Publications

training programs to strengthen pennsylvania's public health response.	this report describes pennsylvania's 9-year experience in implementing training programs to strengthen public health response to emerging infectious diseases. during the biannual 3-5-day-long pennsylvania public health institute (phi) events, which have been held since 2000, courses have covered topics such as emerging infectious disease outbreaks, monitoring of antimicrobial-resistant pathogens in retail food, and zoonotic diseases commonly associated with companion animals. core competency cou ...	2009	19635002
clostridium difficile ribotype 027-associated disease in children with norovirus infection.	two previously healthy children developed clostridium difficile ribotype 027-associated disease concomitantly with norovirus infection. viral gastroenteritis may contribute to epithelial homeostasis of the intestine and exacerbate the effects of toxins produced by c. difficile ribotype 027.	2009	19636284
bacillus polyfermenticus ameliorates colonic inflammation by promoting cytoprotective effects in colitic mice.	although human consumption of bacillus polyfermenticus provides several health benefits, the probiotic effect of this bacterium against colonic inflammation has not yet, to our knowledge, been studied. therefore, we induced colitis in mice by oral or intrarectal administration of dextran sodium sulfate (dss) or trinitrobenzenosulfonic acid (tnbs), respectively, and investigated the effect of b. polyfermenticus on colitis. we found that mice treated with dss or tnbs along with b. polyfermenticus ...	2009	19675103
evidence for moxifloxacin in community-acquired pneumonia: the impact of pharmaco-economic considerations on guidelines.	in an era of limited resources, policy makers and health care payers are concerned about the costs of treatment in addition to its effectiveness. however, guidelines do not tend to consider the cost-effectiveness of treatment options. this paper aims to conduct an international literature review with a view to assessing the impact of pharmaco-economic considerations of cap treatment with moxifloxacin on recent guidelines.	2009	19678752
responses to the efficacy of 'green' cleaning products article.		2009	19681388
responses to the efficacy of 'green' cleaning products article.		2009	19681389
responses to the efficacy of 'green' cleaning products article.		2009	19681390
response to third-party review of cleaning products article.		2009	19681391
fatal clostridium difficile enteritis caused by the bi/nap1/027 strain: a case series of ileal c. difficile infections.	clostridium difficile generally causes diarrhoea and colitis. small-bowel infections are considered to be rare. twelve cases of ileal c. difficile infections are presented, including the first reported case proven to be caused by the hypervirulent bi/nap1/027 strain. this case series suggests that small bowel involvement in c. difficile infections may be more frequent than previously thought.	2009	19681954
assessment of changes in the epidemiology of clostridium difficile isolated from diarrheal patients in hungary.	150 clostridium difficile strains isolated from diarrheal feces were collected from three parts of hungary and the presence of genes responsible for toxin a and b, and binary toxin production were examined. mic distribution against clindamycin, erythromycin, metronidazole, moxifloxacin and rifampin of 80 toxigenic strains selected from the above-mentioned strains and 20 large clostridial toxins (lcts)-positive strains chosen from our earlier strain collection were determined. 80% of the examined ...	2009	19682411
production of clostridium difficile toxin in a medium totally free of both animal and dairy proteins or digests.	in the hope of developing a vaccine against clostridium difficile based on its toxin(s), we have developed a fermentation medium for the bacterium that results in the formation of toxin a and contains no meat or dairy products, thus obviating the problem of possible prion diseases. particular preparations of hydrolyzed soy proteins, especially soy peptone a3, have been found to replace both the meat/dairy product tryptone in the preparation of working cell banks and seed media, and nz-soy bl4 do ...	2009	19651616
does my patient have clostridium difficile infection?	clostridium difficile infection (cdi) seems to be changing-with increasing virulence and incidence, more resistance to metronidazole, and worse outcomes. accurate diagnosis is critical, but 3 common misconceptions lead to misdiagnosis: clostridium difficile infection is a possibility when the patient has fewer than 3 loose stools per day; the glutamate dehydrogenase test for cdi is sensitive and thus is a good initial test; and repeating an insensitive laboratory test for cdi is useful. these mi ...	2009	19652187
asymptomatic carriage of clostridium difficile among hcws: do we disregard the doctor?		2009	19653823
fulminant clostridium difficile-associated pouchitis with a fatal outcome.	background. a 61-year-old woman who had undergone an ileostomy closure 10 days previously presented to a tertiary medical center with abdominal pain, vomiting, diarrhea, dehydration, and oliguria. the patient had undergone a staged total proctocolectomy with ileal-pouch-anal anastomosis and a loop ileostomy 8 months previously to treat her steroid-refractory ulcerative colitis.investigations. physical examination, abdominal and pelvic ct scan, blood laboratory tests, pouch endoscopy, and fecal t ...	2009	19654602
a novel genetic switch controls phase variable expression of cwpv, a clostridium difficile cell wall protein.	clostridium difficile is a nosocomial pathogen that can cause severe gastrointestinal infections. c. difficile encodes a family of cell wall proteins, some of which are implicated in pathogenesis. here we have characterized cwpv, the largest member of this family. cwpv is surface expressed and post-translationally processed in a manner analogous to the major s-layer protein slpa. expression of cwpv is phase variable, with approximately 5% of cells in a population expressing the protein under sta ...	2009	19656296
clinically important interaction between statin drugs and clostridium difficile toxin?	clostridium difficile associated disease (cdad), a common type of antibiotic associated diarrhea, is increasing in frequency and affecting patients outside of traditional populations. at one time cdad exclusively occurred in hospitalized patients or frail elderly patients receiving antibiotic therapy. it is now occurring more commonly in younger patients who are relatively healthy and may not be receiving antibiotics. co-factors that might explain this increase incidence and changing demographic ...	2009	19656639
changing clostridium difficile infection testing and treatment trends at a large tertiary care teaching hospital.	to assess changes in testing and treatment trends of cdi at a time when the clostridium difficile hypervirulent strain was first identified.	2009	19657721
detection and characterization of clostridium difficile from patients with antibiotic-associated diarrhoea in a tertiary care hospital in north india.		2009	19661200
proceedings of an international conference entitled "new views on clostridium difficile infections", september 2008, leipzig, germany.		2009	19663050
detection of virulence genes of clostridium difficile by multiplex pcr.	clostridium difficile strains belonging to the pcr ribotype 027, pulse-field gel electrophoresis (pfge) type nap1, toxinotype iii and restriction endonuclease analysis group bi harbouring mutations in the tcdc gene and possessing binary toxin components a and b have been described to cause epidemics with increased morbidity and mortality. in the present study we developed a conventional multiplex pcr designed to detect selected virulence associated markers of the hypervirulent c. difficile pcr r ...	2009	19664132
antimicrobial stewardship: application in the intensive care unit.	critical-care units can be barometers for appropriate antimicrobial use. there, life and death hang on empirical antimicrobial therapy for treatment of infectious diseases. with increasing therapeutic empiricism, triple-drug, broad-spectrum regimens are often necessary, but cannot be continued without fear of the double-edged sword: a life-saving intervention or loss of life following clostridium difficile infection, infection from a resistant organism, nephrotoxicity, cardiac toxicity, and so o ...	2009	19665090
infection prevention in the intensive care unit.	hospital-acquired infections have profound social, economic, and personal costs to patients in the intensive care unit (icu). numerous risk factors, such as poor nutrition and hyperglycemia, directly involve patients. meanwhile, hand hygiene, environmental cleaning, and appropriate hospital staffing can impact icu infection rates. a multidirectional approach-including continuing staff education, minimizing risk factors, and implementing guidelines established by national committees-is necessary ...	2009	19665091
clostridium difficile infection in the intensive care unit.	clostridium difficile infection (cdi) is becoming more common worldwide. the morbidity and mortality associated with c difficile is also increasing at an alarming rate. critically ill patients are at particularly high risk for cdi because of the prevalence of multiple risk factors in this patient population. treatment of c difficile continues to be a difficult problem in patients with severe or recurrent disease. this article seeks to provide a broad understanding of cdi in the intensive care un ...	2009	19665092
examination of potential mechanisms to explain the association between proton pump inhibitors and clostridium difficile infection.	proton pump inhibitors (ppis) have been associated with clostridium difficile infection (cdi) in several recent studies. however, other studies have not shown this association, and the mechanism by which ppis might promote cdi has not been elucidated. we hypothesized two possible mechanisms of causation: first, by raising ph, ppis may prevent gastric contents from killing c. difficile spores; second, gastric contents of ppi-treated patients may promote germination and outgrowth of c. difficile s ...	2009	19667292
a description of ct features of clostridium difficile infection of the small bowel in four patients and a review of literature.	clostridium difficile associated disease is an increasingly common cause of morbidity and mortality. pseudomembranous colitis following hospital-administered antibiotic treatment is the most common symptomatic manifestation. small bowel enteritis caused by c. difficile, however, is rarely described. here, we present a series of four patients with hospital-acquired small bowel enteritis caused by c. difficile, discuss its ct and histopathological features, and review the current literature.	2009	19620176
a diarrhoeal illness with a difference?		2009	19620222
clostridium difficile-associated disease and mortality among the elderly critically ill.	: to describe the epidemiology of and to develop a simple 30-day mortality clinical decision rule among critically ill patients > or =65 yrs. increasing incidence of hospitalizations with and emergence of hypervirulent epidemic strains have made clostridium difficile-associated disease an important public health concern. advanced age is a risk factor for development of and death from clostridium difficile-associated disease. intensive care unit patients with clostridium difficile-associated dise ...	2009	19623053
clinical and microbiological characteristics of community-onset clostridium difficile infection in the netherlands.	to elucidate the prevalence, characteristics and risk factors of community-onset clostridium difficile infection (co-cdi), an uncontrolled prospective study was performed. for 3 months in 2007-2008, three laboratories in the netherlands tested all unformed stool samples submitted by general practitioners (gps) for c. difficile by enzyme immunoassay for toxins a and b, irrespective of whether gps specifically requested this. patients with positive results were asked to complete a questionnaire. p ...	2009	19624512
distinct ribotypes and rates of antimicrobial drug resistance in clostridium difficile from shanghai and stockholm.	seventy-five clinical isolates of clostridium difficile from shanghai and 80 from stockholm were investigated. the prevalence of toxin a-negative, toxin b-positive isolates of c. difficile among isolates from shanghai (33.3%) was significantly higher than among isolates from stockholm (0%). both sets of isolates were fully susceptible to metronidazole and vancomycin. however, the mics of fluoroquinolones, erythromycin-clindamycin, tetracycline, rifampin and fusidic acid were significantly higher ...	2009	19624517
tigecycline use in cancer patients with serious infections: a report on 110 cases from a single institution.	tigecycline, the first in a new class of glycylcyclines, has been approved for the treatment of complicated skin and skin structure and intraabdominal infections in adults. however, clinical data on its safety and effectiveness in cancer patients are lacking. we reviewed the records of all cancer patients treated with tigecycline for more than 48 hours between june 2005 and september 2006 at our institution and identified 110 consecutive cases (median age, 58 yr; range, 18-81 yr). we collected d ...	2009	19593226
automated system to identify clostridium difficile infection among hospitalised patients.	the purpose of this study was to assess whether data on stool frequency collected electronically could identify patients at high risk for clostridium difficile infection (cdi). all patients with reports of diarrhoea were assessed prospectively for number of stools per day and number of diarrhoea days. c. difficile testing was requested independently from study investigators. number of days with diarrhoea and maximum number of unformed stools was assessed as a cdi predictor. a total of 605 patien ...	2009	19596490
controversies in infection: infection control or antibiotic stewardship to control healthcare-acquired infection?	despite record resource being devoted to the control of healthcare-acquired infection (hcai), rates have never been higher. although the discovery of the contagiousness of puerperal sepsis by alexander gordon heralded the golden era of bacteriology and antibiotics, this led to a belief that infection was beaten. this in its turn may well have led us into a false sense of security and an over-reliance on antibiotics. modern medicine has built many of its advances on a need for antibiotics, but th ...	2009	19596494
clostridium difficile-associated diarrhoea (cdad): new and contentious issues.		2009	19602514
laboratory tests for patients with ileal pouch-anal anastomosis: clinical utility in predicting, diagnosing, and monitoring pouch disorders.	restorative proctocolectomy with ileal pouch-anal anastomosis (ipaa) is the surgical treatment of choice for patients with medically refractory ulcerative colitis (uc) or uc-associated dysplasia, and for the majority of patients with familial adenomatous polyposis. pouchitis and other complications of ipaa are common. there are scant data on laboratory markers for the evaluation and diagnosis of pouch disorders. the presence of immunogenotypic markers such as genetic polymorphisms of interleukin ...	2009	19603012
healthcare-associated infections as patient safety indicators. notes from the editor-in-chief.		2009	19593070
healthcare-associated infections as patient safety indicators.	healthcare-associated infections (hais) are a pressing and imminent patient safety concern as they cause substantial preventable morbidity and mortality. despite this, there is a strong tendency for healthcare administrators and providers to view them as far less of a threat to patient safety than adverse events such as medication administration errors and falls. further, validated strategies to prevent hais are frequently slow to be adopted. this paper reviews two hais of increasing visibility ...	2009	19593071
healthcare-associated infections: infection prevention and control within the accreditation canada qmentum program.	gardam, lemieux, reason, van dijk and goel argue that healthcare-associated infections (hais) are "a pressing and imminent concern in the context of patient safety." accreditation canada supports the position taken by these authors. the prevention and control of two hais of great concern, methicillin-resistant staphylococcus aureus and clostridium difficile, are an integral part of the accreditation canada program. a coordinated approach to combating hais and developing a culture of infection pr ...	2009	19593072
[comparison of two enzyme immunoassay for detection of clostridium difficile toxin a and toxin b].	enzyme immunoassay (eia) capable of detecting both toxin a and toxin b is strongly recommended for the diagnosis of clostridium difficile associated disease. therefore, we evaluated two different eias for the detection of c. difficile toxin a/b.	2009	19411778
a 69-year-old woman presenting to the hospital with 48 hours of abdominal pain and diarrhea.		2009	19500692
working out the bug in the accordion.		2009	19501204
evaluation of new selective culture media and a rapid fluorescence in situ hybridization assay for identification of clostridium difficile from stool samples.	two new clostridium difficile-selective agars, from oxoid (according to brazier) and from bd, were compared with cycloserine-cefoxitin-fructose agar (oxoid) for their sensitivity of recovery of toxigenic c. difficile from stool samples. for the culture-positive samples, the sensitivities were 84.0, 42.6 and 90.4 %, respectively. in addition, a c. difficile-specific fluorescence in situ hybridization assay was developed, facilitating rapid and reliable identification of cultured isolates.	2009	19502365
toxin a-producing clostridium difficile as an aetiological factor of post-traumatic wound infection.	clostridium difficile is a well-known cause of hospital-acquired infection such as antibiotic associated diarrhoea or pseudomembranous colitis. extraintestinal infections caused by this pathogen are described rarely. a case of post-traumatic wound infection caused by c. difficile in an immunocompetent, young and otherwise healthy trauma patient is reported. a 31-year-old female, a car accident victim, was admitted to hospital because of polytrauma. after open reduction and internal fixation of a ...	2009	19502374
inhibition of cytokinesis by clostridium difficile toxin b and cytotoxic necrotizing factors--reinforcing the critical role of rhoa in cytokinesis.	low molecular weight gtp-binding proteins of the rho family control the organization of the actin cytoskeleton in eukaryotic cells. rhoa governs the formation of actin stress fibers and is responsible for the formation of the contractile ring in cytokinesis. cytokinesis completion requires rhoa inactivation resulting in disassembly of the contractile ring. cytokinesis thus requires switching of rhoa activity. this switch of rhoa activity is blocked by rho-modifying bacterial protein toxins that ...	2009	19504561
microscale sample preparation for pcr of c. difficile infected stool.	in this paper, we describe the design of a microfluidic sample preparation chip for human stool samples infected with clostridium difficile. we established a polymerase chain reaction able to distinguish c. difficile in the presence of several other organisms found in the normal intestinal flora. a protocol for on-chip extraction of nucleic acids from clinical samples is described that can detect target dna down to 5.0x10(-3) ng of template. the assay and sample preparation chip were then valida ...	2009	19505511
the management of clostridium difficile infection.	introduction/background: clostridium difficile is the commonest cause of nosocomial diarrhoea. the epidemiology and clinical phenotype of the disease has dramatically changed with the global emergence of a virulent strain of c. difficile.	2009	19505955
identification of candidate genes for susceptibility to reactive arthritis.	this study was undertaken to evaluate the gene expression profile in monocytes from three patients with reactive arthritis (rea) in remission in order to identify candidate genes accounting for a potential susceptibility to rea. gene expression analyses revealed eight differentially expressed mrna transcripts in monocytes of rea patients. the major part of genes encoded cytokines, growth factors and chemokines. there was a remarkably high proportion of proangiogenic factors, in particular ip10, ...	2009	19506876
infliximab and other immunomodulating drugs in patients with inflammatory bowel disease and the risk of serious bacterial infections.	there remain concerns about the safety of infliximab therapy in patients with inflammatory bowel disease (ibd).	2009	19438424
application of multiple-locus variable-number tandem-repeat analysis to determine clonal spread of toxin a-negative clostridium difficile in a general hospital in buenos aires, argentina.	isolates from patients with clostridium difficile infection (cdi) usually produce both toxin a (tcda) and toxin b (tcdb), but an increasing number of reports from europe and asia mention infections with tcda-negative, tcdb-positive (a-/b+) strains, usually characterized as pcr ribotype 017 (type 017). incidence rates of cdi per 10 000 admissions in a 200-bed argentinean general hospital were 37, 84, 67, 43, 48 and 42 for the years 2000 to 2005, respectively. the annual percentages of type 017 cd ...	2009	19438624
prospective, observational, cross-sectional study of intestinal infections among acutely active inflammatory bowel disease patients.	intestinal infections have been claimed to precipitate or aggravate flares of inflammatory bowel disease (ibd). the reported incidence of such infections among ibd patients varies between 9 and 13%, but only a few prospective studies have been conducted.	2009	19439968
antibiotics and probiotics in inflammatory bowel disease: why, when, and how.	to summarize recent evidence on the role of intestinal bacteria in inflammatory bowel diseases, and of antibiotics and probiotics in their treatment. the implications connected with the use of antibiotics are also examined.	2009	19444096
[probiotics. a review].	probiotics are defined viable microorganisms which in sufficient amount reach the intestine in an active state, to be able to exert positive health benefit on the host. thus far, they have shown particular promise on prevention or treatment of various pathologic conditions. our aim has been to report the most recent articles (until october 2008), resulting from randomized, double controlled trials, according to the conventional and molecular methods. in this review we have taken into considerati ...	2009	19445282
enteral clostridium difficile, an emerging cause for high-output ileostomy.	the loss of fluid and electrolytes from a high-output ileostomy (>1200 ml/day) can quickly result in dehydration and if not properly managed may cause acute renal failure. the management of a high-output ileostomy is based upon three principles: correction of electrolyte disturbance and fluid balance, pharmacological reduction of ileostomy output, and treatment of any underlying identifiable cause. there is an increasing body of evidence to suggest that clostridium difficile may behave pathologi ...	2009	19447832
clostridium difficile in hip fracture patients: prevention, treatment and associated mortality.	a series of infection control measures were introduced at the university hospitals of leicester nhs trust in 2006-2007 to reduce the incidence of clostridium difficile infection.	2009	19450797
fulminant clostridium difficile colitis: patterns of care and predictors of mortality.	there exist predictors of mortality and the need for colectomy among patients with fulminant clostridium difficile colitis.	2009	19451485
inflammatory bowel disease potpourri: a vignette-based discussion.		2009	19452754
diagnosis and treatment of acute or persistent diarrhea.	studies of microbial pathogens and the toxins they produce are important for determining the mechanisms by which they cause disease and spread throughout a population. some bacteria produce secretory enterotoxins (such as cholera toxin or the heat-labile or stable enterotoxins produced by escherichia coli) that invade cells directly. others invade cells or produce cytotoxins (such as those produced by shigella, enteroinvasive e coli, or clostridium difficile) that damage cells or trigger host re ...	2009	19457416
treatment of clostridium difficile-associated disease.	clostridium difficile infection is an increasing burden to the health care system, totaling more than $1 billion/year in the united states. treatment of patients with c difficile infection with metronidazole or vancomycin reduces morbidity and mortality, although the number of patients that do not respond to metronidazole is increasing. despite initial response rates of greater than 90%, 15%-30% of patients have a relapse in symptoms after successful initial therapy, usually in the first few wee ...	2009	19457418
clostridium difficile infection caused by the epidemic bi/nap1/027 strain.	rates and severity of clostridium difficile infection (cdi) in hospitals in north america and europe have increased since 2000 and correlate with dissemination of an epidemic strain characterized by higher than usual toxin a and b production, the presence of a third toxin, binary toxin, and high-level resistance to fluoroquinolone antibiotics. the strain, which is restriction endonuclease analysis group bi, pulse-field gel electrophoresis type nap1, and polymerase chain reaction ribotype 027, is ...	2009	19457419
hospital-acquired infections and infection control practices: what are the consequences to the elderly patient?		2009	19514546
novel fit for purpose single use tourniquet: best of both worlds.	healthcare associated infections (hai), such as meticillin resistant staphylococcus aureus (mrsa) and clostridium difficile (c. diff) are estimated to cost the nhs pound1 billion and contribute to 5000 deaths/year in the uk. to date the main emphasis to reduce hais has been on hand hygiene. however environmental microbial load and compliance limits the efficacy of hand washing alone. cultures from tourniquets have demonstrated contamination by pathogens including mrsa. consequently, many uk trus ...	2009	19517293
[infectiology and tropical medicine 2009].		2009	19517328
comparison of molecular typing methods applied to clostridium difficile.	since the 1980s the epidemiology of clostridium difficile infection (cdi) has been investigated by the application of many different typing or fingerprinting methods. to study the epidemiology of cdi, a typing method with a high discriminatory power, typeability, and reproducibility is required. molecular typing methods are generally regarded as having advantages over phenotypic methods in terms of the stability of genomic markers and providing greater levels of typeability. a growing number of ...	2009	19521874
combination immunomodulator and antibiotic treatment in patients with inflammatory bowel disease and clostridium difficile infection.	management of clostridium difficile infection in patients with flaring inflammatory bowel disease (ibd) has not been optimized. we investigated the effects of combination therapy with antibiotics and immunomodulators in patients with ibd and c difficile infection.	2009	19523534
portrait of a canine probiotic bifidobacterium--from gut to gut.	the gastrointestinal environment is a complex interactive system involving the host, ingested dietary components, and numerous microbial species. we hypothesized that isolation and screening of lactobacilli and bifidobacteria adherent to healthy canine gastrointestinal tissue would yield strains with commensal activity in canines. the aims of this study were (1) to isolate a bank of commensal organisms from the canine gastrointestinal tract; (2) to screen these novel microbial isolates for poten ...	2009	19523775
detection and enumeration of clostridium difficile spores in retail beef and pork.	recent studies have identified clostridium difficile in food animals and retail meat, and concern has been raised about the potential for food to act as a source of c. difficile infection in humans. previous studies of retail meat have relied on enrichment culture alone, thereby preventing any assessment of the level of contamination in meat. this study evaluated the prevalence of c. difficile contamination of retail ground beef and ground pork in canada. ground beef and ground pork were purchas ...	2009	19525267
probiotic lactobacilli in breast milk and infant stool in relation to oral intake during the first year of life.	this is to identify factors affecting the prevalence of lactobacillus reuteri in maternal faeces and breast milk and infant faeces after oral supplementation with l reuteri and to assess the influence on microbial ecology, particularly clostridium difficile and bifidobacterium colonization.	2009	19525871
c. difficile infection - a tool for improving practice and reducing rates.	clostridium difficile infection (cdi) is a recognized health-care-acquired infection (hai) and as such it is vital that hospitals do more to reduce the rates of infection. patients, especially older people, become particularly susceptible to cdi after treatment with antibiotics. mention of cdi on death certificates is increasing and surveillance, especially when accompanied by feedback to clinicians, has long been established as an effective tool to lower hais. in february 2008, a manchester hos ...	2009	19525909
is clostridium difficile a threat to australia's biosecurity?		2009	19527197
first australian isolation of epidemic clostridium difficile pcr ribotype 027.	we report the first isolation in australia of a hypervirulent epidemic strain of clostridium difficile, pcr ribotype 027. it was isolated from a 43-year-old woman with a permanent ileostomy, who appears to have been infected while travelling in the united states. the isolate was positive for toxin a, toxin b and binary toxin, and resistant to fluoroquinolone antimicrobials, and had characteristic deletions in the tcdc gene. all diagnostic laboratories and health care facilities in australia shou ...	2009	19527210
clostridium difficile infection: new developments in epidemiology and pathogenesis.	clostridium difficile is now considered to be one of the most important causes of health care-associated infections. c. difficile infections are also emerging in the community and in animals used for food, and are no longer viewed simply as unpleasant complications that follow antibiotic therapy. since 2001, the prevalence and severity of c. difficile infection has increased significantly, which has led to increased research interest and the discovery of new virulence factors, and has expanded a ...	2009	19528959
clostridium difficile-associated diarrhoea, a frequent complication in patients with acute myeloid leukaemia.	diarrhoea occurs frequently in neutropenic patients with acute leukaemia receiving chemotherapy and may be caused by either infection- or drug-induced cytotoxicity. since clostridium difficile is the most common cause of nosocomial infectious diarrhoea in non-haematologic patients, we were interested in its incidence in patients with acute myeloid leukaemia (aml). in this retrospective study, we analysed 134 patients with aml receiving a total of 301 chemotherapy courses. diarrhoea occurred duri ...	2009	19533126
comparing immunocard with two eia assays for clostridium difficile toxins.	to compare three clostridium difficile eia kits for the detection of c. difficile toxins from clinical specimens.	2009	19534439
[clostridium difficile infection in the elderly: update in epidemiology and treatment].		2009	19535111
sasp gene delivery: a novel antibacterial approach.	antibiotic resistance is a global problem, and with bacteria having developed resistance to all approved antibacterial agents there is a growing need for innovative solutions. phico therapeutics has developed a new class of antibacterial agent, a platform technology called saspject. saspject comprises modified, disabled bacterial viruses (bacteriophages) injecting a gene encoding an antibacterial protein, sasp, into target bacteria. sasp, or small, acid-soluble spore protein(s), inactivate bacte ...	2009	19536364
clostridium difficile--a continually evolving and problematic pathogen.	clostridium difficile is a unique pathogen that often predominates in the bowel microflora as a result of the microbial compositional changes following antibiotic treatment. the hospital environment and patients undergoing antibiotic treatment provide a discrete ecosystem where c. difficile persists and where virulent clones thrive. the continued rise of c. difficile infection (cdi) worldwide has been accompanied by the rapid emergence and transcontinental spread of highly virulent clones, desig ...	2009	19539054
clostridium difficile: emerging public health threat and other nosocomial or hospital acquired infections. foreword.		2009	19540993
clostridium difficile: emerging public health threat and other nosocomial or hospital acquired infections. introduction.		2009	19540994
nosocomial or hospital-acquired infections: an overview.		2009	19540995
clostridium difficile.		2009	19540996
proteomic and genomic characterization of highly infectious clostridium difficile 630 spores.	clostridium difficile, a major cause of antibiotic-associated diarrhea, produces highly resistant spores that contaminate hospital environments and facilitate efficient disease transmission. we purified c. difficile spores using a novel method and show that they exhibit significant resistance to harsh physical or chemical treatments and are also highly infectious, with <7 environmental spores per cm(2) reproducibly establishing a persistent infection in exposed mice. mass spectrometric analysis ...	2009	19542279
the first case of antibiotic-associated colitis by clostridium difficile pcr ribotype 027 in korea.	clostridium difficile (c. difficile) is a common causative agent of pseudomembranous colitis (pmc). c. difficile-associated diarrhea (cdad) ranges from mild diarrhea to life threatening pmc. recently, a highly virulent strain of c. difficile polymerase chain reaction ribotype 027 was found in north america, europe, and japan. a 52-yr-old woman with anti-tuberculosis medication and neurogenic bladder due to traffic accident experienced five episodes of c. difficile pmc after taking antibiotics fo ...	2009	19543521
clostridium difficile infection.		2009	19549659
establishment of an outpatient and home parenteral antimicrobial therapy service at a london teaching hospital: a case series.	outpatient and home parenteral antimicrobial therapy (ohpat) is becoming increasingly commonplace in the uk, enabling those patients who would previously have been obliged to remain in hospital for intravenous treatment to be managed as outpatients or in their own homes. the ohpat service at st mary's hospital, london, was established in 2004. this paper describes the types of infection, antimicrobial management and outcomes of patients referred to the service in the 3.5 years since its inceptio ...	2009	19549671
structure-function analysis of inositol hexakisphosphate-induced autoprocessing in clostridium difficile toxin a.	the action of clostridium difficile toxins a and b depends on inactivation of host small g-proteins by glucosylation. cellular inositol hexakisphosphate (insp6) induces an autocatalytic cleavage of the toxins, releasing an n-terminal glucosyltransferase domain into the host cell cytosol. we have defined the cysteine protease domain (cpd) responsible for autoprocessing within toxin a (tcda) and report the 1.6 a x-ray crystal structure of the domain bound to insp6. insp6 is bound in a highly basic ...	2009	19553670
rapid analysis of clostridium difficile strains recovered from hospitalized patients by using the slpa sequence typing system.	clostridium difficile is a nosocomial pathogen that is transmissible between patients via hospital staff and via contaminated environmental surfaces. recently, a typing system based on the slpa sequence for c. difficile was developed. to elucidate the validity and efficacy of the system in the setting of a local hospital, we carried out typing of c. difficile from patients in our hospital using the system. twenty-eight stool samples obtained from 17 patients with c. difficile-associated diarrhea ...	2009	19554407
antibiotic associated diarrhea in children.	keeping in view the recent flooding of the indian market with antibiotic and probiotic combinations, we decided to look at the prevalence of antibiotic associated diarrhea (aad) and clostridium difficile infection (cdi) in children and reviewed evidence available for use of probiotics in the prevention of aad.	2009	19556659
truncation in the tcdc region of the clostridium difficile pathloc of clinical isolates does not predict increased biological activity of toxin b or toxin a.	the increased severity of disease associated with the nap1 strain of clostridium difficile has been attributed to mutations to the tcdc gene which codes for a negative regulator of toxin production. to assess the role of hyper-production of toxins a and b in clinical isolates of clostridium difficile, two nap1-related and five nap1 non-related strains were compared.	2009	19558711
clostridium difficile: how much do hospital staff know about it?	the aim of this study was to determine the awareness of clostridium difficile infection amongst healthcare professionals.	2009	19558760
government claims measures to cut mrsa and c difficile rates will help reduce other infections.		2009	19561052
rifampin-associated pseudomembranous colitis.	pseudomembranous colitis (pmc) is known to develop after antibiotic treatment, but is rarely associated with antituberculosis (anti-tb) agents. we report a 28-year-old woman without underlying diseases developing pmc after 126 days of anti-tb treatment. severe diarrhea and abdominal cramping pain were experienced. colonoscopic biopsy proved the diagnosis of pmc. her symptoms improved after discontinuing the anti-tb agents but recurred shortly after challenging with rifampin and isoniazid. metron ...	2009	19561451
antibiotic treatment of clostridium difficile carrier mice triggers a supershedder state, spore-mediated transmission, and severe disease in immunocompromised hosts.	clostridium difficile persists in hospitals by exploiting an infection cycle that is dependent on humans shedding highly resistant and infectious spores. here we show that human virulent c. difficile can asymptomatically colonize the intestines of immunocompetent mice, establishing a carrier state that persists for many months. c. difficile carrier mice consistently shed low levels of spores but, surprisingly, do not transmit infection to cohabiting mice. however, antibiotic treatment of carrier ...	2009	19564382
proton pump inhibitors and the risk for clostridium difficile infection.		2009	19567433
q: what is the role of probiotics in the treatment of acute clostridium difficile-associated diarrhea?		2009	19570969
clostridium difficile strains from community-associated infections.	clostridium difficile isolates from presumed community-associated infections (n = 92) were characterized by toxinotyping, pulsed-field gel electrophoresis, tcdc and cdtb pcr, and antimicrobial susceptibility. nine toxinotypes (tox) and 31 pfge patterns were identified. tox 0 (48, 52%), tox iii (18, 20%), and tox v (9, 10%) were the most common; three isolates were nontoxigenic.	2009	19571021
clostridium difficile infection: current perspectives.	clostridium difficile infection (cdi), long-associated with morbidity and mortality in healthcare settings, has evolved in recent years with unprecedented clinical manifestations. today, cdi is characterized by unusually toxigenic and resistant subtypes, expanded epidemiology, and a growing list of risk factors. in this article, we discuss current trends and research for cdi in critical care settings, and new controversies that influence clinical practice.	2009	19578325
length of vancomycin administration for treatment of clostridium difficile-associated diarrhea may depend on presentation of colonic ulcer.	clostridium difficile-associated diarrhea (cdad) is a notorious iatrogenic infection with typical endoscopic features consisting of pseudomembranes (pms). concomitant colonic ulcers are sometimes endoscopically detected. we hypothesized that length of vancomycin (vcm) administration for treatment depends on presentation of colonic ulcer.	2009	19579589
human alpha-defensins inhibit hemolysis mediated by cholesterol-dependent cytolysins.	many pathogenic gram-positive bacteria release exotoxins that belong to the family of cholesterol-dependent cytolysins. here, we report that human alpha-defensins hnp-1 to hnp-3 acted in a concentration-dependent manner to protect human red blood cells from the lytic effects of three of these exotoxins: anthrolysin o (alo), listeriolysin o, and pneumolysin. hd-5 was very effective against listeriolysin o but less effective against the other toxins. human alpha-defensins hnp-4 and hd-6 and human ...	2009	19581399
in vitro activities of telavancin and six comparator agents against anaerobic bacterial isolates.	the antimicrobial activities of telavancin and six comparators were evaluated against 460 isolates of anaerobic bacteria. telavancin demonstrated excellent activity against gram-positive anaerobes (mic90, 2 microg/ml) and was the most potent agent tested against clostridium difficile (mic90, 0.25 microg/ml). as expected, gram-negative isolates were not inhibited by telavancin.	2009	19581457
probiotics.	the term "probiotic" was first used in 1965, by lilly and stillwell, to describe substances secreted by one organism which stimulate the growth of another. the use of antibiotics, immunosuppressive therapy and irradiation, amongst other means of treatment, may cause alterations in the composition and have an effect on the git flora. therefore, the introduction of beneficial bacterial species to gi tract may be a very attractive option to re-establish the microbial equilibrium and prevent disease ...	2009	19584499
prediction of complicated clostridium difficile infection by pleural effusion and increased wall thickness on computed tomography.	abdominal computed tomography (ct) is often used to evaluate complications in patients with clostridium difficile infection (cdi), but no study has correlated ct findings with the risk of developing a complicated cdi. furthermore, the value of ct has not been evaluated since the emergence of the bi/nap1/027 hypervirulent strain of c. difficile. we sought to describe and correlate abdominal ct findings with complicated cdi and to compare them before and after the emergence of the epidemic strain.	2009	19591596