Publications

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a call to arms: the imperative for antimicrobial stewardship.antimicrobial resistance is a major public health crisis. the prevalence of drug-resistant organisms, such as the emerging nap1 strain of clostridium difficile, now highly resistant to fluoroquinolones, acinetobacter species, klebsiella pneumoniae carbapenemase-producing organisms, and methicillin-resistant staphylococcus aureus, is increasing nationwide. the sources of antimicrobial resistance are manifold, but there is a well-documented causal relationship between antimicrobial use and misuse ...201121795727
the insect peptide, coprisin, prevents clostridium difficile-mediated acute inflammation and mucosal damage through selective antimicrobial activity.clostridium difficile-associated diarrhea and pseudomembranous colitis are typically treated with vancomycin or metronidazole, but recent increases in relapse incidence and the appearance of drug-resistant strains of c. difficile indicate the need for new antibiotics. we previously isolated an antibacterial peptide from copris tripartitus, a korean dung beetle, and identified a nine-amino-acid peptide (coprisin: llcialrkk) that had antimicrobial activity. here, we examined whether coprisin treat ...201121807975
clostridium difficile-associated diarrhea in radiooncology: an underestimated problem for the feasibility of the radiooncological treatment?abstract: background and purpose: over the last years an increasing incidence of clostridium difficile-associated diarrhea (cdad) has been reported. especially haematology-oncology patients are at risk of developing cdad. the aim of this analysis is to determine the incidence of cdad in radiooncological patients and to find out what relevance cdad has for the feasibility of the radiooncological treatment, as well as to detect and describe risk factors. patients and methods: in a retrospective an ...201121806799
the interplay between microbiome dynamics and pathogen dynamics in a murine model of clostridium difficile infection.clostridium difficile infection (cdi) arises in the setting of antibiotic administration where disruption of the normal indigenous gut microbiota leads to susceptibility to c. difficile colonization and colitis. using a murine model of cdi, we demonstrate that changes in the community structure of the indigenous gut microbiota are associated with the loss of colonization resistance against c. difficile. several antibiotic regimens were tested in combination for the ability to overcome colonizati ...201121804357
both, toxin a and toxin b, are important in clostridium difficile infection.the bacterium clostridium difficile is the leading cause of healthcare associated diarrhoea in the developed world and thus presents a major financial burden. the main virulence factors of c. difficile are two large toxins, a and b. over the years there has been some debate over the respective roles and importance of these two toxins. to address this, we recently constructed stable toxin mutants of c. difficile and found that they were virulent if either toxin a or toxin b was functional. this u ...201121804353
disinfection methods for spores of bacillus atrophaeus, b. anthracis, clostridium tetani, c. botulinum and c. difficile.to evaluate disinfection methods for environments contaminated with bioterrorism-associated microorganism (bacillus anthracis), we performed the following experiments. first, the sporicidal effects of sodium hypochlorite on spores of five bacterial species were evaluated. bacillus atrophaeus was the most resistant to hypochlorite, followed in order by b. anthracis, clostridium botulinum and clostridium tetani, and clostridium difficile. subsequently, using b. atrophaeus spores that were the most ...201121804226
structure-based modification of a clostridium difficile targeting endolysin affects activity and host range.endolysin cd27l causes cell lysis of the pathogen c. difficile, a major cause of nosocomial infection. we report a structural and functional analysis of the catalytic activity of cd27l against c. difficile and other bacterial strains. we show that truncation of the endolysin to the n-terminal domain cd27l(1-179) gave an increased lytic activity against cells of c. difficile, while the c-terminal region cd27l(180-270) failed to produce lysis. cd27l(1-179) also has increased activity against other ...201121803993
evaluation of the sporicidal activity of different chemical disinfectants used in hospitals against clostridium difficile.decontamination of surfaces and medical equipment is integral to the control of clostridium difficile transmission, and many products claim to inactivate this bacterium effectively. thirty-two disinfectants were tested against spores of c. difficile in a suspension test based on european standard bs en 13704:2002, with contact times of 1 and 60min in simulations of clean (0.3% albumin) and dirty (3% albumin) conditions. the addition of a 1-min contact time was chosen as a more realistic simulati ...201121802172
fidaxomicin-the next step? a new narrow-spectrum macrocyclic antibiotic for the management of clostridium difficile infection. 201121801724
mortality and associated risk factors in consecutive patients admitted to a uk nhs trust with community acquired bacteraemia.purpose within the uk, there is lack of contemporary data on clinical outcomes in patients admitted to hospital with severe community acquired infection. the purpose of this study was to determine outcomes and risk factors associated with mortality in consecutive patients admitted to a uk nhs trust with community acquired infections that cause bacteraemia. methods from september 2007 to august 2008, demographic, clinical and microbiological data were collected on patients with laboratory confirm ...201121798969
high alpha-1 antitrypsin clearance predicts severity of gut graft-versus-host disease (gvhd) in children.hagen lem, schechter t, luk y, brodovitch a, gassas a, doyle jj. high alpha-1 antitrypsin clearance predicts severity of gut graft-versus-host disease (gvhd) in children. pediatr transplantation 2011. © 2011 john wiley & sons a/s. abstract: the clinical evaluation and management of gut gvhd is a significant challenge in pediatric hsct. it is often difficult to obtain pathological evidence to confirm diagnosis and/or to determine response to treatment. the severity of the disease itself may not ...201121797957
expression, purification, crystallization and preliminary crystallographic analysis of a putative clostridium difficile surface protein cwp19.cwp19 is a putatively surface-located protein from clostridium difficile. a recombinant n-terminal protein (residues 27-401) lacking the signal peptide and the c-terminal cell-wall-binding repeats (pfam04122) was crystallized using the sitting-drop vapour-diffusion method and diffracted to 2 å resolution. the crystal appeared to belong to the primitive monoclinic space group p2(1), with unit-cell parameters a = 109.1, b = 61.2, c = 109.2 å, ß = 111.85°, and is estimated to contain two molecules ...201121795789
a clostridium difficile infection "intervention": change in toxin assay results in fewer c difficile infection cases without changes in patient outcomes.background: clostridium difficile infection (cdi) is most commonly diagnosed using toxin enzyme immunoassays (eias). a sudden decrease in cdi incidence was noted after a change in the eia used at barnes-jewish hospital in st louis. the objective of this study was to determine whether the decreased cdi incidence related to the change in eia resulted in adverse patient outcomes. methods: electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients ...201121794950
[risk factors for clostridium difficile infections in hospitalized patients.]background and objectives: to identify risk factors, and to estimate the crude effects attributable to hospital acquired clostridium difficile infection (cdi). patients and methods: case-control study matched by age, gender, and admission date. patient and healthcare risk factors were evaluated. hospital stays and mortality were compared. results: thirty-eight cases and 76 controls were included (mean age 73 years). cases presented worse charlson index (p .02), higher pre-infection stay (median ...201121794881
impact of a multipronged education strategy on antibiotic prescribing in quebec, canada.background. antibiotic overuse and resistance have become a major threat in the last 2 decades. many programs tried to optimize antibiotic consumption in the inpatient setting, but the outpatient environment that represents the bulk of antibiotic use has been challenging. following a significant rise of clostridium difficile infections, all the health care stakeholders in the province of quebec, canada initiated a global education program targeting physicians and pharmacists. methods. a bundle a ...201121791439
clostridium difficile and methicillin-resistant staphylococcus aureus shedding by slaughter-age pigs.abstract: background: clostridium difficile and methicillin-resistant staphylococcus aureus are critical human pathogens and of increasing concern in food animals. because of the apparent impact of age on prevalence of these organisms, studies of slaughter age pigs are important when considering the potential for contamination of food. this study evaluated c. difficile and mrsa shedding by slaughter age pigs from farms across canada. results: clostridium difficile was isolated from 30/436 (6.9%) ...201121791057
update on the management of ulcerative colitis.the treatment options for inflammatory bowel disease have expanded with the introduction of biological therapies. recently published controlled clinical trials were searched and those that impact the clinical management of ulcerative colitis (uc) are discussed in this review. in the management of mild to moderate uc, mesalamine still remains the first choice of drug. the newly developed once daily formulations have shown equal efficacy to divided doses and possibly portend better compliance owin ...201121789495
mutagenic analysis of the clostridium difficile flagellar proteins, flic and flid, and their contribution to virulence in hamsters.although toxins a and b are known to be important contributors to the acute phase of clostridium difficile infection (cdi), the role of colonization and adherence to host tissues in the overall pathogenesis of these organisms remains unclear. consequently, we used the recently introduced intron-based clostron gene interruption system to eliminate the expression of two reported c. difficile colonization factors, the major flagellar structural subunit (flic) and the flagellar cap protein (flid), t ...201121788384
role of faecal gas analysis for the diagnosis of ibd.the diagnosis of ibd (inflammatory bowel disease) is based on the clinical evaluation of symptoms and signs leading to a series of investigations. the investigations used are often unpleasant for patients; they are invasive, costly and potentially dangerous. patients often report that the odour of flatus, or the gas emitted from faeces, is abnormal during a flare of their ibd. our group has characterized the vocs (volatile organic compounds) in the headspace gas emitted from faecal samples from ...201121787351
a quantitative proteomic analysis of the heat stress response in <i>clostridium difficile</i> strain 630.<i>clostridium difficile</i> is a serious nosocomial pathogen whose prevalence worldwide is increasing. post genomic technologies can now be deployed in order to develop understanding of the evolution and diversity of this important human pathogen, yet little is known about the adaptive ability of <i>c. difficile</i>. we used itraq labelling and 2d-lc-ms/ms driven proteomics to investigate the response of <i>c. difficile</i> 630 to a mild, but clinically relevant heat stress. a statistically val ...201121786815
localization of the clostridium difficile cysteine protease cwp84 and insights into its maturation process.clostridium difficile is a nosocomial pathogen involved in antibiotic-associated diarrhea. c. difficile expresses a cysteine protease, cwp84, which has been shown to degrade some proteins of the extracellular matrix and play a role in the maturation of the precursor of the s-layer proteins. we sought to analyze the localization and the maturation process of this protease. two identifiable forms of the protease were found to be associated in the bacteria: a form of about 80 kda and a cleaved one ...201121784932
the relation between farm specific factors and prevalence of clostridium difficile in slaughter pigs.foodborne ingestion through pork products of clostridium difficile has been suggested a possible route of transmission of c difficile from pigs to humans. to determine whether c. difficile bacteria are present in the intestines of slaughter pigs, rectum contents of 677 slaughter pigs from 52 farms were collected at the slaughterhouse. data on farm specific factors were collected and the association of these factors with the presence of c. difficile in pig herds from 39 farms was assessed. the pr ...201121783332
direct detection of clostridium difficile 027 in diarrhoeal stool samples. 201121783275
emergence of clostridium difficile ribotype 027 in korea.clostridium difficile infection (cdi) has markedly risen and is associated with hypervirulent ribotype 027 outbreaks in north america and europe since 2003. the aims of this study were to determine the prevalence of ribotype 027 among c. difficile isolates in korea, to characterize the ribotype 027 isolates, and to determine the clinical severity of cdi in patients infected with these isolates.201121779194
the impact of recombination on dn/ds within recently emerged bacterial clones.the development of next-generation sequencing platforms is set to reveal an unprecedented level of detail on short-term molecular evolutionary processes in bacteria. here we re-analyse genome-wide single nucleotide polymorphism (snp) datasets for recently emerged clones of methicillin resistant staphylococcus aureus (mrsa) and clostridium difficile. we note a highly significant enrichment of synonymous snps in those genes which have been affected by recombination, i.e. those genes on mobile elem ...201121779170
comparison of a commercially available rep-pcr system (diversilab(r)) with pcr-ribotyping for typing of clostridium difficile strains.this study compared a rep-pcr method (diversilab® system) to pcr-ribotyping. the discriminatory power of rep-pcr was 0.997. among the pcr-ribotype 027, different rep-types could be distinguished. rep-pcr showed a higher discriminatory power than pcr-ribotyping. nevertheless, this method requires technical skill and visual interpretation of rep-pcr fingerprint patterns may be difficult.201121775548
at least it won't hurt: the personal risks of antibiotic exposure.this review presents recent evidence regarding the adverse effects of antibiotic therapy mediated by collateral damage to commensal flora. two major drivers have characterized recent research in this field: new perspectives into human microbiota afforded by next-generation dna sequencing techniques and ongoing attention to antimicrobial resistance. new molecular techniques have illustrated that antibiotic therapy can disturb human microbiota, and that these changes are associated with infection. ...201121775205
spread and persistence of clostridium difficile spores during and after cleaning with sporicidal disinfectants. 201121775017
laboratory diagnosis of clostridium difficile infection: in a state of transition or confusion or both? 201121775016
multidrug resistance in european clostridium difficile clinical isolates.objectives multidrug resistance and antibiotic resistance mechanisms were investigated in 316 clostridium difficile clinical isolates collected during the first european surveillance on c. difficile in 2005. methods mics of eight different antibiotics were determined using etest. reserpine- and carbonyl cyanide m-chlorophenylhydrazone-sensitive efflux was tested using the agar dilution method. molecular analysis of the resistance mechanisms was performed using pcr assays, pcr mapping and sequenc ...201121771851
awareness about clostridium difficile infection among internal medicine residents in the united states.clostridium difficile infection (cdi) is the leading infective cause of antibiotic associated diarrhea. the principal objective of this study was to assess the knowledge and awareness of internal medicine (im) residents regarding the epidemiology, clinical recognition, diagnosis and management of cdi.201121769073
terminal decontamination of patient rooms using an automated mobile uv light unit.objective. to determine the ability of a mobile uv light unit to reduce bacterial contamination of environmental surfaces in patient rooms. methods. an automated mobile uv light unit that emits uv-c light was placed in 25 patient rooms after patient discharge and operated using a 1- or 2-stage procedure. aerobic colony counts were calculated for each of 5 standardized high-touch surfaces in the rooms before and after uv light decontamination (uvld). clostridium difficile spore log reductions ac ...201121768755
membrane translocation of binary actin-adp-ribosylating toxins from clostridium difficile and clostridium perfringens is facilitated by cyclophilin a and hsp90.some hypervirulent strains of clostridium difficile produce the binary actin-adp-ribosylating toxin cdt in addition to the rho-glucosylating toxins a and b. it has been suggested that the presence of cdt increases the severity of the c. difficile-associated diseases including pseudomembranous colitis. cdt contains a binding and translocation component cdtb, which mediates the transport of the separate enzyme component cdta into the cytosol of target cells, where cdta modifies actin. here, we hav ...201121768281
pneumocystis carinii interactions with lung epithelial cells and matrix proteins induce expression and activity of the pcste20 kinase with subsequent phosphorylation of the downstream cell wall biosynthesis kinase pccbk1.eukaryotic cell proliferation and phenotype are highly regulated by contact dependent mechanisms. we have previously shown that the binding and interaction of the opportunistic fungal pathogen pneumocystis carinii (pc) to lung epithelial cells and extracellular matrix proteins induces mrna expression of both the map kinase pcste20 and the cell wall remodeling enzyme pccbk1 (16). herein, we report that in addition to up-regulation of pcste20 mrna expression, pneumocystis pcste20 kinase activity i ...201121768277
clostridium difficile infection after malaria chemoprophylaxis with doxycycline: is there an association?malaria chemoprophylaxis with doxycycline is commonly used in the united kingdom and in many other countries. it is considered to be associated with an increased risk of clostridium difficile associated diarrhea (cdad). we describe a case of diarrhea and a positive stool assay for c. difficile in a returning traveler, and review available literature. the commonly held concept of an association between doxycycline chemoprophylaxis and cdad is not supported by available data.201121767993
reproducibility of broth microdilution and comparison to agar dilution for testing cb-183,315 against clinical isolates of clostridium difficile.this study evaluated the reproducibility and agreement of broth microdilution to agar dilution (ad) for testing cb-183,315, a novel lipopeptide antibiotic for clostridium difficile. reproducibility was 100% within ± one 2-fold dilution for 10 strains tested; agreement was 90-95% within one 2-fold dilution with ad for 103 clinical isolates.201121767714
best strategies in recurrent or persistent clostridium difficile infection.abstract background: clostridium difficile infection (cdi) is the primary cause of antibiotic-associated colitis and 15-25% of nosocomial antibiotic-associated diarrhea. its clinical manifestations can range from mild diarrhea to toxic megacolon, bowel perforation, septic shock, and death. over the past decade, more virulent strains have become increasingly common causes, and the incidence of cdi has risen, especially in elderly patients. these developments have led to an increase in recurrent c ...201121767157
clostridium difficile: trouble for adults and children. 201121765334
clinical and infection control implications of clostridium difficile infection with negative enzyme immunoassay for toxin.in a prospective study of 132 patients with a diagnosis of clostridium difficile infection (cdi) by polymerase chain reaction, 43 (32%) had enzyme immunoassay (eia) results negative for toxin. eia-negative patients with cdi did not differ in clinical presentation from eia-positive patients and presented a similar risk for transmission of spores.201121765078
impact of changes in clostridium difficile diagnostic testing on detection of c. difficile infection and all england mandatory surveillance data.following the report of the centre for evidence-based purchasing, which suggested poor performance of clostridium difficile testing kits, revised guidance was issued by the department of health (england) recommending a two-test algorithm. the aim of this study was to survey english national health service (nhs) diagnostic microbiology laboratories using an electronic questionnaire to investigate changes in laboratory procedures in response to the guidance and model the impact these changes had o ...201121764171
incidence of and risk factors for community-associated clostridium difficile infection: a nested case-control study.abstract: background: clostridium difficile is the most common cause of nosocomial infectious diarrhea in the united states. however, recent reports have documented that c. difficile infections (cdis) are occurring among patients without traditional risk factors. the purpose of this study was to examine the epidemiology of ca-cdi, by estimating the incidence of ca-cdi and ha-cdi, identifying patient-related risk factors for ca-cdi, and describing adverse health outcomes of ca-cdi. methods: we co ...201121762504
genome mining for radical sam protein determinants reveals multiple sactibiotic-like gene clusters.thuricin cd is a two-component bacteriocin produced by bacillus thuringiensis that kills a wide range of clinically significant clostridium difficile. this bacteriocin has recently been characterized and consists of two distinct peptides, trnβ and trnα, which both possess 3 intrapeptide sulphur to α-carbon bridges and act synergistically. indeed, thuricin cd and subtilosin a are the only antimicrobials known to possess these unusual structures and are known as the sactibiotics (sulplur to alpha ...201121760885
novel inhibitors of surface layer processing in clostridium difficile.clostridium difficile, a leading cause of hospital-acquired bacterial infection, is coated in a dense surface layer (s-layer) that is thought to provide both physicochemical protection and a scaffold for host-pathogen interactions. the key structural components of the s-layer are two proteins derived from a polypeptide precursor, slpa, via proteolytic cleavage by the protease cwp84. here, we report the design, synthesis and in vivo characterization of a panel of protease inhibitors and activity- ...201121752656
[the use of immunoglobulins in the treatment of infectious diseases].the use of immunoglobulins in the treatment of infectious diseases has a long tradition. initially immunoglobulins from hyperimmunised animals were used for their antitoxic and antimicrobial activity. the development of preparations of human intravenous immunoglobulin (ivig) and the observations of their long-term use enabled to assess their usefulness in the treatment of the diseases of proven or probable infectious etiology. in the treatment of infectious diseases ivig are currently used as im ...201121751556
[the disease caused by clostridium difficile in geriatric patients].the disease caused by the bacterium clostridium difficile/clostridium difficile associated disease/diarrhoea (cdad) is becoming a serious problem especially in geriatric patients, who are now relatively often treated by broad-spectrum antibiotics. the goal of our study was to evaluate the occurrence of the risk factors and to evaluate the complex of relations and coherence which lead to the cdad disease in a selected group of seniors treated at our institution.201121751507
binary toxin and death after clostridium difficile infection.we compared 30-day case-fatality rates for patients infected with clostridium difficile possessing genes for toxins a and b without binary toxin (n = 212) with rates for patients infected with c. difficile possessing genes for a, b, and binary toxin. the latter group comprised patients infected with strains of pcr ribotype 027 (cd027, n = 193) or non-027 (cd non-027, n = 72). patients with binary toxin had higher case-fatality rates than patients without binary toxin, in univariate analysis (rel ...201121749757
epidemic strains of clostridium difficile are present in auckland, new zealand. 201121747433
molecular epidemiology and susceptibility profiles of clostridium difficile in new zealand, 2009.the aim of this study was to provide baseline information on the molecular epidemiology and the antimicrobial susceptibility of clostridium difficile (c. difficile) clinical isolates from patients throughout new zealand.201121747423
identification of a novel virulence factor in clostridium difficile modulating toxin sensitivity of cultured epithelial cells.two glucosylating toxins named toxins a and b play a role in pathogenesis of clostridium difficile infection. the interaction of the toxins with host cell factors proceeds to downstream stages of cytotoxic effects in cells, in which involvement of other c. difficile factors remains unknown. we utilized culture filtrate of c. difficile with a low dilution to characterize the influence of putative minor proteins on the organization of the actin cytoskeleton in cultured epithelial cells and found a ...201121746858
clinical features of clostridium difficile infection and molecular characterization of the isolated strains in a cohort of danish hospitalized patients.the purpose of this study was to compare clinical features of clostridium difficile infection (cdi) to toxin gene profiles of the strains isolated from danish hospitalized patients. c. difficile isolates were characterized by pcr based molecular typing methods including toxin gene profiling and analysis of deletions and truncating mutations in the toxin regulating gene tcdc. clinical features were obtained by questionnaire. thirty percent of the cdi cases were classified as community-acquired. i ...201121744281
marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research.to estimate the relative inpatient costs of hospital-acquired conditions.201121719478
use of antimicrobials for eus-guided fna of pancreatic cysts: a retrospective, comparative analysis.pancreatic cystic lesions present a challenge for patients and physicians alike. morphology alone is inaccurate in discriminating lesion pathology, and use of eus-guided fna (eus-fna) improves accuracy. current american society for gastrointestinal endoscopy guidelines recommend prophylactic antibiotics during fna of cystic lesions to minimize infection risk. however, evidence pertaining to infection risk has been conflicting. the use of prophylactic antibiotics might not be free of other advers ...201121704808
pcr ribotype prevalence and molecular basis of macrolide-lincosamide-streptogramin b (mlsb) and fluoroquinolone resistance in irish clinical clostridium difficile isolates.background antimicrobial use is recognized as a risk factor for clostridium difficile infection (cdi) and outbreaks. we studied the relationship between pcr ribotype, antimicrobial susceptibility and the genetic basis of resistance in response to exposure to antimicrobial agents. methods c. difficile isolates were cultured from 133 cdi patients for whom recent antimicrobial drug exposure had been recorded. isolates were ribotyped by pcr and assessed for their susceptibility to the macrolide-linc ...201121712239
current use for old antibacterial agents: polymyxins, rifamycins, and aminoglycosides.this article reviews three classes of antibacterial agents that are uncommonly used in bacterial infections and therefore can be thought of as special-use agents. the polymyxins are reserved for gram-negative bacilli that are resistant to virtually all other classes of drugs. rifampin is used therapeutically, occasionally as a companion drug in treatment of refractory gram-positive coccal infections, especially those involving foreign bodies. rifaximin is a new rifamycin that is a strict enteric ...201121679793
evaluation of a simultaneous detection kit for the glutamate dehydrogenase antigen and toxin a/b in feces for diagnosis of clostridium difficile infection.rapid detection kits for toxin a/b in feces are widely used as a diagnostic tool for clostridium difficile infection (cdi). their low sensitivity, however, has been considered a problem. in this study, we evaluated a new rapid diagnostic kit for simultaneous detection of the glutamate dehydrogenase (gdh) antigen and toxin a/b, c. diff quik chek complete. a total of 60 stool specimens from 60 patients with antibiotic-associated diarrhea were examined. using c. difficile culture as the reference m ...201121725661
vancomycin "telephone". 201121690636
risk factors for recurrence of clostridium difficile infection: effect of vancomycin-resistant enterococci colonization.recurrent clostridium difficile infection (cdi) is one of the most difficult problems in healthcare infection control. we evaluated the risk factors associated with recurrence in patients with cdi. a retrospective cohort study of 84 patients with cdi from december 2008 through october 2010 was performed at pusan national university yangsan hospital. recurrence occurred in 13.1% (11/84) of the cases and in-hospital mortality rate was 7.1% (6/84). stool colonization with vancomycin-resistant enter ...201121738336
bacteria as trigger for chronic gastrointestinal disorders.apart from acute infections, microorganisms may also induce or perpetuate chronic inflammatory diseases and reversible or irreversible proliferation of various cells in the gastrointestinal tract (the extreme being adenocarcinoma and lymphoma). helicobacter pylori is not only involved in the pathogenesis of lymphoma and gastric adenocarcinoma. the steps and mechanisms of the carcinogenic process involve host predisposition, environmental factors, and strain virulence. the steps of lymphoma genes ...201121734380
increased health burden associated with clostridium difficile diarrhoea in inflammatory bowel disease. 201121726248
proton pump inhibitor-associated pneumonia: not a breath of fresh air after all?over the past two decades, proton pump inhibitors (ppis) have emerged as highly effective and relatively safe agents for the treatment of a variety of gastrointestinal disorders. unfortunately, this desirable pharmacological profile has also contributed to superfluous and widespread use in both the inpatient and outpatient settings. while generally well-tolerated, research published over the last decade has associated these agents with increased risks of clostridium difficile disease, fractures ...201121731913
neuroleptic malignant syndrome with metoclopramide overdose coexisting with clostridium difficile diarrhea. 201121688103
inhibition of the cytotoxic effect of clostridium difficile in vitro by clostridium butyricum miyairi 588 strain.in contrast to most modern pharmaceuticals, probiotics are used in many parts of the world with little or no research data on the complex system of interactions that each strain may elicit in the human body. research on probiotics has recently become more essential as probiotics have begun to be prescribed by clinicians as an alternative for some gut infections, especially when antibiotics are contraindicated. in this study, we attempt to elucidate the inhibitory interaction between the japanese ...201121700738
high horn's index score predicts poor outcomes in patients with clostridium difficile infection.several variables have been proposed to predict the prognosis of patients with clostridium difficile infection (cdi), but a clinically useful tool to stratify resource utilization has not been determined. horn's index, a severity score based on underlying clinical illness, reliably predicts patients at high risk of cdi. the purpose of this study was to assess the use of horn's index to stratify patients with cdi at high risk of poor clinical and economic outcomes. hospitalized patients diagnosed ...201121700363
procalcitonin-guided antibiotic therapy for chronic obstructive pulmonary disease exacerbations.the aim of this article is to review the current literature examining the use of procalcitonin-guided antibiotic therapy for management of chronic obstructive pulmonary disease (copd) exacerbations. procalcitonin is a serum marker that rises in response to bacterial infections, but remains low in nonbacterial infections and other proinflammatory conditions. to date, there are four randomized clinical trials which compare procalcitonin-guided antibiotic therapy to standard therapy in patients wit ...201121692680
diagnostic testing for clostridium difficile: a comprehensive survey of laboratories in england.recent studies have shown poor performance of commonly used toxin enzyme immunoassays (eias) for laboratory testing for clostridium difficile infection (cdi). in 2009-2010, the uk health protection agency and the european society of clinical microbiology and infectious diseases stated that toxin eia testing alone is suboptimal, and recommended a two-step testing protocol (i.e. screening with one method and confirming the results with another method). all acute english national health service tru ...201121724296
clostridium difficile outbreak strain bi is highly endemic in chicago area hospitals.objective.ôçâdescribe the clinical and molecular epidemiology of incident clostridium difficile infection (cdi) cases in chicago area acute healthcare facilities (hcfs). design and setting.ôçâlaboratory, clinical, and epidemiologic information was collected for patients with incident cdi who were admitted to acute hcfs in february 2009. stool cultures and restriction endonuclease analysis typing of the recovered c. difficile isolates was performed. patients.ôçâtwo hundred sixty-three patients fr ...201121828970
[apoptosis-inducing effect of clostridium difficile toxin a on k562 cells and its mechanism].this study was purposed to investigate the growth inhibition and apoptosis-inducing effect of clostridium difficile toxin a (tcda) on the leukemia cell line k562. the proliferative activity of k562 cells exposed to tcd a was tested by mtt assay, cell apoptosis was detected by flow cytometry; immunocytochemistry and colorimetric assay were employed to detect the protein expressions of bcl-2/bax and the activity of caspase-3, respectively. the results indicated that the proliferation of k562 cells ...201121729540
clostridium difficile colitis: factors associated with outcome and assessment of mortality at a national level.previous descriptions of clostridium difficile colitis (cdc) epidemics may overestimate cost and mortality of cdc.201121720924
clostridium difficile laboratory testing in australia and new zealand: national survey results and australasian society for infectious diseases recommendations for best practice.in order to improve the future reliability of surveillance for clostridium difficile infection (cdi), an australia/new zealand-wide survey was conducted to examine methods of laboratory diagnosis in use, identify deficiencies in practice and burden of cdi.201121716158
detection of clostridium difficile and salmonella in feral swine population in north carolina.we sampled 161 feral pigs in eastern north carolina, usa, to determine the prevalence and antimicrobial resistance profile of clostridium difficile and salmonella. seven (4.4%) and eight (5.0%) pigs tested positive for c. difficile and salmonella, respectively, highlighting the importance of determining the epidemiology of these pathogens in feral pigs.201121719851
what would we do without metronidazole?metronidazole is a treatment of choice for several types of infections, but coexisting conditions or concomitant medications may preclude its use. although tinidazole, a newer nitroimidazole, may be an option in cases where drug interactions make the use of metronidazole inadvisable, similar absolute contraindications exist. in situations where nitroimidazole use is contraindicated or inadvisable, clinicians may have difficulty deciding on efficacious treatment options. for the treatment of tric ...201121817887
pyrosequencing-based molecular monitoring of the intestinal bacterial colonization in preterm infants.objectives:: to investigate the previously unexplored diversity of neonatal intestinal microbiota and monitor early intestinal colonization patterns in korean preterm infants using high-throughput pyrosequencing technology combined with 16s rdna- based molecular methods methods:: a total of 46,369 partial 16s rdna sequences obtained from 30 fecal samples serially taken from 10 very low birth weight preterm infants were analyzed. results:: a significant proportion of the molecular species (21.9%) ...201121734604
biology of clostridium difficile: implications for epidemiology and diagnosis.clostridium difficile is an anaerobic, spore-forming, gram-positive rod that causes a spectrum of antibiotic-associated colitis through the elaboration of two large clostridial toxins and other virulence factors. since its discovery in 1978 as the agent responsible for pseudomembranous colitis, the organism has continued to evolve into an adaptable, aggressive, hypervirulent strain. advances in molecular methods and improved animal models have facilitated an understanding of how this organism su ...201121682645
right lower quadrant abdominal pain in an immunocompromised patient: importance for an urgent diagnosis and treatment.this is a case of a 34 years old male hispanic patient with history of aids who presented to the er with severe right lower quadrant abdominal pain of three days of evolution, associated with fever, chills, nausea, vomiting, watery diarrhea, weakness and general malaise. acute appendicitis, clostridium difficile colitis and ischemic colitis were the most important clinical conditions to consider in the differential diagnosis. abdominal ct with iv contrast demonstrated thickening of the ascending ...201121696104
efficacy of fidaxomicin versus vancomycin as therapy for clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections.background.ôçâtreatment guidelines recommend stopping all implicated antibiotics at the onset of clostridium difficile infection (cdi), but many individuals have persistent or new infections necessitating the use of concomitant antibiotics (cas). we used data from 2 phase 3 trials to study effects of cas on response to fidaxomicin or vancomycin. methods.ôçâsubjects with cdi were treated for 10 days with fidaxomicin 200 mg every 12 hours or vancomycin 125 mg every 6 hours, assessed for resolution ...201121844027
endoscopic fecal microbiota transplantation: "first-line" treatment for severe clostridium difficile infection? 201121716124
tigecycline for the treatment of severe clostridium difficile infection.to evaluate the evidence for the use of tigecycline in the treatment of clostridium difficile infection (cdi).201121730279
the impact of practice environment on laparoscopic colectomy utilization following colorectal residency: a survey of the ascrs young surgeons.aim:ôçé it is often thought that practice patterns are different in private (pp) versus university hospital (uh) settings. we aimed to describe the impact of practice environment on the type of laparoscopic colectomy procedures performed by graduating colorectal surgeons. method:ôçé a review was carried out of prospectively gathered self-reported questionnaire data. graduates of ascrs approved colorectal residencies from 2004-2008 underwent an on-line survey, developed by the ascrs young surgeon ...201121689306
busulfan and metronidazole: an often forgotten but significant drug interaction.to report the case of a clinically significant drug interaction between intravenous busulfan and oral metronidazole observed through busulfan therapeutic drug monitoring (tdm).201121730282
lack of effect of strain type on detection of toxigenic clostridium difficile by glutamate dehydrogenase and polymerase chain reaction.glutamate dehydrogenase (gdh) is popular as a preliminary test for the detection of clostridium difficile. recent work has suggested that gdh sensitivity may vary according to ribotype and may be lower for ribotypes 002, 027, and 106 compared with polymerase chain reaction (pcr). we investigated this effect using a dilution series of 64 isolates tested by gdh and cepheid genexpert pcr. pcr was significantly more sensitive than gdh overall; however, there was no difference in detection according ...201121683272
unnecessary use of fluoroquinolone antibiotics in hospitalized patients.abstract:201121729289
laparoscopic colorectal surgery - why would you not want to have it and, more importantly, not be trained in it? a consecutive series of 500 elective resections with anastomoses.we analysed the outcome of a consecutive series of 500 unselected patients who underwent elective laparoscopic colorectal resection with anastomosis (elcra) under the care of a single surgeon.201119888953
is clostridium difficile infection a particular problem after reversal of ileostomy?clostridium difficile infection (cdi) is a cause of morbidity and mortality in hospitals. various independent risk factors have been identified, including age and antibiotic exposure. this study attempted to determine whether surgery and associated antibiotic use influence the development of cdi.201119925492
comparison of repetitive extragenic palindromic sequence-based pcr with pcr ribotyping and pulsed-field gel electrophoresis in studying the clonality of clostridium difficile.clostridium difficile infection is most often induced by antibiotic treatment. recently, morbidity and mortality resulting especially from c. difficile pcr ribotype 027 have increased significantly. in addition, more severe disease has been associated with c. difficile pcr ribotype 078 strains. thus, reliable typing methods for epidemic control are needed. in the present study, we compared an automated repetitive extragenic palindromic sequence-based pcr (rep-pcr) method (diversilab; bacterial b ...201120331683
clostridium difficile does not only affect the colon: a case series. 201120478005
carriage of clostridium difficile and other enteric pathogens among a 4-h avocational cohort.clostridium difficile (cd), salmonella, campylobacter and enterohemorrhagic escherichia coli (ehec) are major causes of morbidity in a variety of enteric diseases in humans and animals, but subclinical carriage in both is probably more common than are clinical cases. little is known regarding the prevalence of these pathogens in animals raised for exhibit at michigan county fairs or the frequency with which michigan citizens raising these animals may have been subclinically colonized. to address ...201120529211
clostridium difficile-related pancolitis in lung-transplanted patients with cystic fibrosis.c. difficile (c. d.) is the main cause of antibiotic-associated diarrhea and colitis. it is shown in literature a high asymptomatic carriage rate of c. d. in patients with cystic fibrosis (cf), though c. d.-related colitis is an uncommon complication in these patients, despite the use of multiple high-dose antibiotic regimes and the frequency of hospital admissions. lung transplantation with the associated immunosuppression and aggressive antibiotic therapy may increase the risk of the clinical ...201120642799
correlations between bed occupancy rates and clostridium difficile infections: a time-series analysis.a time-series analysis was performed to identify the impact of bed occupancy rates and length of hospital stay on the incidence of clostridium difficile infections (cdi). between january 2003 and july 2008, a mean incidence of 0·5 cdi cases/1000 patient days was recorded. application of a multivariate model (r2=0·50) showed that bed occupancy rates on general wards (p<0·01) and length of stay in intensive care units (icus) (p<0·01) influenced the incidence of cdi. overcrowding on general wards a ...201120513253
effect of broad- and narrow-spectrum antimicrobials on clostridium difficile and microbial diversity in a model of the distal colon.vancomycin, metronidazole, and the bacteriocin lacticin 3147 are active against a wide range of bacterial species, including clostridium difficile. we demonstrate that, in a human distal colon model, the addition of each of the three antimicrobials resulted in a significant decrease in numbers of c. difficile. however, their therapeutic use in the gastrointestinal tract may be compromised by their broad spectrum of activity, which would be expected to significantly impact on other members of the ...201120616009
detection of cross-infection associated to a brazilian pcr-ribotype of clostridium difficile in a university hospital in rio de janeiro, brazil.clostridium difficile is an important nosocomial enteric pathogen and is the etiological agent of pseudomembranous colites. recently, the rates of c. difficile infection (cdi) have increased worldwide, but in brazil few data about this situation and the incidence of clonal types of c. difficile exist. this study aimed to isolate and characterize c. difficile strains from samples obtained of a university hospital (hucff) in rio de janeiro city, brazil. cdi was identified by elisa in 27.1% of hucf ...201120623188
clostridium difficile infection of the small bowel--two case reports with a literature survey.diseases associated with clostridium difficile range from antibiotic-related diarrhea to pseudomembranous enterocolitis, and are serious nosocomial infections with high morbidity and mortality. the c. difficile infection has thus far been regarded as a disease typically affecting the colon. however, the literature contains an increasing number of reports describing infections of the small bowel with fulminant clinical courses and high mortality rates of 60-83%. we think this situation is not ver ...201120628882
fulminant, non-antibiotic associated clostridium difficile colitis following salmonella gastroenteritis.in the last decade there has been increasing awareness of the virulence and changing epidemiology of clostridium difficile (c. difficile). while the vast majority of clinical cases of c. difficile are associated with antimicrobial or nosocomial exposure, this syndrome has been well described in the absence of antibiotic use. we present an unusual case of fatal, non-antibiotic associated c. difficile colitis following salmonella serotype saintpaul gastroenteritis in a previously healthy young per ...201120697966
recurrence rate of clostridium difficile infection in hospitalized pediatric patients with inflammatory bowel disease.the incidence and associated morbidity of clostridium difficile (cd) infection has been increasing at an alarming rate in north america. clostridium difficile-associated diarrhea (cdad) is the leading cause of nosocomial diarrhea in the usa. patients with cdad have longer average hospital admissions and additional hospital costs. evidence has demonstrated that patients with inflammatory bowel disease (ibd) have a higher incidence of cd in comparison to the general population. the aim of this stu ...201120722068
clostridium difficile and methicillin-resistant staphylococcus aureus: emerging concepts in vaccine development.both clostridium difficile and staphylococcus aureus asymptomatically colonize a significant percentage of humans, particularly during the first year of life. the epidemiology of both has been and continues to be quite dynamic; presently, we are in the midst of epidemics of infections by c. difficile and s. aureus. these ancient microbes are now armed with more potent virulence factors, which have extended their reach from the hospital into community settings, and from the elderly and debilitate ...201120707676
clostridium difficile-associated disease acquired in the cardiothoracic intensive care unit.to determine the prevalence, severity, and outcome associated with clostridium difficile-associated disease (cdad) acquired while in the cardiothoracic intensive care unit (cticu).201120638863
temporal trends in disease outcomes related to clostridium difficile infection in patients with inflammatory bowel disease.clostridium difficile has emerged as an important pathogen in patients with inflammatory bowel disease (ibd) and is associated with increased morbidity and mortality. no studies have examined the temporal change in severity of c. difficile infection (cdi) complicating ibd.201120824818
the attachment, internalization, and time-dependent, intracellular distribution of clostridium difficile toxin a in porcine intestinal explants.toxin a (tcda), secreted by toxigenic strains of clostridium difficile, produces lesions typical of c. difficile-associated disease (cdad) in susceptible mammal species. porcine colon explants maintained for 2 hours with tcda developed severe lesions characterized by cell swelling, swelling of mitochondria and other organelles, distension of cytoplasmic vesicles, expansion of paracellular spaces, apoptosis, and necrosis. severity of lesions was proportional to the dosage of toxin. no lesions wer ...201120861504
oral vancomycin may have significant absorption in patients with clostridium difficile colitis.a patient on haemodialysis with bowel ischemia was given vancomycin 500 mg orally every 6 h for superimposed clostridium difficile colitis resulting in a high vancomycin serum concentration. when treating c. difficile colitis in patients with significant renal impairment and bowel injury, we recommend administering the lower dose of oral vancomycin.201120831355
innate resistance to sporicides and potential failure to decontaminate.bacterial spores are frequently intrinsically resistant to biocides and only a number of alkylating and oxidising biocides are sporicidal under certain conditions. activity against spores is affected by several key factors such as concentration, exposure time, soiling, and the types of surface to be treated. sporicidal efficacy is usually achieved after an exposure time of several minutes with a high concentration of a biocide. failure to understand these factors will result in decreased sporici ...201120850897
currently available sporicides for use in healthcare, and their limitations.clostridium difficile has been recognised for some time as a pathogen which can contaminate the environment and which is associated with secondary spread via this route. unfortunately many of the disinfectants currently used in healthcare environments are inactive against this organism. for example, alcohol-containing hand rubs do not have sporicidal activity and some quaternary ammonium compounds and detergents may even encourage sporulation. european standards have been developed to allow a st ...201120850900
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