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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
physician density and hospitalization for inflammatory bowel disease.inflammatory bowel diseases (ibds) are chronic illnesses that require frequent and regular healthcare contact. regular maintenance care may reduce complications or the need for hospitalization. availability of physicians may be an important determinant of ibd hospitalizations.201120848540
differential role of rho gtpases in intestinal epithelial barrier regulation in vitro.maintenance of intestinal epithelial barrier functions is crucial to prevent systemic contamination by microbes that penetrate from the gut lumen. gtpases of the rho-family such as rhoa, rac1, and cdc42 are known to be critically involved in the regulation of intestinal epithelial barrier functions. however, it is still unclear whether inactivation or activation of these gtpases exerts barrier protection or not. we tested the effects of rho gtpase activities on intestinal epithelial barrier func ...201120945370
pathogenic c difficile is here (and everywhere) to stay. 201121084110
clostridium difficile infection in europe: a hospital-based survey.little is known about the extent of clostridium difficile infection in europe. our aim was to obtain a more complete overview of c difficile infection in europe and build capacity for diagnosis and surveillance.201121084111
typhlitis in children with malignancy: a single center experience.in a case-control study, medical records of all children (below 18 y of age) who were diagnosed with any malignancy between january 1988 and december 2008 were reviewed. children who developed typhlitis during the course of their malignancy were identified. age and sex-matched controls who were diagnosed with malignancy during the same time period but did not develop typhlitis were identified (1:4 ratio). the variables that were examined included underlying malignancy, chemotherapy, and final ou ...201121127432
recto-vesical fistulation complicating a faecal incontinence management product in clostridium difficile diarrhoea. 201121054743
ischemic colitis after capecitabine plus cisplatin treatment in advanced gastric cancer.systemic chemotherapy can be complicated by colonic toxicity, which usually determines the onset of pseudomembranous colitis and, rarely, of ischemic colitis in patients with cancer. this report describes the case of a 45-year-old man with advanced gastric cancer who developed severe ischemic colitis after chemotherapy with cisplatin and capecitabine. the patient developed symptoms of gastrointestinal toxicity with abdominal pain and bloody diarrhea. he had a normal white blood cell count throug ...201121069429
the role of environmental cleaning in health care-associated infections.multidrug-resistant organisms such as methicillin-resistant staphylococcus aureus (mrsa) and toxin-producing organisms such as clostridium difficile have been a concern for over 30 years. an increasing focus is being placed on the role that an unclean environment can play in transmission. this article describes the pathogens of concern and the use of a robust environmental cleaning program to help reduce the chances for hospital-acquired infections.201121160295
Microbiology of regressive autism.This manuscript summarizes some of our earlier work on the microbiology of autism subjects' stool specimens, as compared with stools from control subjects. Our most recent data indicating that Desulfovibrio may play an important role in regressive autism is also presented. In addition, we present information on antimicrobial susceptibility patterns of Desulfovibrio using the CLSI agar dilution susceptibility technique. In addition, we summarize data from our earlier studies showing the impact of ...201122202440
molecular analysis of relapses or reinfections of clostridium difficile-associated diarrhea.recurrence is a major complication of clostridium difficile-associated diarrhea and occurs in 15 to 20% of patients after discontinuation of therapy. strains from 53 patients with clostridium difficile recurrences were fingerprinted by pcr ribotyping. reinfection with a different strain occurred in 15 out of 53 patients (28,3%), while 38 patients relapsed. these data suggest the need to perform molecular typing for implementation of infection control procedures and for a more appropriate therape ...201122143813
Surface proteins from Lactobacillus kefir antagonize in vitro cytotoxic effect of Clostridium difficile toxins.In this work, the ability of S-layer proteins from kefir-isolated Lactobacillus kefir strains to antagonize the cytophatic effects of toxins from Clostridium difficile (TcdA and TcdB) on eukaryotic cells in vitro was tested by cell detachment assay. S-layer proteins from eight different L. kefir strains were able to inhibit the damage induced by C. difficile spent culture supernatant to Vero cells. Besides, same protective effect was observed by F-actin network staining. S-layer proteins from ag ...201122126976
Detection of Clostridium difficile Toxin A/B Genes by Multiplex Real-Time PCR for the Diagnosis of C. difficile infection.Toxigenic Clostridium difficile culture is considered to be a reference diagnostic method for C. difficile infection (CDI), but it is time-consuming. Enzyme immunoassay is rapid and ease-to-use, but has low sensitivity. We evaluated a real-time PCR kit, AdvanSure CD real-time PCR (RT-PCR; LG Life Sciences), which can simultaneously detect C. difficile toxins A and B. A total of 127 fresh diarrheal stool specimens submitted to the clinical microbiology laboratory for C. difficile culture were tes ...201121959205
fidaxomicin: in clostridium difficile infection.fidaxomicin is a first-in-class macrocyclic antibacterial that primarily demonstrates activity against species of clostridia, predominantly clostridium difficile, while having limited or no activity against normal faecal microflora. fidaxomicin is minimally absorbed following oral administration and is excreted almost solely in the faeces. fidaxomicin displayed a high level of antibacterial activity against c. difficile in vitro, with a minimum inhibitory concentration required to inhibit 90% of ...201122141387
Indications and Relative Utility of Lower Endoscopy in the Management of Clostridium difficile Infection.Background. Diagnosis and management of Clostridium difficile infection (CDI) rely upon clinical assessments and diagnostic studies. Among diagnostic tests, lower gastrointestinal (GI) endoscopy in the setting of CDI remains controversial. Objective. To describe the role of lower endoscopy in CDI management. Methods. Retrospective study of lower endoscopies in CDI at four metropolitan hospitals, July 2005 through December 2007. Results. Of 1760 CDI inpatients, 45 lower endoscopies were performed ...201122028704
clostridium difficile infections in china.clostridium difficile (c. difficile) infection has become one of the major hospital-associated infections in western countries in the last two decades. however, there is limited information on the status of c. difficile infection in chinese healthcare settings. given the large and increasing elderly population and the well-recognized problem of over-prescribing of broad spectrum antibiotics in china, it is critical to understand the epidemiology and potential risk factors that may contribute to ...201023554657
scandal-hit hospital empowers ward sisters to slash infection rates.a hospital where clostridium difficile was found to have contributed to the deaths of 90 patients has slashed infection rates by empowering ward sisters.201027741749
clostridium difficile infection.clostridium difficile can be cultured from the stool of 3 per cent of healthy adults but most people remain asymptomatic. clinical disease develops when normal gut flora is disrupted, usually by antibiotic exposure, thereby creating conditions that favour c. difficile proliferation in the colon. gastrointestinal diseases associated with c. difficile infection range from mild diarrhoea to fulminant colitis. some 'silent' infections present with abdominal pain and distension but little or no diarr ...201027741668
mortality in hospitalized older adults associated with clostridium difficile infection at a district hospital.clostridium difficile is the most common cause of hospital acquired infectious diarrhea in the developed world and has re-emerged in recent years with apparent greater morbidity and mortality. despite this, there is little recent published data from the uk concerning associated mortality. we performed a case control study at a uk district general hospital of 66 hospitalized patients over the age of 65 years with c. difficile infection compared to 3-5 controls matched for age, sex and minimum len ...201024470889
laparobotic duodenal diverticulectomy and choledochoduodenostomy: a case study and review of the literature.the duodenum is the second most common site for diverticulae, after the colon. they are common after the fifth decade and usually asymptomatic. ten percent of patients present with symptoms, which include abdominal pain, hemorrhage, duodenal obstruction, diverticulitis, perforation, pancreatitis, and obstructive jaundice. after a thorough search of medline we present, for the first time, a case of obstructive jaundice secondary to duodenal diverticulum compressing the common bile duct. it was ma ...201027628639
clostridium difficile infection in the absence of a colon.clostridium difficile (cd) infection is almost always confined to the colon causing a spectrum of illness ranging from diarrhoea to fulminant colitis. cd infection of the small intestine has been described but the identification of cd toxin in the stoma effluent of a patient with an end ileostomy is rare. we describe a 91-year-old woman, with a history of proctocolectomy for ulcerative colitis, presenting with profuse ileostomy diarrhoea after a course of antibiotics. ileostomy effluent was posi ...201022791474
quantitative real time pcr detection of clostridium difficile growth inhibition by probiotic organisms.probiotic microorganisms are potential treatments for clostridium difficile diarrheal disease (cdd) but better methods are needed to determine the relative potency of probiotic microorganisms against pathogenic organisms in mixed cultures.201022624106
association between use of proton pump inhibitors and a clostridium difficile-associated disease outbreak: case-control study.the use of proton pump inhibitors (ppis) has been implicated as a potential contributor to the development of clostridium difficile-associated disease (cdad) because of the ability of these drugs to substantially reduce the bactericidal effect of gastric acid. this study focused on the impact of ppis, among other known risk factors, during an outbreak of cdad in a hospital setting.201022478951
toxic megacolon from hypervirulent clostridium difficile infection (ribotype 027) following elective total knee replacement: an emerging challenge in modern health care.we present a rare case of community acquired (presenting in hospital on the day of admission or within 48 h of admission) clostridium difficile infection (cdi) with the hypervirulent (ribotype 027) strain causing toxic megacolon in a patient, diagnosed on the third postoperative day following an elective total knee replacement. the patient did not have any of the commonly reported risk factors for cdi. the source of sepsis was initially presumed to be the operated prosthetic joint, and this caus ...201022242068
toxic megacolon associated clostridium difficile colitis.toxic megacolon is a severe complication of clostridium difficile (c. difficile) colitis. as the prevalence of c. difficile colitis increases and treatments become more refractory, clinicians will encounter more patients with c. difficile associated toxic megacolon in the future. here, we review a case of toxic megacolon secondary to c. difficile colitis and review the current literature on diagnosis and management. we identify both clinical and radiologic criteria for diagnosis and discuss both ...201021160629
severe colitis associated with docetaxel use: a report of four cases.diarrhea is a common side effect of chemotherapy. pseudomembranous colitis is a well known complication of antibiotic treatment that can also be observed, albeit rarely, with certain chemotherapeutic agents. we present four cases of severe colitis in patients undergoing treatment with taxane-based chemotherapy for pancreatic, lung and breast cancer. none of them had recently received antibiotics. one patient presented with a bowel perforation and three had endoscopic findings of pseudomembranous ...201021160890
effect of probiotic lactobacillus (lacidofil® cap) for the prevention of antibiotic-associated diarrhea: a prospective, randomized, double-blind, multicenter study.antibiotic-associated diarrhea (aad) is a common complication of antibiotic use. there is growing interest in probiotics for the treatment of aad and clostridium difficile infection because of the wide availability of probiotics. the aim of this multicenter, randomized, placebo-controlled, double-blind trial was to assess the efficacy of probiotic lactobacillus (lacidofil® cap) for the prevention of aad in adults. from september 2008 to november 2009, a total of 214 patients with respiratory tra ...201021165295
fecal lactoferrin and clostridium spp. in stools of autistic children.stools from autistic and healthy children were studied for fecal lactoferrin, clostridium difficile toxins, clostridium perfringens enterotoxin and cultured for clostridium spp. elevated level of fla was demonstrated in 24.4% stools, all from boys (31.25%). no toxins were detected. clostridium spp. was isolated with similar frequency from all samples. c. perfringens were isolated significantly often from the autistic stools, intermediate sensitive strains to penicillin 19%, to clindamycin 11.3%, ...201021167951
analysis of ultra low genome conservation in clostridium difficile.microarray-based comparative genome hybridisations (cgh) and genome sequencing of clostridium difficile isolates have shown that the genomes of this species are highly variable. to further characterize their genome variation, we employed integration of data from cgh, genome sequencing and putative cellular pathways. transcontinental strain comparison using cgh data confirmed the emergence of a human-specific hypervirulent cluster. however, there was no correlation between total toxin production ...201021170335
clostridium difficile: the importance of toxin a is re-established in clostridium difficile infection. 201021171215
a comparative study of three methods to evaluate an intervention to improve empirical antibiotic therapy for acute bacterial infections in hospitalized patients.in order to limit the use of broad-spectrum antibiotics, standardized empirical therapy against acute bacterial infections has been advocated.201021171827
anti-pseudomonal beta-lactams for the initial, empirical, treatment of febrile neutropenia: comparison of beta-lactams.several beta-lactams are recommended as single agents for the treatment of febrile neutropenia.201021069685
clostridium difficile in vegetables, canada.clostridium difficile is an important gastrointestinal pathogen of humans and animals. it has been isolated from various foods, including meat and ready-to-eat salads, and concern has been expressed regarding food as a possible source of human c. difficile infection (cdi).201021069911
antibiotic prophylaxis in variceal hemorrhage: timing, effectiveness and clostridium difficile rates.to investigate if antibiotics administered within 8 h of endoscopy reduce mortality or increase the incidence of clostridium difficile infection (cdi).201021072894
a common polymorphism in the interleukin-8 gene promoter is associated with an increased risk for recurrent clostridium difficile infection.neutrophil recruitment coordinated by intestinal interleukin (il)-8 secretion is a key component in the pathogenesis of clostridium difficile infection (cdi). we hypothesized that a common single-nucleotide polymorphism (snp) in the -251 region of the il-8 gene promoter may be predictive of recurrent cdi.201021058913
sustained reduction in antimicrobial use and decrease in methicillin-resistant staphylococcus aureus and clostridium difficile infections following implementation of an electronic medical record at a tertiary-care teaching hospital.we evaluated the effect of implementation of an electronic medical record (emr) on the use of antimicrobial agents and on the rates of infections with clostridium difficile and methicillin-resistant staphylococcus aureus (mrsa).201021059617
the effect of hospital-acquired clostridium difficile infection on in-hospital mortality.the effects of hospital-acquired clostridium difficile infection (cdi) on patient outcomes are incompletely understood. we conducted this study to determine the independent impact of hospital-acquired cdi on in-hospital mortality after adjusting for the time-varying nature of cdi and baseline mortality risk at hospital admission.201021059973
therapeutic success of rifaximin for clostridium difficile infection refractory to metronidazole and vancomycin.we report the case of a 46-year-old white male with confirmed clostridium difficile infection for >4 weeks after fluoroquinolone therapy. the patient received two courses of metronidazole 500 mg three times daily (t.i.d.) during which time diarrhea resolved; however, symptoms recurred 14-15 days after treatment termination. he received a 2-week course of vancomycin 125 mg four times daily, with symptoms recurring 10 days after treatment conclusion. the patient then received a pulsed tapering sch ...201021060709
manganese binds to clostridium difficile fbp68 and is essential for fibronectin binding.clostridium difficile is an etiological agent of pseudomembranous colitis and antibiotic-associated diarrhea. adhesion is the crucial first step in bacterial infection. thus, in addition to toxins, the importance of colonization factors in c. difficile-associated disease is recognized. in this study, we identified fbp68, one of the colonization factors that bind to fibronectin (fn), as a manganese-binding protein (k(d) = 52.70 ± 1.97 nm). furthermore, the conformation of fbp68 changed dramatical ...201021062746
targeting selenium metabolism and selenoproteins: novel avenues for drug discovery.selenoproteins play a wide range of roles in metabolism and oxidative stress defense and are produced by organisms in all three domains of life. recent evidence has been presented that metal based cancer drugs target the selenol nucleophile of the active site selenocysteine in thioredoxin reductase isoenzymes. other metals and metalloids, such as tin, arsenic and gold, have also recently been shown to form stable complexes with hydrogen selenide, a required precursor for the synthesis of selenop ...201021069141
automated surveillance of clostridium difficile infections using biosense.to determine the feasibility of using electronic laboratory and admission-discharge-transfer data from biosense, a national automated surveillance system, to apply new modified clostridium difficile infection (cdi) surveillance definitions and calculate overall and facility-specific rates of disease.201021128815
the continuing crisis in antibiotic resistance.the emergence of antibiotic resistance in bacterial pathogens is an inevitable consequence of antibiotic use. despite repeated warnings, negligent antibiotic use and poor infection-control practice have led to the continuing development of extensive resistance problems worldwide. multidrug-resistant pathogens are now characterized by their heterogeneity, increasing virulence, resistance even to reserve agents and spread within and between hospitals and the community. examples are glycopeptide-re ...201021129629
monomicrobial clostridium difficile bacteraemias and relationship to gut infection. 201021129818
thirty-day mortality of clostridium difficile infection in a uk national health service foundation trust between 2002 and 2008.few standardised data are available on mortality rates in patients with clostridium difficile infection (cdi). the literature often reports 'attributable' mortality or cannot be universally applied. we aimed to investigate the pattern and trends in all-cause mortality in a large unselected cohort of patients affected by cdi. this was done by means of a retrospective cohort study between 2002 and 2008 of all patients with positive stool toxin tests indicating cdi in one national health service (n ...201021129821
herpes simplex virus: a marker of severity in bacterial ventilator-associated pneumonia.purpose: ventilator-associated pneumonia (vap) is the most frequent nosocomial infection in intensive care units and has a high morbidity and mortality rate. it is mainly a bacterial disease, although the potential role of viruses as pathogens or copathogens in vap is under discussion. our study aims were to determine the incidence of herpes simplex virus (hsv) in the lower respiratory tract (lrt) secretions in patients with bacterial vap and to assess its potential clinical relevance. material ...201021129912
gaseous and air decontamination technologies for clostridium difficile in the healthcare environment.the recent data for hospital-acquired infections suggest that infection rates for meticillin-resistant staphylococcus aureus (mrsa) and clostridium difficile are beginning to decrease. however, while there is still pressure to maintain this trend, the resistance of c. difficile spores to standard detergents continues to present a problem for many uk hospitals trying to prevent its spread or control outbreaks. alternative disinfection technologies such as gaseous decontamination are currently bei ...201021130521
infection probability score: a predictor of clostridium difficile-associated disease onset in patients with haematological malignancy.purpose: to assess the predictive power of three systems: infection probability score, apache ii and karnofsky score for the onset of clostridium difficile-associated disease (cdad) in hematology-oncology patients. methods and sample: a retrospective pilot surveillance survey was conducted in the hematology unit of a general hospital in greece. data were collected by using an anonymous standardised case-record form. the sample consisted of 102 hospitalized patients. results: the majority of the ...201021130685
prevalence of clostridium difficile in retailed meat in the netherlands.recent reports indicate that a large proportion of community-acquired clostridium difficile infections (ca-cdi) are not linked to recent antibiotic therapy, older age, significant comorbidity or previous hospitalization. possible community sources for ca-cdi include animals and food, and therefore a surveillance study on the prevalence of c. difficile in meat was performed. samples of different meat species were collected from the retail trade and analyzed for the presence of c. difficile using ...201021131085
protective roles of cx3cr1-mediated signals in toxin a-induced enteritis through the induction of heme oxygenase-1 expression.the injection of clostridium difficile toxin a into the ileal loops caused fluid accumulation with the destruction of intestinal epithelial structure and the recruitment of neutrophils and macrophages. concomitantly, intraileal gene expression of cx3cl1/fractalkine (fkn) and its receptor, cx3cr1, was enhanced. when treated with toxin a in a similar manner, cx3cr1-deficient (cx3cr1(-/-)) mice exhibited exaggerated fluid accumulation, histopathological alterations, and neutrophil recruitment, but ...201021131421
from cosubstrate similarity to inhibitor diversity--inhibitors of adp-ribosyltransferases from kinase inhibitor screening.adp-ribosyltransferases (adp-rts) use nad(+) to transfer an adp-ribosyl group to target proteins. although some adp-rts are bacterial toxins only few inhibitors are known. here we present the development of fluorescence-based assays and a focussed library screening using kinase inhibitors as a new approach towards inhibitors of adp-rts. different screening setups were established using surrogate small molecule substrates or the quantitation of the cofactor nad(+). proof-of-principle screening ex ...201021132207
efficacy of three surface disinfectants against spores of clostridium difficile ribotype 027.the emergence of clostridium difficile ribotype 027 raised the question of sporicidal surface disinfectants are also effective against spores of c. difficile ribotype 027.201021134785
tigecycline exhibits inhibitory activity against clostridium difficile in the colon of mice and does not promote growth or toxin production.tigecycline is a broad-spectrum glycylcycline antibiotic with potent in vitro activity against clostridium difficile. we used a mouse model to test the hypothesis that tigecycline has a low propensity to promote colonization and toxin production by c. difficile due to inhibitory activity in the colon. mice (5 to 8 per group) received subcutaneous injections of tigecycline (low and high doses) alone or in combination with clindamycin for 6 days. growth of and toxin production by 3 strains of c. d ...201021135181
[entero-colitis implicated by antimicrobial agents]. 201021139357
the role of glutamate dehydrogenase for the detection of clostridium difficile in faecal samples: a meta-analysis.clostridium difficile causes a serious, occasionally fatal, hospital-acquired infection. the laboratory diagnosis of c. difficile infection (cdi) needs to be accurate to ensure optimal patient management, infection control and reliable surveillance. commercial enzyme-linked immunosorbent assays for c. difficile toxins have poor sensitivity when compared with cell culture cytotoxin assay (cta) and toxigenic culture (tc). we performed a meta-analysis of the role of glutamate dehydrogenase (gdh) in ...201021145132
critical gastrointestinal bleeding at an inpatient rehabilitation center: incidence, risk factors, and the role of gastrointestinal prophylaxis.to determine the incidence of critical gastrointestinal bleeding at an inpatient rehabilitation center, the risk factors associated with said bleeding, and the role of gastrointestinal prophylaxis.201021145522
in vitro activity and single-step mutational analysis of rifamycin sv tested against enteropathogens associated with traveler's diarrhea and clostridium difficile.rifamycin sv is a broad-spectrum, poorly absorbed antimicrobial agent that, when coupled with mmx technology, is being targeted for the oral treatment of traveler's diarrhea (td) and clostridium difficile-associated disease (cdad). rifamycin sv was tested for activity against 911 td-associated enteropathogens and 30 c. difficile isolates collected from several global surveillance studies. rifamycin sv demonstrated similar antimicrobial activity levels against the enterobacteriaceae, with mic₅₀ v ...201021149623
therapeutic transplantation of the distal gut microbiota.although it is generally accepted that the distal gut microbiota are relatively stable in healthy adult individuals, a collapse of the microbial community structure resulting from antibiotic therapy or pathogen presence can lead to gut dysfunction. however, recent findings demonstrate that it is possible to engraft new microbiota from a donor source, resulting in the restoration of gut functionality and improvement in health. this builds upon decades of case reports and series in which fecal tra ...201021150894
the risk factors of clostridium difficile colitis in colorectal surgery. 201021152130
risk factors for the development of clostridium difficile-associated colitis after colorectal cancer surgery.clostridium difficile (c. difficile)-associated colitis, a known complication of colon and rectal surgery, can increase perioperative morbidity and mortality, leading to increased hospital stay and costs. several contributing factors, including advanced age, mechanical bowel preparation, and antibiotics, have been implicated in this condition. the purpose of this study was to determine the clinical features of and factors responsible for c. difficile-associated colitis after colorectal cancer su ...201021152135
scientists probe herpes in neonates, c. difficile acquisition in children. 201021156940
using the lived experiences of patients with clostridium difficile infection to improve care.to better understand the lived experiences and needs of patients who have clostridium difficile infection.201021086831
using the waterlow tool to predict clostridium difficile infection risk in hospital settings.c difficile is the most important cause of infectious healthcare acquired diarrhoea and risk of infection is a public concern. many acute and primary care trusts are working to further reduce rates of c difficile and targets have been set. global reduction strategies include prudent antibiotic prescribing and intensive cleaning programmes. while risk assessment tools for c difficile exist, they are not easy to use in hospital. this article introduces an inexpensive and easy to use assessment too ...201021086834
insights into the mechanism of type i dehydroquinate dehydratases from structures of reaction intermediates.the biosynthetic shikimate pathway consists of seven enzymes that catalyze sequential reactions to generate chorismate, a critical branch point in the synthesis of the aromatic amino acids. the third enzyme in the pathway, dehydroquinate dehydratase (dhqd), catalyzes the dehydration of 3-dehydroquinate to 3-dehydroshikimate. we present three crystal structures of the type i dhqd from the intestinal pathogens clostridium difficile and salmonella enterica. structures of the enzyme with substrate a ...201021087925
practice of gastroenterologists in treating flaring inflammatory bowel disease patients with clostridium difficile: antibiotics alone or combined antibiotics/immunomodulators?background:: the optimal management of clostridium difficile infection (cdi) in flaring inflammatory bowel disease (ibd) patients has not been defined. limited data suggest that coadministration of immunomodulators (im) with antibiotics (ab) results in a worse outcome. we investigated the prevalent practice among north american gastroenterologists in this scenario. methods:: a structured questionnaire presented the clinical cases of two hospitalized patients with ulcerative colitis and concomita ...201021089183
[clostridium difficile: a serious outpatient infection?].secondary to severe hospital outbreaks due to hypervirulent strains of clostridium difficile, several surveillance systems in north-america and europe observed an increase in infections due to this micro-organism, also in the outpatient setting. the case reported in the present article illustrates the fulminant presentation that a c. difficile colitis can show in a previously healthy person without prior contact with healthcare facilities. it introduces a review of some recent publications on th ...201021089556
a rare cause of chronic mesenteric ischemia from fibromuscular dysplasia: a case report.abstract:201021092091
disarming clostridium difficile.in this issue, puriet al. (2010) present inhibitors that prevent the autocatalytic activation of the clostridial toxin tcdb in vivo. their approach is likely to provide guidance for the development of novel drugs targeting virulence factors and thereby rendering bacterial pathogens innocuous.201021095563
rational design of inhibitors and activity-based probes targeting clostridium difficile virulence factor tcdb.clostridium difficile is a leading cause of nosocomial infections. the major virulence factors of this pathogen are the multi-domain toxins tcda and tcdb. these toxins contain a cysteine protease domain (cpd) that autoproteolytically releases a cytotoxic effector domain upon binding intracellular inositol hexakisphosphate. currently, there are no known inhibitors of this protease. here, we describe the rational design of covalent small molecule inhibitors of tcdb cpd. we identified compounds tha ...201021095570
clostridium perfringens tpel glycosylates the rac and ras subfamily proteins.clostridium perfringens tpel belongs to a family of large clostridial cytotoxins that encompasses clostridium difficile toxin a (tcda) and b (tcdb) and clostridium sordellii lethal toxin (tcsl). we report here the identification of the tpel-catalyzed modification of small gtpases. a recombinant protein (tpel1-525) derived from the tpel n-terminal catalytic domain in the presence of streptolysin o (slo) induced the rounding of vero cells and the glycosylation of cellular rac1. among several hexos ...201021098103
cyclic-di-gmp reaches out into the bacterial rna world.the ubiquitous bacterial signaling molecule bis-(3'-5')-cyclic guanosine monophosphate (c-di-gmp) has brought second messenger signaling back onto the agenda of molecular microbiologists. this is due not only to its general role in promoting biofilm formation, but also to the increasingly diverse array of effector molecules bound by c-di-gmp and of the target processes affected. effectors include diverse transcription factors and proteins that directly interact with complex cellular machineries, ...201021098727
update on clostridium difficile infection.purpose of review: this review summarizes the most recent epidemiological data and advances in research into the pathogenesis, diagnosis and treatment of clostridium difficile infection (cdi). recent findings: the epidemiology of cdi has changed with the emergence of hypervirulent strains. cdi rates have increased in the community, in children and in patients with inflammatory bowel disease. although the north american pulsed-field gel electrophoresis type 1, restriction endonuclease analysis gr ...201021099432
rapid and sensitive loop-mediated isothermal amplification test for clostridium difficile detection challenges cytotoxin b cell test and culture as gold standard.compared to the composite gold standard cytotoxin b assay and toxigenic culture, the loop-mediated isothermal amplification (lamp) test for clostridium difficile had a sensitivity and specificity of 98%, positive predictive value of 92%, and negative predictive value of >99%. a one-hour turnaround time for the lamp test provides rapid diagnosis and cost savings.201021106782
acquisition of clostridium difficile by piglets.clostridium difficile is recognized as an important cause of nosocomial diarrhoea in humans especially in association with administration of antibiotics. in pigs, c. difficile can cause neonatal enteritis and can be isolated from faeces from both diseased and healthy animals. the presented prospective study describes how soon c. difficile can be isolated from newborn piglets after normal parturition and how c. difficile spreads within a pig farm. six sows, their farrowing crates and their litter ...201021111541
[use of endorectal tube actiflo in the management of clostridium difficile colitis in icu]. 201021112728
pneumatosis coli associated with pseudomembranous colitis in a patient following colonic surgery.pneumatosis intestinalis is a rare disorder characterized by gas-filled cysts within the subserosal and/or submucosal regions of the intestinal wall. the source of this gas and its translocation across the mucosa is incompletely understood. most (85%) cases are associated with medical conditions, ranging from psychiatric through respiratory disorders to gastrointestinal-related diseases; the remaining 15% lack any recognizable cause or association. in this case report, pneumatosis coli (affectin ...201021113293
alternative therapies for clostridium difficile infections.clostridium difficile infection is a serious condition responsible for significant morbidity and mortality, especially in patients being treated with antimicrobials. increasing frequency of the infection and hypervirulent c. difficile strains have resulted in more severe disease as well as therapeutic failures with traditional treatment (metronidazole and vancomycin). to review the studies assessing nontraditional therapies for the prevention and treatment of primary or recurrent c. difficile in ...201021114394
outcome for gram-negative bacteraemia when following restrictive empirical antibiotic guidelines.restrictions in prescribing broad spectrum antimicrobials have been part of a strategy to reduce clostridium difficile cases in the uk in recent years. however, there has been little work on assessing the safety of alternative antimicrobial agents.201021115461
adenosine deaminase inhibition prevents clostridium difficile toxin a-induced enteritis in mice.toxin a (txa) is able to induce most of the classical features of clostridium difficile-associated disease in animal models. the objective of this study was to determine the effect of an inhibitor of adenosine deaminase, ehna [erythro-9-(2-hydroxy-3-nonyl)-adenine], on txa-induced enteritis in c57bl6 mice and on the gene expression of adenosine receptors. ehna (90 μmol/kg) or phosphate-buffered saline (pbs) was injected intraperitoneally (i.p.) 30 min prior to txa (50 μg) or pbs injection into t ...201021115723
reference assays for clostridium difficile infection: one or two gold standards?accurate diagnosis of clostridium difficile infection (cdi) is essential for optimal treatment, prevention and control. there are two reference assays for cdi diagnosis: the cell cytotoxicity assay (ccta) and toxigenic culture (tc). importantly, these tests actually detect different targets: ccta detects the presence of c difficile toxins (primarily toxin b, but also toxin a), whereas tc detects the presence in the stool of c difficile with the potential to produce toxin. not surprisingly studie ...201021118850
clostridium difficile infection: epidemiology, risk factors and management.the epidemiology of clostridium difficile infection (cdi) has changed over the past decade. there has been a dramatic worldwide increase in its incidence, and new cdi populations are emerging, such as those with community-acquired infection and no previous exposure to antibiotics, children, pregnant women and patients with ibd. diagnosis of cdi requires identification of c. difficile toxin a or b in diarrheal stool. the accuracy of current diagnostic tests remains inadequate and the optimal diag ...201021119612
in-plane parallel scanning: a microarray technology for point-of-care testing.a new microarray technology is described for rapid, inexpensive, multiplex diagnostics assays. referred to as "in-plane parallel scanning" (ipps), this technology replaces expensive laser scanning with a grid of 100-μm-wide waveguides embedded in the chip's substrate, enabling real-time quantification of molecular complex formation on the chip's surface. compared to conventional microarray technology, ipps has advantages of shorter assay time and lower instrument cost and complexity so that the ...201020945920
antimicrobial susceptibility and heteroresistance in chinese clostridium difficile strains.one hundred and ten toxigenic clostridium difficile isolates collected between december 2008 and may 2009 at fudan university hospital huashan were analyzed for their antibiotic susceptibility patterns and resistance molecular basis. the heteroresistance to metronidazole in fresh isolates were detected as well. sixteen different pcr ribotypes were identified with a dominant clone 017 accounting for 37.3% of the isolates, followed by 001 and h. ribotype 027 was not found but one isolate belonged ...201020849968
the pathogenesis of infection and immune response.an understanding of the pathogenesis of infection, and the complex and fascinating 'relationship', or interaction, between the infecting organism and the host are advantageous when caring for patients with infections/infectious diseases, particularly as many of the clinical features of infection are as a consequence of the defence mechanisms mounted by the immune system. this article aims to provide a brief overview of the pathogenesis of infection, explaining how the two branches of the immune ...201020852457
clostridium difficile: moving beyond antimicrobial therapy. 201020854648
post-esophagectomy pseudomembranous inflammation of the interposed colon.pseudomembranous colitis (pmc) usually is caused by antibiotic-related changes in colonic anaerobic microflora, leading to clostridium difficile overgrowth and overproduction of toxins. we present the first reported case of pmc affecting the intrathoracic, interposed colon of an esophagectomy patient in the absence of inflammation of the in situ colon.201020858162
outcomes of patients who develop symptomatic clostridium difficile infection after solid organ transplantation.clostridium difficile-associated diarrhea is the most common cause of hospital-associated diarrhea in the uk. infection can produce a spectrum of manifestations from mild diarrhea to toxic megacolon, colonic perforation, and death. the aim of this study was to evaluate the outcomes of patients who developed symptomatic clostridium difficile infection (cdi) within the first year after solid organ transplantation. between 2004 and 2007, we performed 682 transplantation: 433 from deceased-donor kid ...201020832558
evaluating the link between the management of clinical waste in the national health service (nhs) and the risk of the spread of infections: a case study of three hospitals in england.this study aimed to evaluate waste management practices in three case study nhs trusts in england and the potential risks of the spread of pathogens causing healthcare associated infections (hcais). using a combination of microbiological techniques, interviews and questionnaire surveys, four target microbes were studied, namely: meticillin resistant staphylococcus aureus (mrsa), meticillin sensitive staphylococcus aureus (mssa), clostridium difficile (c. difficile) and vancomycin-resistant enter ...201020833586
[emergence of clostridium difficile ribotype 027 in germany: epidemiological and clinical characteristics].in september 2007 an increase of severe clostridium difficile-associated infections (cdi) was noticed in a hospital in the city of trier, germany. it was assumed that a new, possibly hypervirulent strain (pcr ribotype 027) was related to these events. an outbreak investigation was initiated by the local health authorities and the robert koch institute to describe the epidemiology of the possible outbreak and to identify and control the possible sources.201020839161
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