Publications

imipenem-induced clostridium difficile diarrhea in a patient with chronic renal failure.	an 80-year-old man was diagnosed to have pneumonia and advanced chronic kidney disease. he presented with anuria and hemodialysis, by temporary femoral catheter, was initiated. he was empirically treated with imipenem/cilastatin 500 mg/24 h after hemodialysis. after 10 days of antibiotic intake, he developed severe diarrhea. diagnosis of clostridium difficile (cd)-associated diarrhea was confirmed by detection of the toxins a and b in his stool. imipenem therapy was discontinued; vancomycin 500 ...	2011	21566316
recurrent clostridium difficile infection: what are the treatment options?	clostridium difficile infection (cdi) is an increasing problem in hospitalized patients. recurrences of disease, despite the recommended treatments with metronidazole or vancomycin, are frequently seen and pose major problems for the clinical management of patients with cdi. evidence for efficient clinical cure and low recurrence rates with primary use of alternative antibacterial treatment, such as fidaxomicin and rifaximin, is growing and these treatment strategies need further exploration. th ...	2011	21568363
prevalence of clostridium difficile in horses.	fecal samples were collected to establish the apparent prevalence of clostridium difficile shedding in standardbred and thoroughbred racehorses housed at 4 racetracks and 2 breeding facilities, and in horses admitted to a referral large animal clinic. forty-one (7.59%) of 540 racetrack horses, seven (5.83%) of 120 breeding farm horses, and four (4.88%) out of 82 horses admitted to the referral clinic were culture-positive for c. difficile. an overall fecal culture prevalence of 7.01% for c. diff ...	2011	21570780
[clostridium difficile enteritis.]	introduction: clostridium difficile infection of the small intestine is infrequent. method: we present the first case of c. difficile enteritis (cde) diagnosed in spain and provide a review of the literature. results: a 30-year-old man underwent surgery for recurrence of a retroperitoneal germ cell tumor. seven days later the patient developed vomiting, diarrhea and, finally, intestinal obstruction due to pseudomembranes caused by cde. only 57 cases of cde have been reported in the literature. t ...	2011	21571399
the key sigma factor of transition phase, sigh, controls sporulation, metabolism and virulence factor expression in clostridium difficile.	toxin synthesis in clostridium difficile increases as cells enter into stationary phase. we first compared the expression profiles of strain 630e during exponential growth and at the onset of stationary phase and showed that genes involved in sporulation, cellular division, motility as well as carbon and amino acid metabolisms were differentially expressed under these conditions. we inactivated the sigh gene encoding an alternative sigma factor involved in the transition to post-exponential phas ...	2011	21572003
feruloylated and nonferuloylated arabino-oligosaccharides from sugar beet pectin selectively stimulate the growth of bifidobacterium spp. in human fecal in vitro fermentations.	the side chains of the rhamnogalacturonan i fraction in sugar beet pectin are particularly rich in arabinan moieties, which may be substituted with feruloyl groups. in this work the arabinan-rich fraction resulting from sugar beet pulp based pectin production was separated by amberlite xad hydrophobic interaction and membrane separation into four fractions based on feruloyl substitution and arabino-oligosaccharide chain length: short-chain (dp 2-10) and long-chain (dp 7-14) feruloylated and nonf ...	2011	21574556
a mouse relapse model of clostridium difficile infection.	clostridium difficile is the causative agent of primary and recurrent antibiotic-associated diarrhea and colitis in hospitalized patients. the disease is mainly caused by two exotoxins tcda and tcdb produced by the bacteria. recurrent c. difficile infection (cdi) constitutes one of the most significant clinical issues of this disease, and occurs in more than 20% of patients after the first episode, and may be increasing in frequency. however, there is no well-established animal model of cdi rela ...	2011	21576341
infective complications after transrectal ultrasound-guided prostate biopsy following a new protocol for antibiotic prophylaxis aimed at reducing hospital-acquired infections.	study type - therapy (case series) level of evidence 4 what's known on the subject? and what does the study add? • clostridium difficile infections have been a serious problem throughout the nhs and have forced clinicians to change the types of antibiotics they routinely prescribe. • ciprofloxacin is a good choice of prophylactic agent for trusp bx • co-amoxiclav and gentamicin have never been studied in combinations as prophylaxis for trusp bx. • co-amoxiclav and gentamicin in combination a ...	2011	21592292
clostridium difficile transcriptome analysis using pig ligated loop model reveals modulation of pathways not modulated in vitro.	a pig ligated loop model was used to analyze the in vivo transcriptome response of clostridium difficile. bacterial rna from the loops was retrieved at different times and was used for microarray analysis. several virulence-associated genes and genes involved in sporulation cascade were differentially expressed (de). in concordance with observed upregulation of toxin genes in microarray, enzyme-linked immunosorbent assay estimation of total toxin showed high amounts of toxin in the loops. severa ...	2011	21592991
differential binding and internalisation of clostridium difficile toxin a by human peripheral blood monocytes, neutrophils and lymphocytes.	colitis due to c. difficile infection is mediated by secreted toxins a and b and is characterised by infiltration by cells from the systemic circulation. the aim of our study was to investigate interactions between fluorescently labelled toxin a and peripheral blood monocytes, neutrophils and lymphocytes. purified toxin a was labelled with alexa fluor(®) 488 (toxin a(488) ) and incubated with isolated human peripheral blood mononuclear cells (pbmncs) or washed whole blood cells for varying time ...	2011	21595735
evaluation of automated repetitive-sequence-based pcr (diversilab) compared to pcr ribotyping for rapid molecular typing of community- and nosocomial-acquired clostridium difficile.	automated repetitive pcr (rep-pcr; diversilab) was compared to pcr ribotyping of the 16s-23s rna intergenic spacer of clostridium difficile (cd) as the "gold standard" method for cd typing. pcr products were separated on diversilab labchips (biomérieux, st. laurent, quebec, canada) utilizing a 2100 bioanalyzer (agilent technologies, santa clara, ca) operating the diversilab v1.4 assay. bioanalyzer data were exported to a secure diversilab website and analyzed with diversilab v3.4 software. repli ...	2011	21596222
use of alternative or adjuvant pharmacologic treatment strategies in the prevention and treatment of clostridium difficile infection.	infection with clostridium difficile is currently the leading cause of infectious diarrhea in hospitalized patients, and recent surveillance data indicate that c. difficile has surpassed methicillin-resistant staphylococcus aureus as the number one cause of hospital-acquired infections in some areas of the usa. in addition, concern over c. difficile has increased over the past decade due to the appearance of new hypervirulent strains. metronidazole and vancomycin have remained the treatments of ...	2011	21596604
colonoscopic fecal bacteriotherapy in the treatment of recurrent clostridium difficile infection--results and follow-up.		2011	21608450
clostridium difficile infection: a comprehensive review.	clostridium difficile is one of the most important causes of healthcare acquired diarrhea. the disease spectrum caused by c. difficile infection ranges from mild, self-limited, illness to a severe, life-threatening colitis. the incidence of c. difficile associated disease has risen dramatically over the last decade, leading to increased research interest aiming at the discovery of new virulence factors and the development of new treatment and prevention regimens. this review summarizes the patho ...	2011	21609252
a possible oligosaccharide-conjugate vaccine candidate for clostridium difficile is antigenic and immunogenic.	nosocomial infections with the gram-positive pathogen clostridium difficile pose a major risk for hospitalized patients and result in significant costs to health care systems. here, we present the chemical synthesis of a ps-ii hapten of a cell wall polysaccharide of hypervirulent ribotype 027 of c. difficile. mice were immunized with a conjugate consisting of the synthetic hexasaccharide and the diphtheria toxoid variant crm(197). the immunogenicity of the glycan repeating unit was demonstrated ...	2011	21609839
binding of clostridium difficile toxins to human milk oligosaccharides.	the binding of recombinant fragments of the c-terminal cell-binding domains of the two large exotoxins, toxin a (tcda) and toxin b (tcdb), expressed by clostridium difficile and a library consisting of the most abundant neutral and acidic human milk oligosaccharides (hmos) was examined quantitatively at 25 °c and ph 7 using the direct electrospray ionization mass spectrometry (es-ms) assay. the results of the es-ms measurements indicate that both toxins fragments investigated, tcdb-b1 and tcda-a ...	2011	21610194
[luminal gastroenterology and inflammation.]	luminal inflammation of the intestine is a trigger of numerous gastrointestinal and non-gastrointestinal diseases. several mechanisms have an impact on luminal inflammation, such as antibiotic or immunosuppressive therapies. in this paper recent data and new therapeutic approaches are reported concerning gastrointestinal and non-gastrointestinal diseases, for example eosinophilic esophagitis, irritable bowel syndrome, crohn's disease and hepatic encephalopathy. in addition, recommendations are p ...	2011	21611929
super toxins from a super bug: structure and function of clostridium difficile toxins.	clostridium difficile, a highly infectious bacterium, is the leading cause of antibiotic-associated pseudomembranous colitis. in 2009, the number of death certificates mentioning c. difficile infection in the u.k. was estimated at 3933 with 44% of certificates recording infection as the underlying cause of death. a number of virulence factors facilitate its pathogenicity, among which are two potent exotoxins; toxins a and b. both are large monoglucosyltransferases that catalyse the glucosylation ...	2011	21615333
targeting the tcda gene: is this appropriate for detection of a and/or b clostridium difficile toxin-producing strains?		2011	21617002
drug-related admissions and hospital-acquired adverse drug events in germany: a longitudinal analysis from 2003 to 2007 of icd-10-coded routine data.	abstract: background: adverse reactions and medication errors are complications of drug use. spontaneous reporting systems and pharmacoepidemiological studies incompletely detect the occurrence of these events in daily hospital care. in this study, the frequency and type of drug-related admissions and hospital-acquired adverse drug events (ade) in germany were assessed using routinely collected hospital data. methods: the study was based on aggregated hospital routine data covering the period 20 ...	2011	21619706
a case of hypocalcemia-related epilepsia partialis continua.	epilepsia partialis continua (epc) is a syndrome clinically defined as continuous spontaneous jerking confined to one part of the body, sometimes aggravated by action or sensory stimuli, occurring over hours, days or even years. in adults the more frequent recognized cause of epc is an acute cerebrovascular disease. acute severe hypocalcemia is a highly epileptogenic ionic disturbance, abnormally increasing neuronal excitability. in this short communication we describe the first probable case of ...	2011	21621427
clinical clostridium difficile: clonality and pathogenicity locus diversity.	clostridium difficile infection (cdi) is an important cause of mortality and morbidity in healthcare settings. the major virulence determinants are large clostridial toxins, toxin a (tcda) and toxin b (tcdb), encoded within the pathogenicity locus (paloc). isolates vary in pathogenicity from hypervirulent pcr-ribotypes 027 and 078 with high mortality, to benign non-toxigenic strains carried asymptomatically. the relative pathogenicity of most toxigenic genotypes is still unclear, but may be infl ...	2011	21625511
effective utilization of evolving methods for the laboratory diagnosis of clostridium difficile infection.	physicians should understand the performance characteristics of evolving laboratory tests used to diagnose clostridium difficile infection if they are to correctly integrate test results with clinical information and formulate an appropriate therapeutic intervention for patients with antibiotic-associated diarrhea.	2011	21628487
prsw is required for colonization, resistance to antimicrobial peptides and expression of extra-cytoplasmic function {sigma} factors in clostridium difficile.	clostridium difficile is an anaerobic, gram-positive, spore-forming opportunistic pathogen which is the most common cause of hospital-acquired infectious diarrhea. in numerous pathogens, stress response mechanisms are required for survival within the host. extra-cytoplasmic function sigma (σ) factors (ecf σ factors) are a major family of signal transduction systems which sense and respond to extracellular stresses. we have identified three c. difficile ecf σ factors. these ecf σ factors csft, cs ...	2011	21628514
reutericyclin and related analogues kill stationary phase clostridium difficile at achievable colonic concentrations.	objectives the stationary phase of clostridium difficile, which is associated with the symptoms of the diarrhoeal disease, is refractory to antibiotic killing. the aim of this study was to explore whether probiotic-derived reutericyclin and related synthetic analogues could kill stationary phase c. difficile at concentrations achievable in the gastrointestinal tract. methods the bactericidal activities of reutericyclin and lead compound derivatives were examined against logarithmic and stationar ...	2011	21632577
use of modified pcr ribotyping for detection of clostridium difficile ribotypes directly in stool samples.	pcr ribotyping was modified to allow direct detection of clostridium difficile from stool samples. direct pcr ribotyping was possible in 86 out of 99 c. difficile positive stool samples and in 84 cases (84,8%) the ribotype determined directly from the stool sample was identical to the ribotype of the strain isolated from the same stool sample.	2011	21632902
prophylactic antibiotics for variceal hemorrhage: clostridium difficile infection still can be a risk.	bron et al presented a retrospective study regarding the prophylactic use of antibiotics for variceal hemorrhage. antibiotics appeared to improve the survival rate of patients without increasing clostridium difficile infection (cdi). we argue against the conclusion of the authors and consider that this result may be simply due to concurrent use of metronidazole, a therapeutic agent against cdi.	2011	21633604
isolation of the first three cases of clostridium difficile polymerase chain reaction ribotype 027 in singapore.	introduction: the incidence of clostridium (c.) difficile infection (cdi) was on the rise from 2001 to 2006 in singapore. recent unpublished data suggests that its incidence had remained stable or decreased in most local public hospitals between 2006 and 2010. it is, however, not known if the polymerase chain reaction (pcr) ribotype 027 strains have been circulating, although reports suggest that this strain is emerging in asia, with the first cases reported from japan in 2007, as well as in hon ...	2011	21633771
characterization of a sugar-o-methyltransferase tias5 affords new tiacumicin analogues with improved antibacterial properties and reveals substrate promiscuity.	the 18-membered macrocyclic glycoside tiacumicin b, an rna polymerase inhibitor, is of great therapeutic significance in treating clostridium difficile infections. the recent characterization of the tiacumicin b biosynthetic gene cluster from dactylosporangium aurantiacum subsp. hamdenensis nrrl 18085 revealed the functions of two glycosyltransferases, a c-methyltransferase, an acyltransferase, two cytochrome p450s, and a tailoring dihalogenase in tiacumicin biosynthesis. here we report the gene ...	2011	21633995
repeat stool testing to diagnose clostridium difficile infection using enzyme immunoassay does not increase diagnostic yield.	background & aims: clostridium difficile infection (cdi) is a hospital-acquired infection with increasing incidence and severity. the most frequently used test to diagnose cdi is an enzyme immunoassay (eia) for toxins a and b in stool samples. it is common to test 2 or more stool samples, based on the assumption that this detects cdi with greater sensitivity than analysis of 1 sample. we investigated whether repeat stool testing significantly improves the diagnostic yield for cdi. methods: we pe ...	2011	21635969
two-step algorithm for the detection of clostridium difficile from stool samples.		2011	21636166
evaluation of hospitalization for infections that are present on admission.	hospitals have experienced increasing requirements for public reporting of various infection rates using clinical and administrative data. until recently, such reports have not included analysis of "present on admission" (poa), an indicator designed to assess whether such infections are hospital acquired. the authors evaluated the frequency of the poa coding designation for 167 university healthsystem consortium hospitals for sepsis/septicemia (s-s), methicillin-resistant staphylococcus aureus ( ...	2011	21724961
differential risk of clostridium difficile infection with proton pump inhibitor use by level of antibiotic exposure.	purpose: clostridium difficile infection (cdi) is a major cause of hospital-acquired diarrhea worldwide. we examined the risk of cdi associated with the use of acid-suppressive agents (proton pump inhibitors [ppi] and histamine-2 receptor blockers) and determined whether this risk varied by number or type of antibiotic (high or low cdi risk) received during hospitalization. methods: we conducted a retrospective cohort study of hospitalizations among adult patients at an academic teaching hospita ...	2011	21833992
a role for tlr4 in clostridium difficile infection and the recognition of surface layer proteins.	clostridium difficile is the etiological agent of antibiotic-associated diarrhoea (aad) and pseudomembranous colitis in humans. the role of the surface layer proteins (slps) in this disease has not yet been fully explored. the aim of this study was to investigate a role for slps in the recognition of c. difficile and the subsequent activation of the immune system. bone marrow derived dendritic cells (dcs) exposed to slps were assessed for production of inflammatory cytokines, expression of cell ...	2011	21738466
laboratory diagnosis of clostridium difficile infection in spain: a population-based survey.	a survey of laboratory diagnosis of clostridium difficile infection (cdi) was conducted in 103 spanish hospitals. a mean of 23.2 stool specimens/1000 admissions were processed to detect cdi. overall, 35.9% of the laboratories specifically selected stool specimens for diagnostic c.-ádifficile toxin testing. the most commonly used criteria were loose or watery stools, previous antibiotic therapy and nosocomial diarrhoea. most laboratories (95.1%) processed the stool specimens in house, mainly five ...	2011	21741114
cholesterol- and sphingolipid-rich microdomains are essential for microtubule-based membrane protrusions induced by clostridium difficile transferase (cdt).	clostridium difficile toxin (cdt) is a binary actin-adp-ribosylating toxin that causes depolymerization of the actin cytoskeleton and formation of microtubule-based membrane protrusions, which are suggested to be involved in enhanced bacterial adhesion and colonization of hypervirulent c. difficile strains. here, we studied the involvement of membrane lipid components of human colon adenocarcinoma (caco-2) cells in formation of membrane protrusions. depletion of cholesterol by methyl-+¦-cyclodex ...	2011	21705797
epidemiology of suspected clostridium difficile-associated hospital-acquired diarrhea in hospitalized patients at siriraj hospital.	clostridium difficile-associated disease (cdad) is an important cause of hospital-acquired diarrhea.	2011	21721449
structural basis for a kolbe-type decarboxylation catalyzed by a glycyl radical enzyme.	4-hydroxyphenylacetate decarboxylase is a [4fe-4s] cluster containing glycyl radical enzyme proposed to use a glycyl/thiyl radical dyad to catalyze the last step of tyrosine fermentation in clostridia. the decarboxylation product p-cresol (4-methylphenol) is a virulence factor of the human pathogen clostridium difficile . here we describe the crystal structures at 1.75 and 1.81 +à resolution of substrate-free and substrate-bound 4-hydroxyphenylacetate decarboxylase from the related clostridium s ...	2011	21823587
recurrence of clostridium difficile infection after total colectomy in an allogeneic stem cell transplant patient.		2011	21691259
chapter 2-12-7. anaerobic infections (individual fields): antibiotic-associated diarrhea and enterocolitis.		2011	21728113
comparative effects of the immediate and the extended release formulations of ciprofloxacin on normal human intestinal microflora.	ciprofloxacin is a well-known fluoroquinolone, active in vitro against most gram-negative and gram-positive bacteria. the purpose of the present study was to evaluate the ecological effects of an orally administered extended-release formulation of ciprofloxacin in comparison with an immediate-release formulation of ciprofloxacin on the normal human intestinal microflora. thirty-six healthy female subjects were included in the study. the extended-release formulation of ciprofloxacin was given as ...	2011	21742583
impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of clostridium difficile infection.	objectives to evaluate the impact of an 'intervention' consisting of revised antibiotic guidelines for empirical treatment of common infections and enhanced stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of clostridium difficile infection (cdi). methods this was a retrospective, quasi-experimental study using interrupted time series (its) over 12 months before and after the intervention. the setting was adult medical and surgical wards in university hospital ...	2011	21676904
the intestinal microbiota and chronic disorders of the gut.	mucosal surfaces of the gut are colonized by large numbers of heterogeneous bacteria that contribute to intestinal health and disease. in genetically susceptible individuals, a 'pathogenic community' may arise, whereby abnormal gut flora contributes to alterations in the mucosa and local immune system leading to gastrointestinal disease. these diseases include enteric infections, such as clostridium difficile infection, small intestinal bacterial overgrowth, functional gastrointestinal disorders ...	2011	21844910
review article: faecal transplantation therapy for gastrointestinal disease.	evidence is emerging regarding the relationship between a dysbiosis of the human gut microbiota and a number of gastrointestinal diseases as well as diseases beyond the gut. probiotics have been investigated in many gastrointestinal disease states, with variable and often modest outcomes. faecal transplantation is an alternative approach to manipulate the gut microbiota.	2011	21682755
activities of a clostridium difficile infection reduction team.		2011	21719589
[left-sided ulcerative colitis reactivated and aggravated during clostridium difficile infection].	clostridium difficile (c. difficile) infection appears to be closely related to reactivation, diagnostic delay, and disease progression in patients with inflammatory bowel disease. however, whether c. difficile infection triggers the reactivation of inflammatory bowel disease or vice versa is not certain. we report a case of reactivated and progressed left ulcerative colitis following c. difficile infection in a 56-year-old woman. a series of endoscopic findings in this case report strongly supp ...	2011	21694491
[proton pump inhibitors and infection risk].	gastric antisecretory drugs, especially proton pump inhibitors, are among the most used drugs both in ambulatory and hospital settings, and prescription does not always follows approved indications. experimental data suggest that gastric acid inhibition and the effects of proton pump inhibitors on the immune system can promote the development of infections. in recent years a number of observational studies have found an independent association between the use of proton pump inhibitors and an inc ...	2011	21412664
the host immune response to clostridium difficile.	clostridium difficile is the most common cause of nosocomial bacterial diarrhoea in the western world. diarrhoea and colitis are caused by the actions of toxins a and b released by pathogenic strains of c. difficile. adaptive immune responses to these toxins influence the outcomes of c. difficile infection (cdi). symptomless carriers of toxinogenic c. difficile and those with a single episode of cdi without recurrence show more robust antitoxin immune responses than those with symptomatic and re ...	2011	21415200
characterization and antimicrobial susceptibility of clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in poland, 2004-2006.	this study analysed 330 clostridium difficile strains isolated from patients with c. difficile infection who were hospitalized in two university hospitals (h1 and h2) in warsaw, poland, over the period 2004-2006. strains were investigated for the presence of tcda (a), tcdb (b) and binary toxin (cdt) genes, and antimicrobial susceptibility was determined against nine agents. among the 330 c. difficile isolates, 150 (45.4?%) were classified as a(+)b(+)cdt(-), 18 (5.5?%) as a(+)b(+)cdt(+), 144 (43. ...	2011	21415206
antimicrobial photodynamic therapy in the colon: delivering a light punch to the guts?	a paper in this issue of photochemistry and photobiology by cassidy et al. describes the use of a sophisticated drug delivery vehicle prepared by the hot melt extrusion process to deliver photosensitizers to the colon. the smart vehicle protects its cargo through the acidic environment of the stomach but releases the active photosensitizers in the higher ph and anaerobic environment of the colon. the goal is to use photodynamic therapy (pdt) to destroy pathogenic microorganisms that can cause di ...	2011	21418077
increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients.	to explore the clinical impact and economic burden of hospital-acquired infections (hais) in trauma patients using a nationally representative database.	2011	21422331
primary human colonic myofibroblasts are resistant to clostridium difficile toxin a-induced, but not toxin b-induced, cell death.	colonic inflammation in clostridium difficile infection is mediated by released toxins a and b. we investigated responses to c. difficile toxins a and b by isolated primary human colonic myofibroblasts, which represent a distinct subpopulation of mucosal cells that are normally located below the intestinal epithelium. following incubation with either purified toxin a or b, there was a change in myofibroblast morphology to stellate cells with processes that were immunoreactive for alpha-smooth mu ...	2011	21245273
toll-like receptor 5 stimulation protects mice from acute clostridium difficile colitis.	clostridium difficile is a spore-forming bacterium that infects the lower intestinal tract of humans and is the most common known cause of diarrhea among hospitalized patients. clostridium difficile colitis is mediated by toxins and develops during or following antibiotic administration. we have used a murine model of c. difficile infection, which reproduces the major features of the human disease, to study the effect of innate immune activation on resistance to c. difficile infection. we found ...	2011	21245274
postantibiotic effect of fidaxomicin and its major metabolite, op-1118, against clostridium difficile.	fidaxomicin (fdx), a narrow-spectrum antibiotic recently shown to be superior to vancomycin in providing sustained clinical response to clostridium difficile infection, was investigated along with its major metabolite, op-1118, with regard to their postantibiotic effects (pae). fdx was found to have a prolonged pae (10 h versus atcc strains and 5.5 h versus a clinical isolate), and op-1118's pae was longer than that of the standard comparator, vancomycin (3 versus 0 to 1.5 h, respectively).	2011	21709084
clostridium difficile infection: monoclonal or polyclonal genesis?	clostridium difficile is considered to be a leading cause of hospital-acquired diarrhea. c. difficile (cdi) infection shows a high rate of recurrence. there would have to be a predominantly monoclonal mechanism of cdi within individual patients in order for molecular epidemiologic tools such as polymerase chain reaction (pcr) ribotyping to be useful in outbreak investigation or differentiation between infection relapse versus re-infection. it was the aim of our study to determine whether cdi is ...	2011	21826436
prevalence and genotypic characteristics of clostridium difficile in a closed and integrated human and swine population.	recently, an apparent rise in the number of cases attributed to community-acquired clostridium difficile infection has led researchers to explore additional sources of infection. the finding of c. difficile in food animals and retail meat has raised concern about potential food-borne and occupational exposures. the objective of this study was to compare c. difficile isolated from a closed population of healthy individuals consisting of both humans and swine in order to investigate possible food ...	2011	21724899
probiotics in the prevention of antibiotic-associated diarrhoea and clostridium difficile infection.	diarrhoea, as a common side effect of antibiotics, increases treatment costs and length of stay in acute healthcare facilities. one potential strategy to prevent this side effect is the concurrent use of probiotic bacteria or yeast. this review discusses the evidence for the efficacy of probiotics in the prevention of antibiotic-associated diarrhoea and clostridium difficile infection; the potential mechanisms by which probiotics may work; their safety; what future research is required; and reco ...	2011	21694803
immunization of hamsters against clostridium difficile infection using the cwp84 protease as an antigen.	clostridium difficile is a pathogen responsible for diarrhoea and colitis, particularly after antibiotic treatment. we evaluated the c. difficile protease cwp84, found to be associated with the s-layer proteins, as a vaccine antigen to limit the c. difficile intestinal colonization and therefore the development of the infection in a clindamycin-treated hamster model. first, we evaluated the immune response and the animal protection against death induced by several immunization routes: rectal, in ...	2011	21707776
comparative susceptibilities of fidaxomicin (opt-80) of isolates collected at baseline, recurrence, and failure from patients in two fidaxomicin phase iii trials of clostridium difficile infection.	background: a 10-day course of oral fidaxomicin (200 mg bid), a potent new macrocyclic drug, was compared to vancomycin (125 mg qid) in 1,164 adults (1,105 modified intention to treat (mitt) population ) with cdi in two phase 3 randomized, double-blind trials at sites in north america and 7 european countries. results: of 1,105 mitt patients: 792 (71.7%) including 719/999 (72.0%) of the per-protocol population (pp) provided a c. difficile strain at baseline of which 356 received fidaxomicin with ...	2011	21844318
impact of pcr testing for clostridium difficile on incident rates and potential on public reporting: is the playing field level?		2011	21828981
comparison of five assays for detection of clostridium difficile toxin.	performance characteristics of five assays for detection of clostridium difficile toxin were compared using fresh stool samples from patients with c. difficile infection (cdi). assays were performed simultaneously and according to the manufacturers' instructions. patients were included in the study if they exhibited clinical symptoms consistent with cdi. nonmolecular assays included glutamate dehydrogenase antigen tests, with positive findings followed by the premier toxin a and b enzyme immunoa ...	2011	21704273
emergency colectomy for fulminant clostridium difficile colitis: striking the right balance.	abstract the number of reported cases of clostridium difficile (cd) infections has increased markedly worldwide. cd causes a spectrum of clinical syndromes, ranging from mild diarrhea to a very severe illness in the form of pseudomembranous colitis (pmc), toxic megacolon, leading to colonic perforation, peritonitis, and even death. in today's practice, toxic megacolon is more often caused by pseudomembranous colitis than ulcerative colitis. there is urgent need to establish clear guidelines abou ...	2011	21843039
Over-diagnosis of Clostridium difficile.		2011	21831939
clostridium difficile disease and vancomycin--questionable clinical superiority.		2011	21690637
management of gram-positive bacterial infections in patients with cancer.	abstract bacterial infections, particularly those due to gram-positive bacteria, continue to predominate in patients with cancer. coagulase-negative and coagulase-positive staphylococci and enterococci remain as common pathogenic microorganisms. clostridium difficile has emerged as a significant pathogen. major clinical syndromes include vascular catheter-related infection, febrile neutropenia, diarrhea and colitis. rising antimicrobial resistance among gram-positive bacteria is of serious con ...	2011	21740298
Clostridium difficile Has an Original Peptidoglycan Structure with a High Level of N-Acetylglucosamine Deacetylation and Mainly 3-3 Cross-links.	The structure of the vegetative cell wall peptidoglycan of Clostridium difficile was determined by analysis of its constituent muropeptides with a combination of reverse-phase high pressure liquid chromatography separation of muropeptides, amino acid analysis, mass spectrometry and tandem mass spectrometry. The structures assigned to 36 muropeptides evidenced several original features in C. difficile vegetative cell peptidoglycan. First, it is characterized by a strikingly high level of N-acetyl ...	2011	21685382
Rifaximin: new therapeutic indication and future directions.	Rifaximin is a nonabsorbable oral antibiotic that acts locally in the gastrointestinal tract with minimal systemic adverse effects. Rifaximin received new labeling for reduction in the risk of the recurrence of overt hepatic encephalopathy (HE) in patients with advanced liver disease in March of 2010.	2011	21741091
improving surveillance for pediatric clostridium difficile infection: derivation and validation of an accurate case-finding tool.	the incidence of clostridium difficile infection (cdi) is increasing. multicenter studies of cdi have been limited by the lack of valid case-finding tools. to facilitate pediatric studies of cdi, we constructed a case-finding tool using administrative data.	2011	21079527
systemic absorption of oral vancomycin in patients with clostridium difficile infection.	oral vancomycin is utilized in the treatment of severe clostridium difficile infection (cdi). we prospectively measured serum vancomycin concentrations (svc) in patients treated with oral vancomycin. the svc was measured by immunoassay prior to, and at least 3 days after, the administration of oral vancomycin 125 mg every 6 h. patients treated with intravenous vancomycin were excluded. fifty-seven patients with a mean age of 74 y (± 18) were enrolled. there was no detectable svc in 56 patients ( ...	2011	21198337
rapid stool-based diagnosis of clostridium difficile infection by real-time pcr in a children's hospital.	clostridium difficile is a major cause of nosocomial antibiotic-associated infectious diarrhea and pseudomembranous colitis. detection of c. difficile by anaerobic bacterial culture and/or cytotoxicity assays has been largely replaced by rapid enzyme immunoassays (eia). however, due to the lack of sensitivity of stool eia, we developed a multiplex real-time pcr assay targeting the c. difficile toxin genes tcda and tcdb. stool samples from hospitalized pediatric patients suspected of having c. di ...	2011	21209161
insulin-like growth factor-1 receptor transactivation modulates the inflammatory and proliferative responses of neurotensin in human colonic epithelial cells.	neurotensin (nt) is a gastrointestinal neuropeptide that modulates intestinal inflammation and healing by binding to its high-affinity receptor ntr1. the dual role of nt in inflammation and healing is demonstrated in models of colitis induced by clostridium difficile toxin a and dextran sulfate sodium, respectively, and involves nf-κb-dependent il-8 expression and egf receptor-mediated mapk activation in human colonocytes. however, the detailed signaling pathways involved in these responses rema ...	2011	21212273
difference in the biological effects of clostridium difficile toxin b in proliferating and non-proliferating cells.	toxin a (tcda) and toxin b (tcdb) from clostridium difficile are the causative agents of the c. difficile-associated diarrhea (cdad) and its severe form, the pseudomembranous colitis. tcda and tcdb both glucosylate and thereby inactivate low molecular weight gtp-binding proteins of the rho, rac, and cdc42 subfamilies. in cultured cell lines, tcdb induces actin re-organization and bi-nucleation ("cytopathic effects") and cell death ("cytotoxic effects"). in this study, the role of cell cycle prog ...	2011	21212934
optical density cut-off values for clostridium difficile enzyme immunoassays.		2011	21216035
neutralization of clostridium difficile toxin a with single-domain antibodies targeting the cell receptor binding domain.	clostridium difficile is a leading cause of nosocomial infection in north america and a considerable challenge to healthcare professionals in hospitals and nursing homes. the gram-positive bacterium produces two high molecular weight exotoxins, toxin a (tcda) and toxin b (tcdb), which are the major virulence factors responsible for c. difficile-associated disease and are targets for c. difficile-associated disease therapy. here, recombinant single-domain antibody fragments (v(h)hs), which specif ...	2011	21216961
us fda grants fast-trackdesignation to sanofi pasteur's investigational clostridium difﬁcile vaccine.		2011	21217176
'game changer' antibiotic and others in works for superbug.		2011	21217660
clostridium difficile from healthy food animals: optimized isolation and prevalence.	two isolation methods were compared for isolation of clostridium difficile from food animal feces. the single alcohol shock method (ss) used selective enrichment in cycloserine-cefoxitin fructose broth supplemented with 0.1% sodium taurocholate, followed by alcohol shock and isolation on tryptic soy agar supplemented with 5% sheep blood, and cycloserine-cefoxitin fructose agar. the double alcohol shock method (ds) used alcohol shock prior to and after selective enrichment in cycloserine-cefoxiti ...	2011	21219775
infection acquisition following intensive care unit room privatization.	patients in intensive care units (icus) often acquire infections, which impose a heavy human and financial burden. the use of private rooms may reduce the acquisition of certain pathogens, but the limited evidence on this topic is inconsistent.	2011	21220658
[epidemiological aspects of gastrointestinal infections].	the aim of this study was to investigate seasonal patterns and age-associated trends of the main bacterial, viral, and parasitic enteric pathogens in southwest germany.	2011	21225552
[rifaximin--a non-resorbable antibiotic with many indications in gastroenterology].	rifaximin, a non-resorbable broadband antibiotic, was approved in germany 2 years ago for the treatment of traveller's diarrhoea caused by non-invasive enteropathogens. on account of the very good tolerance and the high efficacy against almost all enteropathogens this pharmaceutical, which has been available for 25 years, bears a high potential in many other indications which are currently under clinical investigations, including: symptomatic uncomplicated diverticular disease, clostridium diffi ...	2011	21225568
antimicrobial stewardship for inpatient facilities.	antibiotic stewardship aims to improve patient care and reduce unwanted consequences of antimicrobial overuse or misuse, including lowered efficacy, emergence of antimicrobial resistance, development of secondary infections, adverse drug reactions, increased length of hospital stay, and additional healthcare costs. recent guidelines make specific recommendations for the development of institutional programs to enhance antimicrobial stewardship. optimally, such programs should be comprehensive, m ...	2011	21225949
bacteraemia from an unrecognized source (occult bacteraemia) occurring during clostridium difficile infection.	the purpose of this investigation was to determine if disruption of the colonic epithelium during clostridium difficile infection (cdi) is associated with bacteraemia due to secondary bacterial invasion by enteric organisms.	2011	21231808
structural determinants for membrane insertion, pore formation and translocation of clostridium difficile toxin b.	clostridium difficile toxins a and b bind to eukaryotic target cells, are endocytosed and then deliver their n-terminal glucosyltransferase domain after processing into the cytosol. whereas glucosyltransferase, autoprocessing and cell-binding domains are well defined, structural features involved in toxin delivery are unknown. here, we studied structural determinants that define membrane insertion, pore formation and translocation of toxin b. deletion analyses revealed that a large region, cover ...	2011	21231971
epidemiology and risk factors for clostridium difficile infection in children.	pediatric clostridium difficile infection (cdi)-related hospitalizations are increasing. we sought to describe the epidemiology of pediatric cdi at a quaternary care hospital.	2011	21233782
does viral gastroenteritis really increase the reports of clostridium difficile infection?		2011	21239080
the impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals.	to determine the effect of enhanced cleaning of the near-patient environment on the isolation of hospital pathogens from the bed area and staff hands.	2011	21242793
clostridium difficile infection in hospitalized children in the united states.	to evaluate the trend in clostridium difficile infection (cdi) among hospitalized children in the united states and to evaluate the severity of and risk factors associated with these cases of cdi.	2011	21199971
beyond the target pathogen: ecological effects of the hospital formulary.	antibiotic therapy has the potential for intended as well as unintended consequences due to ecological effects that extend beyond the target pathogen. this review examines some of the collateral damage and collateral benefit that may occur when using antibiotic therapy.	2011	21200181
clostridium difficile infection among children with cancer.	we used data from the kids' inpatient database to examine clostridium difficile infection (cdi) among children with cancer. the cdi rate was 15 times greater among children with cancer compared with those without cancer. children with cancer accounted for 21% of all pediatric cdi cases. increased adherence to infection control recommendations is needed to address cdi in children with cancer.	2011	21206395
[public health surveillance and assessment of emerging infectious threats: method and criteria for risk analysis].	one of the objectives of the surveillance systems implemented by the french national institute for public health surveillance is to detect communicable diseases and to reduce their impact. for emerging infections, the detection and risk analysis pose specific challenges due to lack of documented criteria for the event. the surveillance systems detect a variety of events, or "signals" which represent a potential risk, such as a novel germ, a pathogen which may disseminate in a non-endemic area, o ...	2011	21251782
a proposed nomenclature for cell wall proteins of clostridium difficile.	strains of clostridium difficile produce a number of surface-localized proteins, including the s-layer proteins (slps) and other proteins that have suspected roles in pathogenesis. during the third international c. difficile symposium (bled, slovenia, september 2010) discussions were held on standardization of nomenclature. gene designations were proposed for the large family of cell wall proteins that are paralogues of the slp and contain putative cell wall binding motifs. this paper summarizes ...	2011	21252271
clostridium difficile infection causing multiple organ failure and small-bowel enteritis.		2011	21256103
histidine acts as a co-germinant with glycine and taurocholate for clostridium difficile spores.	aims: it is well established that the bile salt sodium taurocholate acts as a germinant for clostridium difficile spores and the amino acid glycine acts as a co-germinant. the aim of this study was to determine whether any other amino acids act as co-germinants. methods and results: clostridium difficile spore suspensions were exposed to different germinant solutions comprising taurocholate, glycine and an additional amino acid for 1 h before heating shocking (to kill germinating cells) or chi ...	2011	21261795
antimicrobial susceptibilities and molecular epidemiology of clinical isolates of clostridium difficile in taiwan.	the antimicrobial susceptibility and virulence factors of clostridium difficile clinical isolates in taiwan have not previously been reported. one hundred and thirteen isolates were collected from two major teaching hospitals in taiwan from 2001 to 2009. molecular typing was performed by an automated repetitive extragenic palindromic sequence-based pcr (rep-pcr) method (diversilab; bacterial barcodes, inc., athens, ga) and pcr ribotyping. detection of tcda, tcdb, cdta, and cdtb genes was perform ...	2011	21263053
probiotic cheese containing lactobacillus rhamnosus hn001 and lactobacillus acidophilus ncfm(®) modifies subpopulations of fecal lactobacilli and clostridium difficile in the elderly.	aging is associated with alterations in the intestinal microbiota and with immunosenescence. probiotics have the potential to modify a selected part of the intestinal microbiota as well as improve immune functions and may, therefore, be particularly beneficial to elderly consumers. in this randomized, controlled cross-over clinical trial, we assessed the effects of a probiotic cheese containing lactobacillus rhamnosus hn001 and lactobacillus acidophilus ncfm on the intestinal microbiota and feca ...	2011	21264685
adaptation of clostridium difficile toxin a for use as a protein translocation system.	a cellular delivery system is a useful biotechnology tool, with many possible applications. two derivatives of clostridium difficile toxin a (tcda) have been constructed (gfp-tcda and luc-tcda), by fusing reporter genes to functional domains of tcda, and evaluated for their ability to translocate their cargo into mammalian cells. the cysteine protease and receptor binding domains of tcda have been examined and found to be functional when expressed in the chimeric construct. whereas gfp failed to ...	2011	21266163
the morbidity of clostridium difficile infection after elective colonic resection-results from a national population database.	clostridium difficile (cd), a gram-positive rod bacterium, resides normally within the human colon. antibiotic treatment alters normal colonic flora, potentiating abnormal overgrowth of cd.	2011	21266214
down-regulation of interleukin-16 in human mast cells hmc-1 by clostridium difficile toxins a and b.	toxin a (tcda) and toxin b (tcdb) are the major virulence factors of clostridium difficile and are the causative agents for clinical symptoms, such as secretory diarrhoea and pseudomembranous colitis. mast cells are essentially involved in the toxin-induced colonic inflammatory processes. to study the direct effects of these toxins on the expression of inflammatory genes, a dna microarray containing evaluated probes of 90 selected inflammatory genes was applied to the immature mast cell line hmc ...	2011	21267712
use of antibacterial prophylaxis for patients with neutropenia. australian consensus guidelines 2011 steering committee.	the use of oral prophylactic antibiotics in patients with neutropenia is controversial and not recommended by this group because of a lack of evidence showing a reduction in mortality and concerns that such practice promotes antimicrobial resistance. recent evidence has demonstrated non-significant but consistent, improvement in all-cause mortality when fluoroquinolones (fqs) are used as primary prophylaxis. however, the consensus was that this evidence was not strong enough to recommend prophyl ...	2011	21272174
sporicides for clostridium difficile: the devil is in the detail.	a taskforce has now been formed with representatives from the department of health's advisory committee on antimicrobial resistance and healthcare associated infection (arhai), the hospital infection society (his), the department of health (england) and the health protection agency. the aims of the arhai/his taskforce on sporicidal disinfectants are: to develop an accepted standard for laboratory testing of disinfectants which claim to have activity against c. difficile spores; to develop a netw ...	2011	21277650