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clostridium difficile associated diarrhea: new rules for an old game.c. difficile associated diarrhea (cdad) is now considered to be one of the commonest causes of nosocomial diarrhea. cdad, once considered to be a "nuisance" disease, has lately become a "killer" disease with appearance of a hypervirulent strain, toxinotype iii. although the incidence and severity of cdad have increased in the western world especially in health care settings; it still is under-recognized in india and asia. any episode of diarrhea with fever and leucocytosis in a patient on some a ...201121922851
systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent clostridium difficile infection.clostridium difficile infection (cdi) is a gastrointestinal disease believed to be causally related to perturbations to the intestinal microbiota. when standard treatment has failed, intestinal microbiota transplantation (imt) is an alternative therapy for patients with cdi. imt involves infusing intestinal microorganisms (in a suspension of healthy donor stool) into the intestine of a sick patient to restore the microbiota. however, protocols and reported efficacy for imt vary. we conducted a s ...201122002980
clostridium difficile infection in hiv-seropositive individuals and transplant recipients.immunocompromise is a commonly cited risk factor for clostridium difficile infection (cdi). we reviewed the experimental and epidemiological literature on cdi in three immunocompromised groups, hiv-seropositive individuals, haematopoietic stem cell or bone marrow transplant recipients and solid organ transplant recipients. all three groups have varying degrees of impairment of humoral immunity, a major factor influencing the outcome of cdi. soluble hiv proteins such as nef and immunosuppressive ...201122178989
comparative effectiveness of clostridium difficile treatments: a systematic review.background: clostridium difficile infection is increasing in incidence and severity. the optimal treatment is unknown. purpose: to determine whether, among adults with c. difficile infection, treatment with certain antibiotics compared with others results in differences in initial cure, recurrence, and harms. data sources: medline, amed, clinicaltrials.gov, and cochrane databases (search dates: inception through august 2011, limited to english-language reports); bibliography review. study se ...201122184691
cefoperazone-treated mice as an experimental platform to assess differential virulence of clostridium difficile strains.the toxin-producing bacterium c. difficile is the leading cause of antibiotic-associated colitis, with an estimated 500,000 cases c. difficile infection (cdi) each year in the u.s with a cost approaching 3 billion dollars. despite the significance of cdi, the pathogenesis of this infection is still being defined. the recent development of tractable murine models of cdi will help define the determinants of c. difficile pathogenesis in vivo. to determine if cefoperazone-treated mice could be utili ...201122198617
diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated clostridium difficile associated disease.to determine whether a minimally invasive, colon-preserving approach could serve as an alternative to total colectomy in the treatment of severe, complicated clostridium difficile-associated disease (cdad).201121865943
Lack of Association between Clinical Outcome of Clostridium difficile Infections, Strain Type, and Virulence-Associated Phenotypes.Clostridium difficile strain NAP1/027 (North American pulsed-field gel electrophoresis [PFGE] type 1 and PCR ribotype 027 [R027]) has been associated with recent outbreaks in North America and Europe. It has been associated with more severe disease symptoms, higher mortality rates, and greater risk of relapse. This strain is thought to produce more toxins and sporulate to higher levels. However, recent studies suggest that this may not always be the case. The objective of our study was to assess ...201121956985
Lipolysis-stimulated lipoprotein receptor (LSR) is the host receptor for the binary toxin Clostridium difficile transferase (CDT).Clostridium difficile infection (CDI) causes antibiotic-associated diarrhea and pseudomembranous colitis. Hypervirulent strains of the pathogen, which are responsible for increased morbidity and mortality of CDI, produce the binary actin-ADP ribosylating toxin Clostridium difficile transferase (CDT) in addition to the Rho-glucosylating toxins A and B. CDT depolymerizes the actin cytoskeleton, increases adherence and colonization of Clostridia by induction of microtubule-based cell protrusions an ...201121930894
concomitant therapy with methotrexate and anti-tnf-α in pediatric patients with refractory crohn's colitis: a case series.background: crohn's colitis refractory to anti-tumor necrosis factor alpha (tnf-α) therapy is commonly seen in tertiary care centers for pediatric inflammatory bowel disease (ibd). we report our experience in managing pediatric refractory crohn's colitis with concomitant use of methotrexate and anti-tnf-α therapy. methods: we reviewed records from 2007 to 2010 at the mayo clinic pediatric ibd center. we included all patients with crohn's disease (cd) failing anti-tnf-α therapy who then received ...201121882301
acquisition of spores on gloved hands after contact with the skin of patients with clostridium difficile infection and with environmental surfaces in their rooms.in a prospective study of 30 patients with clostridium difficile infection, we found that acquisition of spores on gloved hands was as likely after contact with commonly touched environmental surfaces (ie, bed rail, bedside table, telephone, call button) as after contact with commonly examined skin sites (ie, chest, abdomen, arm, hand).201121982209
fidaxomicin: a macrocyclic antibiotic for the treatment of clostridium difficile infection.clostridium difficile is an emerging pathogen in certain health care systems and community-based populations that is associated with high rates of morbidity and mortality, as well as increased costs for the health care system. as recurrence rates increase, new pharmacologic agents to treat c. difficile infection are needed. fidaxomicin, a novel macrocyclic antibiotic, was recently approved by the united states food and drug administration for the treatment of c. difficile-associated diarrhea. or ...201121923589
probiotics for prevention and treatment of diarrhea.probiotics have been extensively studied over the past several years in the prevention and, to a larger extent, in the treatment of diarrheal diseases, especially in pediatric populations. diarrhea is a symptom, and not a disease. this review will not address chronic disorders associated with diarrhea, or clostridium difficile-induced diarrhea. rather it will focus on published clinical trials performed on acute-onset, likely infectious diarrhea occurring in the settings of day-care centers, in ...201121992955
mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy.both gastrointestinal microbiota composition and cesarean section have been linked to atopic manifestations. however, results are inconsistent, and the hypothesized intermediate role of the microbiota in the association between birth mode and atopic manifestations has not been studied yet.201121872915
mechanism for gene control by a natural allosteric group i ribozyme.an allosteric ribozyme consisting of a metabolite-sensing riboswitch and a group i self-splicing ribozyme was recently found in the pathogenic bacterium clostridium difficile. the riboswitch senses the bacterial second messenger c-di-gmp, thereby controlling 5'-splice site choice by the downstream ribozyme. the proximity of this allosteric ribozyme to the open reading frame (orf) for cd3246 suggests that coenzyme-mediated regulation of splicing controls expression of this putative virulence gene ...201121960486
prevalence of antimicrobial-resistant organisms in residential aged care facilities.to assess the frequency of, and risk factors for, colonisation with vancomycin-resistant enterococci (vre), clostridium difficile and extended-spectrum β-lactamase (esbl)-producing organisms in residential aged care facilities (racfs).201122060088
the clostridium difficile cell wall protein cwpv undergoes enzyme-independent intramolecular autoproteolysis.clostridium difficile infection is a leading cause of antibiotic-associated diarrhoea, placing considerable economic pressure on healthcare systems and resulting in significant morbidity and mortality. the pathogen produces a proteinaceous array on its cell surface known as the s-layer, consisting primarily of the major s-layer protein slpa and a family of slpa homologues. cwpv is the largest member of this family and is expressed in a phase variable manner. the protein is post-translationally p ...201122128177
fecal microbiota transplantation and emerging applications.fecal microbiota transplantation (fmt) has been utilized sporadically for over 50 years. in the past few years, clostridium difficile infection (cdi) epidemics in the usa and europe have resulted in the increased use of fmt, given its high efficacy in eradicating cdi and associated symptoms. as more patients request treatment and more clinics incorporate fmt into their treatment repertoire, reports of applications outside of cdi are emerging, paving the way for the use of fmt in several idiopath ...201122183182
clostridium difficile: a problem of concern in developed countries and still a mystery in latin america.clostridium difficile-associated disease (cdad) is caused by a spore-forming bacterium and can result in highly variable disease, ranging from mild diarrhoea to severe clinical manifestations. infections are most commonly seen in hospital settings and are often associated with on-going antibiotic therapy. incidences of cdad have shown a sustained increase worldwide over the last ten years and a hyper-virulent c. difficile strain, pcr ribotype 027/rea type bi/north american pulsed-field (nap) typ ...201122116982
public reporting of clostridium difficile and improvements in diagnostic tests. 201122080669
clostridium difficile infection and proton pump inhibitor use in hospitalized pediatric cystic fibrosis patients.children with cystic fibrosis (cf) often take proton pump inhibitors (ppis), which helps improve efficacy of fat absorption with pancreatic enzyme replacement therapy. however, ppi use is known to be associated with clostridium difficile-(c. diff-) associated diarrhea (cdad). we retrospectively evaluated the incidence of c. diff infection from all pediatric hospital admissions over a 5-year period at a single tertiary children's hospital. we found significantly more c. diff-positive stool tests ...201122144994
co-morbidities as predictors of mortality in clostridium difficile infection and derivation of the arc predictive score.clostridium difficile associated diarrhoea (cdad) has increased significantly in the last 15 years, but predictors of outcome are inadequately understood. this was a cohort study of 2761 patients in north east england between 2002 and 2009, with the end-point of mortality at 30 days. the role of age, gender and co-morbidities was examined by binary logistic regression. rounded odds ratios were used to develop a predictive score. a predictive score based on age, renal disease and cancer (arc scor ...201122047977
bacillus coagulans gbi-30 (bc30) improves indices of clostridium difficile-induced colitis in mice.abstract:201122014083
treating clostridium difficile infection with fecal microbiota transplantation.clostridium difficile infection is increasing in incidence, severity, and mortality. treatment options are limited and appear to be losing efficacy. recurrent disease is especially challenging; extended treatment with oral vancomycin is becoming increasingly common but is expensive. fecal microbiota transplantation is safe, inexpensive, and effective; according to case and small series reports, about 90% of patients are cured. we discuss the rationale, methods, and use of fecal microbiota transp ...201121871249
community-acquired clostridium difficile-associated diarrhea, montréal, 2005-2006: frequency estimates and their validity.a retrospective search for community-acquired clostridium difficile-associated diarrhea in 15 hospitals revealed important discrepancies with numbers for the same period reported in real time to the surveillance system. several of the observed problems could be solved by implementing case-by-case notification with subsequent investigation by local public health, as for other reportable diseases.201121931255
seasonal variations in clostridium difficile infections are associated with influenza and respiratory syncytial virus activity independently of antibiotic prescriptions: a time series analysis in quebec, canada.seasonal variations in clostridium difficile-associated diarrhea (cdad), with a higher incidence occurring during winter months, have been reported. although winter epidemics of respiratory viruses may be temporally associated with an increase in cdad morbidity, we hypothesized that this association is mainly due to increased antibiotic use for respiratory infections. the objective of this study was to evaluate the effect of the two most frequent respiratory viruses (influenza virus and respirat ...201122106208
antibacterial properties of a glycolipid-rich extract and active principle from nunavik collections of the macroalgae fucus evanescens c. agardh (fucaceae).this study investigated the antibacterial activity of glycolipid-rich extracts of the brown macroalga fucus evanescens in cell culture. accessions were collected on the arctic coast of ungava bay, nunavik, quebec. the crude ethyl acetate extract of these accessions showed strong antibacterial activity (≥4 log(10) cfu) against hemophilus influenzae , legionella pneumophila , propionibacterium acnes (atcc and clinical isolate), and streptococcus pyogenes at 100 µg/ml. this algal extract inhibited ...201121859295
Hospital-acquired Clostridium difficile infection: determinants for severe disease.Risk factors of severity (need for surgical intervention, intensive care or fatal outcome) were analysed in hospital-acquired Clostridium difficile infection (CDI) in a 777-bed community hospital. In a prospective analytical cross-sectional study, age (=65 years), sex, CDI characteristics, underlying diseases, severity of comorbidity and PCR ribotypes were tested for associations with severe CDI. In total, 133 cases of hospital-acquired CDI (mean age 74.4 years) were identified, resulting in an ...201122210266
a multiplex, internally controlled real-time pcr assay for detection of toxigenic clostridium difficile and identification of hypervirulent strain 027/st-1.the purpose of this study was to validate a multiplex real-time pcr assay capable of detecting toxigenic clostridium difficile and simultaneously identifying c. difficile ribotype 027/st-1 by targeting the toxin genes tcda, tcdb and cdta in one reaction and in a separate reaction identifying the δ117 deletion in tcdc associated with ribotype 027/st-1. pcr was done prospectively on 704 samples routinely submitted to our department and results were compared to results of toxigenic culture. sequenc ...201121938539
fecal microbiota transplantation for relapsing clostridium difficile infection in 26 patients: methodology and results.: we aim to present a data detailing our success with fecal microbiota transplantation (fmt) and to provide a simple treatment protocol.201122157239
Surgical outcome of community-acquired Clostridium difficile colitis presenting as toxic megacolon: case report.Over the past decade, there has been an increase in both community-acquired and health-care-associated Clostridium difficile colitis secondary to broad-spectrum antibiotic exposure. Toxic megacolon is a rare complication of pseudomembranous colitis that often necessitates emergency colectomy.201121859335
Fidaxomicin (Dificid) for Clostridium difficile infection. 201121921871
toxin assay is more reliable than icd-9 data and less time-consuming than chart review for public reporting of clostridium difficile hospital case rates.objective: clostridium difficile-associated disease (cdad) is common and has a 6.1% mortality. governmental agencies have recommended surveillance, but reporting increases health care costs. we sought to identify a reliable method of reporting cdad that will not significantly increase health care costs. methods: patients were identified via database query for international statistical classification of diseases and related health problems, 9th edition (icd-9) codes and c. difficile toxin positiv ...201122106004
Scientists seek strategies to prevent Clostridium difficile infections. 201122045758
Perirectal swab surveillance for Clostridium difficile by use of selective broth preamplification and real-time PCR detection of tcdB.Active surveillance testing to identify and isolate asymptomatic carriers of toxigenic Clostridium difficile has been limited by the lack of a test that is sensitive, specific, and timely enough to serve as an infection control tool. We tested DNA preamplified from perirectal surveillance specimens in a liquid medium selective for C. difficile by using a modified commercial real-time PCR assay. All fermenting specimens were subcultured, and isolates were tested for toxigenicity. Culture-positive ...201121880961
Real-time polymerase chain reaction testing for Clostridium difficile reduces isolation time and improves patient management in a small community hospital.BACKGROUND: The impact of a switch from a toxin A/B enzyme immunoassay (EIA) to a polymerase chain reaction (PCR) method for detection of toxigenic Clostridium difficile was assessed for C difficile infection (CDI) rates, patient isolation-days, and CDI-related treatment. METHODS: A 6-month retrospective study was done on symptomatic patients tested by the toxin A/B EIA and PCR assays. Data on the number of C difficile tests ordered, patient isolation-days, and treatment with metronidazole or va ...201122153847
Synthesis of Mutual Azo Prodrugs of Anti-inflammatory Agents and Peptides Facilitated by a-Aminoisobutyric Acid.Reported is the synthesis of azo mutual prodrugs of the nonsteroidal anti-inflammatory agents (NSAIDs) 4-aminophenylacetic acid (4-APAA) or 5-aminosalicylic acid (5-ASA) with peptides, including an antibiotic peptide temporin analogue modified at the amino terminal by an a-aminoisobutyric acid (Aib) residue. These prodrugs are designed for colonic delivery of two agents to treat infection and inflammation by the bacterial pathogen Clostridium difficile .201122026631
laboratory testing for clostridium difficile infection: light at the end of the tunnel.clostridium difficile infection (cdi) is changing as evidenced by increasing virulence, rising incidence, unresponsiveness to metronidazole therapy, and worse outcomes. thus, it is critical that cdi diagnosis be accurate so ongoing epidemiology, disease prevention, and treatment remain satisfactory. we tested 10 diagnostic assays, including 1 commercial real-time polymerase chain reaction (qpcr) test for the laboratory detection of toxigenic c difficile on 1,000 stool samples. sensitive culture ...201121846912
a targeted strategy to wipe out clostridium difficile.this study evaluated daily cleaning with germicidal bleach wipes on wards with a high incidence of hospital-acquired clostridium difficile infection (cdi). the intervention reduced hospital-acquired cdi incidence by 85%, from 24.2 to 3.6 cases per 10,000 patient-days, and prolonged the median time between hospital-acquired cdi cases from 8 to 80 days.201122011546
Infection control. Trusts blame new C diff testing for failed targets. 201121853573
[clostridium difficile-induced necrotizing enteritis].clostridium difficile infection usually manifests as pseudomembranous colitis. infection of the small intestine is rare. c. difficile enteritis has a high mortality rate due to secondary enteric necrosis and perforation.201122166175
Hypervirulent Clostridium difficile PCR-ribotypes exhibit resistance to widely used disinfectants.The increased prevalence of Clostridium difficile infection (CDI) has coincided with enhanced transmissibility and severity of disease, which is often linked to two distinct clonal lineages designated PCR-ribotype 027 and 017 responsible for CDI outbreaks in the USA, Europe and Asia. We assessed sporulation and susceptibility of three PCR-ribotypes; 012, 017 and 027 to four classes of disinfectants; chlorine releasing agents (CRAs), peroxygens, quaternary ammonium compounds (QAC) and biguanides. ...201122039420
Clostridium difficile infection in outpatients, Maryland and Connecticut, USA, 2002-2007.Clostridium difficile, the most commonly recognized diarrheagenic pathogen among hospitalized persons, can cause outpatient diarrhea. Of 1,091 outpatients with diarrhea, we found 43 (3.9%) who were positive for C. difficile toxin. Only 7 had no recognized risk factors, and 3 had neither risk factors nor co-infection with another enteric pathogen.201122000379
Comparison between the two-step and the three-step algorithms for the detection of toxigenic Clostridium difficile.To evaluate usefulness of applying either the two-step algorithm (Ag-EIAs and CCNA) or the three-step algorithm (all three assays) for better confirmation of toxigenic Clostridium difficile. The antigen enzyme immunoassays (Ag-EIAs) can accurately identify the glutamate dehydrogenase antigen of toxigenic and nontoxigenic Clostridium difficile. Therefore, it is used in combination with a toxin-detecting assay [cell line culture neutralization assay (CCNA), or the enzyme immunoassays for toxins A ...201121860113
Proceedings from the 3rd International Clostridium difficile Symposium 2010, September 22-24, 2010, Bled, Slovenia. 201121928503
clostridium difficile in the icu: the struggle continues.clostridium difficile infection (cdi) management has become more daunting over the past decade because of alarming increases in cdi incidence and severity both in the hospital and in the community. this increase has concomitantly caused significant escalation of the health-care economic burden caused by cdi, and it will likely be translated to increased icu admission and attributable mortality. some possible causes for difficulty in management of cdi are as follows: (1) inability to predict and ...201122147824
Infective aneurysm of the inferior pancreaticoduodenal artery.INTRODUCTION: Pancreaticoduodenal (PD) artery aneurysms account for less than 2% of all splanchnic aneurysms. A mycotic aetiology is extremely uncommon. INTRODUCTION: Two weeks following an episode of sepsis related to a prostatic biopsy, a 59-year-old man presented with abdominal pain and anaemia. Ultrasonography and computed tomography revealed an inferior PD artery pseudoaneurysm with an associated mesenteric root haematoma. This was treated successfully by transcatheter embolisation. INTRODU ...201121929894
Robotic presacral neurectomy - technique and results.BACKGROUND: The feasibility, safety and outcomes of robotic presacral neurectomy were evaluated. METHODS: A retrospective analysis was performed of 33 patients with midline chronic pelvic pain, who underwent robotic presacral neurectomy. Data were collected during the period March 2004-March 2010. RESULTS: All patients underwent robotic presacral neurectomy and additional robotic procedures. Mean operating time for robotic presacral neurectomy was 5.8 (range 4.4-6.9) min. Mean blood loss, includ ...201121984315
Novel One-Step Method for Detection and Isolation of Active-Toxin-Producing Clostridium difficile Strains Directly from Stool Samples.The alarming emergence of hypervirulent strains of Clostridium difficile with increased toxin production, severity of disease, morbidity, and mortality emphasizes the need for a culture method that permits simultaneous isolation and detection of virulent strains. The C. difficile toxins A and B are critical virulence factors, and strains can either be toxin-producing (virulent) or non-toxin-producing (nonvirulent). Strains that are isolated from human infections generally produce either toxin A ...201121976761
Effective utilization of evolving methods for the laboratory diagnosis of Clostridium difficile infection. 201121960717
Changing incidence and clinical manifestations of Clostridium difficile-associated diarrhea detected by combination of glutamate dehydrogenase and toxin assay in Northern Taiwan.BACKGROUND/PURPOSE: The incidence of Clostridium difficile-associated diarrhea (CDAD) is increasing worldwide. Spread of an epidemic hypervirulent strain in southern Taiwan was associated with poor outcome. This prospective study evaluates the incidence and clinical manifestation of CDAD following a hospital-wide hand hygiene promotion program in a 2,200-bed teaching hospital in northern Taiwan. PATIENTS AND METHODS: From June 1, 2010 to October 31, 2010, a predefined protocol was used to active ...201122209696
[clostridium difficile infections: what is new?].c. difficile is the most common infectious cause of healthcare-associated diarrhea but now is increasingly recognized as a cause of diarrhea in outpatients and persons without apparent health care contacts. emergence and spread of new epidemic clones of c. difficile 027 (pcr-ribotype) and 078/126 (toxinotype) with increase toxin production, an aditional binary toxin and high level resistance to fluoroquinolones and increasing incidence of more rapidly progressive severe disease, require prompt c ...201122046768
acute renal failure in association with community-acquired clostridium difficile infection and mckittrick-wheelock syndrome.we report the case of a 65-year-old caucasian woman who experienced two separate episodes of acute renal failure within an 18-month period, both requiring emergency admission and complicated treatment. each episode was precipitated by hypovolaemia from intestinal fluid losses, but from two rare and independent pathologies. her first admission was attributed to community-acquired clostridium difficile-associated diarrhoea (cdad) and was treated in the intensive therapy unit. she returned 18 month ...201121960946
effects of different replicons in conjugative plasmids on transformation efficiency, plasmid stability, gene expression and n-butanol biosynthesis in clostridium tyrobutyricum.clostridium tyrobutyricum atcc 25755 can produce butyric acid, acetic acid, and hydrogen as the main products from various carbon sources. in this study, c. tyrobutyricum was used as a host to produce n-butanol by expressing adhe2 gene under the control of a native thiolase promoter using four different conjugative plasmids (pmtl82151, 83151, 84151, and 85151) each with a different replicon (pbp1 from c. botulinum nctc2916, pcb102 from c. butyricum, pcd6 from clostridium difficile, and pim13 fro ...201122139042
postoperative antibiotics correlate with worse outcomes after appendectomy for nonperforated appendicitis.acute appendicitis remains the most common cause of acute abdominal pain necessitating operative intervention. although postoperative antibiotics are universally used for perforated appendicitis, no consensus exists on whether postoperative antibiotics are beneficial for preventing surgical site infections (ssis) in nonperforated cases. we set out to determine how postoperative antibiotic therapy affects outcomes after appendectomy for nonperforated appendicitis.201121958510
Differential involvement of ezrin/radixin/moesin proteins in sphingosine 1-phosphate-induced human pulmonary endothelial cell barrier enhancement.Endothelial cell (EC) barrier dysfunction induced by inflammatory agonists is a frequent pathophysiologic event in multiple diseases. The platelet-derived phospholipid sphingosine-1 phosphate (S1P) reverses this dysfunction by potently enhancing the EC barrier through a process involving Rac GTPase-dependent cortical actin rearrangement as an integral step. In this study we explored the role of the ezrin, radixin, and moesin (ERM) family of actin-binding linker protein in modulating S1P-induced ...201121864676
Presumptive identification of Clostridium difficile strain 027/NAP1/BI on Cepheid Xpert: interpret with caution. 201121849697
Trends in antimicrobial resistance in intensive care units in the United States.Antimicrobial resistance and a paucity of new antimicrobial agents are ongoing challenges. This review focuses on the major epidemiologic trends and novel treatments, when available, for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus, Clostridium difficile, and multidrug-resistant Gram-negative bacilli in the United States during 2010-2011.201121900766
Detection of diarrhoeal pathogens in human faeces using an automated, robotic platform.Infectious diarrhoeal diseases represent a major socio-economic burden to humans, and are linked to a range of pathogens, including viruses, bacteria and protists. The accurate detection of such pathogens is central to control. However, detection often relies on methods that have limited diagnostic sensitivity and specificity. Here, we assessed an automated, robotic platform for the simultaneous detection of eight major pathogens associated with infectious diarrhoea. Genomic DNA samples (n = 167 ...201122056326
Progress toward developing a carbohydrate-conjugate vaccine against Clostridium difficile ribotype 027: synthesis of the cell-surface polysaccharide PS-I repeating unit.Clostridium difficile strain ribotype 027 is a hypervirulent pathogen that is responsible for recent, severe outbreaks of serious nosocomial infections. As a foundation for the development of a preventative carbohydrate-based vaccine, we have synthesized a pentasaccharide cell wall repeating unit from PS-I unique to this strain, by the linear assembly of four monosaccharide building blocks.201121998885
Fecal microbiota transplantation for recurrent clostridium difficile infection.With the increasing prevalence of recurrent/refractory Clostridium difficile infection (CDI), alternative treatments to the standard antibiotic therapies are being sought. One of the more controversial of such alternative treatments is fecal microbiota transplantation (FMT). Although the notion of FMT is foreign-even startling-and not esthetic to most people, the concept has been around for many decades. Its benefit and efficacy dates back >50 years to its use for staphylococcal pseudomembranous ...201121992957
the appendix may protect against clostridium difficile recurrence.several risk factors have been identified for the development of recurrent clostridium difficile infection (cdi) that alter host immunity and disrupt colonic flora. although the function of the appendix has been debated, its active, gut-associated lymphoid tissue and biofilm production indicate potential roles in recovery from initial cdi and protection against recurrent cdi. we investigated whether the presence or absence of an appendix is associated with cdi recurrence.201121699818
predictors of severity in ischaemic colitis.purpose: ischaemic colitis (ic) is an inadequate perfusion leading to potentially life-threatening colonic inflammation. the aim was to identify patient characteristics that predict severity in biopsy-confirmed ic. methods: a retrospective study of consecutive patients admitted with a robust diagnosis of ic over a 5-year period was performed. as ic is often misdiagnosed, strict inclusion criteria including supporting histopathology, exclusion of inflammatory bowel disease, absence of recent anti ...201121842142
diarrhoea after broad spectrum antimicrobials. 201121708921
impact of clinical symptoms on interpretation of diagnostic assays for clostridium difficile infections.asymptomatic clostridium difficile colonization is common in hospitalized patients. existing c. difficile assay comparisons lack data on severity of diarrhea or patient outcomes, limiting the ability to interpret their results in regard to the diagnosis of c. difficile infection (cdi). the objective of this study was to measure how including patient presentation with the c. difficile assay result impacted assay performance to diagnose cdi. stool specimens from 150 patients that met inclusion and ...201121697328
clostridium difficile infection and inflammatory bowel disease: a review.the incidence of clostridium difficile infection (cdi) has significantly increased in the last decade in the united states adding to the health care burden of the country. patients with inflammatory bowel disease (ibd) have a higher prevalence of cdi and worse outcomes. in the past, the traditional risk factors for cdi were exposure to antibiotics and hospitalizations in elderly people. today, it is not uncommon to diagnose cdi in a pregnant women or young adult who has no risk factors. c. diffi ...201121915178
systemic dissemination of clostridium difficile toxins a and b is associated with severe, fatal disease in animal models.(see the editorial commentary by johnson, on pages 353-4.) background. clostridium difficile infection (cdi) can cause a wide range of disease, from mild diarrhea to fulminant systemic disease. the incidence of systemic cdi with fatal consequence has increased rapidly in recent years. methods. using an ultrasensitive cytotoxicity assay, we measured c. difficile toxin a (tcda) and c. difficile toxin b (tcdb) in sera and body fluids of piglets and mice exposed to c. difficile to investigate the re ...201122147798
the epidemiology of community-acquired clostridium difficile infection: a population-based study.clostridium difficile infection (cdi) is a common hospital-acquired infection with increasing incidence, severity, recurrence, and associated morbidity and mortality. there are emerging data on the occurrence of cdi in nonhospitalized patients. however, there is a relative lack of community-based cdi studies, as most of the existing studies are hospital based, potentially influencing the results by referral or hospitalization bias by missing cases of community-acquired cdi.201122108454
molecular and microbiological characterization of clostridium difficile isolates from single, relapse, and re-infection cases.in this study, we investigated the correlation between the microbiological characteristics of clostridium difficile clinical isolates and the recurrence of c. difficile-associated disease (cdad). twenty c. difficile isolates recovered from 20 single infection cases and 53 isolates from 20 recurrent cases were analyzed by pulsed-field gel electrophoresis (pfge) and pcr ribotyping, and cytotoxicity, antimicrobial susceptibility and sporulation/germination rates of the isolates were examined. recur ...201122205786
Seasonality of Clostridium difficile infections in Southern Germany.SUMMARYBetween 2000 and 2009, the total number of patients with Clostridium difficile infections increased considerably in Southeastern Germany. A clear seasonality was observed with a higher number of affected patients occurring in the winter months (January-March). Moxifloxacin and erythromycin-resistant C. difficile PCR ribotypes 001 (72%) and 027 (4·6%) were the most commonly isolated strains.201122152928
[Pathogenicity factors of bacteria with glycosylating activity].A and B toxins of Clostridium difficile, a-toxin of C. novyi, lehal toxin of C. sordellii, and TpeL toxin of C. perfringens belong to the group of the so-called large Clostridium toxins. These toxins modify low-molecular weight guanosine triphosphate-binding proteins of the Rho/Ras family by their glycosylation that results in inactivation of major signal pathways in eukaryotic cells. Lgt glycosyltransferases, a new group of pathogenicity factors also capable of inactivating eukaryotic substrate ...201122168036
Savings from the use of a probiotic formula in the prophylaxis of antibiotic-associated diarrhea.Abstract Objective: Antibiotic-associated diarrhea (AAD) and particularly Clostridium difficile-associated diarrhea (CDAD) are the most common causes of healthcare associated infectious diarrhea. A double-blind, dose response, placebo-controlled trial of the probiotic formula (Bio-K+ Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R formula) for prophylaxis of AAD and CDAD was published in 2010. The Bio-K+ Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R formula ...201122023067
Evaluation of chronic diarrhea.Chronic diarrhea, defined as a decrease in stool consistency for more than four weeks, is a common but challenging clinical scenario. It can be divided into three basic categories: watery, fatty (malabsorption), and inflammatory. Watery diarrhea may be subdivided into osmotic, secretory, and functional types. Watery diarrhea includes irritable bowel syndrome, which is the most common cause of functional diarrhea. Another example of watery diarrhea is microscopic colitis, which is a secretory dia ...201122085666
fluoroquinolones, antimicrobial resistance and neutropenic cancer patients.fluoroquinolone antibiotics are widely used in our communities and healthcare facilities. this review focuses upon the relationship between fluoroquinolone use and the rising prevalence in neutropenic cancer patients of multidrug resistant pathogens including methicillin-resistant staphylococcus aureus (mrsa), vancomycin-resistant enterococci, clostridium difficile, and aerobic gram-negative bacilli.201122001945
Durability of silver nanoparticulate films within a silica matrix by flame assisted chemical vapour deposition for biocidal applications.Healthcare acquired infection (HCAI) rates have come under increasing scrutiny in recent years and been a major priority for health professionals in the UK and elsewhere. Of particular concern is the rise of so called 'superbugs', or those resistant to conventional antibiotics, such as Escherichia coli, Clostridium difficile and methicillin resistant Staphylococcus aureus (MRSA). The reasons for this rise are many and complex, but one important factor is bacterial survival rates on wards and oth ...201122097580
comparison of pcr ribotyping and multilocus variable-number tandem-repeat analysis (mlva) for improved detection of clostridium difficile.polymerase chain reaction (pcr) ribotyping is one of the globally accepted techniques for defining epidemic clones of clostridium difficile and tracing virulence-related strains. however, the ambiguous data generated by this technique makes it difficult to compare data attained from different laboratories; therefore, a portable technique that could supersede or supplement pcr ribotyping should be developed. the current study attempted to use a new multilocus variable-number tandem-repeat analysi ...201121961456
reconsidering the sporulation characteristics of hypervirulent clostridium difficile bi/nap1/027.clostridium difficile is the leading cause of antibiotic-associated diarrhoea and a major burden to healthcare services worldwide. in recent years, c. difficile strains belonging to the bi/nap1/027 type have become highly represented among clinical isolates. these so-called 'hypervirulent' strains are associated with outbreaks of increased disease severity, higher relapse rates and an expanded repertoire of antibiotic resistance. spores, formed during sporulation, play a pivotal role in disease ...201121949780
lack of association of outcomes with treatment duration and microbiologic susceptibility data in clostridium difficile infections in a non-nap1/bi/027 setting.abstract background: concerns regarding the poor response of severe clostridium difficile infection (cdi) treated with metronidazole have arisen over the last 5 y. methods: we conducted a prospective, non-interventional study of cdi cases at our institution to evaluate the role of drug resistance, co-morbidities, and the emergence of hypervirulent strains on patient outcomes. a total of 118 adult inpatients with diarrhea and a positive stool for c. difficile toxin immunoassay had positive stoo ...201122077148
Silent menace. C. difficile and its threat to health care facilities. 201121882770
[Epidemiology of Clostridium difficile infection in Spain.]There has been increasing interest in Clostridium difficile infection (CDI) due its association with healthcare and its impact on morbidity and mortality in the elderly. During the last few years there has been a growing increase in the number of published studies on the incidence, changes on the clinical presentation and on the epidemiology, with the description of new risk factors. The frequency of CDI in Spain is not sufficiently characterised. The available data indicates that incidence is w ...201122136747
Diagnostic accuracy of real-time polymerase chain reaction in detection of Clostridium difficile in the stool samples of patients with suspected Clostridium difficile Infection: a meta-analysis.Current detection methods for Clostridium difficile infection (CDI) can be time-consuming and have variable sensitivities. Real-time polymerase chain reaction (PCR) may allow earlier and more accurate diagnosis of CDI than other currently available diagnostic tests. A meta-analysis was performed to determine the diagnostic accuracy of real-time PCR.201121890762
Asymptomatic colonization by Clostridium difficile in older adults admitted to a geriatric unit: a prospective cohort study. 201122098041
Multiplex PCR Method for Detection of Clostridium difficile tcdA, tcdB, cdtA, and cdtB and Internal In-Frame Deletion of tcdC.A multiplex PCR method was developed for the detection of Clostridium difficile toxin genes tcdA, tcdB, ctdA, and cdtB and the major in-frame deletion types (18, 39, and 54 bp) of tcdC. The method has high specificity for PCR ribotype 027 and may identify other C. difficile strains of clinical and epidemiological importance.201121976756
Moderate to High Use of Opioid Analgesics Are Associated With an Increased Risk of Clostridium difficile Infection.INTRODUCTION:: Risk factors for Clostridium difficile infection (CDI) include use of broad-spectrum antibiotics, advanced age and lack of an appropriate immune response. Whether antiperistaltics such as opioid analgesics also increase the risk of CDI is uncertain. The purpose of this preliminary study was to determine whether opioid analgesics increase the risk of developing CDI in hospitalized patients receiving broad-spectrum antibiotics. METHODS:: Hospitalized patients were assessed for incid ...201121934595
Characterisation and carriage ratio of Clostridium difficile strains isolated from a community-dwelling elderly population in the United Kingdom.Community-associated Clostridium difficile infection (CDI) appears to be an increasing problem. Reported carriage rates by C. difficile are debatable with suggestions that primary asymptomatic carriage is associated with decreased risk of subsequent diarrhoea. However, knowledge of potential reservoirs and intestinal carriage rates in the community, particularly in the elderly, the most susceptible group, is limited. We have determined the presence of C. difficile in the faeces of a healthy elde ...201121886769
Isolation and characterization of Clostridium difficile from shellfish and marine environments.This pilot study was carried out to evaluate the occurrence of Clostridium difficile in marine environments and in edible shellfish. Samples of seawater, sediment, and zooplankton were collected at five sampling stations in the Gulf of Naples. Six samples of edible shellfish, furthermore, were obtained: two from mussel farms and four from wholesalers. The isolation and the characterization of C. difficile strains were carried out using selective media and molecular techniques, respectively. C. d ...201121901293
relative frequency of health care-associated pathogens by infection site at a university hospital from 1980 to 2008.background: we describe the relative frequency of health care-associated pathogens by infection site over 29 years using hospital-wide surveillance data from a large academic hospital. methods: comprehensive hospital-wide surveillance was provided by trained infection preventionists using centers for disease control and prevention definitions. five 5-year blocks and one 4-year block were created for each site: bloodstream infections (bsi), urinary tract infections (uti), respiratory tract infect ...201121943832
implementation and outcomes of a hospital-wide computerised antimicrobial stewardship programme in a large medical centre in taiwan.antibiotic stewardship is important to address the problem of antimicrobial resistance, but a practical and sustainable strategy to provide stewardship in a large hospital setting is lacking. we developed a hospital-wide computerised antimicrobial approval system (hcaas) to guide the use of antimicrobial agents in late 2004 in a 3500-bed medical centre in taiwan. the objective of this study was to evaluate the impacts of hcaas on the hospital from 2003 to 2009. following hcaas deployment, the gr ...201121982143
clostridium difficile in retail meat and processing plants in texas.the incidence and severity of disease associated with toxigenic clostridium difficile have increased in hospitals in north america from the emergence of newer, more virulent strains. toxigenic c. difficile has been isolated from food animals and retail meat with potential implications of transfer to human beings. the objective of the present study was to determine the prevalence of c. difficile in pork from sausage manufacturing plants and retail meat in texas. twenty-three c. difficile isolates ...201121908329
clostridium difficile infection in newly diagnosed pediatric patients with inflammatory bowel disease: prevalence and risk factors.background: epidemiological and microbiological data suggest that clostridium difficile infection (cdi) plays a substantial role in the clinical initiation of inflammatory bowel disease (ibd). the aim of the present study was to investigate the prevalence and risk factors of cdi in newly diagnosed pediatric patients with ibd. methods: the current investigation was a retrospective study. all patients newly diagnosed with ibd in the pediatric gastroenterology clinic in warsaw between 2007 and 2010 ...201121936029
Do admissions and discharges to long-term care facilities influence hospital burden of Clostridium difficile infection?BACKGROUND: Substantial geographical clustering of Clostridium difficile infection (CDI) outbreaks in hospitals in the USA have previously been demonstrated. AIM: To test the hypothesis that hospital burden of CDI is associated with admission from and discharge to long-term care facilities (LTCFs). METHODS: Hospital discharge data from 19 states in the USA were used to identify all patients discharged with a diagnosis of CDI from 1 January 2002 to 31 December 2004. For every hospital, the propor ...201122137065
Spread and persistence of Clostridium difficile spores during and after cleaning with sporicidal disinfectants. 201122177022
Gas discharge plasmas are effective in inactivating Bacillus and Clostridium spores.Bacterial spores are the most resistant form of life and have been a major threat to public health and food safety. Nonthermal atmospheric gas discharge plasma is a novel sterilization method that leaves no chemical residue. In our study, a helium radio-frequency cold plasma jet was used to examine its sporicidal effect on selected strains of Bacillus and Clostridium. The species tested included Bacillus subtilis, Bacillus stearothermophilus, Clostridium sporogenes, Clostridium perfringens, Clos ...201122075631
clostridium difficile diarrhea and fecal transplantation. 201121555950
modified fecal transplantation. 201121555954
epidemiological model for clostridium difficile transmission in healthcare settings.objective. recent outbreaks of clostridium difficile infection (cdi) have been difficult to control, and data indicate that the importance of different sources of transmission may have changed. our objectives were to evaluate the contributions of asymptomatic and symptomatic c. difficile carriers to new colonizations and to determine the most important epidemiological factors influencing c. difficile transmission. design, setting, and patients. retrospective cohort study of all patients admitted ...201121558767
an evaluation of the impact of a single-dose intravenous immunoglobulin regimen in the treatment of clostridium difficile infections. 201121558782
[prevention of antibiotic-associated diarrhea in children].one of the most frequent complications of antibiotic therapy is a diarrheal syndrome, which may be related both to the direct toxic effects of antibiotics on the gastrointestinal tract, and the activation of conditionally pathogenic intestinal flora. particular attention gets to present the problem of c. difficile-infection, which may be the consequence of the development of pseudomembranous colitis in both children and adults. the article presents current data on the prevalence, etiology, patho ...201121560397
fidaxomicin for clostridium difficile infection. 201121561360
fidaxomicin for clostridium difficile infection. 201121561361
clospore: a liquid medium for producing high titers of semi-purified spores of clostridium difficile.clostridium difficile continues to cause infections in healthcare and other settings. its spores survive well indoors and require sporicidal chemicals for infection control. however, proper testing of disinfectants is impeded due to difficulties in obtaining viable spores of high enough quality and titers to meet current regulations for sporicidal claims. a new liquid medium (clospore) has been developed, based on a systematic review of the compositions of 20 other available media. c. difficile ...201121563698
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