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clostridium difficile infection in the republic of ireland: results of a 1-month national surveillance and ribotyping project, march 2009. 201020731596
is gastrointestinal endoscopy a risk factor for clostridium difficile associated diarrhea? 201020736117
evaluation of a chromogenic culture medium for isolation of clostridium difficile within 24 hours.rapid and effective methods for the isolation of clostridium difficile from stool samples are desirable to obtain isolates for typing or to facilitate accurate diagnosis of c. difficile-associated diarrhea. we report on the evaluation of a prototype chromogenic medium (id c. difficile prototype [idcd]) for isolation of c. difficile. the chromogenic medium was compared using (i) 368 untreated stool samples that were also inoculated onto clo medium, (ii) 339 stool samples that were subjected to al ...201020739493
a statewide assessment of surgical site infection following colectomy: the role of oral antibiotics.to determine the utility of adding oral nonabsorbable antibiotics to the bowel prep prior to elective colon surgery.201020739852
clostridium difficile infections: what every clinician should know.the leading cause of nosocomial enteric infections in the us is a potentially lethal condition that influences the daily care of medical and surgical patients across all specialties. the incidence is increasing because of the emergence of a new virulent strain, the development of antibiotic resistance, and an increase in infection rates within populations once believed to be at low risk. current strategies for the prevention, diagnosis, and treatment are cited. transmission can be minimized with ...201020740115
does the handling time of unrefrigerated human fecal specimens impact the detection of clostridium difficile toxins in a hospital setting?the stability of clostridium difficile toxins is an important factor in determining the accuracy of the enzyme immunoassay (eia). the centers for disease control has stated that c. difficile toxins may become undetectable in unrefrigerated stool specimens within 2 h after collection.201020740339
use of purified clostridium difficile spores to facilitate evaluation of health care disinfection regimens.clostridium difficile is a major cause of antibiotic-associated diarrheal disease in many parts of the world. in recent years, distinct genetic variants of c. difficile that cause severe disease and persist within health care settings have emerged. highly resistant and infectious c. difficile spores are proposed to be the main vectors of environmental persistence and host transmission, so methods to accurately monitor spores and their inactivation are urgently needed. here we describe simple qua ...201020802075
adverse effects of proton pump inhibitor drugs: clues and conclusions.to review evidence relating to the strength of associations that have appeared in largely observational studies, between high-dose or long-term use of proton pump inhibitor drugs and certain possibly attributable side-effects, which emerge from studies confounded by other variables. in retrospective studies not designed to assess safety, evidence of causality is generally lacking.201020802330
intra-abdominal hypertension in fulminant clostridium difficile infection--an under-recognized treatable complication.clostridium difficile is the most common cause of nosocomial infectious diarrhea in adults, with recent reports of increased severity and case fatality. intra-abdominal hypertension (iah) and abdominal compartment syndrome (acs) are increasingly recognized and treatable complications of severe illness in medical patients, and are independent predictors of mortality. patients with severe clostridium difficile infection (cdi) are at increased risk for iah and acs. however, acs has been only rarely ...201020802420
room decontamination with uv radiation.to determine the effectiveness of a uv-c-emitting device to eliminate clinically important nosocomial pathogens in a contaminated hospital room.201020804377
variations in tcdb activity and the hypervirulence of emerging strains of clostridium difficile.hypervirulent strains of clostridium difficile have emerged over the past decade, increasing the morbidity and mortality of patients infected by this opportunistic pathogen. recent work suggested the major c. difficile virulence factor, tcdb, from hypervirulent strains (tcdb(hv)) was more cytotoxic in vitro than tcdb from historical strains (tcdb(hist)). the current study investigated the in vivo impact of altered tcdb tropism, and the underlying mechanism responsible for the differences in acti ...201020808849
triggering germination represents a novel strategy to enhance killing of clostridium difficile spores.clostridium difficile is an anaerobic, spore-forming bacterium that is the most common cause of healthcare-associated diarrhea in developed countries. control of c. difficile is challenging because the spores are resistant to killing by alcohol-based hand hygiene products, antimicrobial soaps, and most disinfectants. although initiation of germination has been shown to increase susceptibility of spores of other bacterial species to radiation and heat, it was not known if triggering of germinatio ...201020808871
bacteriophage treatment significantly reduces viable clostridium difficile and prevents toxin production in an in vitro model system.clostridium difficile is primarily a nosocomial pathogen, causing thousands of cases of antibiotic-associated diarrhoea in the uk each year. in this study, we used a batch fermentation model of a c. difficile colonised system to evaluate the potential of a prophylactic and a remedial bacteriophage treatment regime to control the pathogen. it is shown that the prophylaxis regime was effective at preventing the growth of c. difficile (p = <0.001) and precluded the production of detectable levels o ...201020816997
[clostridium difficile infections. an increasing problem in westernized medicine[editorial]]. 201020820067
[clostridium difficile infections at landspítali - 1998-2008].to study the epidemiology and severity of c. difficile infections (cdi) at landspítali over 11 year period, 1998-2008.201020820068
impact of different empirical antibiotic treatment regimens for community-acquired pneumonia on the emergence of clostridium difficile.treatment of community-acquired pneumonia (cap) with newer fluoroquinolones may contribute to selection for clostridium difficile. we studied the prevalence of c. difficile carriage and c. difficile infection (cdi) on admission, and nosocomial acquisition rates in patients hospitalized for cap and compared different empirical treatment strategies.201020823105
new antibiotics for selective treatment of gastrointestinal infection caused by clostridium difficile.clostridium difficile infection (cdi) is associated with consumption of antibiotics which disrupt the normal microbial flora of the gut, allowing c. difficile to establish itself and produce disease. currently, only vancomycin or metronidazole are recommended for treatment and many patients suffer from relapse on infection. hence, there is a need for new treatment options.201020698814
challenges and advances in infection control of hematopoietic stem cell transplant recipients.hematopoietic stem cell transplantation (hsct) has revolutionized the outcome of many malignant and non-malignant disorders; however, infection still accounts for a substantial number of deaths after both allogeneic and autologous transplants. hospital-acquired infections (hai) such as bloodstream infections, pneumonias, and diarrhea are common in this population and account for significant morbidity and cost of care. also, there is renewed focus on epidemiologically important organisms as the c ...201020701577
impact of strain type on detection of toxigenic clostridium difficile: comparison of molecular diagnostic and enzyme immunoassay approaches.a multicenter clinical trial assessed the performance of the cepheid xpert c. difficile assay on stool specimens collected from patients suspected of having clostridium difficile infection (cdi). a total of 2,296 unformed stool specimens, collected from seven study sites, were tested by xpert c. difficile enrichment culture followed by cell culture cytotoxicity testing of the isolates (i.e., toxigenic culture with enrichment) and the study sites' standard c. difficile test methods. the methods i ...201020702676
mechanisms behind variation in the clostridium difficile 16s-23s rrna intergenic spacer region.clostridium difficile infection is an increasing problem in hospitals worldwide, mainly due to the recent emergence of a hypervirulent c. difficile strain. c. difficile pcr ribotyping, based on size variation of the 16s-23s rrna intergenic spacer region (16s-23s isr), is widely used in europe for molecular epidemiological investigation. the mechanism underlying the 16s-23s isr size variations in the genome of c. difficile is currently not completely understood. to elucidate this mechanism, isola ...201020705731
an allosteric self-splicing ribozyme triggered by a bacterial second messenger.group i self-splicing ribozymes commonly function as components of selfish mobile genetic elements. we identified an allosteric group i ribozyme, wherein self-splicing is regulated by a distinct riboswitch class that senses the bacterial second messenger c-di-gmp. the tandem rna sensory system resides in the 5' untranslated region of the messenger rna for a putative virulence gene in the pathogenic bacterium clostridium difficile. c-di-gmp binding by the riboswitch induces folding changes at aty ...201020705859
lethal clostridium difficile colitis associated with paclitaxel and carboplatin chemotherapy in ovarian carcinoma: case report and review of the literature.clostridium difficile colitis, although rare, could represent a serious complication following chemotherapy. prior antibiotic use has been considered the single most important risk factor in the development of c. difficile infection. recently, the association between antineoplastic therapy and c. difficile-associated diarrhea in the absence of a prior antibiotic therapy has become more apparent. a 75-year-old woman with serous adenocarcinoma of the ovary developed lethal pancolitis caused by c. ...201020706661
stronger correlation between antibiotic use and the incidence of clostridium difficile determined by culture results instead of faecal toxin detection only.the detection of clostridium difficile in previous studies evaluating antibiotic use as a risk factor was limited to toxin assay tests. the reported associations may have been misleading due to the low sensitivity of toxin assay tests compared to culture results. antibiotic use and the incidence of c. difficile of 19 units (wards) over 5 years were analysed. stool samples were tested for toxin a/b and cultured. the correlation of antibiotic use with the incidence of c. difficile determined by cu ...201020706856
community-acquired clostridium difficile-associated diarrhea in a patient on chronic peritoneal dialysis.a 66-year-old woman on chronic peritoneal dialysis was admitted because of intermittent diarrhea and abdominal pain, and anorexia for 1 month. she had not been given antibiotics nor hospitalized for at least 6 months prior to the onset of symptoms. clostridium difficile and its toxin were detected in the stool and clostridium difficile-associated diarrhea (cdad) was diagnosed. colonoscopic examination revealed pseudomembrane formation and colitis in the whole colon. clostridium difficile and its ...201020630134
[first symposium of the bavarian lare (statewide working group on multiresistant pathogens)]. 201020631971
comparison of resistance against erythromycin and moxifloxacin, presence of binary toxin gene and pcr ribotypes in clostridium difficile isolates from 1990 and 2008.worldwide increasing rates of clostridium difficile infections (cdi) with severe courses and outbreaks have been reported. this change in cdi epidemiology has on one hand been related to the spread of specific pcr ribotypes (e.g. 027) and on the other hand to increased prevalence of resistant c. difficile strains. this single-centre retrospective analysis characterized resistance against erythromycin and moxifloxacin, presence of binary toxin gene and ribotypes in 73 c. difficile isolates from 2 ...201020632051
fulminant clostridium difficile colitis in a post-liver transplant patient. 201020635145
audit of the laboratory diagnosis of clostridium difficile infection in the uk.a uk-wide audit of the laboratory diagnosis of clostridium difficile infection (cdi) was undertaken by the association of clinical pathologists and the royal college of pathologists, in conjunction with keele university. a postal questionnaire was sent out to all consultant microbiologists, with eighty responses available for analysis. there was considerable variation in laboratory practices. in particular, only 56% of laboratories gave guidance on follow-up testing of toxin-negative samples, 68 ...201020635470
prospective assessment of two-stage testing for clostridium difficile.commonly used immunoassays have limitations as stand-alone tests for the diagnosis of clostridium difficile infection (cdi). in particular, the specificity of these assays means that these tests generate a relatively large number of false-positive results. we introduced a two-stage regimen for cdi as routine. unformed stool samples received in our laboratory were initially tested with a meridian premier enzyme immunoassay (eia) and positive samples were retested with reference testing methods (t ...201020638749
structural organization of the functional domains of clostridium difficile toxins a and b.clostridium difficile toxins a and b are members of an important class of virulence factors known as large clostridial toxins (lcts). toxin action involves four major steps: receptor-mediated endocytosis, translocation of a catalytic glucosyltransferase domain across the membrane, release of the enzymatic moiety by autoproteolytic processing, and a glucosyltransferase-dependent inactivation of rho family proteins. we have imaged toxin a (tcda) and toxin b (tcdb) holotoxins by negative stain elec ...201020624955
extended spectrum beta-lactamase-producing bacteria and clostridium difficile in patients with pouchitis.treatment with fluoroquinolones is associated with the development of clostridium difficile and extended spectrum beta-lactamase-producing bacteria (esbl). clostridium difficile and esbl are resistant to many antibiotics and each may cause pouchitis after restorative proctocolectomy (rpc) refractory to empirical antibiotic therapy.201020626734
proposed changes to management of lower respiratory tract infections in response to the clostridium difficile epidemic.clostridium difficile infection (cdi) remains a major healthcare problem associated with antibiotic use in hospitals. recent years have seen a dramatic increase in the incidence of cdi in the uk and internationally. lower respiratory tract infections (lrtis) are the leading indication for antibiotic prescription in hospitals and are therefore a critical battleground in the fight against inappropriate antibiotic use and healthcare-associated infections. this article reviews the evidence for inter ...201020179023
[changing epidemiology of infections in the netherlands in 2008/'09].to describe the epidemiological characteristics of clostridium difficile infection (cdi) in the netherlands.201020619033
disseminated intravascular coagulation, meningococcal infection, and ischemic changes affecting the lower extremities: a case study.a middle-aged woman presented from an outside hospital with a diagnosis of neisseria meningitidis and meningococcemia. a nonpalpable purpuric skin rash evolved into multiple wounds, with gradual necrosis of bilateral lower and upper extremities. throughout the course of hospitalization, the patient developed ventricular tachycardia, normocytic anemia, thrombocytosis, clostridium difficile infection, depression, and transient right eye blindness. the finding of decreased ch50 in the complement ca ...201020619693
repetitive domain of clostridium difficile toxin b exhibits cytotoxic effects on human intestinal epithelial cells and decreases epithelial barrier function.we have used recombinant repetitive domain of clostridium difficile toxin b obtained from two different strains, rec-tcdb3(10463) and rec-tcdb3(8864) and a model intestinal epithelial cell line(s) to characterize their cytotoxic and cytopathic effect and influence on tight-junction organization. both recombinant receptor binding domains caused intestinal epithelial cell damage, decreased transepithelial electrical resistance and induced translocation of zo-1 from tight-junction proteins although ...201020620216
peritoneal fluid culture in appendicitis: review in changing times.appendicectomy is one of the commoner operations with a lifetime risk as high as 12% or 23% in males or females, respectively. since the 1940s intra-operative intra-peritoneal swabs have commonly been taken from the appendix site, the spectrum of infecting organisms and their antibiotic sensitivity may be gauged from the culture results. this approach remains common but in recent years, studies have claimed that intra-peritoneal swabs are unnecessary; however, they relied upon retrospective pati ...201020621208
infection due to c. difficile ribotype 078: first report of cases in the republic of ireland.clostridium difficile is an important healthcare-associated pathogen. hypervirulent strains such as those belonging to ribotype 027 have been widely reported in recent years. a second strain associated with hypervirulence is ribotype 078 and the prevalence of clostridium difficile infection (cdi) due to this ribotype appears to be increasing. this report describes an outbreak, in which 15cases of cdi due to ribotype 078 were detected in an irish hospital and from a nursing home in the hospital's ...201020621236
empiric therapy for gram-negative pathogens in nosocomial and health care-associated pneumonia: starting with the end in mind.nosocomial pneumonia is a major cause of morbidity and mortality for hospitalized patients. antimicrobial resistance is increasing, creating a strain between ensuring the provision of adequate empiric therapy and slowing the development of antimicrobial resistance. excessive antimicrobial therapy places patients are at greater risk of drug interactions, adverse events, and superinfections. ways to maximize adequate empiric therapy include (1) categorizing each patient's risk of being infected wi ...201020622257
[clostridium-difficile-associated infections].c. difficile is a spore-forming anaerobic enteropathogen. this bacillus is responsible for virtually all cases of pseudomembranous colitis and for 15 to 25% of cases of antibiotic-associated diarrhoea. clostridium difficile associated-infections (cdi) have a wide range of clinical features which vary from mild uncomplicated diarrhoea to severe debilitating disease, paralytic ileus, toxic megacolon, or even perforation and sometimes death. risk factors for cdi include age > 65 years, previous hos ...201020188046
stool studies: tried, true, and new.much information can be obtained about a patient's gastrointestinal and overall nutritional status through stool samples. important infectious processes and neoplastic processes are initially identified through diagnostic tests and screening of stool samples. although in some arenas they are a source of embarrassment and distaste, the value of correctly obtained samples is unquestionable. patient collaboration with a critical care nurse is integral to obtaining stool samples.201020193887
antibiotic-associated hemorrhagic colitis caused by cytotoxin-producing klebsiella oxytoca.klebsiella oxytoca was recently described as the causative organism for antibiotic-associated hemorrhagic colitis (aahc). it is currently not known if this novel gastrointestinal infection exists in children. aahc is usually preceded by antibiotic treatment with penicillins, which are frequently prescribed for pediatric patients. in contrast to colitis caused by clostridium difficile, colitis caused by k oxytoca is usually segmental and located predominantly in the right colon. patients with aah ...201020194278
fatal clostridium difficile infection associated with vinorelbine chemotherapy: case report and literature review.differentiating between chemotherapy-related diarrhoea and clostridium difficile-associated diarrhoea (cdad) can be extremely difficult. there is increasing evidence that cdad can be seen in patients on chemotherapy without prior antibiotic usage. we report the first case of cdad secondary to vinorelbine chemotherapy and review the literature.201020198401
clostridium difficile toxin b differentially affects gpcr-stimulated ca2+ responses in macrophages: independent roles for rho and pla2.clostridium difficile toxins cause acute colitis by disrupting the enterocyte barrier and promoting inflammation. toxb from c. difficile inactivates rho family gtpases and causes release of cytokines and eicosanoids by macrophages. we studied the effects of toxb on gpcr signaling in murine raw264.7 macrophages and found that toxb elevated ca(2+) responses to galphai-linked receptors, including the c5ar, but reduced responses to galphaq-linked receptors, including the udp receptors. other rho inh ...201020200401
clostridium difficile.clostridium difficile has re-emerged as a major hospital-acquired infection since 2001. despite development of polymerase chain reaction-based testing, no single clinical diagnostic test has emerged with sufficient sensitivity, specificity, and turnaround time to be entirely reliable for disease diagnosis. the importance of c difficile acquired outside the hospital environment remains an unknown factor and awaits further epidemiologic investigation. this article discusses the changing epidemiolo ...201020513554
lack of increased colonization with vancomycin-resistant enterococci during preferential use of vancomycin for treatment during an outbreak of healthcare-associated clostridium difficile infection.to assess whether use of oral vancomycin for treatment during an outbreak of clostridium difficile infection (cdi) was associated with increased rates of colonization with vancomycin-resistant enterococci (vre).201020518636
changing antibiotic prophylaxis for transrectal ultrasound-guided prostate biopsies: are we putting our patients at risk?to evaluate whether changing antibiotic prophylaxis from quinolone to penicillin antibiotics has affected infectious complication rates in those men undergoing transrectal ultrasound-guided prostate biopsy (trusgpb).201020518764
transcriptional profiling of clostridium difficile and caco-2 cells during infection.clostridium difficile is well recognized as the most common infectious cause of nosocomial diarrhea. the incidence and severity of c. difficile infection (cdi) is increasing worldwide. here, we evaluated simultaneously the transcriptional changes in the human colorectal epithelial caco-2 cells and in c. difficile after infection. a total of 271 transcripts in caco-2 cells and 207 transcripts in c. difficile were significantly differentially expressed at 1 time point during cdi. we used the gene ...201020521945
the need for additional investigation of room decontamination processes. 201020521961
future novel therapeutic agents for clostridium difficile infection.clostridium difficile is the most important definable cause of healthcare acquired diarrhea. the increasing incidence and mortality associated with this enteric pathogen and the significant rate of treatment failures and recurrences with current antibiotics emphasize the need for the discovery of new and improved therapeutic and preventative agents.201020521993
probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial.enteral administration of probiotics may modify the gastrointestinal environment in a manner that preferentially favors the growth of minimally virulent species. it is unknown whether probiotic modification of the upper aerodigestive flora can reduce nosocomial infections.201020522788
differential activation of eosinophils by 'probiotic' bifidobacterium bifidum and 'pathogenic' clostridium difficile.recent studies suggest that probiotics alleviate pathophysiological processes of allergic diseases and inflammatory bowel diseases, whereas 'non-probiotic' microflora has negative effects. however, the underlying mechanisms are not well known, especially in relation to eosinophils, the major effector cells of these inflammatory diseases.201020523069
diagnosis, management, and prevention of clostridium difficile infection in long-term care facilities: a review.clostridium difficile is a significant healthcare-associated pathogen and the major cause of antibiotic-associated diarrhea. the incidence and severity of c. difficile infection have increased in many parts of north america and europe in the past few years with the widespread dissemination of a hypervirulent strain of c. difficile, referred to as north american pulsed-field type 1, polymerase chain reaction ribotype 027 (nap1/027). c. difficile infection appears to affect older adults disproport ...201020646106
hand hygiene in the intensive care unit.healthcare-associated infections affect 1.4 million patients at any time worldwide, as estimated by the world health organization. in intensive care units, the burden of healthcare-associated infections is greatly increased, causing additional morbidity and mortality. multidrug-resistant pathogens are commonly involved in such infections and render effective treatment challenging. proper hand hygiene is the single most important, simplest, and least expensive means of preventing healthcare-assoc ...201020647787
recognition and prevention of hospital-associated enteric infections in the intensive care unit.the objectives of this article were to review the causes and extent of hospital-associated infectious diarrhea and associated risks in the general hospital ward and intensive care unit (icu), to compare microorganisms with similar symptoms to aid in recognition that will lead to timely and appropriate treatment and control measures, and to propose infection prevention protocols that could decrease human process errors in the icu. this literature review describes epidemiology, comparison of micro ...201020647790
proton pump inhibitors as a risk factor for recurrence of clostridium-difficile-associated diarrhea.to investigate the risk factors for clostridium-difficile-associated diarrhea (cdad) recurrence, and its relationship with proton pump inhibitors (ppis).201020653067
[intestinal flora and antibiotics]. 201020654929
correlation of the detection of clostridium difficile toxins in stools and presence of the clostridia in tissues of children.clostridium difficile toxin is frequently found in the stool of children; however, pseudomembranous colitis is rare. studying the usefulness of clostridium difficile toxin assays in pediatrics is required. we performed a correlation between presence of clostridium difficile toxin in stool and evidence of clostridium difficile in gastrointestinal pediatric tissue samples using immunohistochemistry (with a pan-clostridial antibody) and polymerase chain reaction (with primers for toxin genes). we s ...201020656321
reducing clostridium difficile infection in acute care by using an improvement collaborative.in 2006, despite a focus on infection control, salford royal had the fourth highest rate of clostridium difficile infection in north west england.201020659985
results of faecal donor instillation therapy for recurrent clostridium difficile-associated diarrhoea.we report a success rate of 83% with faecal donor instillation therapy (fdit) in this retrospective study of 40 patients with recurrent clostridium difficile-associated diarrhoea (cdad), treated at a medium sized norwegian hospital from 1994 through 2008. the stool transplant was instilled either in the duodenum through a gastroscope or in the colon through a colonoscope with next of kin or other household member as donor. in 29 cases (73%) the first treatment was successful, with no documented ...201020662620
antibiotic prophylaxis. mrsa and clostridium difficile are falling. 201020663825
the role of toxin a and toxin b in clostridium difficile-associated disease: past and present perspectives.recently, we constructed and characterized isogenic tcda and tcdb mutants of a virulent clostridium difficile strain and used a hamster model of disease to demonstrate that toxin b, not toxin a, is essential for virulence of this emerging pathogen. earlier studies had shown that purified toxin a alone was able to induce c. difficile disease pathology and that purified toxin b was not effective unless it was co-administered with toxin a, suggesting that the toxins act synergistically. in this add ...201020664812
laboratory diagnosis of clostridium difficile infection. 201020668301
glutamate dehydrogenase for laboratory diagnosis of clostridium difficile infection. 201020668302
[clostridium difficile infections. not just a hospital problem]. 201020672581
evaluation of a rapid molecular screening approach for the detection of toxigenic clostridium difficile in general and subsequent identification of the tcdc δ117 mutation in human stools.we have developed and validated a rapid molecular screening protocol for toxigenic clostridium difficile, that also enables the identification of the hypervirulent epidemic 027/nap1 strain. we describe a multiplex real-time pcr assay, which detects the presence of the tcda and tcdb genes directly in stool samples. in case of positive pcr results, a separate multiplex real-time pcr typing assay was performed targeting the tcdc gene frame shift mutation at position 117. we prospectively compared t ...201020674616
inhibiting the initiation of clostridium difficile spore germination using analogs of chenodeoxycholic acid, a bile acid.to cause disease, clostridium difficile spores must germinate in the host gastrointestinal tract. germination is initiated upon exposure to glycine and certain bile acids, e.g., taurocholate. chenodeoxycholate, another bile acid, inhibits taurocholate-mediated germination. by applying michaelis-menten kinetic analysis to c. difficile spore germination, we found that chenodeoxycholate is a competitive inhibitor of taurocholate-mediated germination and appears to interact with the spores with grea ...201020675492
human hypervirulent clostridium difficile strains exhibit increased sporulation as well as robust toxin production.toxigenic clostridium difficile strains produce two toxins (tcda and tcdb) during the stationary phase of growth and are the leading cause of antibiotic-associated diarrhea. c. difficile isolates of the molecular type nap1/027/bi have been associated with severe disease and hospital outbreaks worldwide. it has been suggested that these "hypervirulent" strains produce larger amounts of toxin and that a mutation in a putative negative regulator (tcdc) allows toxin production at all growth phases. ...201020675495
characterization of bacterial infections in allogeneic hematopoietic stem cell transplant recipients who received prophylactic levofloxacin with either penicillin or doxycycline.to describe the effect of a combination prophylactic regimen of levofloxacin, a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class, with either penicillin or doxycycline on the changing epidemiology of bacterial infections and antimicrobial resistance patterns of isolated organisms in the allogeneic hematopoietic stem cell transplant (hsct) patient population.201020675508
rifaximin for the treatment of recurrent clostridium difficile infection after liver transplantation: a case series.previous data have suggested that the nonsystemic antibiotic rifaximin may be effective for the treatment of clostridium difficile infection (cdi). this single-center retrospective study evaluated the efficacy of rifaximin for the treatment of cdi refractory to standard treatments in patients who had received liver transplants. among 205 patients who had received liver transplants between july 2001 and december 2007, 3 patients with a confirmed diagnosis of c. difficile experienced recurrent dia ...201020677286
epidemiological patterns and hospital characteristics associated with increased incidence of clostridium difficile infection in quebec, canada, 1998-2006.to explore epidemiological patterns of the incidence of clostridium difficile infection (cdi) and hospital characteristics associated with increased incidence during nonepidemic and epidemic years.201020677973
the growing incidence and severity of clostridium difficile infection in inpatient and outpatient settings.clostridium difficile infection (cdi) is a leading cause of nosocomial infections, with disease severity ranging from mild diarrhea to fulminant colitis. the incidence and severity of cdi has been on the rise over the last 10-20 years, with cdi being increasingly described outside healthcare settings and in populations previously thought to be at low risk. there has also been an increase in the morbidity, mortality and economic burden associated with cdi in the last several years. this increasin ...201020678014
clostridium difficile bacteremia, taiwan.to determine clinical characteristics and outcome of patients with clostridium difficile bacteremia (cdb), we identified 12 patients with cdb in 2 medical centers in taiwan; all had underlying systemic diseases. five had gastrointestinal diseases or conditions, including pseudomembranous colitis (2 patients); 4 recalled diarrhea, but only 5 had recent exposure to antimicrobial drugs. ten available isolates were susceptible to metronidazole and vancomycin. five isolates had c. difficile toxin a o ...201020678312
clostridium difficile colitis: a call for aggressive management. 201020679044
use of intravenous co-trimoxazole to treat bacterial infection: analysis of 50 treatment episodes.co-trimoxazole is infrequently prescribed in the uk due to concerns regarding adverse events. however, it has a low association with clostridium difficile-associated disease (cdad) and may represent an alternative to higher-risk agents. this retrospective study examines the efficacy and safety of intravenous co-trimoxazole in treatment of bacterial infection in a uk inpatient population of 50 inpatients. outcome was determined to be successful in 58% of treatment episodes; in hospital-acquired p ...201020685632
is repeat pcr needed for diagnosis of clostridium difficile infection?patients with diarrhea, defined as loose or watery stool, and two or more clostridium difficile tcdb pcr tests within 14 days of each other were investigated. repeat pcr for 293 patients with a prior negative result yielded negative results in 396 (97.5%) of 406 tests. ten new positives were detected, including one false positive. repeat pcr within 7 days appears rarely useful, except for patients with evidence of a new infection.201020686078
relatedness of human and animal clostridium difficile pcr ribotype 078 isolates determined on the basis of multilocus variable-number tandem-repeat analysis and tetracycline resistance.totals of 102 and 56 clostridium difficile type 078 strains of human and porcine origins, respectively, from four european countries were investigated by an optimized multilocus variable-number tandem-repeat analysis (mlva) and for tetracycline susceptibility. eighty-five percent of all isolates were genetically related, irrespective of human or porcine origin. human strains were significantly more resistant to tetracycline than porcine strains. all tetracycline-resistant strains contained the t ...201020686080
simple strategy helped patient handle short-term memory loss. 201020687287
inhibition of rho-rock signaling induces apoptotic and non-apoptotic ps exposure in cardiomyocytes via inhibition of flippase.subsequent to myocardial infarction, cardiomyocytes within the infarcted areas and border zones expose phosphatidylserine (ps) in the outer plasma membrane leaflet (flip-flop). we showed earlier that in addition to apoptosis, this flip-flop can be reversible in cardiomyocytes. we now investigated a possible role for rho and downstream effector rho-associated kinase (rock) in the process of (reversible) ps exposure and apoptosis in cardiomyocytes. in rat cardiomyoblasts (h9c2 cells) and isolated ...201020691698
clostridium difficile its potential as a source of foodborne disease.clostridium difficile has been recognized as an important human pathogen for several decades, but its importance as an agent of animal disease was established only recently. the number of reports on c. difficile in food is rising, but the findings vary among studies. in north america, the prevalence of contamination in retail meat and meat products ranges from 4.6% to 50%. in european countries, the percentage of c. difficile positive samples is much lower (0-3%). this chapter summarizes current ...201020691953
comment on: increasing incidence of community-associated atypical clostridium difficile disease in children. 201020693524
multicenter study of clostridium difficile infection rates from 2000 to 2006.to compare incidence rates of clostridium difficile infection (cdi) during a 6-year period among 5 geographically diverse academic medical centers across the united states by use of recommended standardized surveillance definitions of cdi that incorporate recent information on healthcare facility (hcf) exposure.201020695799
clostridium difficile toxin a decreases acetylation of tubulin, leading to microtubule depolymerization through activation of histone deacetylase 6, and this mediates acute inflammation.clostridium difficile toxin a is known to cause actin disaggregation through the enzymatic inactivation of intracellular rho proteins. based on the rapid and severe cell rounding of toxin a-exposed cells, we speculated that toxin a may be involved in post-translational modification of tubulin, leading to microtubule instability. in the current study, we observed that toxin a strongly reduced α-tubulin acetylation in human colonocytes and mouse intestine. fractionation analysis demonstrated that ...201020696758
clostridium difficile infection.clostridium difficile is the leading cause of hospital-acquired diarrhea in europe and north america and is a serious reemerging pathogen. recent outbreaks have led to increasing morbidity and mortality and have been associated with a new strain (bi/nap1/027) of c difficile that produces more toxin than historic strains. with the increasing incidence of c difficile infection, clinicians have also seen a change in the epidemiology with increased infections in previously low-risk populations. this ...201020697257
clostridium difficile: an update for the primary care clinician.clostridium difficile infection (cdi) is an important cause of intestinal disease, primarily affecting hospitalized patients exposed to antibiotics. infection has been associated with prolonged hospital stays and excess healthcare expenditures. recent changes in the epidemiology, pathogenesis, and treatment of cdi have occurred, leading to renewed scrutiny of this pathogen. increases in its incidence and severity have been documented, possibly due to the emergence of a hypervirulent strain that ...201020697321
guideline: appropriate use of tigecycline.tigecycline, the first of a new class of antibiotics, the glycylcyclines, was licensed in south africa for the parenteral treatment of adult patients with complicated intra-abdominal infections (ciais) and complicated skin and soft-tissue infections (csstis).201020529440
[right-sided lower abdominal pain and diarrhea of a young diabetic woman].we report the case of a 24-years old diabetic women hospitalised because of right-sided lower abdominal pain and diarrhea. she fulminantly developed shock before appendectomy could be performed and was transferred to intensive care unit. hypotension remained and laparoscopy revealed primary peritonitis and toxic shock syndrome by group a streptococcus which was cultivated in blood and ascites. therapy with penicilline and clindamycine resolved symptoms. during hospitalisation clostridium diffici ...201020533233
characterization of the membrane-targeting c1 domain in pasteurella multocida toxin.pasteurella multocida toxin (pmt) is a virulence factor responsible for the pathogenesis of some forms of pasteurellosis. the toxin activates g(q)- and g(12/13)-dependent pathways through the deamidation of a glutamine residue in the alpha-subunit of heterotrimeric gtpases. we recently reported the crystal structure of the c terminus (residues 575-1285) of pmt (c-pmt), which is composed of three domains (c1, c2, and c3), and that the c1 domain is involved in the localization of c-pmt to the plas ...201020534589
semi-automated risk estimation using large databases: quinolones and clostridium difficile associated diarrhea.the availability of large databases with person time information and appropriate statistical methods allow for relatively rapid pharmacovigilance analyses. a semi-automated method was used to investigate the effect of fluoroquinolones on the incidence of c. difficile associated diarrhea (cdad).201020535755
probiotics and the immune response to vaccines.probiotics are bacteria, but sometimes fungi, which when taken by the oral route may give some health benefits. the most compelling evidence for beneficial effects of probiotics is in the prevention and reduction in the duration of symptoms related to gut infectious disease. there is also evidence to show that some specific probiotics are beneficial in clostridium difficile diarrhoea in the elderly. as further and better controlled clinical studies have appeared, some specific probiotics also ap ...201020540823
the occurrence and high diversity of clostridium difficile genotypes in rivers.clostridium difficile is mainly associated with nosocomial infections but can be present also in other environments. in this study we compared three methods (culturing with and without ethanol shock and real-time pcr) for detection of c. difficile in water and have used them on a series of river water samples. c. difficile was present in 17 of 25 rivers tested (68.0%) and in 42 of 69 water samples tested (60.9%). positive sampling sites correlated with increased population densities. isolates we ...201020541023
the potential value of clostridium difficile vaccine: an economic computer simulation model.efforts are currently underway to develop a vaccine against clostridium difficile infection (cdi). we developed two decision analytic monte carlo computer simulation models: (1) an initial prevention model depicting the decision whether to administer c. difficile vaccine to patients at-risk for cdi and (2) a recurrence prevention model depicting the decision whether to administer c. difficile vaccine to prevent cdi recurrence. our results suggest that a c. difficile vaccine could be cost-effecti ...201020541582
detection of toxigenic clostridium difficile in diarrheal stools by rapid real-time polymerase chain reaction.the cepheid xpert polymerase chain reaction assay (sunnyvale, ca) had a sensitivity of 100%, specificity of 96.7%, and positive and negative predictive values of 90.5% and 100%, respectively, compared with toxigenic culture for the laboratory diagnosis of clostridium difficile in diarrheal stool samples. this test appears to be a significant improvement to poorly performing enzyme immunoassays.201020542211
clostridium difficile infections in a tertiary hospital: value of surveillance. 201020542596
the emergence of 'hypervirulence' in clostridium difficile.the impact of clostridium difficile-associated disease (cdad) in healthcare settings throughout the developed world is considerable in terms of mortality, morbidity, and disease management. the incidence of cdad has risen dramatically since the turn of this century, concomitant with the emergence of so-called hypervirulent strains which are thought to cause a more severe disease, higher relapse rates, and increased mortality. pre-eminent amongst hypervirulent strains are those belonging to ribot ...201020547099
hospital adverse events and control charts. 201020547431
fecal bacteriotherapy for relapsing clostridium difficile infection in a child: a proposed treatment protocol.clostridium difficile infection (cdi) is a potentially serious emerging infectious disease. the incidences of cdi in childhood and cdi cases complicated by relapses have increased by 50% or more in north america during the past 2 decades. we report here the case of a 2-year-old child with relapsing cdi caused by the epidemic strain bi/nap1/o27 that was refractory to saccharomyces boulardii and lactobacillus rhamnosus gg probiotics and to intensive therapy with traditional (metronidazole, vancomy ...201020547640
clostridium difficile isolates resistant to fluoroquinolones in italy: emergence of pcr ribotype 018.recent evidence strongly suggests an association between the use of fluoroquinolones and clostridium difficile infection (cdi). resistance to fluoroquinolones has been described not only in the hypervirulent strain 027, but also in other important pcr ribotypes circulating in hospital settings. in a european prospective study conducted in 2005, strains resistant to moxifloxacin represented 37.5% of c. difficile clinical isolates. in this study, we investigated a sample of 147 toxigenic c. diffic ...201020554809
clostridium difficile colitis in children following lung transplantation.risk factors for clostridium difficile diarrhea are antibiotic exposure, hospitalization, extreme ages, and immunodeficiency. patients with cf have a high rate of colonization with c. difficile. we performed a retrospective chart review of patients at texas children's hospital who underwent lung transplantation since the inception of our program in october 2002 until october 2008. there were 78 pediatric lung transplants performed at our institution during the study period. four patients develop ...201020561346
kinetic evidence for the presence of putative germination receptors in clostridium difficile spores.clostridium difficile is a spore-forming bacterium that causes clostridium difficile-associated disease (cdad). intestinal microflora keeps c. difficile in the spore state and prevents colonization. following antimicrobial treatment, the microflora is disrupted, and c. difficile spores germinate in the intestines. the resulting vegetative cells are believed to fill empty niches left by the depleted microbial community and establish infection. thus, germination of c. difficile spores is the first ...201020562307
[prevalence of clostridium difficile in the gastrointestinal tract of hospitalized children under two years of age].the aim of this study was to determine prevalence of c. difficile in the gastrointestinal tract of hospitalized children under two years of age and a comparison of phenotypic and genotypic features. hundred and seventy-eight samples collected from the faecal samples of children aged 2 months to 2 years, hospitalized in 2003-2006 were examined for the presence of toxin a/b of c. difficile. toxigenicity of strains was confirmed using pcr. susceptibility to antimicrobials was determined using e-tes ...201020564974
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