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isolation of clostridium difficile from peritoneal fluid. 201223163311
current and emerging management options for clostridium difficile infection: what is the role of fidaxomicin?until recently, treatment of clostridium difficile infection (cdi) was mainly limited to oral metronidazole and vancomycin, neither of which is optimal. up to 25% of patients with cdi experience recurrence of infection within 30 days following treatment with these agents, while c. 45-65% of these patients experience further (and sometimes multiple) recurrences. recurrent cdi represents a major treatment challenge for which new therapeutic options are sorely needed. fidaxomicin is a first-in-clas ...201223121552
can we identify patients at high risk of recurrent clostridium difficile infection?although most patients with clostridium difficile infection (cdi) can be managed effectively with discontinuation of prescribed antibiotics and additional treatment with oral metronidazole or vancomycin, up to 25% experience disease recurrence, usually within 30 days of treatment. failure to mount a systemic anti-toxin antibody response differentiates patients with cdi and recurrent cdi from symptomless carriers of toxinogenic c. difficile. the immunological senescence that accompanies ageing ma ...201223121551
overcoming barriers to effective recognition and diagnosis of clostridium difficile infection.with the frequency of cases of clostridium difficile infection (cdi) increasing in many developed countries, accurate and reliable laboratory diagnosis of cdi is more important than ever. however, the diagnosis of cdi has been handicapped by the existence of two reference standards, one of which detects c. difficile toxin (cytotoxin assay) and the other only toxigenic strains (cytotoxigenic culture). being relatively slow and laborious to perform, these reference methods were largely abandoned a ...201223121550
consequences of clostridium difficile infection: understanding the healthcare burden.clostridium difficile is the leading cause of infectious nosocomial diarrhoea in developed countries, with a measured incidence of approximately five episodes per 10,000 days of hospital stay in europe. accurate diagnosis of c. difficile infection (cdi) is a prerequisite for obtaining reliable epidemiological data, but in many european countries diagnosis is probably suboptimal. a significant percentage of cdi cases are missed because clinicians often fail to request tests for c. difficile toxin ...201223121549
breaking the cycle of recurrent clostridium difficile infections. 201223121548
time to act against clostridium difficile infection. 201223121547
[infection frequency in patients with chronic idiopathic ulcerative colitis].ulcerative colitis (uc) is a chronic inflammatory bowel disease characterized by diffuse inflammation of the mucosa of the colon. up to now, diverse observational studies have implicated a wide variety of pathogenic microorganisms as causal and exacerbating factors in uc. clostridium difficile (c. difficile) infection has been associated with recurrence and treatment failure and its incidence in patients with uc has been on the rise in the last few years.201223159238
probiotics prevent clostridium difficile in people taking antibiotics. 201223169808
an unusual method of diagnosing a common disease.a 34-year-old woman presented with non-bloody diarrhoea of 14 days duration and vomiting. physical examination was unremarkable. she had hypokalaemia and metabolic acidosis. stool studies were negative for clostridium difficile toxin, faecal leucocytes and parasites. colon appeared normal on colonoscopy. pronounced scalloping of ileal folds was noted on ileoscopy. ileal biopsies revealed villous blunting, crypt hyperplasia, marked intraepithelial lymphocytosis and lymphocytic infiltration of the ...201223166167
effect of biotherapeutics on antitoxin igg in experimentally induced clostridium difficile infection.recurrent diarrhoea after successful treatment of primary clostridium difficile associated disease (cdad) occurs due to bowel flora alterations and failure to mount an effective antibody response. apart from antibiotics, risk factors include immunosuppressive and acid-suppressive drug administration. biotherapeutics such as probiotic and epidermal growth factor (egf) may offer potential effective therapy for cdad.201223183468
clostridium difficile toxin a inhibits erythropoietin receptor-mediated colonocyte focal adhesion through inactivation of janus kinase-2.previously, we demonstrated that the erythropoietin receptor (epor) is present on fibroblasts, where it regulates focal contact. here, we assessed whether this action of epor is involved in the reduced cell adhesion observed in colonocytes exposed to clostridium difficile toxin a. epor was present and functionally active in cells of the human colonic epithelial cell line ht29 and epithelial cells of human colon tissues. toxin a significantly decreased activating phosphorylations of epor and its ...201223221524
nosocomial infections in leukemic and solid-tumor cancer patients: distribution, outcome and microbial spectrum of anaerobes.nosocomial infections cause significant morbidity and mortality in cancer patients. as a result of their debilitated immune system, cancer patients are likely candidates for colonization with anaerobes. we sought to compare the distribution of nosocomial infections in neutropenic and non-neutropenic cancer patients and to calculate the associated mortality rates.201223231490
epidemiology, diagnosis and treatment of clostridium difficile infection.clostridium difficile infection (cdi) is considered to be the main cause of bacterial infectious diarrhea in nosocomial settings. since the beginning of the new century a continuous rise in the incidence of severe cdi has been observed worldwide. even though some cdi cases are not associated with previous antibiotic exposure, this remains as the principal risk factor for the development of cdi. the rate of recurrences represents perhaps one the most challenging aspect on the management of cdi. t ...201223253319
adenosine a2a receptor activation reduces recurrence and mortality from clostridium difficile infection in mice following vancomycin treatment.activation of the a2a adenosine receptor (a2aar) decreases production of inflammatory cytokines, prevents c. difficile toxin a-induced enteritis and, in combination with antibiotics, increases survival from sepsis in mice. we investigated whether a2aar activation improves and a2aar deletion worsens outcomes in a murine model of c. difficile (strain vpi10463) infection (cdi).201223217055
[acute clostridium difficile gastroenteritis at the department of infectious diseases].clostridium difficile infection is known as the primary cause of nosocomial gastroenteritis, which accounts for approximately 20-25% of all diarrhea. infection can lead to a potentially fatal disease and the incidence of that is increasing worldwide.201223220365
colonoscopic fecal microbiota transplant for recurrent clostridium difficile infection in a child. 201223211865
association of decreased serum protein fractions with clostridium difficile infection in the acute care setting: a case-control study.this study examines the association of decreased levels of serum proteins with the occurrence of clostridium difficile-associated diarrhea (cdad) in hospitalized patients.201223075246
retraction notice to "apoptosis of ct26 colorectal cancer cells induced by clostridium difficile toxin a stimulates potent anti-tumor immunity" [biochem. biophys. res. commun. 422 (2012) 15-21]. 201223071973
modeling the role of peroxisome proliferator-activated receptor γ and microrna-146 in mucosal immune responses to clostridium difficile.clostridium difficile is an anaerobic bacterium that has re-emerged as a facultative pathogen and can cause nosocomial diarrhea, colitis or even death. peroxisome proliferator-activated receptor (ppar) γ has been implicated in the prevention of inflammation in autoimmune and infectious diseases; however, its role in the immunoregulatory mechanisms modulating host responses to c. difficile and its toxins remains largely unknown. to characterize the role of pparγ in c. difficile-associated disease ...201223071818
succession in the gut microbiome following antibiotic and antibody therapies for clostridium difficile.antibiotic disruption of the intestinal microbiota may cause susceptibility to pathogens that is resolved by progressive bacterial outgrowth and colonization. succession is central to ecological theory but not widely documented in studies of the vertebrate microbiome. here, we study succession in the hamster gut after treatment with antibiotics and exposure to clostridium difficile. c. difficile infection is typically lethal in hamsters, but protection can be conferred with neutralizing antibodi ...201223071679
aminoacyl-trna synthetase inhibitors as antimicrobial agents: a patent review from 2006 till present.aminoacyl-trna synthetases (aarss) are one of the leading targets for development of antimicrobial agents. although these enzymes are well conserved among prokaryotes, significant divergence has occurred between prokaryotic and eukaryotic aarss, which can be exploited in the discovery of broad-spectrum antibacterial agents. although several aars inhibitors have been reported before, they failed as a result of poor selectivity and limited cell penetration.201223062029
impact of clostridium difficile colitis on 5-year health outcomes in patients with ulcerative colitis.clostridium difficile colitis (cdc) is associated with an increased short-term mortality risk in hospitalised ulcerative colitis (uc) patients. we sought to determine whether cdc also impacts long-term risks of adverse health events in this population.201223061526
immune responses to clostridium difficile infection.clostridium difficile is the causal agent of antibiotic-associated diarrhea and is a leading cause of hospital-acquired infections in the us. c. difficile has been known to cause severe diarrhea and colitis for more than 30 years, but the emergence of a newer, hypervirulent strain of c. difficile (bi/nap1) has further compounded the problem, and recently both the number of cases and mortality associated with c. difficile-associated diarrhea have been increasing. one of the major drivers of disea ...201223084763
impact of infectious complications after elective surgery on hospital readmission and late deaths in the u.s. medicare population.whereas the negative impact of infectious complications (ic) during the index hospitalization after elective surgery is well established, the long-term ramifications of hospital-acquired post-operative infections are not well studied. this analysis evaluated the impact of a hospital-acquired ic after open abdominal vascular surgery on the readmission rate and the mortality rates 30 and 90 days after initial discharge.201223082877
prevalence of clostridium difficile toxin in diarhoeal stool samples of patients from a tertiary hospital in north eastern penisular malaysia.this study describes the prevalence of clostridium difficile toxin (cdt) in loose stool samples from inpatients aged more than two years of a tertiary hospital. a total of 175 samples that had been examined were from stool samples that were sent to the medical microbiology & parasitology laboratory for various clinical indications. the toxin was detected by a commercial immunochromatograhic test, and the patients' demography, clinical features, treatment and outcomes were analyzed from their med ...201223082450
toward an understanding of changes in diversity associated with fecal microbiome transplantation based on 16s rrna gene deep sequencing.fecal microbiome transplantation by low-volume enema is an effective, safe, and inexpensive alternative to antibiotic therapy for patients with chronic relapsing clostridium difficile infection (cdi). we explored the microbial diversity of pre- and posttransplant stool specimens from cdi patients (n = 6) using deep sequencing of the 16s rrna gene. while interindividual variability in microbiota change occurs with fecal transplantation and vancomycin exposure, in this pilot study we note that cli ...201223093385
comparison of genexpert pcr to bd geneohm for detecting c. difficile toxin gene in gdh positive toxin negative samples.the need for rapid diagnosis of clostridium difficile (c. difficile) associated infection in a clinical microbiology laboratory has provided the stimulus for new diagnostic tests and testing protocols. a two-test algorithm has been proposed using assays such as quik chek complete, which detects both c. difficile glutamate dehydrogenase (gdh) and c. difficile toxins a and b, followed by reflex testing of samples having inconclusive results (gdh positive and toxin negative) with pcr for identifica ...201223090736
current and future challenges in the development of antimicrobial agents.micro-organisms exist to survive. even in the absence of antimicrobial agents, many have determinants of resistance that may be expressed phenotypically, should the need arise. with the advent of the antibiotic age, as more and more drugs were developed to treat serious infections, micro-organisms (particularly bacteria) rapidly developed resistance determinants to prevent their own demise.the most important determinants of resistance have been in the gram-positive and gram-negative bacteria. am ...201223090595
[clostridium-difficile-colitis: more frequent and more severe]. 201223088039
[clostridium difficile--unfairly set in the corner?]. 201223097893
vitamin d deficiency: a potential risk factor for clostridium difficile infection. 201223097616
[clostridium difficile epidemic, chile 2012: report of the chilean society for infectious diseases. a scientific historical analysis].a summary report from the chilean society for infectious diseases regarding the presence of a clostridium difficile epidemic with several fatalities in chile's premier emergency public hospital in santiago is used to make a scientific historical analysis of the situation. this summary report identifies several hygienic and sanitary shortcomings that may have played a role in triggering this major epidemic. these include deficiencies in hand washing policies, overcrowding of beds in wards, relaxa ...201223096554
[clostridium difficile associated infections: an updated view].clostridium difficile is an emerging anaerobic, spore forming pathogen, recognized as the etiological agent of ~ 30% of antibiotic associated diarrheas. clinical symptoms can fluctuate from mild to moderate diarrhea, pseudomembranous colitis and toxic megacolon. the incidence of c. difficile associated infections (cdai) is ~ 1% of total hospitalized patients. cdai has a mortality rate of ~1 to 5%, and a relapse rate of ~ 20%. the appearance of severe outbreaks of cdai could be attributed to chan ...201223096544
fecal microbiota transplantation: techniques, applications, and issues.fecal microbiota transplantation (fmt) has gained widespread recognition in light of the recent clostridium difficile infection (cdi) epidemic, responsible for almost 110,000 deaths per year. the procedure's success rate has caused experts to reflect on what other conditions may benefit. this article provides an overview of (1) description and history of fmt, (2) fmt publications in cdi, (3) the concept of the gut microbiota as a virtual organ, (4) rationale for fmt use, (5) fmt use in inflammat ...201223101687
the role of probiotics in the prevention and treatment of antibiotic-associated diarrhea and clostridium difficile colitis.clostridium difficile colitis is the most common gastrointestinal infection, exceeding all other gastrointestinal infections combined. there has been a dramatic increase in clostridium difficile infection (cdi) worldwide during the past decade. antibiotic therapy is a trigger precipitating antibiotic-associated diarrhea (aad), which may lead to cdi. the antibiotic alters the protective, diverse bacteria allowing pathogenic bacteria to cause disease. probiotics have been effective in reducing aad ...201223101686
clostridium difficile infection and partial membrane cofactor protein (cd46) deficiency. 201223101426
new molecular methods for the diagnosis of clostridium difficile infections.clostridium difficile is recognized as the major agent responsible for nosocomial diarrhea in hospitalized patients. accurate diagnosis of c. difficile infection (cdi) is essential for optimal treatment and prevention but continues to be challenging. there are currently two reference assays for the diagnosis of cdi with different targets: the cytotoxicity assay that detects free toxins and the toxigenic culture which detects the organism with the potential to produce toxin. in 2009, nucleic acid ...201223110263
community-acquired clostridium difficile nap1/027-associated diarrhea in an eighteen month old child.clostridium difficile infection (cdi), characterized by symptoms varying from diarrhea to life-threatening colitis, is a major complication of antibiotic therapy. studies suggested that cdi is emerging as an important cause of childhood diarrhea in community and hospital settings. this work is the first report of a documented case of community-acquired cdi by a nap1 hypervirulent strain in an eighteen month old child from latin america.201223116882
[current data and trends on the development of antibiotic resistance of clostridium difficile].clostridium difficile is the most common pathogen causing antibiotic-associated diarrhea. antibiotic therapy also favors the development and the epidemic spreading of multiresistant strains. in this present retrospective study clinical isolates from the university of saarland medical center and of other german isolate referring hospitals were characterized by genotyping and antibiotic resistance testing. the most prevalent strains were ribotypes 001 (18%), 014 (16%) and 027 (15%). sensitivity to ...201223114440
clostridium difficile 027-associated pseudomembranous colitis after short-term treatment with cefuroxime and cephalexin in an elderly orthopedic patient: a case report.clostridium difficile ribotype 027 has become increasingly prevalent in european countries. the clinical picture varies from self-limiting diarrhea to pseudomembranous colitis with toxic megacolon and ultimately death. use of antibiotics is the principal risk factor; others include comorbidity, advanced age and hospitalization. however even with extensive knowledge of risk factors, it remains difficult to define "minimum risk," as illustrated by the following case.201223113897
pneumatosis intestinalis in a patient with recurrent clostridium difficile infection.a 65-year-old man with long-standing diarrhoea, recurrent clostridium difficile infection (cdi) in the previous 5 months presented to the gastroenterology clinic with recurrent diarrhoea and abdominal cramping. physical examination was negative for signs of acute abdomen. stool c difficile pcr was positive. abdominal imaging demonstrated an extensive pneumatosis intestinalis involving the small bowel and a dilated small bowel loop. he was treated conservatively with oral vancomycin for recurrent ...201223112256
clostridium difficile in young farm animals and slaughter animals in belgium.faecal carriage of clostridium difficile in healthy animals has been reported recently, especially in piglets and calves. however there is limited data about carriage in animals just prior to slaughter in europe. the main objective of this study was to determine the presence of c. difficile in pigs and cattle at the slaughterhouse. c. difficile was isolated in 6.9% of the cattle at the slaughterhouse. none of the pig slaughter samples were positive for c. difficile after an enrichment time of 72 ...201223041559
association of relapse of clostridium difficile disease with bi/nap1/027.recurrent clostridium difficile infection (cdi) occurs in up to 35% of patients. recurrences can be due to either relapse with the same strain or reinfection with another strain. in this study, multilocus variable-number tandem-repeat analysis (mlva) was performed on c. difficile isolates from patients with recurrent cdi to distinguish relapse from reinfection. in addition, univariate and multivariate analyses were performed to identify risk factors associated with relapse. among patients with a ...201223052318
hospital-onset clostridium difficile infection rates in persons with cancer or hematopoietic stem cell transplant: a c3ic network report.a multicenter survey of 11 cancer centers was performed to determine the rate of hospital-onset clostridium difficile infection (ho-cdi) and surveillance practices. pooled rates of ho-cdi in patients with cancer were twice the rates reported for all us patients (15.8 vs 7.4 per 10,000 patient-days). rates were elevated regardless of diagnostic test used.201223041818
burden of clostridium difficile infection in long-term care facilities in monroe county, new york.long-term care facility (ltcf) residents are at increased risk of clostridium difficile infection (cdi). however, little is known about the incidence, recurrence, and severity of cdi in ltcfs or the extent to which acute care exposure contributes to cdi in ltcfs. we describe the epidemiology of cdi in a cohort of ltcf residents in monroe county, new york, where recent estimates suggest a cdi incidence in hospitals of 9.2 cases per 10,000 patient-days.201223041808
empirical antimicrobial prescriptions in patients with clostridium difficile infection at hospital admission and impact on clinical outcome.to determine, among patients with clostridium difficile infection (cdi) at hospital admission, the impact of concurrent use of systemic, non-cdi-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.201223041807
effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections.chlorhexidine gluconate (chg) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. the objective was to determine the effect of hospital-wide chg patient bathing on healthcare-associated infections (hais).201223041806
equal efficacy of glucoprotamin and an aldehyde product for environmental disinfection in a hematologic transplant unit: a prospective crossover trial.the inanimate hospital environment has emerged as an important reservoir of nosocomial pathogens. in particular, multidrug-resistant pathogens, such as methicillin-resistant staphylococcus aureus, acinetobacter species, and clostridium difficile, play a major role in the transmission of hospital-acquired infections. in europe, aldehydes, chlorine, and quaternary ammonium compounds have been commonly used for environmental disinfection. glucoprotamin, a newer active compound for disinfectants, ha ...201223041803
[clostridium difficile associated diarrhea: reliable therapy with vancomycin capsules]. 201223045940
recent changes in clostridium difficile infection.clostridium difficile is the main cause of nosocomial diarrhea. diarrhea associated with c. difficile has increased incidence, morbidity, and mortality in the last few years. the major related risk factors include use of antibiotics, elderly patients and prolonged hospital stay. many patients receive combinations of antibiotics or multiple antibiotics, which represents the main risk to develop diarrhea associated to c. difficile or its recurrence. therefore, interventions to improve antibiotic p ...201223045838
intrarectal instillation of clostridium difficile toxin a triggers colonic inflammation and tissue damage: development of a novel and efficient mouse model of clostridium difficile toxin exposure.clostridium difficile, a major cause of hospital-acquired diarrhea, triggers disease through the release of two toxins, toxin a (tcda) and toxin b (tcdb). these toxins disrupt the cytoskeleton of the intestinal epithelial cell, increasing intestinal permeability and triggering the release of inflammatory mediators resulting in intestinal injury and inflammation. the most prevalent animal model to study tcda/tcdb-induced intestinal injury involves injecting toxin into the lumen of a surgically ge ...201223045481
contribution of adenosine a(2b) receptors in clostridium difficile intoxication and infection.clostridium difficile toxins a (tcda) and b (tcdb) induce a pronounced systemic and intestinal inflammatory response. a(2b) adenosine receptors (a(2b)ars) are the predominant adenosine receptors in the intestinal epithelium. we investigated whether a(2b)ars are upregulated in human intestinal cells by tcda or tcdb and whether blockade of a(2b)ars can ameliorate c. difficile tcda-induced enteritis and alter the outcome of c. difficile infection (cdi). adenosine receptor subtype (a(1), a(2a), a(2b ...201223045479
clostridium difficile postantibiotic diarrhoea diagnosis.to study the frequency of clostridium difficile in postantibiotic diarrhoea in patients admitted to the medical ward of a secondary care hospital.201223058147
diagnosis of clostridium difficile-associated disease: examination of multiple algorithms using toxin eia, glutamate dehydrogenase eia and loop-mediated isothermal amplification.the laboratory diagnosis of clostridium difficile infection (cdi) needs to be accurate and timely to ensure optimal patient management, infection control and reliable surveillance. three methods are evaluated using 810 consecutive stool samples against toxigenic culture: cdt tox a/b premier enzyme immunoassay (eia) kit (meridian bioscience, europe), premier eia for c. difficile glutamate dehydrogenase (gdh) (meridian bioscience, europe) and the illumigene kit (meridian bioscience, europe), both ...201223057158
clostridium difficile: changing epidemiology, treatment and infection prevention measures.clostridium difficile was first reported as a cause of antibiotic-associated colitis in 1978. in more recent years we have witnessed disturbing trends associated with c. difficile infection (cdi). cdi has become more common, affecting populations previously considered at low risk, more severe with an associated increase in mortality, and more difficult to treat with some patients experiencing multiple relapses and a reduced responsiveness to previously effective antibiotics. these trends have be ...201223054932
[epidemiology, diagnosis, complications and surgery in inflammatory bowel disease].in digestive disease week 2012, held in san diego, numerous studies were presented on the epidemiology of inflammatory bowel disease. some of these studies were population-based, providing greater information on known risk factors and helping to eliminate proposed risk factors for which there is no known evidence. in this meeting, special attention was paid to the natural history of the disease as well as surgery in patients aged more than 65 years old who should clearly be treated as a separate ...201223018008
temporal differential proteomes of clostridium difficile in the pig ileal-ligated loop model.the impact of clostridium difficile infection (cdi) on healthcare is becoming increasingly recognized as it represents a major cause of nosocomial diarrhea. a rising number of cdi cases and outbreaks have been reported worldwide. here, we developed the pig ileal-ligated loop model for semi-quantitative analysis comparing temporal differential proteomes in c. difficile following in vivo incubation with in vitro growth using isobaric tags for relative and absolute quantification (itraq). proteins ...201223029131
icesp1116, the genetic element responsible for erm(b)-mediated, inducible resistance to erythromycin in streptococcus pyogenes.icesp1116, responsible for erm(b)-mediated, inducible erythromycin resistance in streptococcus pyogenes, was comprehensively characterized, and its chromosomal integration site was determined. it displayed a unique mosaic organization consisting of a scaffold, related to tngallo1 from streptococcus gallolyticus, with two inserted fragments separated by is1216. one fragment, containing erm(b), displayed high-level identity to a portion of the s. pyogenes plasmid psm19035; the other, containing a ...201223027190
outcome of clostridium difficile-associated disease in solid organ transplant recipients: a prospective and multicentre cohort study.clostridium difficile-associated disease (cdad) is the most common cause of nosocomial diarrhea. information about cdad in solid organ transplant (sot) recipients is scarce. to determine its epidemiology and risk factors, we conducted a cohort study in which 4472 sot patients were prospectively included in the resitra/reipi (spanish research network for the study of infection in transplantation) database between july 2003 and july 2006. forty-two episodes of cdad were diagnosed in 36 patients. t ...201223039822
prebiotics, probiotics and digestive health.the human gastrointestinal lumen is inhabited by a wide variety of microbiota. our understanding of the intestinal microbiota and its full consequences on gastrointestinal health is still evolving. however, it is well accepted that altered colonic flora drives the pathogenesis of many disorders and diseases as seen in antibiotic-associated diarrhea and clostridium difficile infection. recent works published in the area of probiotics are reviewed here.201223037903
clostridium difficile-associated infection: a disease of varying severity.clostridium difficile-associated infection (cdi) can have varying severity from asymptomatic carriage to fulminant colitis. its incidence and virulence in north america are increasing. the increase in virulence is associated with emergence of the highly toxigenic north american pulsed field gel electrophoresis-1 strain. the major risk factor for cdi is exposure to antibiotics. another major risk factor is hospitalization. the spectrum of cdi ranges from asymptomatic carriers to fulminant disease ...201223036604
the microbiome and inflammatory bowel disease: is there a therapeutic role for fecal microbiota transplantation?one hypothesis for the etiology of inflammatory bowel disease is that an altered or pathogenic microbiota causes inflammation in a genetically susceptible individual. understanding the microbiota's role in the pathogenesis of the disease could lead to new ibd treatments aimed at shifting the bacteria in the gut back to eubiosis. probiotics have some efficacy in the treatment of ulcerative colitis (uc), but our current repertoire is limited in potency. fecal microbiota therapy (fmt) is an emergin ...201223034604
proton pump inhibitor use and association with spontaneous bacterial peritonitis in patients with cirrhosis and ascites.to evaluate the literature regarding the efficacy and safety of proton pump inhibitors (ppis) when they are used in patients with cirrhosis and ascites.201223032651
the role of acute care surgery in the treatment of severe, complicated clostridium difficile-associated disease.clostridium difficile associated disease (cdad) is the result of colonic bacterial overgrowth with this gram positive anaerobic organism and the production of toxins that typically induce diarrhea. most patients with cdad respond to treatment with oral metronidazole or vancomycin, but a subset of patients will develop a severe systemic illness, multiple organ failure, and death. there are no reliable combinations of clinical or laboratory findings that will distinguish patients who will respond ...201223026914
duexis(®) (ibuprofen 800 mg, famotidine 26.6 mg): a new approach to gastroprotection for patients with chronic pain and inflammation who require treatment with a nonsteroidal anti-inflammatory drug.chronic pain conditions affect at least 116 million us adults and more than one-third of adults worldwide. nonsteroidal anti-inflammatory drugs (nsaids) are used extensively for the treatment of chronic pain due to their efficacy as anti-inflammatory and analgesic agents. gastrointestinal toxicity is the most well known adverse effect of nsaid therapy and it may manifest as dyspepsia, ulcers, or bleeding. current guidelines for the management of patients who require nsaids for chronic pain and i ...201223024710
results from the second scottish national prevalence survey: the changing epidemiology of healthcare-associated infection in scotland.healthcare-associated infections (hais) are a recognized public health problem worldwide. point prevalence surveys (ppss) can be used to measure the burden of all hai types.201223022370
wide variation in adoption of screening and infection control interventions for multidrug-resistant organisms: a national study.we performed a survey of national healthcare safety network hospitals in 2008 to describe adoption of screening and infection control policies aimed at multidrug-resistant organisms (mdro) in intensive care units (icus) and identify predictors of their presence, monitoring, and implementation.201223021413
associations between nosocomial meticillin-resistant staphylococcus aureus and nosocomial clostridium difficile-associated diarrhoea in 89 german hospitals.clostridium difficile is mainly considered as a hospital-acquired pathogen causing diarrhoea in healthcare settings.201223021304
the burden of clostridium difficile-associated disease following digestive tract surgery in japan.although surgery is considered a risk for clostridium difficile-associated disease (cdad), large-scale data on outcomes of postsurgical cdad are rare.201223021129
inpatient diarrhoea and clostridium difficile infection. 201223342416
probiotics for the prevention of clostridium difficile-associated diarrhea: a systematic review and meta-analysis.antibiotic treatment may disturb the resistance of gastrointestinal flora to colonization. this may result in complications, the most serious of which is clostridium difficile–associated diarrhea (cdad).201223362517
clostridium difficile outbreak in costa rica: control actions and associated factors.to describe interventions implemented during a nosocomial outbreak of clostridium difficile in a general hospital in costa rica from december 2009 to april 2010 in order to achieve outbreak control and the factors determined to be associated with c. difficile infection.201223370184
surgical treatment of clostridium colitides.infection with clostridium difficile (cdi) is the most frequent cause of nosocomial diarrhoeas. most cases are successfully treated by antibiotic therapy, but nearly 10% may progress to the fulminative form of this condition. the objective of the work is retrospective evaluation of the results of surgical treatment in patients with the fulminative form of clostridium colitis with revealing of risk factors leading to serious post-operative morbidity and mortality.201223373360
using a dog's superior olfactory sensitivity to identify clostridium difficile in stools and patients: proof of principle study.to investigate whether a dog's superior olfactory sensitivity can be used to detect clostridium difficile in stool samples and hospital patients.201223241268
cd44 promotes intoxication by the clostridial iota-family toxins.various pathogenic clostridia produce binary protein toxins associated with enteric diseases of humans and animals. separate binding/translocation (b) components bind to a protein receptor on the cell surface, assemble with enzymatic (a) component(s), and mediate endocytosis of the toxin complex. ultimately there is translocation of a component(s) from acidified endosomes into the cytosol, leading to destruction of the actin cytoskeleton. our results revealed that cd44, a multifunctional surface ...201223236484
association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.emerging epidemiological evidence suggests that proton pump inhibitor (ppi) acid-suppression therapy is associated with an increased risk of clostridium difficile infection (cdi).201223236397
characterisation of clostridium difficile biofilm formation, a role for spo0a.clostridium difficile is a gram-positive anaerobic, spore-forming bacillus that is the leading cause of nosocomial diarrhoea worldwide. we demonstrate that c. difficile aggregates and forms biofilms in vitro on abiotic surfaces. these polymicrobial aggregates are attached to each other and to an abiotic surface by an extracellular polymeric substance (eps). the eps matrix provides the scaffold bonding together vegetative cells and spores, as well as forming a protective barrier for vegetative ce ...201223236376
concomitant clostridium difficile colitis and cytomegalovirus colitis in an immunocompetent elderly female.a 78-year-old japanese woman with diarrhoea and abdominal pain was admitted for pcr test (pcr)-proven clostridium difficile colitis. the patient's symptoms persisted despite multiple courses of antibiotics including intravenous metronidazole, oral  vancomycin and oral fidaxomicin. she underwent a stool transplant without improvement. biopsies from a colonoscopy revealed concomitant cytomegalovirus (cmv) infection. the patient was immediately started on intravenous ganciclovir. unfortunately, she ...201223234822
a cohort study for derivation and validation of a clinical prediction scale for hospital-onset clostridium difficile infection.to develop and validate a clinical prediction scale for hospital-onset clostridium difficile infection (cdi).201223248788
clostridium difficile 027 infection in central italy.clostridium difficile (cd) has increasingly become recognised as a significant international health burden, often associated with the healthcare environment. the upsurge in incidence of cd coincided with the emergence of a hypervirulent strain of cd characterized as 027. in 2010, 8 cases of cd 027 infections were identified in italy. since then, no further reports have been published. we describe 10 new cases of cd 027 infection occurring in italy.201223259814
[successful treatment of life-threatening, treatment resistant clostridium difficile infection associated pseudomembranous colitis with faecal transplantation].due to world-wide spread of hypervirulent and antibiotic resistant clostridium difficile strains, the incidence of these infections are dramatically increasing in hungary with appalling mortality and recurrence rates. authors present a case of a 59-year-old patient who developed a severe, relapsing pseudomembranous colitis after antibiotic treatment. life-threatening symptoms of fulminant colitis were successfully treated with prolonged administration of metronidazole and vancomycin, careful sup ...201223261996
unusual localization of clostridium difficile infection in an isolated segment of the descending colon in a critical care patient.unrecognized severe pseudomembranous colitis may become life threatening. a typical clostridium difficile infection is associated with involvement of the colon; however, small bowel disease has also been described. here, we present a case of a 48-year-old man with clostridium difficile colitis of an isolated segment in the descending colon treated by a novel catheter intraluminal antibiotic irrigation. the intraluminal antibiotic irrigation was performed through a foley catheter inserted into th ...201223316409
five years experience of clostridium difficile infection in children at a uk tertiary hospital: proposed criteria for diagnosis and management.clostridium difficile infection (cdi) is associated with significant morbidity and mortality in adults. there is increasing evidence of the pathogenic role of c. difficile in the paediatric population. we sought to ascertain the clinical presentation and severity of cdi in children at our institution and develop criteria to aid management.201223300561
phenome based analysis as a means for discovering context dependent clinical reference ranges.robust electronic medical records (emr's) have made large-scale phenome-based analysis feasible. the context-dependent phenome of a large icu-based emr database (mimic ii) was explored, as a function of a clinical feature: white blood cell count (wbc). phenome visualization led to the discovery that peak wbc in the range 15-45 k/μl was highly associated with the diagnoses of clostridium difficile and bacterial sepsis; thus, it is conceivable that clinicians might delay ordering targeted antimicr ...201223304424
understanding gut-immune interactions in management of acute infectious diarrhoea.this article discusses the role that immunity plays in the risk of diarrhoea and the potential role for probiotics in the management of acute infectious diarrhoea in older people, including antibiotic-associated diarrhoea and clostridium difficile-associated diarrhoea.201223311278
characterization of continued antibacterial therapy after diagnosis of hospital-onset clostridium difficile infection: implications for antimicrobial stewardship.to determine the proportion of hospitalized adults with hospital-onset clostridium difficile infection (cdi) who continued to receive concomitant non-cdi antibacterial agents, to characterize the antibacterial therapy that these patients received before and after the diagnosis of cdi, and to compare hospital outcomes between those patients who did and those who did not have their previous antibacterial therapy discontinued after cdi diagnosis.201223307522
[assessment of the usefulness of chromogenic medium for the isolation of clostridium difficile from the gastrointestinal tract of children with diarrhoea].clostridium difficile is well known as an important cause of nosocomial infection. laboratory diagnostics have included bacterial culture or more commonly, direct detection of preformed toxin in stool samples using different assays. the aim of this study was to evaluate and compare two selecitve media to isolation of c. difficile from paediatric diarrhoeal stool samples.201223285773
[report: clostridium difficile outbreak at the dr. alejandro del río emergency hospital in santiago, chile]. 201223282496
an economic evaluation of clostridium difficile infection management in an italian hospital environment.clostridium difficile infection (cdi) accounts for the majority of nosocomial cases of diarrhea, and with recent upsurge of multidrug-resistant strains, morbidity and mortality have increased. data on clinical impact of cdi come mostly from anglo-saxon countries, while in italy only two studies address the issue and no economic data exist on costs of cdi in the in hospital setting. a retrospective cross-sectional study with pharmacoeconomic analysis was performed on the cdi series of the policli ...201223280031
surgical management of clostridium difficile colitis.clostridium difficile infection (cdi) will progress to fulminant disease in 3 to 5% of cases. with the emergence of hypervirulent, multidrug-resistant strains, the incidence and severity of disease are continuing to rise. prompt identification, early resuscitation, and treatment are critical in preventing morbidity and mortality in this increasingly common condition. discontinuation of antibiotics and treatment with oral vancomycin and intravenous or oral metronidazole are first-line treatments, ...201224294121
intestinal superinfections in patients with inflammatory bowel diseases.intestinal superinfections may occur in the setting of inflammatory bowel diseases (ibd), complicating the clinical picture and triggering flares of disease.201122325169
loop-mediated amplification accelerated by stem primers.isothermal nucleic acid amplifications (inaats) have become an important alternative to pcr for in vitro molecular diagnostics in all fields. amongst inaats loop-mediated amplification (lamp) has gained much attention over the last decade because of the simplicity of hardware requirements. lamp demonstrates performance equivalent to that of pcr, but its application has been limited by the challenging primer design. the design of six primers in lamp requires a selection of eight priming sites wit ...201122272122
how a bowel tumour led to meningitis.this report summarises a case history in which a 75-year-old man was admitted with bacterial meningitis caused by streptococcus bovis. a subsequent abdominal investigation in the light of the known association between invasive s bovis infection and colonic cancer confirmed the suspicion of a cancer located to the rectum. the patient died from clostridium difficile enterocolitis with sepsis and multi-organ failure. this is a highly relevant and interesting case presentation, which besides providi ...201122692778
one-day point prevalence of emerging bacterial pathogens in four secondary and five tertiary care german hospitals - results from a pilot study of the german society for hospital hygiene (deutsche gesellschaft für krankenhaushygiene, dgkh).objective: data on the prevalence of emerging bacterial pathogens like extended-spectrum-lactamase-building (esbl) gram negative organisms, multiresistant pseudomonas and acinetobacter species or toxin-building clostridium difficile in german hospitals are sparse. to provide data for different regions in germany, a one-day point prevalence study with five tertiary care hospitals and four secondary care hospitals was conducted on the 10(th) of february 2010.method: for participating hospitals, th ...201122242101
[a study of patients with clostridium difficile infection hospitalized at brno clinic of infectious diseases in 2007-2010.]background: to describe a set of patients hospitalized at the clinic of infectious diseases of the university hospital brno with clostridium difficile infection (cdi), to interpret clinical and epidemiological data, and to determine the risk factors for the disease and its complications. material and methods: a retrospective study of 284 patients with confirmed diagnosis of clostridium difficile infection hospitalized between 1 january 2007 and 31 december 2010. epidemiological, clinical and lab ...201122247031
longitudinal study comparing the dynamics of clostridium difficile in conventional and antimicrobial free pigs at farm and slaughter.clostridium difficile is the leading cause of nosocomial diarrhea in humans and a major cause of enteritis in neonatal piglets, foals and calves. the aim of this longitudinal study was to determine and compare the prevalence, antimicrobial susceptibility, and toxinotype profiles of c. difficile isolated from pigs and their environment in the indoor conventional and outdoor antimicrobial free (abf) production systems. ten conventional and eight abf cohorts of 35 pigs each and their environment we ...201122243897
The anti-sigma factor TcdC modulates hypervirulence in an epidemic BI/NAP1/027 clinical isolate of Clostridium difficile.Nosocomial infections are increasingly being recognised as a major patient safety issue. The modern hospital environment and associated health care practices have provided a niche for the rapid evolution of microbial pathogens that are well adapted to surviving and proliferating in this setting, after which they can infect susceptible patients. This is clearly the case for bacterial pathogens such as Methicillin Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE) s ...201122022270
clostridium difficile pouchitis after proctocolectomy with ileal pouch-anal anastomosis. 201122196625
Group VIA PLA2 (iPLA2ß) is Activated Upstream of p38 MAP Kinase in Pancreatic Islet Beta Cell Signaling.Group VIA Phospholipase A(2) (iPLA(2)ß) in pancreatic islet ß-cells participates in glucose-stimulated insulin secretion and Sarco(endo)plasmic Reticulum ATPase (SERCA) inhibitor-induced apoptosis, and both are attenuated by pharmacologic or genetic reductions in iPLA(2)ß activity and amplified by iPLA(2)ß overexpression. While exploring signaling events that occur downstream of iPLA(2)ß activation, we found that p38 MAP Kinase (MAPK) is activated by phosphorylation in INS-1 insulinoma cells and ...201122194610
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