Publications

survey of incidence of clostridium difficile infection in canadian hospitals and diagnostic approaches.	a questionnaire relating to clostridium difficile disease incidence and diagnostic practices was sent to 380 canadian hospitals (all with > 50 beds). the national questionnaire response rate was 63%. in-house testing was performed in 17.6, 61.5, and 74.2% of the hospitals with < 300, 300 to 500, and > 500 beds, respectively. the average test positivity rates were 17.2, 15.3, and 13.2% for hospitals with < 300, 300 to 500, and > 500 beds, respectively. the average disease incidences were 23.5, 30 ...	1998	9650966
substance p receptor expression in intestinal epithelium in clostridium difficile toxin a enteritis in rats.	we previously reported that the inflammatory effects of clostridium difficile toxin a on rat intestine can be significantly inhibited with a specific neurokinin-1 receptor (nk-1r) antagonist. in this study we investigated the localization and expression of nk-1r mrna and protein in rat intestine by in situ hybridization, northern blot analysis, and immunohistochemistry, respectively, after exposure to toxin a. northern blot analysis showed increased mucosal levels of nk-1r mrna starting 30 min a ...	1998	9655686
a review of the use of teicoplanin in haematological malignancy.	factors determining the change in patterns of antibiotic use in patients with haematological malignancies include the growing numbers of infections caused by gram-positive pathogens, the increasing reliance on indwelling catheters, and strategic movement away from inpatient therapy towards day-case and non-inpatient therapy. the suitability of teicoplanin in this context is examined. the indications for teicoplanin use are now established as: early use in clinically infected patients; as a secon ...	1998	9658685
managing c. difficile-associated diarrhea.		1998	9659963
ashp therapeutic position statement on the preferential use of metronidazole for the treatment of clostridium difficile-associated disease.	ashp supports preferential use of oral metronidazole for treating cdad when antimicrobial therapy is indicated. oral vancomycin should be reserved for severe, potentially life-threatening cases or when oral metronidazole cannot be used. oral metronidazole is as safe and effective as oral vancomycin and is considerably less costly. in addition, preliminary data suggest that routine use of oral vancomycin for cdad may contribute to the spread of vre--emerging nosocomial pathogens that can be extra ...	1998	9659970
chloramphenicol resistance in clostridium difficile is encoded on tn4453 transposons that are closely related to tn4451 from clostridium perfringens.	the chloramphenicol resistance gene catd from clostridium difficile was shown to be encoded on the transposons tn4453a and tn4453b, which were structurally and functionally related to tn4451 from clostridium perfringens. tn4453a and tn4453b excised precisely from recombinant plasmids, generating a circular form, as is the case for tn4451. evidence that this process is mediated by tn4453-encoded tnpx genes was obtained from experiments which showed that in trans these genes complemented a tn4451t ...	1998	9660983
community-acquired clostridium difficile infection.	clostridium difficile-associated disease (cdad) is primarily a nosocomial condition. community-acquired disease has been reported but the incidence is felt to be low and the rate of disease resulting in hospitalization is reported as negligible. we recently experienced a 6-month outbreak of cdad (january to june 1995): 139 patients were involved and four deaths were attributable to pseudomembranous colitis. early in the outbreak period we were aware that many new admissions presented with c. dif ...	1998	9661938
clostridium difficile infection.	clostridium difficile infection is associated with broad-spectrum antibiotic therapy and is the most common cause of infectious diarrhea in hospital patients. pathogenic strains of c. difficile produce two protein exotoxins, toxin a and toxin b, which cause colonic mucosal injury and inflammation. infection may be asymptomatic, cause mild diarrhea, or result in severe pseudomembranous colitis. diagnosis depends on the demonstration of c. difficile toxins in the stool. the first step in managemen ...	1998	9509270
specific inhibition of phorbol ester-stimulated phospholipase d by clostridium sordellii lethal toxin and clostridium difficile toxin b-1470 in hek-293 cells. restoration by ral gtpases.	activation of m3 muscarinic acetylcholine receptor (machr), stably expressed in human embryonic kidney (hek)-293 cells, leads to phospholipase d (pld) stimulation, a process apparently involving rho gtpases, as shown by studies with clostridium botulinum c3 exoenzyme and clostridium difficile toxin b (tcdb). direct activation of protein kinase c (pkc) by phorbol esters, such as phorbol 12-myristate 13-acetate (pma), also induces pld stimulation, which is additive to the machr action and which is ...	1998	9516439
regulated transcription of clostridium difficile toxin genes.	the clostridium difficile toxa and toxb genes, encoding cytotoxic and enterotoxic proteins responsible for antibiotic-associated colitis and pseudomembranous colitis, were shown to be transcribed both from gene-specific promoters and from promoters of upstream genes. however, the gene-specific transcripts represented the majority of tox gene mrnas. the 5' ends of these mrnas were shown to correspond to dna sequences that had promoter activity when fused to the escherichia coli beta-glucuronidase ...	1998	9466260
severe clostridium difficile-associated colitis in young patients with cystic fibrosis.	we report four patients with cystic fibrosis and fulminant clostridium difficile-associated colitis: two died, and one required hemicolectomy. three of four patients carried the n1303k mutation. severe and fatal c. difficile colitis can occur in cystic fibrosis patients, possibly with a genotype-specific predilection (i.e., n1303k/other). because cystic fibrosis patients may have a wide spectrum of gastrointestinal symptoms, disease caused by c. difficile must be considered when these patients h ...	1998	9470027
clostridium difficile-associated diarrhea in a patient with rheumatoid arthritis: comment on the article by ramos et al.		1998	9811067
[probiotic therapy of pseudomembranous colitis. combination of intestinal lavage and oral administration of escherichia coli].	an 82-year-old woman was admitted because of acute left heart failure with pulmonary oedema. there was a right basal pneumonia with congestion which was treated with amoxycillin and clavulanic acid. severe watery diarrhoea with more than 10 stools daily occurred. clostridium difficile was not isolated.	1998	9817997
low rate of clostridium difficile colonization in ambulatory and hospitalized hiv-infected patients in a hospital unit: a prospective survey.	to determine the frequency of clostridium difficile carriage in hiv-infected in- and out-patients, and to assess the role of this carriage in nosocomial transmission of c. difficile.	1998	9821082
clostridium difficile-associated diarrhea and colitis: clinical manifestations, diagnosis, and treatment.	this review examines the pathogenesis, clinical manifestations, diagnosis, and current medical and operative strategies in the treatment of clostridium difficile diarrhea and colitis. prevention and future avenues of research are also investigated.	1998	9823813
pneumatosis intestinalis with clostridium difficile colitis as a cause of acute abdomen after lung transplantation.		1998	9824133
clostridium difficile colitis associated with chronic renal failure.	clostridium difficile-associated diarrhoea (cdad) is a potentially life-threatening illness which has been shown to be more common and more severe in patients with chronic renal failure (crf) than in other groups. a review of cdad in our nephrology unit was carried out.	1998	9829488
identification of two distinct mechanisms of phagocytosis controlled by different rho gtpases.	the complement and immunoglobulin receptors are the major phagocytic receptors involved during infection. however, only immunoglobulin-dependent uptake results in a respiratory burst and an inflammatory response in macrophages. rho guanosine triphosphatases (molecular switches that control the organization of the actin cytoskeleton) were found to be essential for both types of phagocytosis. two distinct mechanisms of phagocytosis were identified: type i, used by the immunoglobulin receptor, is m ...	1998	9831565
single toxin detection is inadequate to diagnose clostridium difficile diarrhea in pediatric patients.	clostridium difficile is an important cause of symptomatic diarrhea in pediatric patients. the bacterium produces two toxins, although many laboratories assay for only one. we questioned this diagnostic approach when patients had positive results for c. difficile at our institution, but initially had tested negative at outside laboratories.	1998	9834258
[diarrhea associated with clostridium difficile. one-year retrospective study at a tertiary hospital].	diarrhea associated with clostridium difficile is a health care problem of growing importance in the last few years specially in the hospital environment. the epidemiologic data and factors associated with this disease have not, to date, been sufficiently studied in spain.	1998	9835150
evaluation of an interdisciplinary re-isolation policy for patients with previous clostridium difficile diarrhea.	diarrhea caused by clostridium difficile is increasingly recognized as a nosocomial problem. the effectiveness and cost of a new program to decrease nosocomial spread by identifying patients scheduled for readmission who were previously positive for toxin was evaluated.	1998	9836843
effectiveness of infection control program in controlling nosocomial clostridium difficile.	to report the effectiveness of use of comprehensive infection control measures to reduce the incidence of clostridium difficile (cd) in an acute-care teaching hospital.	1998	9836844
clostridium difficile colitis requiring subtotal colectomy in a renal transplant recipient: a case report and review of literature.		1998	9838712
dioctahedral smectite neutralization activity of clostridium difficile and bacteroides fragilis toxins in vitro.	the neutralization activity of dioctahedral smectite for ten toxigenic clostridium difficile and eight enterotoxigenic bacteroides fragilis strains was studied using mccoy and ht 29/c1 cell lines, respectively. minimalization of the cytopathic effect of c. difficile toxin b on mccoy cell lines by dioctahedral smectite dissolved in pbs was observed. after incubation with dioctahedral smectite the toxic effects of b. fragilis enterotoxins on ht/29c1 (human colon adenocarcinoma cell line) were elim ...	1998	9839376
bacterial translocation, intestinal microflora and morphological changes of intestinal mucosa in experimental models of clostridium difficile infection.	bacteraemia and subsequent sepsis is one possible complication of clostridium difficile infection. the aim of this study was to examine a correlation between bacterial translocation with morphological changes of intestinal mucosa and shifts of intestinal microflora in experimental models of c. difficile infection. a mouse model was used to study post-antibiotic shifts and mild c. difficile infection, and hamsters were used to study fatal enterocolitis. the influence of pro- and pre-biotics (lact ...	1998	9839563
clostridium difficile associated with acute colitis in mares when their foals are treated with erythromycin and rifampicin for rhodococcus equi pneumonia.	in sweden, mares sometimes develop acute, often fatal, colitis when their foals are treated orally with erythromycin and rifampicin for rhodococcus (r.) equi infection. clostridium (c.) difficile, or its cytotoxin, was demonstrated in faecal samples from 5 of 11 (45%) mares with diarrhoea. by contrast c. difficile was not found in the faecal flora of 12 healthy mares with foals treated for r. equi infection or in 56 healthy mares with healthy untreated foals. no other enteric pathogen was isolat ...	1998	9844966
guidelines for optimal surveillance of clostridium difficile infection in hospitals.	the availability of surveillance data on c. difficile infection in hospitals in england and wales is being jeopardised by the trend not to culture the organism for diagnostic purposes. nhs trust laboratories that no longer have the ability to isolate c. difficile cannot investigate putative outbreaks or monitor antimicrobial susceptibilities. these laboratories may now need to rely on their local public health laboratory for such investigations. recent recommendations from the department of heal ...	1998	9854878
[detection of toxin producing strains of clostridium difficile using rapid diagnostic methods].	feces of 53 patients from different hospital wards suffering from long term post-antibiotic therapy diarrhea were tested. for direct detection of c. difficile toxin a, in samples tcd (becton-dickinson), and c. difficile toxin a test (oxoid) tests were used. toxin a was detected in 16 samples (29.6% tested). c. difficile strains were isolated from 40% of the fecal samples. toxin a was detected in 25 clostridium difficile strains with commercial tests and toxin b was detected using mccoy cell line ...	1998	9857614
clostridium difficile-associated diarrhoea.	at our hospital, the number of cases of clostridium difficile-associated diarrhoea increased from 29 in 1993 to 210 in 1995. the case notes of 110 patients with c difficile-associated diarrhoea during the first 6 months of 1995 were analysed retrospectively. the majority of the patients (106) had received antibiotics before the onset of diarrhoea; 46 had received three or more different antibiotics and 28 had received metronidazole. in 19 patients, the first stool sample after the onset of diarr ...	1998	10197216
the in-vitro activity of hmr 3647, a new ketolide antimicrobial agent.	the in-vitro activity of hmr 3647, a novel ketolide, was investigated in comparison with those of erythromycin a, roxithromycin, clarithromycin (14-membered ring macrolides), amoxycillin-clavulanate and ciprofloxacin against 719 recent clinical gram-positive, gram-negative and anaerobic isolates and type cultures. hmr 3647 generally demonstrated greater activity than the other compounds with mic90s of < or =0.5 mg/l, except for staphylococcus epidermidis (mic90 > 128 mg/l), haemophilus influenza ...	1998	10052892
prevalence of clostridium difficile toxin in kidney transplant recipients.		1998	10066067
toxins from anaerobic bacteria: specificity and molecular mechanisms of action.	major advances have been made in the past five years in the identification of cellular targets of toxins produced by anaerobic bacteria. these targets include the vesicular membrane docking and fusion apparatus, the actin cytoskeleton, the signal transduction machinery and the cell membrane. the recent discovery that large clostridial toxins (clostridium difficile a and b toxins, c. sordellii lethal and hemorrhagic toxins, and alpha c. novyi toxin) are monoglucosyltransferases, together with the ...	1998	10066460
multicenter evaluation of the clostridium difficile tox a/b test.	clostridium difficile, the primary cause of nosocomial diarrhea in the united states and many other industrialized countries, is recognized as a major health concern because of its ability to cause severe intestinal disease leading to complications such as relapses and infections due to vancomycin-resistant enterococci. the disease results from two toxins, toxins a and b, produced by this pathogen. in this study, we evaluated the tox a/b test, a new 1-h enzyme immunoassay (eia) that detects toxi ...	1998	9431944
stool colonization of healthcare workers with selected resistant bacteria.	we examined the carriage of selected resistant bacteria in the stools of healthcare workers who provided direct patient care. neither vancomycin-resistant enterococci, methicillin-resistant staphylococcus aureus, nor clostridium difficile was recovered from the 55 stool specimens collected. a ceftazidime-resistant citrobacter freundii was isolated from one specimen. we conclude that the stool of healthcare workers is colonized infrequently with these resistant organisms.	1998	9475348
vancomycin-resistant enterococcus faecium in a long-term care facility.	to describe the epidemiology and natural history of colonization with vancomycin-resistant enterococcus faecium (vref) in a long-term care facility.	1998	9475442
clostridium difficile toxin b inhibits carbachol-induced force and myosin light chain phosphorylation in guinea-pig smooth muscle: role of rho proteins.	1. clostridium difficile toxin b glucosylates the ras-related low molecular mass gtpases of the rho subfamily thereby inactivating them. in the present report, toxin b was applied as a tool to test whether rho proteins participate in the carbachol-induced increase in the ca2+ sensitivity of force and myosin light chain (mlc) phosphorylation in intact intestinal smooth muscle. 2. small strips of the longitudinal muscle of guinea-pig small intestine were incubated in toxin b (40 ng ml-1) overnight ...	1998	9481674
clostridium difficile infection in a horse.		1998	9481834
chimeric clostridial cytotoxins: identification of the n-terminal region involved in protein substrate recognition.	clostridium sordellii lethal toxin is a member of the family of large clostridial cytotoxins that glucosylate small gtpases. in contrast to clostridium difficile toxins a and b, which exclusively modify rho subfamily proteins, c. sordellii lethal toxin also glucosylates ras subfamily proteins. by deletion analysis and construction of chimeric fusion proteins of c. sordellii lethal toxin and c. difficile toxin b, we localized the enzyme activity of the lethal toxin to the n terminus of the holoto ...	1998	9488398
the impact of clostridium difficile on a surgical service: a prospective study of 374 patients.	to evaluate the epidemiology of clostridium difficile colitis (cdc) in a subset of patients admitted specifically to a surgical service.	1998	9488530
[genotyping of isolates of bacteria and candida].	strain differentiation of staphylococcus species, streptococcus pneumoniae, escherichia coli, clostridium difficile, and candida species was performed by restriction endonuclease analysis (rea) of genomic dna with hinfi or haeiii followed by conventional agarose gel electrophoresis. rea of 19 methicillin-resistant s. aureus isolates and 19 methicillin-susceptible s. aureus isolates revealed 8, and 14 patterns, respectively. fifty-three isolates of s. epidermidis were divided into 39 groups on th ...	1998	9492535
lysophosphatidic acid-mediated signal-transduction pathways involved in the induction of the early-response genes prostaglandin g/h synthase-2 and egr-1: a critical role for the mitogen-activated protein kinase p38 and for rho proteins.	during inflammatory processes of the kidney, lesions of the glomerulus lead to aggregation of thrombocytes and infiltration of macrophages, which can release bioactive mediators. one of these important signalling molecules is lysophosphatidic acid (lpa). incubation of rat mesangial cells with lpa induced mrna and protein expression of the early-response genes pghs-2 (for prostaglandin g/h synthase-2/cyclo-oxygenase-2) and egr-1. as shown by antisense experiments, induction of egr-1 was related t ...	1998	9494074
a prospective nationwide study of clostridium difficile-associated diarrhea in sweden. the swedish c. difficile study group.	clostridium difficile-associated diarrhea (cdad) is regarded as an emerging nosocomial infection. all patients positive for c. difficile in sweden were recorded during 1995, including primary care patients. those positive for toxin in feces were defined as cdad cases. a total of 5,133 cdad cases were recorded (58 per 100,000 inhabitants per year), as compared with 86 cases diagnosed in 1978 and 553 in 1983. cdad was almost twice as prevalent as all (combined) diagnosed domestic cases of reportab ...	1998	9455523
hep-2 cell-adherent escherichia coli and intestinal secretory immune response to human immunodeficiency virus (hiv) in outpatients with hiv-associated diarrhea.	hep-2 cell-adherent escherichia coli and the human immunodeficiency virus (hiv) itself have recently been incriminated as causes of chronic hiv-associated diarrhea. this study sought to determine the prevalence of these two agents among hiv-infected patients with diarrhea in an outpatient setting in the united states and to compare their prevalence to that of other commonly recognized enteropathogens known to be present in this population. hep-2 cell-adherent e. coli was found in 20 of 83 (24.1% ...	1998	9455887
cgrp upregulation in dorsal root ganglia and ileal mucosa during clostridium difficile toxin a-induced enteritis.	we have previously reported that pretreatment of rats with capsaicin (an agent that ablates sensory neurons) or cp-96345 (a substance p receptor antagonist) dramatically inhibits fluid secretion and intestinal inflammation in ileal loops exposed to clostridium difficile toxin a. the aim of this study was to determine whether calcitonin gene-related peptide (cgrp), a neuropeptide also found in sensory afferent neurons, participates in the enterotoxic effects of toxin a. administration of toxin a ...	1998	9458790
primary symptomless colonisation by clostridium difficile and decreased risk of subsequent diarrhoea.	little is known about whether patients who develop clostridium-difficile-associated diarrhoea (cdad) are culture-positive or culture-negative before illness. the most important risk factor is antibiotic exposure. we aimed to find out whether patients identified as primary symptom-free c difficile carriers are at higher risk of developing cdad than patients who are culture-negative.	1998	9500319
timing of surgery for fulminating pseudomembranous colitis.	with increasing antibiotic usage clostridium difficile colitis is becoming more common. surgery for fulminating c. difficile colitis, however, is rare because of the effectiveness of specific anticlostridial chemotherapy. surgical outcome in five patients with fulminating c. difficile colitis involved in a recent outbreak of this disease is reported.	1998	9501823
isolation of a toxin b-deficient mutant strain of clostridium difficile in a case of recurrent c. difficile-associated diarrhea.	clostridium difficile-associated diarrhea (cdad) recurs in approximately 15%-20% of patients after discontinuation of metronidazole or vancomycin therapy. most recurrences are believed to be endogenous relapses due to the persistence of spores. however, there is evidence that reinfection with a different strain is a cause of recurrence. we report the case of a patient with a history of multiple episodes of c. difficile colitis. the patient, a 56-year-old female, has had 5 years of repeated recur ...	1998	9502463
laboratory surveillance method for nosocomial clostridium difficile diarrhea.	clostridium difficile is the most common infectious cause of endemic nosocomial diarrhea, but traditional surveillance methods for this infection can be time-consuming. the purpose of this article is to (1) describe a laboratory surveillance method for nosocomial diarrhea and nosocomial clostridium difficile diarrhea (cdd) that does not require chart review and (2) describe some of the epidemiology of these infections at a university-affiliated, public hospital by using this surveillance method.	1998	9503108
results of chapter project on statistical analysis.		1998	9503120
neurokinin-1 (nk-1) receptor is required in clostridium difficile- induced enteritis.	toxin a, a 308,000-mr enterotoxin from clostridium difficile, mediates antibiotic-associated diarrhea and colitis in humans. injection of toxin a into animal intestine triggers an acute inflammatory response characterized by activation of sensory neurons and immune cells of the intestinal lamina propria, including mast cells and macrophages, and migration of circulating neutrophils in the involved intestinal segment. in this study we show that mice genetically deficient in the neurokinin-1 recep ...	1998	9541482
clostridium difficile bacteremia in an immunocompetent child.		1998	9542965
protease activity of clostridium difficile strains.	the production of proteolytic enzymes by 10 clostridium difficile isolates of varying toxigenicity and clinical origin was studied to determine if all isolates secreted proteases. different protease substrates were studied: gelatin, collagen, phenylazobenzyloxycarbonyl-leucyl-glycyl-l-prolyl-d-arginine (pz-peptide), casein, azocasein, and azocoll. all isolates degraded gelatin, collagen, and azocoll. the supernatants of all isolates contained an enzyme capable of attacking gelatin incorporated i ...	1998	9543717
evaluation of four methods for detection of clostridium difficile or c. difficile toxin: cytotoxin assay, culture, latex agglutination, and a new rapid immunoassay (c. difficile toxin a test).	the performance of c. difficile toxin a test (oxoid, basingstoke, uk), an immunoassay for the detection of c. difficile toxin a in fecal samples, for the diagnosis of c. difficile-associated diarrhea was compared with those of cytotoxin assay, culture, and a latex agglutination assay (culturette brand cdt rapid clostridium difficile test; becton dickinson, cockeysville, md). a total of 105 stool specimens from 71 patients were tested. of the 105 specimens analyzed, 6 (5.7%) samples were positive ...	1998	9544497
glucosylation and adp ribosylation of rho proteins: effects on nucleotide binding, gtpase activity, and effector coupling.	we studied the effects of glucosylation of rhoa, rac1, and cdc42 at threonine-35 and -37 by clostridium difficile toxin b on nucleotide binding, gtpase activity, and effector coupling and compared these results with the adp ribosylation of rhoa at asparagine-41 catalyzed by clostridium botulinum c3 transferase. whereas glucosylation and adp ribosylation had no major effects on gdp release from rhoa, rac1, and cdc42, the rate of gtpgammas release from rho proteins was increased 3-6-fold by glucos ...	1998	9548761
[clostridium difficile toxin-associated diarrhea in geriatrics].	in the course of 1 year, clostridium difficile-associated diarrhea, which may lead to pseudomembranous colitis and therefore may be very harmful in frail elderly people, was diagnosed in six patients of a geriatric clinic. the disease is associated with antibiotic therapy, due to an overgrowth of the intestinal flora with clostridium difficile. symptoms varied from a state of asymptomatic carriage or benign diarrhea to acute stages of the disease with severe diarrhea, abdominal pain, fever and a ...	1998	9553219
clinical significance of alimentary tract microbes in bone marrow transplant recipients.	a prospective study on the microbes isolated from the alimentary tract in 120 bone marrow transplant (bmt) recipients (1991-1993) was undertaken to define the spectrum of organisms isolated under antimicrobial prophylaxis, their temporal sequence of emergence, and the associated morbidity and mortality. clostridium difficile (n = 20), isolated in the pre-engraftment and early post-engraftment periods (day 2-45 post-bmt), was the most common microbe recovered from stool of patients with diarrhea. ...	1998	9554172
[clostridium difficile outbreak in surgical wards].	to evaluate the clinical consequences of a hospital outbreak of clostridium difficile infections in the netherlands.	1998	9557041
direct evidence of mast cell involvement in clostridium difficile toxin a-induced enteritis in mice.	the pathogenesis of clostridium difficile toxin a-induced intestinal inflammation is not completely understood. the aim of this study was to define the contribution of mast cells to the fluid secretion and neutrophil infiltration associated with toxin a-induced enteritis.	1998	9558284
leukocyte-endothelial cell interactions: molecular mechanisms and implications in gastrointestinal disease.	leukocyte-endothelial cell adhesion is now recognized to represent an early and rate-limiting step in the leukocyte infiltration and accompanying tissue injury that is associated with acute and chronic inflammatory diseases of the gastrointestinal tract. adhesive interactions such as leukocyte rolling, adherence, and transendothelial migration are influenced by a variety of physical, chemical, and molecular factors that ultimately result in a net up-regulation or down-regulation of the inflammat ...	1998	9558298
metronidazole may inhibit intestinal colonization with clostridium difficile.	antibiotics suppress normal gut flora, allowing overgrowth of acquired or native clostridium difficile, with release of toxins that cause mucosal inflammation. oral metronidazole is used to treat antibiotic-associated colitis (pseudomembranous colitis). this study was designed to determine whether oral metronidazole, as part of preoperative bowel preparation, prevents or decreases incidence of antibiotic-associated colitis after elective colonic and rectal procedures.	1998	9559631
nosocomial diarrhea.	nosocomial diarrheas are an important problem in hospitals, and in critical care units in particular. hospital-acquired diarrhea may be on an infectious or noninfectious basis. common noninfectious causes of nosocomial diarrhea include medication-induced changes in the fecal flora or changes secondary to enteral hyperalimenation. infectious causes of nosocomial diarrhea are due to enteric pathogens in outbreak situations and virtually all of the causes are due to clostridium difficile. c. diffic ...	1998	9561820
risk factors for early recurrent clostridium difficile-associated diarrhea.	recurrence is a common sequela of clostridium difficile-associated diarrhea (cdd) and may increase morbidity, costs, and treatment-related antimicrobial resistance. because recurrent cdd (rcdd) frequently occurs very soon after an initial episode, our goal was to determine the risk factors for early rcdd (occurring < or = 45 days after the initial episode). we conducted a case-control study, comparing 13 patients with early rcdd (case patients) with 46 patients who had only one cdd episode (cont ...	1998	9564482
molecular analysis of the promoter region of the clostridium difficile toxin b gene that is functional in escherichia coli.	clostridium difficile is a human pathogen that produces two types of toxins, a and b, that cause a potentially lethal gastrointestinal syndrome termed pseudomembranous colitis. virtually nothing is known about the mechanism of regulation of toxin production in this organism, and cis-regulatory regions of neither toxin have yet been identified, thus prompting this investigation. a motif homologous with the shine-dalgarno sequence of escherichia coli occurs upstream from the putative initiation co ...	1998	9568996
the lack of therapeutic effect of saccharomyces boulardii in the prevention of antibiotic-related diarrhoea in elderly patients.	diarrhoea is a common side effect of antibiotic therapy, especially in the elderly. saccharomyces boulardii is a non-pathogenic yeast which has been demonstrated to reduce the frequency of diarrhoea in patients due to a variety of causes. we set out to assess its role in preventing antibiotic-related diarrhoea. consecutive patients over the age of 65 admitted to medical wards, and who were being prescribed antibiotics, were randomized to receive either s. boulardii 113 g twice daily or placebo f ...	1998	9570649
nonspecific binding of clostridium difficile toxin a to murine immunoglobulins occurs via the fab component.	clostridium difficile toxin a binds nonspecifically to a mouse monoclonal antibody (mab) immunoglobulin g3 lambda chain [igg3(lambda)], through the fab component. this binding, which is retained even after boiling the mab, is temperature dependent, with more toxin bound at 4 than 37 degrees c (p = 0.0024). the nonspecific binding was decreased by incubation of the igg3 lambda mab with alpha- or beta-galactosidase (p = 0.0001 and 0.029, respectively), indicating that toxin a binds to a carbohydra ...	1998	9573079
antibodies to recombinant clostridium difficile toxins a and b are an effective treatment and prevent relapse of c. difficile-associated disease in a hamster model of infection.	clostridium difficile causes antibiotic-associated diarrhea and colitis in humans through the actions of toxin a and toxin b on the colonic mucosa. at present, broad-spectrum antibiotic drugs are used to treat this disease, and patients suffer from high relapse rates after termination of treatment. this study examined the role of both toxins in pathogenesis and the ability of orally administered avian antibodies against recombinant epitopes of toxin a and toxin b to treat c. difficile-associated ...	1998	9573084
[diarrhea associated with clostridium difficile].		1998	9580506
gtpgammas-induced actin polymerisation in vitro: atp- and phosphoinositide-independent signalling via rho-family proteins and a plasma membrane-associated guanine nucleotide exchange factor.	in a cell-free system from neutrophil cytosol gtp(&ggr ;)s can induce an increase in the number of free filament barbed ends and massive actin polymerisation and cross-linking. gtp(&ggr ;)s stimulation was susceptible to an excess of gdp, but not bordetella pertussis toxin and could not be mimicked by aluminium fluoride, myristoylated gtpgammas.gialpha2 or gbeta1gamma2 subunits of trimeric g proteins. in contrast, rhogdi and clostridium difficile toxin b (inactivating rho family proteins) comple ...	1998	9580566
[outbreak of nosocomial diarrhea by clostridium difficile in a department of internal medicine].	clostridium difficile (dcd) is the main etiologic agent of nosocomial diarrhea of infectious origin. most of the cases of dcd have been detected in a hospital environment.	1998	9586362
clinical quiz. diffuse pseudomembranous colitis.		1998	9586762
a valid and reliable tool to quantify stool output in tube-fed patients.	a major problem in determining whether diarrhea exists in tube-fed patients is the quantification of stool output. on the basis of this need a stool output assessment tool was developed and tested for validity and reliability. interrater reliability and construct validity were determined by using staff nurses' and principal investigators' observations. observers blindly rated the bowel movement (bm) on size and consistency and on whether the bm was thought to represent "diarrhea." interrater rel ...	1998	9586792
in vitro activities of cefminox against anaerobic bacteria compared with those of nine other compounds.	the agar dilution mic method was used to test the activity of cefminox, a beta-lactamase-stable cephamycin, compared with those of cefoxitin, cefotetan, moxalactam, ceftizoxime, cefotiam, cefamandole, cefoperazone, clindamycin, and metronidazole against 357 anaerobes. overall, cefminox was the most active beta-lactam, with an mic at which 50% of isolates are inhibited (mic50) of 1.0 microg/ml and an mic90 of 16.0 microg/ml. other beta-lactams were less active, with respective mic50s and mic90s o ...	1998	9517922
recurrence of symptoms in clostridium difficile infection--relapse or reinfection?	we have fingerprinted clostridium difficile isolates from patients with symptomatic recurrences of infection, using random amplified polymorphic dna (rapd). the medical records of 55/79 patients were examined, from whom multiple c. difficile-positive faeces were received during hospitalization at least five days, but no more than two months, apart. in 20 of these cases symptoms either did not recur (i.e., absent for at least three days between episodes), or were explainable by other causes, such ...	1998	9522287
simultaneous outbreaks of two strains of toxigenic clostridium difficile in a general hospital.	we report an outbreak of clostridium difficile-associated disease (cdad) in a large dublin hospital. from january to june 1995, inclusive, 139 patients were affected; the mean age of cases was 68.8 +/- 19 years. clinical information is available for 73 cases identified during the first four months of the outbreak. the majority of patients presented with abrupt onset of watery diarrhoea; however, 19.2% presented with an unexplained pyrexia following a course of antimicrobial therapy and 5.5% pres ...	1998	9522288
typhlocolitis caused by clostridium difficile in suckling piglets.		1998	9526873
agents that inhibit rho, rac, and cdc42 do not block formation of actin pedestals in hela cells infected with enteropathogenic escherichia coli.	enteropathogenic escherichia coli (epec) induces formation of actin pedestals in infected host cells. agents that inhibit the activity of rho, rac, and cdc42, including clostridium difficile toxin b (toxb), compactin, and dominant negative rho, rac, and cdc42, did not inhibit formation of actin pedestals. in contrast, treatment of hela cells with toxb inhibited epec invasion. thus, rho, rac, and cdc42 are not required for assembly of actin pedestals; however, they may be involved in epec uptake ...	1998	9529109
clostridium difficile disease: diagnosis and treatment.	clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. disease is usually a consequence of antibiotic therapy, but sporadic cases do occur. cytotoxin assay for toxin b remains the gold standard for confirming diagnosis. several rapid enzyme immunoassay tests are available, but specificity and sensitivity vary; a negative test may not exclude disease. oral metronidazole 250 to 500 mg four times a day is the recommended first-line therapy; vancomycin (125 mg fo ...	1998	9531117
[clostridium difficile-associated diarrhea treated with homologous feces].	the incidence of clostridium difficile-associated diarrhoea has increased during the last few years. treatment with vankomycin or metronidazol is usually effective, but relapses are not uncommon. some good results have been reported with faecal enemas, but it is a controversal form of treatment. 18 patients with c. difficile-associated diarrhoea were given homologous faeces from one healthy donor. in 17 patients faeces was instillated via a coloscope and in one patient via a gastrostoma. c. diff ...	1998	9531822
[method of quantitative assessment of antimicrobial effects of iodine-containing preparations].	iodine-containing preparations were studied by uv spectral analysis. water-soluble composition of 1,3-diethylbenzimidasolium triiodide is inactivated in the presence of meat-peptone broth. dissolving of these preparations in a mixture of acetone and stearic acid does not change the physicochemical properties or impair the antibacterial effect. a high antibacterial effect of 12 iodine-containing compounds has been demonstrated: 15-min exposure suppressed the growth of bacteria at the minimal conc ...	1998	9532902
clostridium difficile toxin-induced colitis after use of clindamycin phosphate vaginal cream.	to report a case of toxin-positive clostridium difficile-induced colitis (cdic) after use of clindamycin phosphate vaginal cream.	1998	9533061
pseudomembraneous clostridium after autologous bone marrow transplantation.	clostridium difficile (c. difficile) pseudomembraneous colitis was diagnosed in a 13-year-old boy with hodgkin's disease 3 months after autologous bone marrow transplantation. hematopoiesis was fully reconstituted at the time. c. difficile infection occurred after gall bladder empyema had been treated conservatively with i.v. antibiotics and prophylactic 4-week administration of oral amoxicillin. c. difficile colitis was diagnosed early and intensive supportive therapy combined with administrati ...	1998	9535046
rho protein inhibition blocks protein kinase c translocation and activation.	small gtp-binding proteins of the ras and rho family participate in various important signalling pathways. large clostridial cytotoxins inactivate gtpases by udp-glucosylation. using clostridium difficile toxin b-10463 (tcdb) for inactivation of rho proteins (rhoa/rac/cdc42) and clostridium sordellii lethal toxin-1522 (tcsl) for inactivation of ras-proteins (ras/rac/ral, rap) the role of these gtpases in protein kinase c (pkc) stimulation was studied. phorbol-myristate-acetate (pma) induced a ra ...	1998	9588200
clostridium difficile toxin b induces apoptosis in intestinal cultured cells.	toxigenic strains of the anaerobic bacterium clostridium difficile produce at least two large, single-chain protein exotoxins involved in the pathogenesis of antibiotic-associated diarrhea and colitis. toxin a (cda) is a cytotoxic enterotoxin, while toxin b (cdb) is a more potent cytotoxin lacking enterotoxic activity. this study dealt with cdb, providing the first evidence that intestinal cells exposed to this toxin exhibit typical features of apoptosis in that a significant proportion of the t ...	1998	9596731
effects of toxin a from clostridium difficile on mast cell activation and survival.	toxins a and b from clostridium difficile are the main cause of antibiotic-associated diarrhea and pseudomembranous colitis. they cause fluid accumulation, necrosis, and a strong inflammatory response when inoculated in intestinal loops. since mast cells are a rich source of inflammatory mediators, abundant in the gut, and known to be involved in c. difficile-induced enteritis, we studied the in vitro effect of toxin a on isolated mast cells. normal rats sensitized by infection with nippostrongi ...	1998	9596744
clostridium difficile--associated diarrhea.		1998	9597221
clostridium difficile colitis: a possible cause of unexplained elevation of serum alkaline phosphatase levels in patients with aids.		1998	9597276
recent trends in diagnosis and treatment of clostridium difficile in a tertiary care facility.	with the prevalence of antibiotic use, the diagnosis and management of clostridium difficile disease requires assessment.	1998	9600288
determination and validation of a predictive model for clostridium difficile diarrhea in hospitalized oncology patients.	clostridium difficile colitis in the cancer patient receiving chemotherapy is a frequent cause of morbidity which may prolong hospitalization. techniques for identifying infection often delay the initiation of therapy.	1998	9602265
hospital-acquired infection in elderly patients.	increasing numbers of elderly people are being treated in hospitals and are at particular risk of acquiring infections. the incidence, risk factors and types of hospital-acquired infection (hai) in the elderly are reviewed. special reference is made to urinary tract infections, respiratory tract infections, gastrointestinal infections including clostridium difficile, bacteraemia, skin and soft tissue infections and infections with antibiotic-resistant organisms.	1998	9602974
inhibition of insulin-stimulated glucose transport in 3t3-l1 cells by clostridium difficile toxin b, clostridium sordellii lethal toxin, and clostridium botulinum c2 toxin.	the role of the actin cytoskeleton and/or gtpases of the rho/rac-family in glucose transport regulation was investigated in 3t3-l1 cells with clostridial toxins which depolymerize actin by inactivation of rho/rac (clostridium difficile toxin b and clostiridium sordellii lethal toxin (lt)) or by direct adp-ribosylation (clostridium botulinum c2 toxin). toxin b and c2 reduced insulin-stimulated, but not basal, 2-deoxyglucose (2-dog) uptake rates in 3t3-l1 fibroblasts. in parallel, the toxins produ ...	1998	9606023
clostridium difficile: a pathogen of the nineties.		1998	9665293
comparative in vitro activity of bay 12-8039 and five other antimicrobial agents against anaerobic bacteria.	the in vitro activity of bay 12-8039 against 360 anaerobic clinical isolates was determined by the agar dilution method and compared to that of five other antimicrobial agents. bay 12-8039 and imipenem were the most active agents tested. the following mic90 values were determined for bay 12-8039: peptostreptococcus spp. (50 isolates), 1 mg/l; propionibacterium acnes (30 isolates). 0.25 mg/l; clostridium perfringens (30 isolates), 0.5 mg/l; clostridium difficile (50 isolates), 2 mg/l; bacteroides ...	1998	9665302
identification of toxin a-negative, toxin b-positive clostridium difficile by pcr.	toxigenic strains of clostridium difficile have been reported to produce both toxins a and b nearly always, and nontoxigenic strains have been reported to produce neither of these toxins. recent studies indicate that it is not always true. we established a pcr assay to differentiate toxin a-negative, toxin b-positive (toxin a-, toxin b+) strains from both toxin-positive (toxin a+, toxin b+) strains and both toxin-negative (toxin a-, toxin b-) strains as an alternative to cell culture assay and e ...	1998	9665986
a novel toxinotyping scheme and correlation of toxinotypes with serogroups of clostridium difficile isolates.	two hundred nineteen clostridium difficile isolates from 22 serogroups were screened for changes in the genes coding for toxin b (tcdb) and toxin a (tcda). parts of the toxin genes were amplified, and the pcr fragments were checked for length polymorphisms and cut with several restriction enzymes to monitor restriction fragment length polymorphisms (rflps). for 47 strains (21%), differences in the toxin genes were found compared to the toxin genes of reference strain vpi 10,463. polymorphisms we ...	1998	9665999
clostridium difficile colitis associated with treatment of helicobacter pylori infection.	helicobacter pylori infection of the stomach is being detected and treated more often now than ever before. this is likely to result in an increase in complications such as antibiotic-associated diarrhea. however, there is no literature on the incidence of such diarrhea, particularly clostridium difficile colitis, in patients treated for helicobacter pylori infection. we report the case of a patient who developed clostridium difficile colitis after treatment for helicobacter pylori infection wit ...	1998	9672359
small gtp-binding proteins of the rho- and ras-subfamilies are not involved in the actin rearrangements induced by attaching and effacing escherichia coli.	attaching and effacing escherichia coli (aeec) are extracellular pathogens that induce the formation of actin-rich structures at their sites of attachment to eukaryotic host cells. we analysed whether small gtp-binding proteins of the rho- and ras-subfamilies, which control the cellular actin system, are essential for these bacterial-induced microfilament reorganizations. for this purpose we specifically inactivated them using the clostridium difficile toxins tcdb-10463 and tcdb-1470. such treat ...	1998	9673012
isolation of a clostridium exotoxin producer other than clostridium difficile from a patient with diarrhea.		1998	9675699
the role of surgery in pseudomembranous enterocolitis.	pseudomembranous enterocolitis is an inflammatory bowel disorder caused by clostridium difficile toxins. classical presentation includes abdominal pain, pyrexia, diarrhoea and leucocytes. the management is mainly conservative but in extreme cases surgery is necessary. resectional procedures (colectomy) carry a better prognosis than diversion procedures (colostomy). a careful history, a high index of suspicion, and early diagnosis and treatment would reduce the associated morbidity and mortality ...	1998	9683974
[clostridium difficile infections. current aspects].	clostridium difficile is a gram-positive anaerobe that forms subterminal spores. it is now one of major nosocomial pathogens, mainly in older patients, because of its ability to persist in the environment and to become established in the gastrointestinal tract once the natural microflora has been modified by antibiotic therapy. toxigenic strains of c. difficile produce toxin a (enterotoxin) or toxin b (cytotoxin) or both with cause the cytotoxic effect "rounding". c. difficile can spread from pa ...	1998	9691734
clostridium difficile and older adults: what primary care providers should know.	clostridium difficile poses particular risk for older adults, who are subject to more serious symptoms than younger patients. antibiotic exposure and other risk factors are associated with the pathogenesis of c. difficile-associated disease. treatment goals include prescribing anti-c. difficile activity agents (when indicated), attending to volume status and prescribing oral rehydration therapy as needed, avoiding the use of antiperistaltic drugs, discontinuing any offending antibiotics, avoidin ...	1998	9695082