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array comparative hybridisation reveals a high degree of similarity between uk and european clinical isolates of hypervirulent clostridium difficile.clostridium difficile is a gram-positive, anaerobic, spore-forming bacterium that is responsible for c. difficile associated disease in humans and is currently the most common cause of nosocomial diarrhoea in the western world. this current status has been linked to the emergence of a highly virulent pcr-ribotype 027 strain. the aim of this work was to identify regions of sequence divergence that may be used as genetic markers of hypervirulent pcr-ribotype 027 strains and markers of the sequence ...201020565959
role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, clostridium difficile, and acinetobacter species.health care-associated infections (hai) remain a major cause of patient morbidity and mortality. although the main source of nosocomial pathogens is likely the patient's endogenous flora, an estimated 20% to 40% of hai have been attributed to cross infection via the hands of health care personnel, who have become contaminated from direct contact with the patient or indirectly by touching contaminated environmental surfaces. multiple studies strongly suggest that environmental contamination plays ...201020569853
letter in response to the article "optimum timing of blood tests for monitoring patients with clostridium difficile-associated diarrhea" (j investig med.2010;58[4]:621-624). 201020571442
enteric bacterial pathogens with zoonotic potential isolated from farm-raised deer.the raising of captive white-tailed deer (odocoileus virginianus) is a growing agricultural industry in ohio as it is in several other areas of the united states and around the world. pooled fecal samples were collected from 30 white-tailed deer confinement facilities. samples were cultured for five enteric bacterial pathogens. premise prevalence rates were as follows: escherichia coli o157, 3.3%; listeria monocytogenes, 3.3%; salmonella enterica, 0%; yersinia enterocolitica, 30%; and clostridiu ...201020575673
clostridium difficile infection in polish pediatric outpatients with inflammatory bowel disease.the prevalence of clostridium difficile infection (cdi) in pediatric patients with inflammatory bowel disease (ibd) is still not sufficiently recognized. we assessed the prevalence of cdi and recurrences in outpatients with ibd. in addition, the influence of ibd therapy on cdi and antimicrobial susceptibility of the potentially causative c. difficile strains was assessed. this was a prospective, single-center, observational study. all specimens were obtained between january 2005 and january 2007 ...201020577773
the food glycome: a source of protection against pathogen colonization in the gastrointestinal tract.trillions of microbes inhabit the gastrointestinal tract of humans with significant differences in the composition and distribution of intestinal flora along its length. normally there is a symbiotic relationship between the intestinal microflora and the host, with mutual advantages for both partners. when this relationship is altered, commensal bacteria can rapidly shift toward pathogenicity resulting in the onset and progression of gastrointestinal infection. pathogen adhesion and colonization ...201020580113
clostridium difficile infection in general surgery patients; identification of high-risk populations.risk factors associated with clostridium difficile infection (cdi) in general surgical patients are poorly characterised. this study aimed to characterise the incidence and associations of c. difficile positivity (cdp) in general surgical inpatients to aid in the design of future policies regarding focused screening and risk-stratification mechanisms in this patient subpopulation.201020580865
avoiding colectomy during surgical management of fulminant clostridium difficile colitis.clostridium difficile is the most common cause of nosocomial diarrhea in adults. over the last decade, there has been a substantial increase in the disease-associated morbidity and mortality rate from this infection accompanied by identification of new hypervirulent strains. fulminant colitis, a severe and complicated form of the disease that frequently necessitates surgical intervention, occurs in 3-8% of patients infected with c. difficile. the postoperative mortality rate for fulminant coliti ...201020583866
increase in use of vancomycin for clostridium difficile infection in us hospitals. 201020586649
physiologic reference ranges for captive black-tailed prairie dogs (cynomys ludovicianus).the black-tailed prairie dog (cynomys ludovicianus) is a member of the order rodentia and the family sciuridae. ecologically, prairie dogs are a keystone species in prairie ecology. this species is used as an animal model for human gallbladder disease and diseases caused by infection with clostridium difficile, yersinia pestis, francisella tularensis, and most recently, orthopoxvirus. despite increasing numbers of prairie dogs used in research and kept as pets, few data are available on their ba ...201020587156
investigation of a large outbreak of clostridium difficile pcr-ribotype 027 infections in northern france, 2006-2007 and associated clusters in 2008-2009.in 2006 and 2007, a large outbreak of clostridium difficile infections (cdis) with pcr-ribotype 027 was identified in northern france. overall, 38 healthcare facilities notified 529 cdis over a 22-month period, including 281 laboratory-confirmed cdi 027 and 248 non-confirmed cdi 027 cases (incidence rate per 10,000 elective bed days: 1.63, range: 0.07 to 7.94). the cases occurred mainly in long-term care hospital facilities and nursing homes, near the border between france and belgium. an active ...201020587362
clostridium difficile in patients undergoing primary hip and knee replacement.antibiotic prophylaxis is routinely administered during joint replacement surgery and may predispose patients to clostridium difficile-associated disease (cdad). the primary aim of this study was to determine the incidence of this following joint replacement, using a cefuroxime-based regimen. patients developing cdad were compared with a control group of patients without cdad. the incidence of the former was 1.7 per 1000 primary joint replacements. those patients prescribed additional antibiotic ...201020595121
clostridium difficile: no longer an enigmatic pathogen?never before has there been a more timely opportunity to investigate the molecular genetics of clostridium difficile. over the last few years the perception of c. difficile has changed from an obscure, and often under-researched, bacterium to one of major clinical importance, at least in industrialized nations. coupled with the increased interest in this organism researchers now have a greater understanding of its genetic content and molecular epidemiology; a direct consequence of the multiple c ...201020596999
clostridium difficile and the disease it causes.clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. frequent and early colonization of the human intestinal flora is common and often asymptomatic. antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin a and b it precipitates c. difficile infection (cdi). the enterocytic detachment and bowel inflammation provoke c. difficile-associated diarrhoea (cdad) sometimes developing ...201020597000
clostridium difficile isolation and culture techniques.clostridium difficile infection (cdi) occurs as a disease with a spectrum of severity ranging from mild, self-limiting diarrhoea to a severe colitis, pseudomembraneous colitis or toxic megacolon. the disease arises as a major complication of antibiotic therapy and is most commonly acquired in hospital. the laboratory investigation of faecal samples is supportive of a clinical suspicion that a patient has the disease. currently the mainstay of diagnosis is the demonstration of c. difficile toxins ...201020597001
molecular typing methods for clostridium difficile: pulsed-field gel electrophoresis and pcr ribotyping.molecular typing methods for clostridium difficile are based on gel electrophoresis of restriction fragments (endonuclease restriction analysis, rea; pulsed field gel electrophoresis pfge; toxinotyping), pcr amplification (pcr ribotyping, arbitrarily primed pcr, multilocus variable-number tandem-repeat analysis mlva), and sequence analysis (multilocus sequence typing mlst; slpa typing, tandem repeat sequence typing). we will describe two standard methods (pcr ribotyping predominantly used throug ...201020597002
clostridium difficile toxinotyping.clostridium difficile shows considerable variability in the paloc region encoding two main virulence factors, toxins tcda and tcdb. strains with changes in paloc are defined as variant toxinotypes and currently 27 such groups are recognized (i to xxvii). toxinotype 0 includes strains with paloc identical to the reference laboratory strain vpi 10463. toxinotyping is a rflp-pcr-based method using a combination of restriction patterns of part of tcdb and tcda genes for determination of toxinotype. ...201020597003
multilocus sequence typing for clostridium difficile.multilocus sequence typing (mlst), a nucleotide sequence-based characterization of allelic polymorphism of housekeeping genes, has been proposed as a new approach for population and evolutionary genetics and global epidemiology of bacterial pathogens. mlst provides unambiguous sequence data that can be generated from various laboratories and should be shared in a common web database. here are presented most of materials, methods, and programs or software necessary to perform mlst on clostridium ...201020597004
molecular methods to study transcriptional regulation of clostridium difficile toxin genes.toxin a (tcda) and toxin b (tcdb) are the major virulence factors that contribute to the pathogenesis of clostridium difficile-associated diarrhoea (cdad). these enterotoxins act by glucosylation of members of the rho protein family of small gtp-binding proteins. this leads to the disorganization of the host cell actin cytoskeleton (cytopathic effect) and apoptosis (cytotoxic effect). due to their glucosyltransferase activity, they are referred as "clostridial glucosylating toxins". the severe f ...201020597005
dissecting the cell surface.the bacterial cell surface is an important structure as it mediates interactions with the external environment. in the case of pathogens like clostridium difficile, the cell wall and its components also have to mediate interactions with the host cells and their products. in this chapter we discuss the various methods used for dissecting the cell surface and the biochemical and immunological procedures that are commonly used to analyse the properties of the proteins within the cell wall. a major ...201020597006
human intestinal epithelial response(s) to clostridium difficile.clostridium difficile is a gram-positive, spore-forming, toxin-producing anaerobic bacillus that is being increasingly implicated as the leading cause of diarrhea and colitis, particularly in hospitalized, elderly patients. studies to date suggest that c. difficile toxins a and b play a major role in the observed colonic inflammation and associated disease pathogenesis; however, the role of other potential bacterial factors at present remains unknown. early effects of c. difficile on host intest ...201020597007
clostridium difficile using dna microarrays.clostridium difficile is a pathogen on the move, as evidenced by the rapid transcontinental spread of the so-called hypervirulent 027 strains, followed by the emergence of further pcr ribotypes such as 017, 078 and 106. this provides a rare opportunity to study the evolution of virulence in action. however, to fully exploit this opportunity, robust phylogenetic methods on a diverse set of characterised strains are required to provide a reference evolutionary framework to study c. difficile epide ...201020597008
clostron-targeted mutagenesis.members of the genus clostridium have long been recognised as important to humankind and its animals, both in terms of the diseases they cause and the useful biological processes they undertake. this has led to increasing efforts directed at deriving greater information on their basic biology, most notably through genome sequence. accordingly, annotated sequences of all of the most important species are now available. however, full exploitation of the data generated has been hindered by the lack ...201020597009
methods for gene cloning and targeted mutagenesis.clostridium difficile is the causative agent of a range of intestinal diseases, collectively referred to as clostridium difficile-associated disease (cdad). the recent emergence of "hypervirulent" strains associated with increased rates of mortality and severity of disease in humans has highlighted the need to study this organism at the molecular level. these studies will increase our knowledge of the mechanisms by which c. difficile causes disease and facilitate the rational design of new and i ...201020597010
transposon mutagenesis in clostridium difficile.genetic manipulation of clostridium difficile is notoriously difficult, currently there is only one reliable method for generating random mutations in the organism and that is to use the conjugative transposon tn916. tn916 enters the genome of most strains of c. difficile with no obvious target site preference. in order to use the genome strain c. difficile 630 for transposon mutagenesis a erythromycin-sensitive derivative c. difficile 630deltaerm was constructed and the tn916 derivative, tn916d ...201020597011
refinement of the hamster model of clostridium difficile disease.the golden syrian hamster is widely regarded as the most relevant small animal model of clostridium difficile disease as oral infection of animals pre-treated with antibiotics reproduces many of the symptoms observed in man. these include diarrhoea, histological damage, colonisation of the large bowel and sporulation of the organism at the terminal stage of the disease. however, infection results in a fatal outcome, which in the past has been used as an experimental endpoint. more recently, atte ...201020597012
methods for working with the mouse model.mouse models have been developed to study the pathogenic process of clostridium difficile infections, first the intestinal colonization and second the toxin production. these models have also been used to test the role of environmental conditions that modulate infection. different mouse models have been used successfully to study c. difficile infections such as conventional mice, gnotobiotic mouse models including the monoxenic c. difficile mouse model, and the human microbiota-associated mouse ...201020597013
clostridium difficile: an intestinal infection on the rise. 201020597186
dirty ducting poses significant risks.richard norman, managing director of ventilation system cleaning specialist indepth hygiene, discusses the importance of ensuring that such systems are properly cleaned in healthcare facilities, especially, he argues, as dust and debris on internal surfaces of ducting are potentially "ideal nutrients" for the growth of microorganisms such as mrsa and clostridium difficile. in addition he warns that, if not properly and regularly cleaned, grease extract ventilation systems linked to catering faci ...201020597385
death due to community-associated clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected lyme disease. 201020597684
evaluation of candidate reference genes in clostridium difficile for gene expression normalization.quantitative real-time polymerase chain reaction (qpcr) is a sensitive, efficient and reproducible technique for studying gene expression. identification of stably expressed reference genes is required to avoid bias in these studies yet mostly unvalidated reference genes are used in studying gene expression in clostridium difficile. here, we sought to identify a set of stable reference genes used to normalize c. difficile expression data comparing exponential versus stationary phases of growth. ...201020599622
fecal bacteriotherapy, fecal transplant, and the microbiome. 201020601895
pseudo-outbreak of clostridium difficile associated diarrhea (cdad) in a tertiary-care hospital.the objective of this study was to describe a pseudo-outbreak of c. difficile in a hospital, following a change in the method used to detect the toxin. in february 2002, there were two cases of cdad and in march 7 occurred, coinciding with a change of the test (from detection of toxin a to toxin a/b). an outbreak was suspected. active surveillance and education of staff were started. a cdad case was defined as a patient with acute onset of diarrhea (> or = three episodes of liquid stools) and a ...201020602022
barriers to implementing infection prevention and control guidelines during crises: experiences of health care professionals.communicable disease crises can endanger the health care system and often require special guidelines. understanding reasons for nonadherence to crisis guidelines is needed to improve crisis management. we identified and measured barriers and conditions for optimal adherence as perceived by 4 categories of health care professionals.201020605262
prevention of endemic healthcare-associated clostridium difficile infection: reviewing the evidence.clostridium difficile is the most common infectious cause of healthcare-associated diarrhea. because of the increasing incidence and severity of endemic c. difficile infection (cdi), interventions to prevent healthcare-associated cdi are essential. we undertook a systematic review of interventions to reduce healthcare-associated cdi.201020606676
chronic kidney disease as a risk factor for clostridium difficile infection.clostridium difficile-associated diarrhoea (cdad) is the most common cause of nosocomial diarrhoea in the usa. in this study, we sought to determine the association between chronic kidney disease (ckd) and cdad.201020609100
obesity as a risk factor for nosocomial infections in trauma patients.obesity, like multiple trauma, is associated with an inflammatory condition that leads to an immunodeficient state. obese trauma patients are thus thought to be at higher risk of infection compared to patients of normal body mass. despite this risk, studies to date have not defined obesity as an independent risk factor for infection in trauma patients.201020610250
the changing epidemiology of clostridium difficile infections.the epidemiology of clostridium difficile infection (cdi) has changed dramatically during this millennium. infection rates have increased markedly in most countries with detailed surveillance data. there have been clear changes in the clinical presentation, response to treatment, and outcome of cdi. these changes have been driven to a major degree by the emergence and epidemic spread of a novel strain, known as pcr ribotype 027 (sometimes referred to as bi/nap1/027). we review the evidence for t ...201020610822
evaluation of an automated ultraviolet radiation device for decontamination of clostridium difficile and other healthcare-associated pathogens in hospital rooms.environmental surfaces play an important role in transmission of healthcare-associated pathogens. there is a need for new disinfection methods that are effective against clostridium difficile spores, but also safe, rapid, and automated.201020615229
safety of the long-term use of proton pump inhibitors.the proton pump inhibitors (ppis) as a class are remarkably safe and effective for persons with peptic ulcer disorders. serious adverse events are extremely rare for ppis, with case reports of interstitial nephritis with omeprazole, hepatitis with omeprazole and lansoprazole, and disputed visual disturbances with pantoprazole and omeprazole. ppi use is associated with the development of fundic gland polyps (fgp); stopping ppis is associated with regression of fgp. in the absence of helicobacter ...201020480516
surveillance data on outbreaks of clostridium difficile infection in ontario, canada, in 2008-2009. 201020482266
charting the course for the future of science in healthcare epidemiology: results of a survey of the membership of the society of healthcare epidemiology of america.to describe the results of a survey of members of the society for healthcare epidemiology of america (shea) that (1) measured members' perceptions of gaps in the healthcare epidemiology knowledge base and members' priorities for shea research goals, (2) assessed whether members would be willing to participate in consortia to address identified gaps in knowledge, and (3) evaluated the need for training for the next generation of investigators in the field of healthcare epidemiology.201020482374
fecal flora reconstitution for recurrent clostridium difficile infection: results and methodology.recurrent clostridium difficile infection (rcdi) is an increasingly common clinical problem without ideal treatment options. our aim was to evaluate our results using fecal flora reconstitution (ffr), and promulgate our methodology to the gi community to foster its more widespread use in appropriate candidates.201020485184
clostridium difficile survives minimal temperature recommended for cooking ground meats.we quantified the thermal inhibitory effect of 71°c (recommended for cooking ground meats), and re-heating at 85°c, on food- and food-animal-derived clostridium difficile spores. all c. difficile strains tested (n=20) survived 71°c for 2 h, but 90% died within 10 min when re-heated at 85°c. current cooking recommendations would need revision to include c. difficile.201020488251
biological activity of modified and exchanged 2-amino-5-nitrothiazole amide analogues of nitazoxanide.head group analogues of the antibacterial and antiparasitic drug nitazoxanide (ntz) are presented. a library of 39 analogues was synthesized and assayed for their ability to suppress growth of helicobacter pylori, campylobacter jejuni, clostridium difficile and inhibit ntz target pyruvate:ferredoxin oxidoreductase (pfor). two head groups assayed recapitulated ntz activity and possessed improved activity over their 2-amino-5-nitrothiazole counterparts, demonstrating that head group modification i ...201020488706
how is diarrhoea managed in uk care homes? a survey with implications for recognition and control of clostridium difficile infection.policy and regulatory efforts to reduce clostridium difficile infection (cdi) rates now focus increasingly on the community setting, especially residential and nursing homes for the elderly. we aimed to describe how potentially infectious diarrhoea is managed in care homes, and to explore related infection control and human waste management practices.201020488944
what is the evidence for the use of probiotics in the treatment of inflammatory bowel disease?the purpose of this article is to investigate the use of probiotics in the treatment of inflammatory bowel disease.201020492035
clostridial glucosylating toxins enter cells via clathrin-mediated endocytosis.clostridium difficile toxin a (tcda) and toxin b (tcdb), c. sordellii lethal toxin (tcsl) and c. novyi alpha-toxin (tcna) are important pathogenicity factors, which represent the family of the clostridial glucosylating toxins (cgts). toxin a and b are associated with antibiotic-associated diarrhea and pseudomembraneous colitis. lethal toxin is involved in toxic shock syndrome after abortion and alpha-toxin in gas gangrene development. cgts enter cells via receptor-mediated endocytosis and requir ...201020498856
comment on: caution should be taken before operating on patients with clostridium difficile colitis. 201020501024
low occurrence of clostridium difficile in fecal samples of healthy calves and pigs at slaughter and in minced meat in switzerland.clostridium difficile is a cause of diarrhea and colitis in humans. the increase of incidence and severity of c. difficile infections in humans in past years is due, at least in part, to the emergence of more virulent strains (pcr ribotypes 027 and 078). recent studies describe the occurrence of hypervirulent strains in ground meat products. therefore, food animals and food need to be assessed for their possible role as vectors of c. difficile to humans. in this pilot study, fecal samples of 204 ...201020501051
increased clostridium difficile virulence demands new treatment approach. 201020501917
antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease.guidelines recommend antibiotic therapy for acute exacerbations of chronic obstructive pulmonary disease (copd), but the evidence is based on small, heterogeneous trials, few of which include hospitalized patients.201020501925
fidaxomicin: difimicin; lipiarmycin; opt 80; opt-80; par 101; par-101.fidaxomicin, an rna polymerase inhibitor, is being developed by optimer and par pharmaceuticals as a narrow-spectrum antibacterial for the treatment of clostridium difficile infections. it is currently in phase iii development with promising results so far. this review looks at the development history and scientific profile of this drug to date.201020509714
clostridium difficile pcr ribotype 027: assessing the risks of further worldwide spread.highly virulent strains of clostridium difficile have emerged since 2003, causing large outbreaks of severe, often fatal, colitis in north america and europe. in 2008-10, virulent strains spread between continents, with the first reported cases of fluoroquinolone-resistant c difficile pcr ribotype 027 in three asia-pacific countries and central america. we present a risk assessment framework for assessing risks of further worldwide spread of this pathogen. this framework first requires identific ...201020510280
asymptomatic colonization by clostridium difficile in infants: implications for disease in later life.approximately 60% to 70% of healthy newborns and infants are colonized by the enteric pathogen clostridium difficile. for reasons that remain obscure, these colonized infants show no ill effects from the potent exotoxins released by this anaerobe, in contrast to older children and adults who are susceptible to severe diarrhea and colitis. the organism is acquired in infancy, as in adults, from environmental contamination in the nursery or home environment. between 12 and 24 months c difficile is ...201020512057
effectiveness of alcohol-based hand rubs for removal of clostridium difficile spores from hands.alcohol-based hand rubs (abhrs) are an effective means of decreasing the transmission of bacterial pathogens. alcohol is not effective against clostridium difficile spores. we examined the retention of c. difficile spores on the hands of volunteers after abhr use and the subsequent transfer of these spores through physical contact.201020429659
reexamining methods and messaging for hand hygiene in the era of increasing clostridium difficile colonization and infection. 201020429660
prevention and control of clostridium difficile infection.this article examines risk factors, pathogenesis, symptoms and management of clostridium difficile infection, which is the major cause of enteric infections among people aged over 65 years in healthcare settings. symptoms range from mild to profuse watery diarrhoea, which may be accompanied by severe life-threatening inflammation of the intestine. transmission is by the faecal-oral route, via the hands of health workers and from environmental reservoirs. eradication is difficult because c. diffi ...201020432784
expression, purification and cell cytotoxicity of actin-modifying binary toxin from clostridium difficile.clostridium difficile infection (cdi) is a serious problem within the healthcare environment where the bacterium causes symptoms ranging from mild diarrhoea to life-threatening colitis. in addition to its principal virulence factors, toxin a and toxin b, some c. difficile strains produce a binary toxin (cdt) composed of two sub-units namely cdta and cdtb that are produced and secreted from the cell as two separate polypeptides. once in the gut these fragments have the potential to combine to for ...201020433927
thuricin cd, a posttranslationally modified bacteriocin with a narrow spectrum of activity against clostridium difficile.the last decade has seen numerous outbreaks of clostridium difficile-associated disease (cdad), which presented significant challenges for healthcare facilities worldwide. we have identified and purified thuricin cd, a two-component antimicrobial that shows activity against c. difficile in the nanomolar range. thuricin cd is produced by bacillus thuringiensis dpc 6431, a bacterial strain isolated from a human fecal sample, and it consists of two distinct peptides, trn-alpha and trn-beta, that ac ...201020435915
genome analysis of the clostridium difficile phage phicd6356, a temperate phage of the siphoviridae family.the temperate phages phicd6356 and phicd6365 were isolated and characterised following mitomycin c induction of 43 clostridium difficile strains. both phages belong to the siphoviridae family and have genome sizes of 37,664 bp for phicd6356 based on sequence data and approximately 50 kb for phicd6365 based on restriction analysis. protein analysis revealed similar protein profiles and indicated posttranslational processing of the phicd6356 major capsid protein. the genome sequence of phicd6356 i ...201020438817
diarrhea, clostridium difficile, and intestinal inflammation in residents of a long-term care facility.long-term care facilities (ltcf) residents have been estimated to have the highest incidence of diarrheal illness among adults living in the developed world. this study describes undiagnosed diarrhea, intestinal inflammation, and clostridium difficile colonization in a ltc population and explores whether these are associated with functional decline, as defined by weight loss or a change in cognitive or adl status.201020439046
clostridium difficile-associated disease acquired in the neurocritical care unit.clostridium difficile is an important cause of nosocomial infection on the intensive care unit. little is known about infection rates on the neurocritical care unit (nicu). the purpose of this study was to determine the prevalence, severity, and outcome associated with clostridium difficile-associated disease (cdad) acquired on the nicu.201020443154
two-step testing for c. difficile: no answers yet. 201020444522
fidaxomicin (opt-80) for the treatment of clostridium difficile infection.clostridium difficile infection (cdi) has become an increasingly important healthcare-associated complication in many countries. cdi outbreaks, a new 'hypervirulent' form and increased worldwide rates have underscored four urgent unmet needs for this disease: i) effective prevention of cdi; ii) therapies to produce faster resolution of cdi symptoms; iii) therapies to treat severe cdi more effectively and reduce its mortality; and iv) therapies to reduce the cdi recurrence rate following treatmen ...201020446864
preoperative mechanical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy.mechanical bowel preparations (mbps) are commonly administered preoperatively to patients who undergo pancreaticoduodenectomy (pd); however, their effectiveness over a clear liquid diet (cld) preparation remains unclear. the aim of this study was to determine whether mbp offers an advantage to patients who undergo pd.201020447669
a retrospective study of the epidemiology of clostridium difficile infection at a university hospital in japan: genotypic features of the isolates and clinical characteristics of the patients.clostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections. the epidemiology of c. difficile infection (cdi), including the prevalent polymerase chain reaction (pcr) ribotypes and the clinical characteristics of the patients, is not well known in japan, compared to the situation in the united states and europe. we performed pcr ribotyping of c. difficile isolates from 71 consecutive patients with cdi at a university hospita ...201020449624
nonagenarians in internal medicine: characteristics, outcomes and predictors for in-hospital and post-discharge mortality.parallel to increased life expectancy, the number of very elderly patients hospitalized in internal medicine departments is growing rapidly, although clinical data on hospital care are lacking.201020450122
predictors of death after clostridium difficile infection: a report on 128 strain-typed cases from a teaching hospital in the united kingdom.we assessed the relationship between strain type, clinical factors, and outcome in 128 patients with clostridium difficile infection. strain type was not associated with any outcome measure. on multivariate analysis, ischemic heart disease and hypoalbuminemia predicted death. metronidazole treatment in severe disease was associated with a higher rate of treatment failure and death.201020450417
skin care as a tool in the prevention of health care-associated infection.keeping skin healthy is particularly important for patients and all health-care personnel as any break in the skin can potentially harbour bacteria that may become a cross-infection risk to patients. when skin is damaged it is more difficult to remove microrganisms even when staff follow the recommended technique for hand washing (royal college of nursing, 2000). broken skin on patients increases the risk of developing a healthcare-associated infection (hai) as microorganisms can penetrate the s ...201020453823
review of medical and surgical management of clostridium difficile infection.clostridium difficile infection (cdi) has become an important area in our daily clinical practice. c. difficile is known to cause a broad spectrum of conditions ranging from asymptomatic carriage, through mild or moderately severe disease with watery diarrhoea, to the life-threatening pseudomembranous colitis (pmc), with toxic megacolon and ileus. peoples who have been treated with broad-spectrum antibiotics, patients with serious underlying co-morbidities and the elderly are at greatest risk. o ...201020454824
community-associated clostridium difficile infection: experience of a veteran affairs medical center in southeastern usa.there is increasing recognition of the importance of community-associated clostridium difficile infection (ca-cdi) despite little being known about its epidemiology.201020454827
clostridium difficile infection: update on emerging antibiotic treatment options and antibiotic resistance.clostridium difficile infection (cdi) is the most common cause of identifiable diarrhea in hospitalized patients. the incidence and severity of cdis are increasing. the increased incidence and severity of the disease has sparked interest in the optimal treatment of cdi as well as the use of new therapies and drug discovery. current treatment strategies are inadequate with decreased response rates to metronidazole, and high recurrence rates with the use of metronidazole and oral vancomycin. altho ...201020455684
clostridium difficile infection at a medical center in southern taiwan: incidence, clinical features and prognosis.an increase in incidence of clostridium difficile infection (cdi) among western countries has been noted in recent years. epidemiological data of cdi are scarce in taiwan. this study is intended to depict the clinical features of cdi at a medical center in southern taiwan.201020457428
proton pump inhibitors and risk for recurrent clostridium difficile infection.proton pump inhibitors (ppis) are widely used gastric acid suppressants, but they are often prescribed without clear indications and may increase risk of clostridium difficile infection (cdi). we sought to determine the association between ppi use and the risk of recurrent cdi.201020458084
iatrogenic gastric acid suppression and the risk of nosocomial clostridium difficile infection.the incidence and severity of clostridium difficile infections are increasing. acid-suppressive therapy has been suggested as a risk factor for c difficile, but this remains controversial.201020458086
efficacy of cleaning products for c. difficile: environmental strategies to reduce the spread of clostridium difficile-associated diarrhea in geriatric rehabilitation.to review the evidence for the efficacy of products used for environmental or hand cleaning on the rates of clostridium difficile-associated diarrhea (cdad).201020463269
treatment of refractory/recurrent c. difficile-associated disease by donated stool transplanted via colonoscopy: a case series of 12 patients.purpose and objective: over the past 20 years, clostridium difficile has emerged as an important microbial cause of nosocomial diarrhea. recurrence is common and management of recurrent disease is not standardized. in this case series, we describe 12 patients with refractory/recurrent c. difficile-associated disease (cdad) treated at our institution by transplantation of donated stool via colonoscopy.201020463588
concordance between two enzyme immunoassays for the detection of clostridium difficile toxins.the diagnosis of clostridium difficile-associated disease (cdad) is based on the detection of toxins from stool samples. there are several immunoassays for this purpose. the aim of this study was to determine the concordance between the two immunoassays and their performance in comparison to the toxigenic culture as part of the initial evaluation of a suspected case of cdad.201020470937
[experiences with outbreak of clostridium difficile 027]. 201020334786
rifaximin treatment in hepatic encephalopathy.hepatic encephalopathy is a chronically debilitating complication of hepatic cirrhosis. the efficacy of rifaximin, a minimally absorbed antibiotic, is well documented in the treatment of acute hepatic encephalopathy, but its efficacy for prevention of the disease has not been established.201020335583
re-evaluation of current a0 value recommendations for thermal disinfection of reusable human waste containers based on new experimental data.issues over the correct cleaning and disinfection of reusable medical devices are of great concern for local infection control teams. we investigated the heat resistance of two important micro-organisms implicated in nosocomial infections, enterococcus spp. and spores of bacillus subtilis (a surrogate for clostridium difficile). disinfection with moist heat, based on the a(0) concept (en iso 15883-1), is the most common method for disinfection of human waste containers in the hospital setting. t ...201020338666
molecular characterization of toxin a-negative, toxin b-positive variant strains of clostridium difficile isolated in korea.a(-)b(+)clostridium difficile strains are prevalent in korea. we performed pulsed-field gel electrophoresis (pfge), polymerase chain reaction ribotyping, and toxinotyping in 82 a(-)b(+) clinical isolates in korea. pfge showed highest discriminatory capability among the 3 methods. by pfge, persistence of a clone was found, suggesting this clone has adapted to the hospital environment.201020338708
clostridium difficile is not associated with outbreaks of viral gastroenteritis in the elderly in the netherlands.the coincidental increase in norovirus outbreaks and clostridium difficile infection (cdi) raised the question of whether these events could be related, e.g. by enhancing spread by diarrhoeal disease outbreaks. therefore, we studied the prevalence of c. difficile in outbreaks of viral gastroenteritis in nursing homes for the elderly and characterised enzyme immunoassay (eia)-positive stool samples. stool samples from nursing home residents (n = 752) in 137 outbreaks of viral aetiology were inves ...201020339889
hypoxia-inducible factor signaling provides protection in clostridium difficile-induced intestinal injury.clostridium difficile is the leading cause of nosocomial infectious diarrhea. antibiotic resistance and increased virulence of strains have increased the number of c difficile-related deaths worldwide. the innate host response mechanisms to c difficile are not resolved; we propose that hypoxia-inducible factor (hif-1) has an innate, protective role in c difficile colitis. we studied the impact of c difficile toxins on the regulation of hif-1 and evaluated the role of hif-1alpha in c difficile-me ...201020347817
clostridium difficile and the surgeon. 201020349650
trends in clostridium difficile infection among peripartum women.with use of the nationwide inpatient sample, we conducted a study to determine whether rates of clostridium difficile infection for delivery-associated hospitalizations are increasing. from 1998 to 2006, the number and incidence of c. difficile infection among peripartum women increased significantly. these increases were comparable to those observed in the general hospitalized population.201020350150
trial of universal gloving with emollient-impregnated gloves to promote skin health and prevent the transmission of multidrug-resistant organisms in a surgical intensive care unit.to compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (mdros) and to measure the effect on healthcare workers' (hcws') hand skin health.201020350197
clostridium difficile infections among hospitalized children, united states, 1997-2006.we evaluated the annual rate (cases/10,000 hospitalizations) of pediatric hospitalizations with clostridium difficile infection (cdi; international classification of diseases, 9th revision, clinical modification code 008.45) in the united states. we performed a time-series analysis of data from the kids' inpatient database within the health care cost and utilization project during 1997-2006 and a cross-sectional analysis within the national hospital discharge survey during 2006. the rate of pedi ...201020350373
fluoroquinolone resistance and clostridium difficile, germany.we characterized 670 clostridium difficile isolates collected from patients in 84 hospitals in germany in 2008. pcr ribotyping showed high prevalence of ribotype 001 and restricted dissemination of ribotype 027 strains. fluoroquinolone resistance and associated gyrase mutations were frequent in various ribotypes, but no resistance to metronidazole or vancomycin was noted.201020350385
hypervirulent clostridium difficile strains in hospitalized patients, canada.to determine the incidence rate of infections with north american pulsed-field types 7 and 8 (nap7/nap8) strains of clostrodium difficile, ribotype 078, and toxinotype v strains, we examined data collected for the canadian nosocomial infections surveillance program (cnisp) cdi surveillance project during 2004-2008. incidence of human infections increased from 0.5% in 2004/2005 to 1.6% in 2008.201020350386
clostridium difficile in ground meat, france. 201020350408
fidaxomicin: a new macrocyclic, rna polymerase-inhibiting antibiotic for the treatment of clostridium difficile infections.clostridium difficile infection is now a major concern throughout the developed world and its occurrence is a consequence of broad-spectrum antibiotic therapy primarily in the elderly in-patient population and high spore loads in hospitals in these regions. with the emergence of a hypervirulent, endemic strain, more severe disease is being recognized and is occurring in previously considered unusual patient groups. vancomycin and metronidazole are the current mainstays for therapy of severe and ...201020353295
the relationship between inpatient fluoroquinolone use and clostridium difficile-associated diarrhea.limited evidence suggests there may be a link between fluoroquinolone use and clostridium difficile-associated diarrhea (cdad), but such an association remains unclear due to conflicting data.201020354161
in vitro susceptibility of clostridium difficile to rifaximin and rifampin in 359 consecutive isolates at a university hospital in houston, texas.this was an in vitro study to analyse the susceptibility of clostridium difficile isolates to rifampin and rifaximin.201020354207
[change of clostridium difficile colitis during recent 10 years in korea].our clinical experience and recent published literatures suggest that clostridium difficile colitis (cdc) has become more common and potentially more pathogenic in recent years. the aim of study was to evaluate changes in the epidemiological features of cdc in hospitalized patients in korea.201020357527
[the incidence and clinical features of clostridium difficile infection; single center study].clostridium difficile is the predominant cause of nosocomial diarrhea. recently, the incidence of clostridium difficile infection (cdi) increases in europe and north america. a retrospective study was performed to evaluate the change of incidence and clinical features of cdi in korea.201020357528
[is clostridium difficile infection increasing in korea?]. 201020357534
trial watch: phase iii success for novel clostridium difficile antibiotic. 201020357795
[clostridium difficile infection]. 201020358497
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