the procedure of choice for the majority of patients with ulcerative colitis who require surgical treatment. pouchitis, the most common long-term complication of the procedure, involves a spectrum of disease processes with heterogeneous risk factors, clinical features, disease courses and prognoses. in addition, clinical symptoms of pouchitis are not specific and often overlap with those of other inflammatory and functional ...201222508158
clostridium difficile infection in hospitalized liver transplant patients: a nationwide analysis.the incidence of clostridium difficile infection (cdi) is increasing among hospitalized patients. liver transplantation (lt) patients are at higher risk for acquiring cdi. small, single-center studies (but no nationwide analyses) have assessed this association. we used the nationwide inpatient sample of the healthcare cost and utilization project (2004-2008) for this retrospective, cross-sectional study. patients with any discharge diagnosis of lt composed the study population, and they were ide ...201222505356
prevalence of clostridium difficile in uncooked ground meat products from pittsburgh, pennsylvania.the prevalence of clostridium difficile in retail meat samples has varied widely. the food supply may be a source for c. difficile infections. a total of 102 ground meat and sausage samples from 3 grocers in pittsburgh, pa, were cultured for c. difficile. brand a pork sausages were resampled between may 2011 and january 2012. two out of 102 (2.0%) meat products initially sampled were positive for c. difficile; both were pork sausage from brand a from the same processing facility (facility a). on ...201222504814
lactobacillus equigenerosi strain le1 invades equine epithelial cells.lactobacillus equigenerosi strain le1, a natural inhabitant of the equine gastrointestinal tract, survived ph 3.0 and incubation in the presence of 1.5% (wt/vol) bile salts for at least 2 h. strain le1 showed 8% cell surface hydrophobicity, 60% auto-aggregation, and 47% coaggregation with clostridium difficile c6. only 1% of the cells adhered to viable buccal epithelial cells and invaded the cells within 20 min after contact. preincubation of strain le1 in a buffer containing pronase prevented a ...201222504808
a gastroenterologist's guide to probiotics.the enteric microbiota contribute to gastrointestinal health, and their disruption has been associated with many disease states. some patients consume probiotic products in attempts to manipulate the intestinal microbiota for health benefit. it is important for gastroenterologists to improve their understanding of the mechanisms of probiotics and the evidence that support their use in practice. clinical trials have assessed the therapeutic effects of probiotic agents for several disorders, inclu ...201222504002
diagnosis of clostridium difficile infection. 201222503848
detecting and treating clostridium difficile infections in patients with inflammatory bowel disease.the prevalence of cdi in patients with ibd has increased over the last decade. the excess morbidity and mortality associated with cdi appears to be greater in patients with ibd than in those without preexisting bowel disease. the risk factors for cdi in ibd and non-ibd populations appear similar; unique ibd-related risk factors are use of maintenance immunosuppression and extent and severity of prior colitis. nevertheless, a significant proportion of cdi-ibd patients may have the disease without ...201222500522
probiotics in the gastrointestinal diseases of the elderly.changes of the gut microflora in elderly appear to involve a reduction in numbers of healthy bacteria (lactobacilli and bifidobacteria) and an increase in numbers of potentially pathogenic species. these changes are generally described as gastrointestinal disorders and infections. this review analyses benefits of probiotics in old people, with particular interesting for the latest researches relevant to elderly people, e.g. trials examining enteric infections, antibiotic-associated diarrhea and ...201222499466
clinical and economic burden of clostridium difficile infection in europe: a systematic review of healthcare-facility-acquired infection.pubmed, embase and conference abstracts were reviewed systematically to determine the clinical and economic burden associated with clostridium difficile infection (cdi) acquired and treated in european healthcare facilities. inclusion criteria were: published in the english language between 2000 and 2010, and study population of at least 20 patients with documented cdi acquired/treated in european healthcare facilities. data collection was completed by three unblinded reviewers using the cochran ...201222498638
the implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer.the incidence of hospital acquired adverse events in radical cystectomy and their implications for hospital outcomes and costs remain poorly described. we describe the incidence of hospital acquired adverse events in radical cystectomy, and characterize its relationship with in-hospital mortality, length of stay and hospitalization costs.201222498229
proton pump inhibitor use and clostridium difficile colitis: cause or coincidence? 201222495812
evaluating contemporary antibiotics as a risk factor for clostridium difficile infection in surgical trauma patients.with most clostridium difficile infections (cdi) occurring after exposure to antimicrobial treatment, specific antibiotics and duration of exposure were evaluated independently for increased risk of cdi in surgical patients.201222491554
the roles of clostridium difficile and norovirus among gastroenteritis-associated deaths in the united states, 1999-2007.globally, gastroenteritis is recognized as an important contributor to mortality among children, but population-based data on gastroenteritis deaths among adults and the contributions of specific pathogens are limited. we aimed to describe trends in gastroenteritis deaths across all ages in the united states and specifically estimate the contributions of clostridium difficile and norovirus.201222491338
[animal sources of clostridium difficile].the bacterium clostridium difficile is pathogenic for both humans and animals. this feared nosocomial infectious agent is increasingly more important in the community as well. like in humans, the gastrointestinal tract is infected in animals. the bacterium may be transmitted from animals to humans via the food chain (e.g. pork meat) or by direct contact. identical human and animal isolates of c. difficile have been reported in several studies. the article presents results from a small local stud ...201222484972
interval appendectomy after perforated appendicitis: what are the operative risks and luminal patency rates?the need for interval appendectomy after nonoperative management of a perforated appendicitis is being questioned owing to recent studies that estimated recurrence rates as low as 5% because of obliteration of the appendiceal lumen. we review our experience with interval appendectomy in this subset of patients to determine the postoperative outcomes and luminal patency rates.201222482752
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