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vancomycin vs metronidazole for clostridium difficile infection: focus on recurrence and mortality. 201728681270
increasing incidence of clostridium difficile ribotype 001 associated with severe course of the infection and previous fluoroquinolone use in the czech republic, 2015.the aim of the study was to provide an update on the epidemiology of c. difficile infection (cdi) in a representative number of hospitals within the czech republic in 2015. in 2015, twenty-eight czech hospitals were invited to participate in a cdi study. laboratories sent the first 20 consecutive c. difficile isolates for characterization by capillary-electrophoresis (ce) ribotyping and the presence of toxin genes and collected patient data on previous hospitalization, antibiotic treatment, the ...201728681203
outcome after discontinuation of proton pump inhibitors at a residential care site: quality improvement project.increased prescribing of proton pump inhibitors (ppis) in the past few decades can be attributed mainly to long-term use of this type of therapy. recent evidence indicates signals of harm associated with long-term use of ppis, such as increased risk of clostridium difficile infection, recurrence of c. difficile infection, and fracture. a few studies have assessed the effectiveness of step-down management of patients receiving long-term ppi therapy in ambulatory care settings. however, it is unkn ...201728680175
cwp2 from clostridium difficile exhibits an extended three domain fold and cell adhesion in vitro.colonization of the gut by clostridium difficile requires the adhesion of the bacterium to host cells. a range of cell surface located factors have been linked to adhesion including the s-layer protein lmw slp and the related protein cwp66. as well as these proteins, the s-layer of c. difficile may contain many others. one such protein is cwp2. here, we demonstrate the production of a c. difficile strain 630 cwp2 knockout mutant and assess the effect on the bacterium. the mutant results in incre ...201728677344
update on intestinal microbiota in crohn's disease 2017: mechanisms, clinical application, adverse reactions and outlook.the pathogenesis of cd is complex and it is thought to be associated with the environment, immune, hereditary, microbe and other factors. if the balance between the host and the intestinal microbes in cd patients was broken, immune-inflammatory response of susceptible individuals might be triggered. probiotics could improve the intestinal microbial flora balance and treat human effectively. there are several new mechanisms which might explain the role of probiotics. fecal microbiota transplantat ...201728677158
fool me thrice: the evolving story of multiply recurrent clostridium difficile infection. 201728672286
increasing incidence of multiply recurrent clostridium difficile infection in the united states: a cohort study.clostridium difficile infection (cdi), the most common health care-associated infection, often recurs. fecal microbiota transplantation is increasingly used to treat multiply recurrent cdi (mrcdi).201728672282
assessment of automating safety surveillance from electronic health records: analysis for the quality and safety review system.in an effort to improve and standardize the collection of adverse event data, the agency for healthcare research and quality is developing and testing a patient safety surveillance system called the quality and safety review system (qsrs). its current abstraction from medical records is through manual human coders, taking an average of 75 minutes to complete the review and abstraction tasks for one patient record. with many healthcare systems across the country adopting electronic health record ...201728671914
is clostridium difficile infection a risk factor for subsequent bloodstream infection?clostridium difficile infection (cdi) is a common nosocomial diarrheal illness increasingly associated with mortality in united states. the underlying factors and mechanisms behind the recent increases in morbidity from cdi have not been fully elucidated. murine models suggest a mucosal barrier breakdown leads to bacterial translocation and subsequent bloodstream infection (bsi). this study tests the hypothesis that cdi is associated with subsequent bsi in humans.201728669864
clostridium difficile chimeric toxin receptor binding domain vaccine induced protection against different strains in active and passive challenge models.clostridium difficile is the number one cause of nosocomial antibiotic-associated diarrhea in developed countries. historically, pathogenesis was attributed two homologous glucosylating toxins, toxin-a (tcda) and toxin-b (tcdb). over the past decade, however, highly virulent epidemic strains of c. difficile (b1/nap1/027) have emerged and are linked to an increase in morbidity and mortality. increased virulence is attributed to multiple factors including: increased production of a- and b-toxins; ...201728669616
the effect of ultraviolet light on clostridium difficile spore recovery versus bleach alone. 201728669367
reducing fluoroquinolone use is a key step in controlling the burden of clostridium difficile infection. 201728668696
anesthetic agents, neurodevelopmental risk and the connection to bacterial infections.this short communication identifies a significant flaw in research investigating the neurodevelopmental consequences of general anesthesia exposure. we have identified that chronic environmental exposure to pervasive air pollutants that are also widely used as anesthetic agents, specifically nitrous oxide (n2o), may contribute to the rising prevalence of neurodevelopmental disorders. consistent with the emerging link between microbes and psychiatric illness risk, this epidemiological analysis ex ...201728666807
impact of moving to a new hospital build, with a high proportion of single rooms, on healthcare-associated infections and outbreaks.clostridium difficile infection, meticillin-sensitive staphylococcus aureus (mssa) and escherichia coli bacteraemia rates, and bed-days lost during norovirus outbreaks at north bristol nhs trust were analysed over a five-year period to determine whether moving to a new-build hospital with 75% single rooms reduced healthcare-associated infection rates. c. difficile, mssa bacteraemia and e. coli bacteraemia showed no change in the rate of decline after the move. bed-days lost due to norovirus were ...201728666780
a cfr-like gene cfr(c) conferring linezolid resistance is common in clostridium difficile.clostridium difficile t10 and clostridium bolteae 90b3 were co-resistant to phenicols, lincosamides, oxazolidinones, pleuromutilins and streptogramin a (phlopsa) and harbored an unreported cfr-like determinant that may alter the 23s rrna by m(8)a2503 methylation. the cfr-like cfr(c) gene was cloned in c. difficile 630δerm in which it conferred phlopsa resistance. in c. bolteae 90b3: (i) qrt-pcr analysis indicated that cfr(c) was similarly expressed in the absence or presence of either chloramphe ...201728663118
fatal course of takotsubo cardiomyopathy in a female with recurrent clostridium difficile infection.among diverse triggering factors of stress-induced takotsubo cardiomyopathy (tc), a viral or bacterial infection is rarely observed. sepsis is an exception, regardless of the etiologic pathogen, in which case an excess of catecholamines may result in acute left ventricular dysfunction. tc precipitated by clostridium difficile infection (cdi) has been reported only in two patients so far.201728662012
the role of antimicrobial sutures in preventing surgical site infection.introduction healthcare associated infections (hcais) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant staphylococcus aureus or emergent pathogens such as clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (ssi), either in the uk, the eu or the us. ssi is one of the hcais, which are all avoidable complications of a surgical ...201728660816
moxifloxacin versus levofloxacin or ciprofloxacin prophylaxis in acute myeloid leukemia patients receiving chemotherapy.patients receiving intensive chemotherapy regimens are at high risk for infectious complications due to prolonged neutropenia and hospital stay. fluoroquinolone antibiotics, mainly levofloxacin and ciprofloxacin, are the mainstay of prophylactic therapy for these patients. there is limited data regarding the utilization of other quinolone antibiotics including moxifloxacin in this setting.201728660351
clostridium difficile toxin biology.clostridium difficile is the cause of antibiotics-associated diarrhea and pseudomembranous colitis. the pathogen produces three protein toxins: c. difficile toxins a (tcda) and b (tcdb), and c. difficile transferase toxin (cdt). the single-chain toxins tcda and tcdb are the main virulence factors. they bind to cell membrane receptors and are internalized. the nterminal glucosyltransferase and autoprotease domains of the toxins translocate from low-ph endosomes into the cytosol. after activation ...201728657883
the remedy within: will the microbiome fulfill its therapeutic promise?the last decade of research has witnessed a tremendous upsurge in our understanding of the intestinal microbiome and its role in a large range of human diseases, which has incited hopes for a rapid clinical utilization of the new insights for the development of microbiome-based therapies. nonetheless, only a single microbiome-targeted therapy has so far found its way into clinical routine: fecal microbiota transplantation for patients suffering from recurrent clostridium difficile infections. he ...201728656322
clostridium difficile infection and the role of adaptive immunity in the microbiome. 201728656028
clinical and molecular characteristics of community-acquired clostridium difficile infections in comparison with those of hospital-acquired c. difficile.community-acquired clostridium difficile infection (ca-cdi) is a growing concern. ca-cdi differs from hospital-acquired c. difficile infection (ha-cdi) in its epidemiology, risk factors, severity, and outcomes. in this study, we investigated c. difficile infections in a tertiary care hospital in seoul, korea, and compared the ca-cdi and ha-cdi cases diagnosed in the same period. total 593 cases were confirmed as cdi in 2014, of which ca-cdi accounted for 68 (11.5%) of the total cdi cases. compar ...201728655581
tobacco use as a screener for clostridium difficile infection outcomes.we conducted a retrospective cohort study to evaluate the utility of self-reported tobacco use for developing a clinical prediction rule for poor outcomes of clostridium difficile infection. we found that patients with any history of smoking were significantly less likely than never smokers to be cured of their infection within two weeks. disease recurrence, readmission within thirty days, death before treatment completion, and the severity of clostridium difficile infection were not associated ...201728655511
a nutrient-regulated cyclic diguanylate phosphodiesterase controls clostridium difficile biofilm and toxin production during stationary phase.the signaling molecule cyclic diguanylate (c-di-gmp) mediates physiological adaptation to extracellular stimuli in a wide range of bacteria. the complex metabolic pathways governing c-di-gmp synthesis and degradation are highly regulated, but the specific cues that impact c-di-gmp signaling are largely unknown. in the intestinal pathogen clostridium difficile, c-di-gmp inhibits flagellar motility and toxin production and promotes pilus-dependent biofilm formation, but no specific biological func ...201728652311
probiotic containing lactobacillus casei, lactobacillus bulgaricus, and streptococcus thermophiles (actimel) for the prevention of clostridium difficile associated diarrhoea in the elderly with proximal femur fractures.the incidence of clostridium difficile associated diarrhoea (cdad) is greater in elderly patients. probiotics may have a beneficial effect in the prevention of cdad. however, their effect in elderly orthopaedic patients has not been previously reported. between april 2013 and april 2014, 105 patients admitted with femoral neck fractures, and who required 3days of antibiotics for infection of any cause, were prescribed the probiotic actimel until 3days after the last antibiotic dose. the incidenc ...201728652125
clostridium difficile-associated colitis post-transplant is not associated with elevation of tacrolimus concentrations.diarrhea is a common condition after solid organ transplant (sot); clostridium difficile-associated colitis (cdac) is one of the most common infections after sot. we documented previously that some types of enteritis are associated with an elevation of tacrolimus (tac) trough concentrations by interfering with the drug's complex metabolism.201728650734
identification of donor microbe species that colonize and persist long term in the recipient after fecal transplant for recurrent clostridium difficile.fecal microbiota transplantation has been shown to be an effective treatment for patients with recurrent c. difficile colitis. although fecal microbiota transplantation helps to re-establish a normal gut function in patients, the extent of the repopulation of the recipient microbial community varies. to further understand this variation, it is important to determine the fate of donor microbes in the patients following fecal microbiota transplantation. we have developed a new method that utilizes ...201728649413
use of antibiotics and the prevalence of antibiotic-associated diarrhoea in patients with spinal cord injuries: an international, multi-centre study.little is known about the use of antibiotics and the extent of antibiotic-associated diarrhoea (aad) in patients with spinal cord injuries (scis).201728647425
fecal microbiota transplantation for recurrent clostridium difficile infection in children.fecal microbiota transplantation (fmt) is a relatively simple, promising treatment for recurrent clostridium difficile infection. while there are a wide variety of approaches including mode of delivery, the results are nonetheless encouraging, even amongst younger children. experience with fmt in the pediatric population is increasing, showing similar success compared to adults. this article will provide an overview of c. difficile infection along with review of the rationale, methods and compli ...201728646951
impact of end stage kidney disease on costs and outcomes of clostridium difficile infection.to assess the impact of end stage kidney disease (eskd) on the outcomes of clostridium difficile infection (cdi), including complications of infection, length of hospital stay, overall mortality, and healthcare burden.201728645569
impact of the nap-1 strain on disease severity, mortality, and recurrence of healthcare-associated clostridium difficile infection.studies are conflicting regarding the association of the north american pulsed-field gel electrophoresis type 1 (nap1) strain in clostridium difficile infection (cdi) and outcomes. we evaluated the association of nap1 with healthcare-associated cdi disease severity, mortality, and recurrence at our academic medical center.201728645479
poorer outcomes among cancer patients diagnosed with clostridium difficile infections in united states community hospitals.cancer predisposes patients to clostridium difficile infection (cdi) due to health care exposures and medications that disrupt the gut microbiota or reduce immune response. despite this association, the national rate of cdi among cancer patients is unknown. furthermore, it is unclear how cdi affects clinical outcomes in cancer. the objective of this study was to describe cdi incidence and health outcomes nationally among cancer patients in the united states (u.s.).201728645266
predictors of mortality in cirrhosis inpatients with clostridium difficile infection.clostridium difficile is a bacterial pathogen associated with significant morbidity and mortality in patients with cirrhosis.201728644310
the effects of fasting and massive diarrhea on absorption of enteral vancomycin in critically ill patients: a retrospective observational study.although vancomycin (vcm) is not absorbed from healthy intestinal mucosa, elevations in the serum vcm concentrations have been reported in some cases. the aims of this study are to evaluate the necessity of therapeutic drug monitoring (tdm) during enteral vcm administration in critically ill patients.201728642864
the role of tigecycline in the management of clostridium difficile infection: a retrospective cohort study.we aimed to compare the outcomes of patients with c.difficile infection (cdi) treated either with tigecycline associated with vancomycin, or with vancomycin alone.201728642147
increasing rates of clostridium difficile infection in mexican hospitals.the epidemiology of clostridium difficile infection (cdi) has changed in the last two decades. there is a lack of information regarding incidence and severity of cdi, especially in the developing world.201728641091
using probiotics in clinical practice: where are we now? a review of existing meta-analyses.the scientific literature has demonstrated that probiotics have a broad spectrum of activity, although often the results are contradictory. this study provides a critical overview of the current meta-analyses that have evaluated the efficacy of probiotics in physiologic and pathological conditions, such as metabolic disease, antibiotic-associated and clostridium difficile-associated diarrhea, ibs, constipation, ibd, chemotherapy-associated diarrhea, respiratory tract infection, ventilator-associ ...201728640662
the effect of hospital biocide sodium dichloroisocyanurate on the viability and properties of clostridium difficile spores.clostridium difficile is the primary cause of healthcare-associated diarrhoea globally and produces spores which are resistant to commonly used biocides and are able persist on contaminated surfaces for months. this study examined the effect of sublethal concentrations of the biocide sodium dichloroisocyanurate (nadcc) on the viability of spores produced by 21 clinical isolates of c. difficile representing a range of pcr ribotypes. spores exposed to 500 ppm nadcc for 10 min exhibited between a 4 ...201728639362
economic barriers in the treatment of clostridium difficile infection with oral vancomycin.vancomycin is an increasingly important option for the treatment of clostridium difficile infection, but economic barriers to its use remain significant in the outpatient setting. generic vancomycin capsules are still inexplicably expensive and not universally covered by insurers. this report highlights the potential adverse consequences of cost-related nonadherence to vancomycin therapy and the challenges that clinicians face when prescribing oral vancomycin.201728638841
risk factors that predict recurrent clostridium difficile infections in surgical patients.clostridium difficile (c. difficile) infection (cdi) is a serious problem mostly studied during patients' index infections. the aim of this study is to define the incidence of primary and recurrent postoperative (postop) cdi in a single institution's entire surgical population and to identify risk factors that influence disease recurrence. using electronic medical records from 2002 to 2012, charts were reviewed from all patients with laboratory-proven (enzyme-linked immunosorbent assay or polyme ...201728637570
ibd: a growing and vulnerable cohort of hospitalized patients with clostridium difficile infection.the most recent nationwide data show a rising incidence of clostridium difficile infection in hospitalized patients with ulcerative colitis (uc). we describe recent national trends with regard to incidence, mortality, and the rate of total colectomy. the nationwide inpatient sample database identified patients admitted to hospitals in the united states with diagnoses of c. difficile and inflammatory bowel disease (ibd) during the study years 2007 to 2013. we analyzed incidence of c. difficile, m ...201728637562
bezlotoxumab: anti-toxin b monoclonal antibody to prevent recurrence of clostridium difficile infection.clostridium difficile infection (cdi) is the most common nosocomial infection in the u.s. 25% of cdi patients go on to develop recurrent cdi (rcdi) following current standard of care (soc) therapy, leading to morbidity, mortality and economic loss. the first passive immunotherapy drug targeting c.difficile toxin b (bezlotoxumab) has been approved recently by the fda and ema for prevention of rcdi. areas covered: a body of key studies was selected and reviewed by the authors. the unmet needs in c ...201728636484
covalent attachment and pro-pro endopeptidase (ppep-1)-mediated release of clostridium difficile cell surface proteins involved in adhesion.in the past decade, clostridium difficile has emerged as an important gut pathogen. this anaerobic, gram-positive bacterium is the main cause of infectious nosocomial diarrhea. whereas much is known about the mechanism through which the c. difficile toxins cause diarrhea, relatively little is known about the dynamics of adhesion and motility, which is mediated by cell surface proteins. this review will discuss the recent advances in our understanding of the sortase-mediated covalent attachment o ...201728636257
impact of recurrent clostridium difficile infection: hospitalization and patient quality of life.data quantifying outcomes of recurrent clostridium difficile infection (rcdi) are lacking. we sought to determine the uk hospital resource use and health-related quality of life (hrqol) associated with rcdi hospitalizations.201728633368
prevalence of clostridium difficile infection among the patients attending a tertiary care teaching hospital.clostridium difficile, a most important nosocomial enteric pathogen, is recognized globally as responsible for antibiotic-associated diarrhea and colitis. it is associated with considerable morbidity and mortality due to widespread use of antibiotics.201728631639
effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and clostridium difficile infection: a systematic review and meta-analysis.antibiotic stewardship programmes have been shown to reduce antibiotic use and hospital costs. we aimed to evaluate evidence of the effect of antibiotic stewardship on the incidence of infections and colonisation with antibiotic-resistant bacteria.201728629876
probabilistic invasion underlies natural gut microbiome stability.species compositions of gut microbiomes impact host health [1-3], but the processes determining these compositions are largely unknown. an unexplained observation is that gut species composition varies widely between individuals but is largely stable over time within individuals [4, 5]. stochastic factors during establishment may drive these alternative stable states (colonized versus non-colonized) [6, 7], which can influence susceptibility to pathogens, such as clostridium difficile. here we s ...201728625783
[fulminant clostridium difficile colitis: new challenges in critical care medicine].fulminant clostridium difficile colitis (fcdc) means severe clostridium difficile colitis (cdc), which often manifested with severe diarrhea, fever, abdominal distention, electrolyte disorder, hypoalbuminemia, and it can lead to pseudo membrane colonitis, toxic megacolon, bowel perforation, septic shock, and multiple organ dysfunction. now clostridium difficile (cd) becomes one of the most important medical institutions related infectious pathogens. in particular, the recently discovered mutant ...201728625250
treatment of asymptomatic uti in older delirious medical in-patients: a prospective cohort study.despite clinical practice guidelines, asymptomatic bacteriuria (asb) in older people is frequently treated. a common reason for treating asb is a change in mental status.201728624753
bovine antibodies targeting primary and recurrent clostridium difficile disease are a potent antibiotic alternative.the increased incidence of antibiotic resistant 'superbugs' has amplified the use of broad spectrum antibiotics worldwide. an unintended consequence of antimicrobial treatment is disruption of the gastrointestinal microbiota, resulting in susceptibility to opportunistic pathogens, such as clostridium difficile. paradoxically, treatment of c. difficile infections (cdi) also involves antibiotic use, leaving patients susceptible to re-infection. this serious health threat has led to an urgent call ...201728623367
impact of a collaborative strategy to reduce the inappropriate use of acid suppressive therapy in non-intensive care unit patients.stress ulcer prophylaxis (sup) is inappropriately prescribed in more than 30% of non-intensive care unit (icu) patients, leading to unnecessary adverse events as well as increases in economic burden.201728622739
antibiotic prophylaxis for surgical site infections as a risk factor for infection with clostridium difficile.we aimed to measure the association between 2013 guideline concordant prophylactic antibiotic use prior to surgery and infection with clostridium difficile.201728622340
antibiotic-associated haemorrhagic colitis: not always clostridium difficile.antibiotic-associated colitis is a gastrointestinal complication of antibiotic use commonly seen in hospitalised patients, with clostridium difficile (c. difficile) colitis being the most common type. we present a case of haemorrhagic colitis secondary to klebsiella oxytoca following self-initiated amoxicillin-clavulanic acid use. an 85-year-old woman presented to the emergency department with abdominal pain and mucobloody diarrhoea. history was notable for an ongoing 5-day course of amoxicillin ...201728619975
high metabolic versatility of different toxigenic and non-toxigenic clostridioides difficile isolates.clostridioides difficile (formerly clostridium difficile) is a major nosocomial pathogen with an increasing number of community-acquired infections causing symptoms from mild diarrhea to life-threatening colitis. the pathogenicity of c. difficile is considered to be mainly associated with the production of genome-encoded toxins a and b. in addition, some strains also encode and express the binary toxin cdt. however; a large number of non-toxigenic c. difficile strains have been isolated from the ...201728619474
microbiota therapy for clostridium difficile and antibiotic resistant enteric infections.bacterial pathogens are increasingly antibiotic resistant, and development of clinically effective antibiotics is lagging. curing infections increasingly requires antimicrobials that are broader spectrum, more toxic, and more expensive, and mortality attributable to antibiotic-resistant pathogens is rising. the commensal microbiota, comprising microbes that colonize the mammalian gastrointestinal tract, can provide high levels of resistance to infection, and the contributions of specific bacteri ...201728617651
clostridium difficile pcr cycle threshold predicts free toxin.there is no stand-alone clostridium difficile diagnostic that can sensitively and rapidly detect fecal free toxins. we investigated the performance of the c. difficile pcr cycle threshold (ct ) for predicting free toxin status. consecutive stool samples (n = 312) positive for toxigenic c. difficile by the genexpert c. difficile/epi tcdb pcr assay were tested with the rapid membrane c. diff quik chek complete immunoassay (rmeia). rmeia toxin-negative samples were tested with the cell cytotoxicity ...201728615471
antibiotics vs. appendectomy for acute uncomplicated appendicitis in adults: review of the evidence and future directions.acute appendicitis is the most common abdominal surgical emergency in the united states, with a lifetime risk of 7%-8%. the treatment paradigm for complicated appendicitis has evolved over the past decade, and many cases now are managed by broad-spectrum antibiotics. we determined the role of non-operative and operative management in adult patients with uncomplicated appendicitis.201728614043
glucosyltransferase-dependent and -independent effects of tcdb on the proteome of hep-2 cells.toxin b (tcdb) of the nosocomial pathogen c. difficile has been reported to exhibit a glucosyltransferase-dependent and -independent effect on treated hep-2 cells at toxin concentration above 0.3 nm. in order to investigate and further characterize both effects epithelial cells were treated with wild type tcdb and glucosyltransferase-deficient tcdbnxn and their proteomes were analyzed by lc-ms. triplex silac labeling was used for quantification. identification of 5212 and quantification of 4712 ...201728612519
automatic environmental disinfection with hydrogen peroxide and silver ions versus manual environmental disinfection with sodium hypochlorite: a multicentre randomized before-and-after trial.new technologies for automated disinfection have been developed, including the use of hydrogen peroxide atomized by specific equipment, with associated silver compounds.201728610932
fecal microbiota transplantation in metabolic syndrome: history, present and future.the history of fecal microbiota transplantation (fmt) dates back even to ancient china. recently, scientific studies have been looking into fmt as a promising treatment of various diseases, while in the process teaching us about the interaction between the human host and its resident microbial communities. current research focuses mainly on clostridium difficile infections, however interest is rising in other areas such as inflammatory bowel disease (ibd) and the metabolic syndrome. with regard ...201728609252
intestinal microbiota, fecal microbiota transplantation, and inflammatory bowel disease.inflammatory bowel disease (ibd) is a complex set of diseases that lead to chronic inflammation in the gastrointestinal tract. although the etiology of ibd is not fully understood, it is well-known that the intestinal microbiota is associated with the development and maintenance of ibd. manipulation of the gut microbiota, therefore, may represent a target for ibd therapy. fecal microbiota transplantation (fmt), where fecal microbiota from a healthy donor is transplanted into a patient's gi tract ...201728609251
stress ulcer prophylaxis in the intensive care unit trial: detailed statistical analysis plan.in this statistical analysis plan, we aim to provide details of the pre-defined statistical analyses of the stress ulcer prophylaxis in the intensive care unit (sup-icu) trial. the aim of the sup-icu trial is to assess benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in adult patients in the intensive care unit (icu).201728608496
risk factors for clostridium difficile infections - an overview of the evidence base and challenges in data synthesis.recognition of a broad spectrum of disease and development of clostridium difficile infection (cdi) and recurrent cdi (rcdi) in populations previously considered to be at low risk has renewed attention on differences in the risk profile of patients. in the absence of primary prevention for cdi and limited treatment options, it is important to achieve a deep understanding of the multiple factors that influence the risk of developing cdi and rcdi.201728607673
clostridium difficile flagella induce a pro-inflammatory response in intestinal epithelium of mice in cooperation with toxins.clostridium difficile is the most important enteropathogen involved in gut nosocomial post-antibiotic infections. the emergence of hypervirulent strains has contributed to increased mortality and morbidity of cdi. the c. difficile toxins contribute directly to cdi-associated lesions of the gut, but other bacterial factors are needed for the bacteria to adhere and colonize the intestinal epithelium. the c. difficile flagella, which confer motility and chemotaxis for successful intestinal coloniza ...201728607468
erratum to: surface layer proteins from virulent clostridium difficile ribotypes exhibit signatures of positive selection with consequences for innate immune response. 201728606132
association of adverse events with antibiotic use in hospitalized patients.estimates of the incidence of overall antibiotic-associated adverse drug events (ades) in hospitalized patients are generally unavailable.201728604925
prevalence and molecular epidemiology of clostridium difficile infection in indonesia.clostridium difficile has not been studied in detail in asia, particularly southeast asia. we thus performed a prevalence study across four hospitals in central java province, indonesia. stool samples were collected from patients with diarrhoea and tested by enzyme immunoassay for glutamate dehydrogenase (gdh) and toxin a/b (c diff quik chek complete, techlab). specimens were cultured and molecular typing was performed. in total, 340 samples were tested, of which 70 (20.6%) were gdh positive, wi ...201728603640
antimicrobial susceptibility of clostridium difficile isolated in thailand.exposure to antimicrobials is the major risk factor associated with clostridium difficile infection (cdi). paradoxically, treatment of cdi with antimicrobials remains the preferred option. to date, only three studies have investigated the antimicrobial susceptibility of c. difficile from thailand, two of which were published in the 1990s. this study aimed to investigate the contemporary antibiotic susceptibility of c. difficile isolated from patients in thailand.201728603609
is frozen fecal microbiota transplantation as effective as fresh fecal microbiota transplantation in patients with recurrent or refractory clostridium difficile infection: a meta-analysis?fecal microbiota transplantation (fmt) is a remarkably efficacious therapy for recurrent or refractory clostridium difficile infection (cdi), but not standardized. this work is to determine whether frozen fmt is as effective as fresh fmt. meta-analysis showed that frozen fmt was as effective as fresh fmt, both pooled first effective rate (65.0% (95% ci 57.0-73.0%) vs. 65.0% (95% ci 57.0-73.0%), p=0.962) and pooled second effective rate (95.0% (95% ci 91.0-99.0%) vs. 95.0% (95% ci 92.0-99.0%), p= ...201728602517
impact of an electronic sepsis initiative on antibiotic use and health care facility-onset clostridium difficile infection rates.although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. we aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (hcfo) clostridium difficile infection (cdi) rates.201728602274
prevalence of clostridium difficile infection in acute care hospitals, long-term care facilities, and outpatient clinics: is clostridium difficile infection underdiagnosed in long-term care facility patients?clostridium difficile infection is a common cause of diarrhea in long-term care facility (ltcf) patients. the high prevalence of c difficile infection in ltcfs noted in our study calls for a critical need to educate ltcf staff to send diarrheal stool for c difficile testing to identify more cases and prevent transmission.201728602273
detection of dna amplicons of polymerase chain reaction using litmus test.we report on a new colorimetric dna detection method that takes advantage of the power of polymerase chain reaction (pcr) and the simplicity of the classic litmus test. the strategy makes use of a modified set of primers for pcr to facilitate ensuing manipulations of resultant dna amplicons: their tagging with urease and immobilization onto magnetic beads. the amplicon/urease-laden beads are then used to hydrolyze urea, resulting in the increase of ph that can be conveniently reported by a ph-se ...201728596600
dipping into the clostridium difficile pool: are alcohol-based dispensers fomites for c difficile?the purpose of this study was to evaluate alcohol-based dispensers as potential fomites for clostridium difficile. a convenience sample of 120 alcohol-based dispensers was evaluated for the presence of c difficile either by culture or polymerase chain reaction for c difficile toxin. the results demonstrated that c difficile was not cultured, and c difficile toxin was not detected using polymerase chain reaction; however, gram-positive rods, clostridium perfringens, pantoea agglomerans, coagulase ...201728596022
the dangers of extreme body mass index values in patients with clostridium difficile.to examine the association between body mass index (bmi) and in-hospital mortality in patients presenting with clostridium difficile infections in emergency department visits (ed) in the usa. infected patients with extreme bmis may have an elevated mortality risk, but prior studies examining this question have been too small to reach definitive conclusions.201728593617
clostridium difficile colonization and/or infection during infancy and the risk of childhood allergic diseases.the gut microbiota can influence several diseases through immune modulation; however, the exact role of microbes such as clostridium difficileand the relationship between microbiota colonization and allergic diseases are not well known. this study aimed to determine the relationship between c. difficilecolonization and/or infection (cdci) during infancy and allergic diseases during early childhood.201728592977
cytokines are markers of the clostridium difficile-induced inflammatory response and predict disease severity.the host immune response affects pathogen virulence in clostridium difficile infection (cdi). thus, cytokine responses to cdi likely are associated with disease initiation and progression. understanding the molecular drivers of inflammation and biochemical markers of disease severity is important for developing novel therapies and predicting disease prognosis. in this study, we investigated cytokine production in patients with cdi and evaluated the potential of cytokines to serve as biomarkers f ...201728592627
distinguishing clostridium difficile recurrence from reinfection: independent validation of current recommendations.objective distinguishing recurrent clostridium difficile infection (cdi), defined as cdi caused by the same genotype, from reinfection with a different genotype, has important implications for surveillance and clinical trials investigating treatment effectiveness. we validated the proposed 8-week period for distinguishing "same genotype cdi" from "different genotype cdi," and we aimed to identify clinical variables with distinctiveness to propose an improved definition. methods from january 2004 ...201728592348
external validation of three prediction tools for patients at risk of a complicated course of clostridium difficile infection: disappointing in an outbreak setting.objective estimating the risk of a complicated course of clostridium difficile infection (cdi) might help doctors guide treatment. we aimed to validate 3 published prediction models: hensgens (2014), na (2015), and welfare (2011). methods the validation cohort comprised 148 patients diagnosed with cdi between may 2013 and march 2014. during this period, 70 endemic cases of cdi occurred as well as 78 cases of cdi related to an outbreak of c. difficile ribotype 027. model calibration and discrimin ...201728592343
[a prospective control study of saccharomyces boulardii in prevention of antibiotic-associated diarrhea in the older inpatients].objective: to study the value of saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in older inpatients. methods: a total of 163 older patients who were treated with wide-spectrum antibiotics at least three days during january 2014 to december 2015 were randomly divided into control and study group. in study group, 81 patients were administrated with oral saccharomyces boulardii 500 mg twice a day for 21 days. the control group was of no intervention. morbidity rate of ...201728592037
vancomycin taper and pulsed regimen with careful follow up for patients with recurrent clostridium difficile infection.we retrospectively studied vancomycin taper and pulse treatment on 100 consecutive, evaluable patients with recurrent c. difficile infection. following taper to once-daily vancomycin dosing, 22 of 36 patients (61%) who received every-other-day (qod) and 50 of 64 (81%) who received qod followed by every-third-day dosing were cured (p = 0.03).201728591789
repeat rifaximin for irritable bowel syndrome: no clinically significant changes in stool microbial antibiotic sensitivity.rifaximin has demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome (ibs-d).201728589238
[individualized treatment strategies for clostridium difficile infections].upon hospitalization, up to 15.5% of patients are already colonized with a toxigenic clostridium difficile strain (tcd). the rate of asymptomatic colonization is 0-3% in healthy adults and up to 20-40% in hospitalized patients. the incidence and mortality of c. difficile infection (cdi) has significantly increased during recent years. mortality lies between 3 and 14%. cdi is generally caused by intestinal dysbiosis, which can be triggered by various factors, including antibiotics or immune suppr ...201728589214
effectiveness of various cleaning and disinfectant products on clostridium difficile spores of pcr ribotypes 010, 014 and 027.in healthcare facilities, clostridium difficile infections spread by transmission of bacterial spores. appropriate sporicidal disinfectants are needed to prevent development of clusters and outbreaks. in this study different cleaning/disinfecting wipes and sprays were tested for their efficacy against spores of distinctive c. difficile pcr ribotypes.201728588767
different resistance mechanisms for cadazolid and linezolid in clostridium difficile found by whole-genome sequencing analysis.cadazolid (cdz) is a new antibiotic currently in clinical development for the treatment of clostridium difficile infections. cdz interferes with the bacterial protein synthesis machinery. the aim of the present study was to identify resistance mechanisms for cdz and compare the results to those obtained for linezolid (lzd) in c. difficile by whole-genome sequencing (wgs) of strains generated by in vitro passages and to those obtained for lzd-resistant clinical isolates. clones of c. difficile 63 ...201728584149
targeted metabolomics analysis identifies intestinal microbiota-derived urinary biomarkers of colonization resistance in antibiotic-treated mice.antibiotics excreted into the intestinal tract may disrupt the microbiota that provide colonization resistance against enteric pathogens and alter normal metabolic functions of the microbiota. many of the bacterial metabolites produced in the intestinal tract are absorbed systemically and excreted in urine. here, we used a mouse model to test the hypothesis that alterations in levels of targeted bacterial metabolites in urine specimens could provide useful biomarkers indicating disrupted or inta ...201728584146
safety, tolerability, systemic exposure, and metabolism of crs3123, a methionyl-trna synthetase inhibitor developed for treatment of clostridium difficile, in a phase 1 study.clostridium difficile causes antibiotic-associated diarrhea and is a major public health concern. current therapies disrupt the protective intestinal flora, do not reliably prevent recurrent infections, and will be decreasingly effective should less susceptible strains emerge. crs3123 is an oral agent that inhibits bacterial methionyl-trna synthetase and has potent activity against c. difficile and aerobic gram-positive bacteria but little activity against gram-negative bacteria, including anaer ...201728584140
the 5d framework: a clinical primer for fecal microbiota transplantation to treat clostridium difficile infection. 201728583769
the recognition and characterisation of finnish clostridium difficile isolates resembling pcr-ribotype 027.to characterise and compare twenty-eight finnish clostridiumdifficile rt027-like isolates, selected based on the presence of 18 bp deletion in the tcdc gene and toxin gene profile (a, b, binary), with eleven rt027 isolates from different finnish geographical areas and time periods.201728583353
crystal structure of the multiple antibiotic resistance regulator marr from clostridium difficile.regulators of multiple antibiotic resistance (marrs) are key players against toxins in prokaryotes. marr homologues have been identified in many bacterial and archaeal species which pose daunting antibiotic resistance issues that threaten public health. the continuous prevalence of clostridium difficile infection (cdi) throughout the world is associated with the abuse of antibiotics, and antibiotic treatments of cdi have limited effect. in the genome of c. difficile strain 630, the marr gene (id ...201728580925
identifying environmental reservoirs of clostridium difficile with a scent detection dog: preliminary evaluation.prompted by an article describing a dog trained to detect clostridium difficile in patients, our institution evaluated a dog's ability to detect c. difficile scent from equipment and surfaces to assist in strategic deployment of adjunctive cleaning measures.201728579472
compliance with clostridium difficile treatment guidelines: effect on patient outcomes.guidelines for the severity classification and treatment of clostridium difficile infection (cdi) were published by infectious diseases society of america (idsa)/society for healthcare epidemiology of america (shea) in 2010; however, compliance and efficacy of these guidelines has not been widely investigated. this present study assessed compliance with guidelines and its effect on cdi patient outcomes as compared with before these recommendations. a retrospective study included all adult inpati ...201728578710
extraintestinal clostridium difficile infection due to a ribotype different from that isolated from the feces of the patient: a case report.extraintestinal infections due to clostridium difficile are uncommon. when such infections occur, extraintestinal c. difficile isolates are usually identical to fecal isolates. we present a rare case of a large postoperative abscess caused by c. difficile infection, in which different c. difficile strains were isolated from the abscess and from feces of the patient. an 82-year-old woman with cutaneous polyarteritis nodosa developed pain, skin ulcers, and extensive necrosis of the right leg. abov ...201728578133
assessing the effect of patient screening and isolation on curtailing clostridium difficile infection in hospital settings.patient screening at the time of hospital admission is not recommended as a routine practice, but may be an important strategy for containment of clostridium difficile infection (cdi) in hospital settings. we sought to investigate the effect of patient screening in the presence of asymptomatic carriers and in the context of imperfect patient isolation.201728577357
adherence to clinical practice guidelines for the management of clostridium difficile infection in japan: a multicenter retrospective study.this study was conducted to investigate the adherence to clinical practice guidelines (cpgs) for clostridium difficile infection (cdi). a retrospective multicenter observational study was conducted via chart review at four teaching hospitals in japan from april 2012 through september 2013. cdi was diagnosed based on positive identification of cd toxin by enzyme immunoassay testing. cdi patients were divided into non-severe and severe groups according to the severity criteria of four published gu ...201728577158
safety and efficacy of antibacterial prophylaxis after craniotomy: a decision model analysis.antibiotic prophylaxis has revolutionized the safety of neurosurgical procedures in the last century. today, the clinician's drug of choice before surgery often is based on the antibiotic's resistance profile and drug-induced complications.201728576711
safety and pharmacokinetic study of fidaxomicin in children with clostridium difficile-associated diarrhea: a phase 2a multicenter clinical trial.fidaxomicin is an approved therapy for clostridium difficile-associated diarrhea (cdad) in adults. the safety of fidaxomicin in children has not been reported.201728575523
comparison of control of clostridium difficile infection in six english hospitals using whole-genome sequencing.variation in clostridium difficile infection (cdi) rates between healthcare institutions suggests overall incidence could be reduced if the lowest rates could be achieved more widely.201728575285
vancomycin taper and risk of failure of fecal microbiota transplant in patients with recurrent clostridium difficile infection.we retrospectively analyzed a cohort of 109 subjects treated for rcdi with fmt at tertiary referral center between 2011 and 2014 to determine risk factors for fmt failure.. in a multivariate analysis, failure to use an oral vancomycin taper preceding fmt was associated with a significant risk of fmt failure (odds ratio [95% ci], 0.15 [0.007-0.40]).201728575220
epidemiology, risk factors, and outcomes of infections in patients undergoing liver transplantation for hilar cholangiocarcinoma.the epidemiology of infection after liver transplantation for hilar cholangiocarcinoma has not been systematically investigated. in this study of 124 patients, 255 infections occurred in 105 patients during the median follow-up of 4.2 years. the median time to first infection was 15.1 weeks (iqr 1.6-62.6). the most common sites were the abdomen, bloodstream, and musculoskeletal system. risk factors for any post-transplant infection were pre-transplant vre colonization (hazard ratio [hr] 1.9, p=. ...201728573685
emergence of clostridium difficile tcdc variant 078 in marseille, france.the purpose of this investigation was to evaluate the epidemiology of hypervirulent clostridium difficile ribotypes from january 2013 to february 2017 in the marseille area of southern france. by using the xpert clostridium difficile epi polymerase chain reaction (pcr) assay and sequencing the tcdc gene, we characterised c. difficile isolates from symptomatic patients diagnosed with c. difficile infection (cdi) in marseille university hospitals. we first tested retrospectively 278 c. difficile s ...201728573471
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