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clostridium difficile settles in a nursing home. 19892493005
prevention of antibiotic-associated diarrhea by saccharomyces boulardii: a prospective study.saccharomyces boulardii, a nonpathogenic yeast, has been widely used in europe to prevent antibiotic-associated diarrhea (aad). we performed a prospective double-blind controlled study to investigate aad in hospitalized patients and to evaluate the effect of s. boulardii, a living yeast, given in capsule form concurrently with antibiotics. over 23 mo, 180 patients completed the study. of the patients receiving placebo, 22% experienced diarrhea compared with 9.5% of patients receiving s. boulardi ...19892494098
occurrence and significance of clostridium difficile in faecal specimens of hospitalized children.stool specimens from 766 hospitalized children, 418 with diarrhoea and 348 controls, were investigated for c. difficile. in both groups the rate of isolation was highest (about 30%) during the first year of life, dropping to nearly 5% in older children. there was no significant difference in the frequency of c. difficile in children with diarrhoea and the controls nor was there a significant influence of previous antibiotic therapy on the rate of isolation. 111/135 strains (82.2%) produced toxin ...19892494813
effect of purified clostridium difficile toxins on intestinal smooth muscle. i. toxin a.in these studies we determined the effects of purified clostridium difficile toxin a, an enterotoxin, on the electrophysiological and contractile properties of rabbit intestinal circular smooth muscle and correlated these effects with changes of smooth muscle morphology. simultaneous measurements of intracellular membrane potential and contractility were determined in excised ileal muscle strips after administration of toxin a in vivo (60 micrograms/ml) into an isolated rabbit ileal loop or dire ...19892495733
effect of purified clostridium difficile toxins on intestinal smooth muscle. ii. toxin b.in the companion paper [am. j. physiol. 256 (gastrointest. liver physiol. 19): g759-g766, 1989] we showed that highly purified clostridium difficile toxin a had a profound effect on intestinal smooth muscle after in vivo but not in vitro exposure. in this study we assessed the effects of in vivo and in vitro exposure to c. difficile toxin b on simultaneous measurements of intracellular membrane potential and contractility in rabbit ileal smooth muscle. direct exposure of ileal smooth muscle to t ...19892495734
focal ulcerative ileocolitis with terminal thrombocytopenic purpura in juvenile cotton top tamarins (saguinus oedipus).a newly recognized syndrome characterized by an acute focal ulcerative ileocolitis, anemia and thrombocytopenic purpura in five juvenile cotton-top tamarins is described. the presentation and morphology of this syndrome is distinct from any other reported gastrointestinal disease reported in tamarins. traditional etiologies such as viruses, ingested toxins, campylobacter, salmonella and yersinia and clostridium difficile are not considered likely etiologic agents. nontraditional etiologies such ...19892496272
multiple relapses of clostridium difficile-associated diarrhea responding to an extended course of cholestyramine. 19892496393
polymicrobial septicemia with clostridium difficile in acute diverticulitis.a case is reported of a patient without previous gastrointestinal symptoms, who presented with polymicrobial septicemia caused by escherichia coli, enterococcus faecalis, clostridium difficile and bacteroides vulgatus. septicemia occurred during acute diverticulitis. a strain of clostridium difficile, which was of the same serogroup c as the blood culture isolate and also produced toxin, was recovered from the stools, but the pathogenic role of this organism in the gastrointestinal symptomatolog ...19892497002
relationship between levels of clostridium difficile toxin a and toxin b and cecal lesions in gnotobiotic mice.various clostridium difficile strains were studied with respect to their pathogenicity in monoassociated mice in relation to levels of toxin a and toxin b in vivo and in vitro. two strains which were the most potent toxin producers in vitro induced mortality (100%); mice monoassociated with these strains were found to have high levels of both toxins in their ceca and an intense cecal epithelial ulceration together with a severe inflammatory process. no mortality was observed with the other strai ...19892499546
intestinal colonization with clostridium difficile in infants up to 18 months of age.the faecal colonization with clostridium difficile was investigated among 343 infants during their first 18 months of life. rectal swabs were taken at the ages of 6 days, 6 weeks, 6 months, 11 months and 18 months. about 25% of the children were colonized with clostridium difficile between 6 days and 6 months of age. the colonization rate decreased to 3% at 18 months of age. the rate of strains producing cytotoxin was low in infants less than 6 months of age, but at that age about half of the st ...19892502403
evolution of the caecal epithelial barrier during clostridium difficile infection in the mouse.the most striking effect of clostridium difficile infection is its degrading of the intestinal barrier. the aim of this study is to establish whether the cellular or paracellular constituent of the barrier is the initial target of the toxins produced by c difficile. accordingly, the caecal epithelium of c3h/he mice was challenged under three experimental conditions with the c difficile strain vpi 10463: (1) by in vivo inoculation of axenic mice, (2) by adding the toxins to ligated caeca in vivo, ...19892504650
cloning and characterization of overlapping dna fragments of the toxin a gene of clostridium difficile.clostridium difficile, a human pathogen, produces two very large protein toxins, a and b (250-600 kda), which resist dissociation into subunits. to clone the toxin a gene, a genomic library of 3-8 kb chromosomal dna fragments of c. difficile strain vpi 10463 established in puc12 was screened with a rabbit polyclonal toxin a antiserum. thirty-five clones were isolated which carried 2.5-7.0 kb inserts representing a 10 kb region of the c. difficile genome. all the inserts were oriented in the same ...19892506313
production, purification and characterization of clostridium difficile toxic proteins different from toxin a and from toxin b.the purification and characterization of three new proteins called c1, c2, and c3 from clostridium difficile are described. their estimated molecular mass were about 350 (c1), 270 (c2) and 140 (c3) kda, consisting of subunits of 39 (c1), 43 (c2) and 41 (c3) kda, respectively. immunodiffusion revealed that the three proteins contained similar but not identical antigenic determinants to toxin a. each protein induced a cytotonic effect on hamster ovaric cells; the combined proteins, had a specific ...19892506935
clostridium difficile toxin a. interactions with mucus and early sequential histopathologic effects in rabbit small intestine.clostridium difficile produces two toxins, a (enterotoxic) and b (cytopathic), that are implicated in the pathogenesis of pseudomembranous colitis. however, the relationship of the secretory effect and the early histopathologic events is still unclear. we examined the early histopathologic effect of purified c. difficile toxin a in rabbit ileal loops and correlated the mucosal damage with the secretory response. as early as 2 hours after inoculation, toxin a at 1.0 micrograms caused cytolysis of ...19892507823
comparative in vitro activity of the new oral penem alp-201 against aerobic and anaerobic bacteria.the in vitro activity of the new penem derivative alp-201 against 226 aerobic and 350 anaerobic clinical bacterial isolates was determined using agar dilution techniques. for comparison amoxicillin, cefaclor, ceftazidime, doxycycline, erythromycin, imipenem and trimethoprim/sulfamethoxazole were also tested with aerobic bacteria, and cefoxitin, chloramphenicol, clindamycin, imipenem, metronidazole and piperacillin with anaerobic bacteria. alp-201 was found to be highly active against escherichia ...19892512142
polymicrobial septicaemia and clostridium difficile. 19892512153
molecular studies on the epidemiology and pathogenicity of clostridium difficile. 19892514126
effects of clostridium difficile toxins a and b on cytoskeleton organization in hep-2 cells: a comparative morphological study.a comparative study on the effects of toxin a and toxin b from clostridium difficile on hep-2 cells was carried out. both toxins caused cell retraction and rounding and seemed to exert their effect on cell morphology via a rearrangement of actin and alpha-actinin microfilaments. such a rearrangement occurred at an early stage, when no change in microtubular and cytokeratin systems was detectable. nevertheless, several structural modifications accompanying the cytopathological process induced by ...19892515619
teicoplanin in the treatment of infections by staphylococci, clostridium difficile and other gram-positive bacteria.eighty-three episodes of gram-positive infection in 82 patients were treated with teicoplanin in an open study. infectious episodes included endocarditis (6 cases), bacteraemia (7), osteomyelitis (8), pseudomembranous colitis (13), cellulitis (11), urinary tract infection (5), pneumonia (1), wound and post-surgical infections (9) and erysipelas (23). four patients affected by an overwhelming gram-positive infection as well as eight cases of gram-positive-gram-negative mixed infections received t ...19892526109
clostridium difficile-associated typhlitis in specific pathogen free guineapigs in the absence of antimicrobial treatment.clostridium difficile (toxin) associated typhlitis was diagnosed in untreated barrier-maintained specific pathogen free guineapigs. it resembled the pathological lesions of antibiotic induced enterocolitis. the possible role of limited colonization resistance to c. difficile provided by mouse enteric microflora in the pathogenesis of the disease is discussed.19892527322
treatment of clostridium difficile-associated disease with teicoplanin.forty-seven patients affected by clostridium difficile-associated disease were treated orally with either vancomycin (patients hospitalized from february 1984 to february 1987) or teicoplanin (from march 1987 to december 1988). all patients given teicoplanin remained asymptomatic after discontinuation of treatment, and all but one were also cleared of c. difficile. in the vancomycin group, clinical symptoms recurred in 3 of 23 evaluable patients, and follow-up cultures were positive in another a ...19892528941
observations on phage-typing of clostridium difficile: preliminary evaluation of a phage panel.of the various methods now employed to type clostridium difficile, the performance of the phage-typing, as proposed by sell et al., was investigated on a large collection of isolates from various local epidemiological settings. because those isolates appeared in preliminary trials mostly resistant to the reference phages, the panel was enlarged by including newly isolated phages. the new set was redundant but better suited to the purpose: out of 287 phage sensitivity patterns 8.4% only were resi ...19892529136
mechanism of action of clostridium difficile toxin b: role of external medium and cytoskeletal organization in intoxicated cells.toxin b, an exotoxin produced by clostridium difficile, induces the rounding-up and arborization of cultured mammalian cells, a typical effect which resembles that provoked by cytochalasins. in this study, the effect of toxin b was examined on astroglial cells grown in primary culture. a specific antiserum to toxin b was used to investigate its mechanisms of action. we found that the toxin exerts its effects on cell morphology after its incorporation into cells. the internalization of toxin b re ...19892545447
presence of fructokinase in pancreatic islets.homogenates of rat pancreatic islets that had been heated for 5 min at 70 degrees c to inactive hexokinases, catalyzed the atp-dependent phosphorylation of d-fructose. this reaction was dependent on the presence of k+ and was inhibited by d-tagatose although not by d-glucose or d-glucose 6-phosphate. the phosphorylation product was identified as fructose 1-phosphate through its conversion to a bisphosphate ester by clostridium difficile fructose 1-phosphate kinase. these findings allowed the con ...19892551726
comparative study of clostridium difficile toxin a and cholera toxin in rabbit ileum.the purpose of this study was to compare the effects of clostridium difficile toxin a and cholera toxin on fluid secretion, intestinal permeability, and arachidonate metabolites in rabbit ileum. injection of 25 micrograms of either purified toxin into 10-cm ileal loops caused significant increases in fluid secretion and intestinal permeability to mannitol as well as release of prostaglandin e2 into the lumen. toxin a, but not cholera toxin, caused a severe inflammatory reaction of the lamina pro ...19892551764
cloning and hybridization analysis of ermp, a macrolide-lincosamide-streptogramin b resistance determinant from clostridium perfringens.the erythromycin resistance determinant from clostridium perfringens cp592 was cloned and shown to be expressed in escherichia coli. the resultant plasmid, pjir122 (7.9 kilobase pairs [kb]), was unstable since in both reca+ and reca e. coli hosts spontaneous deletion of 2.7 kb, including the erythromycin resistance determinant, was observed. subcloning, as well as deletion analysis with bal 31, localized the erythromycin resistance gene (ermp) to within a 1.0-kb region of pjir122. a 0.5-kb fragm ...19892552908
enterotoxin induced diarrhoea--an update.the pathogenic personality or the criteria required to be a successful pathogen, of enteric bacteria includes, among others, the ability to produce potent proteins which by different intracellular mechanisms elicit what we overtly see as diarrhoea. enteropathogens belonging to several genera like vibrio, escherichia, shigella, salmonella, campylobacter, aeromonas and yersinia include species capable of elaborating strikingly similar exotoxins which seem to share common mechanisms of action invol ...19892554547
hybridization analysis of three chloramphenicol resistance determinants from clostridium perfringens and clostridium difficile.the chloramphenicol resistance determinant from a nonconjugative strain of clostridium perfringens was cloned and shown to be expressed in escherichia coli. subcloning and deletion analysis localized the resistance gene, catq, to within a 1.25-kilobase (kb) partial sau3a fragment. the catq gene contained internal hindii, haeiii, and drai restriction sites and was distinct from the catp gene, which was originally cloned (l. j. abraham, a. j. wales, and j. i. rood plasmid 14:37-46, 1985) from the ...19892554801
bacteriotherapy for chronic relapsing clostridium difficile diarrhoea in six patients.six patients with chronic relapsing diarrhoea caused by clostridium difficile were treated with rectal instillation of homologous faeces (one patient) or a mixture of ten different facultatively aerobic and anaerobic bacteria diluted in sterile saline (five patients). the mixture led to a prompt loss of cl difficile and its toxin from the stools and to bowel colonisation by bacteroides sp, which had not been present in pre-treatment stool samples. strains of escherichia coli, cl bifermentans, an ...19892566734
protein-losing enteropathy associated with clostridium difficile infection.a commercially available radial immunodiffusion assay was used to measure serum alpha-1-antitrypsin levels in stool samples from subjects aged over 60 years as a marker of protein-losing enteropathy. alpha 1-antitrypsin was found in all of 12 patients with colonoscopy-confirmed pseudomembranous colitis, 6 of 14 (43%) patients with clostridium difficile diarrhoea without pseudomembranes, 6 of 12 (50%) nursing-home patients culture-positive for cl difficile but negative for its cytotoxin, and none ...19892567373
outbreak of clostridium difficile diarrhoea in an orthopaedic unit: evidence by phage-typing for cross-infection.in a three-week period five patients had diarrhoea in an orthopaedic unit. the first case was clinically diagnosed as pseudomembranous colitis but the causative agent was not sought. of the remaining cases, two were clostridium difficile positive. the outbreak then apparently ceased, but during the following several days two of seven stool samples taken at random from asymptomatic patients yielded c. difficile. phage-typing of the isolates showed that all apparently belonged to the same strain.19892567761
bacteriotherapy for clostridium difficile diarrhoea. 19892570250
clostridium difficile infection in health-care workers. 19892571792
clostridium difficle infection in health-care workers. 19892572809
bacteriotherapy for clostridium difficile colitis. 19892572812
effect of the cytotoxin of clostridium difficile on cultured hepatoma cells.clostridium difficile is the major etiologic agent of human pseudomembranous colitis. it produces two toxins: an enterotoxin and a cytotoxin. in cultured hepatoma cells, at very low doses, the cytotoxin inhibits the incorporation of precursors into biological macromolecules. protein synthesis is more affected than rna and dna synthesis. the toxin also induces severe alterations of the cell morphology consisting in damages to the cytoskeleton and to the cell shape.19852581643
intravenous metronidazole and clostridium difficile-associated diarrhea or colitis. 19892584759
intravenous/oral ciprofloxacin versus ceftazidime in the treatment of serious infections.seventy-one adult patients with 72 infections were treated, by random selection, with intravenous/oral ciprofloxacin or intravenously administered ceftazidime. twenty-seven additional patients with 29 infections who were not appropriate for random assignment were treated in an open study with intravenously administered ciprofloxacin only; the latter infections were generally more serious or were caused by ceftazidime-resistant organisms. the most common doses were ciprofloxacin, 200 mg intraveno ...19892589361
[hospital epidemic of clostridium difficile diarrhea: demonstration of cross-infection using a typing technic].two hospital outbreaks of clostridium difficile diarrhoea in two general surgery units of different hospitals are described. moreover, the results of a study on the circulation of c. difficile in a neurosurgery unit following two cases of colitis are reported. c. difficile strains isolated from patients and environment have been typed using antimicrobial susceptibility testing and electrophoretic profiles of edta-extracted proteins. the majority of strains isolated in each hospital shared the sa ...19892589733
high incidence of false positives by a latex agglutination test for the diagnosis of clostridium difficile associated colitis in compromised patients.detection of clostridium difficile cytotoxin using cell culture assays for the diagnosis of antibiotic-associated colitis has been used for over a decade. because the methodology is time consuming and cumbersome, a recently introduced commercial latex agglutination (la) kit has attracted much attention. we compared the sensitivity and specificity of this method with the cytotoxic assay (cta) using diarrheal stools from 652 patients at a referral tertiary care center. specimens from 71 (10.9%) pa ...19892591165
[the occurrence of clostridium difficile in fecal samples of dogs and cats].fecal samples of 150 dogs and 175 cats originating from different veterinary practices were investigated for assessing the occurrence of clostridium (cl.) difficile by using a selective medium for cultural isolation. from dogs without enteric symptoms 7 (9.3%) of 75 samples were positive for cl. difficile, with 2 strains being cytotoxic for bovine embryonic lung fibroblast cells, which could be neutralized by cl. difficile-antitoxin. in samples of 75 dogs with enteric symptoms cl. difficile coul ...19892596198
antibiotic exposure delays intestinal colonization by clostridium difficile in the newborn.two antibiotic regimens commonly used in neonatal intensive care were compared for the rate at which clostridium difficile appeared in the faeces. over a nine month period neonates with suspected sepsis admitted to a special care baby unit (scbu) were randomly allocated to receive either cefotaxime or penicillin and netilmicin. a contemporaneous group also admitted to scbu but without sepsis served as non-treated controls. four hundred and sixteen stool specimens from 158 neonates without diarrh ...19892600001
[infectious diarrhea in the adult].infectious diarrhoeas are usually divided into two types; toxinogenic and invasive. invasive diarrhoeas are copious and responsible for dehydration which is the principal clinical sign; mucosal lesions and bacteraemia are absent. the most typical of toxinogenic diarrhoeas is cholera, but enterotoxicogenic e. coli and aeromonas infections have similar clinical features. in invasive diarrhoeas the responsible microorganisms penetrate into the epithelial cells of the intestine, producing fever and ...19892602888
clostridium difficile in elderly patients. 19892603844
inhibition of clostridium difficile toxin a and b by 1,2-cyclohexanedione modification of an arginine residue.toxin a (enterotoxin) and toxin b (cytotoxin) of clostridium difficile were both inactivated by the arginine specific reagent 1,2-cyclohexanedione. molecular stability during the inactivation process was demonstrated by sds-page analysis showing the same migration rates for modified and unmodified forms of the 230 kda toxin a and of the 250 kda toxin b. cytotoxicity of both toxins as well as mouse lethality of the enterotoxin were drastically decreased as a result of the arginine modification. t ...19892610698
the effect of new broad-spectrum antibiotics on faecal flora of cancer patients.the effects of newly available broad-spectrum antibiotics, used for infection prophylaxis and therapy in cancer patients, on faecal aerobic and anaerobic bacteria were investigated. quantitative and qualitative aerobic and anaerobic cultures were performed in 34 patients before therapy and between the sixth and eleventh day of therapy. of the two prophylactic regimens norfloxacin plus amphotericin-b eliminated enterobacteriaceae and enterococci without encouraging growth of yeasts or clostridium ...19892613606
effect of erythromycin acistrate and erythromycin stearate on human colonic microflora.the effects of erythromycin acistrate (2'-acetyl erythromycin stearate), a new erythromycin derivative, and erythromycin stearate on the faecal microflora were compared in a randomized cross-over study. 12 healthy volunteers were given either drug 500 mg t.i.d. for 1 week. their faeces were studied before, immediately after, and 1 week after the drug administration period. after a wash-out period of 4 weeks, the drugs were interchanged. both erythromycin acistrate and erythromycin stearate induc ...19892617212
medical implications of nosocomial infection with clostridium difficile.88 patients above the age of 60 years who contracted clostridium difficile associated diarrhoea (cdad) between 1979 and 1986, mostly during their stay in hospital were studied retrospectively as regards nursing time and clinical outcome. these patients were compared with 176 control patients who were matched according to diagnosis on admission to hospital, sex, age and underlying disease. thromboembolic complications occurred in 14% in cdad patients (controls 4%) (p = 0.0042). the mortality rate ...19892617213
[a rapid test for detecting clostridium difficile].staphylococcus aureus cells, strain cowan 1, were coated with an anti-clostridium difficile serum, produced in rabbits. this reagents were used in the coagglutination (coa-test) for detection of clostridium difficile. a total of 275 bacterial cultures of different species were tested for detection of clostridium difficile by coa-test and bacterial culture. of 183 strains positive by isolation of the organism, 181 were positive by coa-test. the sensitivity and specificity of the coa-test relative ...19892618112
[clostridium difficile enterocolitis in subjects treated with wide-spectrum antibiotics].after a concise description the main aetiopathogenic features of clostridium difficile colitis, three clinical cases are reported. it is considered that this disease could be easily cured as long as high risk patients are determined.19892622575
disease associated with clostridium difficile infection. 19892643913
anaerobic bacteremia in patients with acute leukemia.we reviewed 402 hospital admissions of patients with acute leukemia to define the frequency and characteristics of anaerobic bacteremia in this patient population. six (5.2%) of the 116 septicemia episodes documented in these patients were caused by anaerobes (bacteroides species, 3; fusobacterium species, 2; and clostridium tertium, 1); two of these episodes were polymicrobial. five patients had had prior bacteremia. all six patients were receiving broad-spectrum antibiotics, including an anti- ...19892647821
clostridium difficile associated reactive arthritis in an hla-b27 positive female: report and literature review.a case of clostridium difficile associated reactive arthritis in an hla-b27 positive female is reported and compared to 9 other cases. the clinical course of c. difficile associated reactive arthritis is similar to that caused by other enteric pathogens. therefore, c. difficile should be considered in the differential diagnosis of the reactive arthritides.19892654390
[antibiotic-associated diarrhea and colitis caused by clostridium difficile]. 19892658892
clostridium difficile and its cytotoxin in diarrhoeic stools of hospitalized patients. toxigenic potential of the isolates.cytotoxin assay and culture for clostridium difficile were performed on 303 diarrhoeic stools from 261 hospitalized patients. specimens from 42 patients were positive by at least one of the methods, and 40 of them had an antibiotic-associated diarrhoea. the cytotoxin assay was positive in 5 of 7 patients with pseudomembranous colitis. thirteen had an appropriate response to specific therapy and the remainder have resolved of diarrhoea without c. difficile directed chemotherapy. these findings sh ...19892660635
[diarrhea induced by antibiotics].the most frequent cause of antibiotic-associated colitis is clostridium difficile. this gram-positive, spore-forming anaerobic bacillus releases toxins, which produce diarrhea and damage the colonic mucosa. endoscopy shows a wide range of alterations, "unspecific colitis" with reddening or edema, ulcerations or at the worst pseudomembranous colitis. nearly all antibiotics are able to trigger clostridium difficile colitis. an enhanced risk is exerted by broad spectrum substances, which act also o ...19892662616
third generation cephalosporins as a risk factor for clostridium difficile-associated disease: a four-year survey in a general hospital.the main clinical features of patients who developed pseudomembranous colitis (pmc) or clostridium difficile-associated diarrhoea (cdad) during their stay at the s. anna general hospital, como, over the period february 1984 to may 1988, are reported. forty patients developed either cdad (ten cases) or pmc (30 cases). twenty-seven (65.7%) had undergone surgery and 32 (80.0%) had received prolonged antibiotic treatment. three patients (7.5%) were given three doses only of ceftriaxone. five patient ...19892663814
rapid method to detect shiga toxin and shiga-like toxin i based on binding to globotriosyl ceramide (gb3), their natural receptor.shiga toxin and the closely related shiga-like toxins produced by escherichia coli represent a group of very similar cytotoxins that may play an important role in diarrheal disease and hemolytic uremic syndrome. these toxins have the same biologic activities and according to recent studies also share the same binding receptor, globotriosyl ceramide (gb3). they are currently detected, on the basis of their ability to damage several cell lines, by using expensive and tedious assays that require fa ...19892666433
etiology of childhood diarrhea in korea.to assess the role of recently recognized enteropathogens in childhood diarrhea in korea, 231 children with diarrhea admitted to and 104 children without diarrhea seen at the well-baby clinic or the outpatient department of hanyang university hospital in seoul, korea, were evaluated during a 14-month period. stools were cultured for bacterial pathogens, including enterotoxigenic (heat-labile and heat-stable enterotoxin-producing) and enteroadherent organisms. only those stools obtained from pati ...19892666437
intestinal infections: current aspects and new possibilities of prophylaxis and treatment.intestinal infections of still high importance from the hygienic-epidemiological aspects and the recent results obtained in this field have been surveyed. recently recognized enteric pathogens (campylobacter, yersinia, rotavirus, clostridium difficile, etc.) as well as the newest data on the pathomechanism of intestinal infections have been discussed. these data not only have increased our knowledge of the pathology but also resulted in basic, favourable changes in therapy. detailed information ...19892667192
[diseases caused by clostridium difficile]. 19892672583
[epidemiology of colitis caused by clostridium difficile]. 19892675504
treatment of recurrent clostridium difficile colitis with vancomycin and saccharomyces boulardii.recurrence of clostridium difficile-associated diarrhea and pseudomembranous colitis occurs in up to 20% of patients after standard therapy. in these patients, subsequent recurrences are even more frequent. saccharomyces boulardii, a nonpathogenic yeast, was found to be effective in preventing clindamycin cecitis recurrence in an animal model. we performed an open trial of s. boulardii to evaluate its efficacy in treating recurrences of c. difficile-associated colitis in humans. thirteen patient ...19892679049
the ecology of the human intestine and its consequences for overgrowth by pathogens such as clostridium difficile. 19892679366
interrelationships between digestive proteolytic activities and production and quantitation of toxins in pseudomembranous colitis induced by clostridium difficile in gnotobiotic mice.clostridium difficile pathogenicity is related to in vivo production of toxins, and it is of great interest to detect toxins produced in biological samples. several reports have shown that proteases in stools interfere with immunological methods for quantitation of toxin a. the purpose of this work was to estimate the relationship between the proteases and the c. difficile toxins produced in a gnotobiotic mouse model of pseudomembranous cecitis. cecal proteolytic activities hydrolyzed toxin a, a ...19892680988
portal venous gas after hepatic transplantation: sonographic detection and clinical significance.in seven (18%) of 39 liver transplantation patients, serial doppler sonographic examinations performed in the first 2 weeks after the transplantation showed transient, highly echogenic nonshadowing particles moving within the portal vein, believed to be portal venous air. this finding was associated with sepsis in one patient, a positive stool culture for clostridium difficile in another, and postoperative ileus in a third patient. a fourth patient had primary graft failure and required a second ...19892683676
identification of clostridium difficile in stool specimens by culture-enhanced gas-liquid chromatography.we have developed a sensitive and specific method for the identification of clostridium difficile in stool specimens based on the detection of metabolic breakdown products of the organism by gas-liquid chromatography after incubation of stool samples in a selective broth medium containing cefoxitin. use of this approach to test samples from two different populations of patients at separate medical centers showed this method to be superior to plate cultures or cytotoxin testing alone for both pop ...19892685021
detection of asymptomatic clostridium difficile carriage by an alcohol shock procedure.direct inoculation to cefoxitin-cycloserine-fructose agar and broth was compared with alcohol shock-chopped meat broth inoculation for optimal detection of clostridium difficile in fecal samples. alcohol shock is significantly more sensitive than cefoxitin-cycloserine-fructose agar or broth and may be the method of choice to detect c. difficile in asymptomatic carriers.19892685035
prospective, randomized comparison of sequential intravenous followed by oral ciprofloxacin with intravenous ceftazidime in the treatment of serious infections.in a prospective, comparative trial, 47 hospitalized patients with serious infections that required parenteral antibiotic therapy were randomly assigned to receive either ciprofloxacin (200 mg every 12 hours intravenously followed by 500 mg every 12 hours orally at a time dependent on the patients' clinical and bacteriologic responses) or ceftazidime (2 g every eight to 12 hours intravenously). all evaluable subjects (39 patients) had documented infections, 23 percent of which were associated wi ...19892686421
in vitro antimicrobial activity and susceptibility testing of ofloxacin. current status.the fluoroquinolone, ofloxacin, exhibits a broad antibacterial spectrum. based on our data and a review of the literature, ofloxacin inhibited essentially 100 percent of staphylococci, including oxacillin-resistant strains, haemophilus influenzae, neisseria spp. and branhamella catarrhalis. ninety-five percent of enterobacteriaceae were susceptible to ofloxacin. pseudomonas aeruginosa and enterococci were less susceptible: 79 and 63 percent, respectively, were susceptible (minimal inhibitory con ...19892690614
a randomized trial to compare amoxycillin/clavulanate with metronidazole plus gentamicin in prophylaxis in elective colorectal surgery.a randomized controlled trial was designed to compare antibiotic prophylaxis with a standard combination of agents, metronidazole and gentamicin, with a single preparation, amoxycillin/clavulanate in 400 patients undergoing elective colorectal surgery. there were 41 patients who were excluded or withdrawn (wrong dose, inappropriate operation, established sepsis or concurrent disease). abdominal wound sepsis occurred in 14% of the assessable patients in the amoxycillin/clavulanate group and in 15 ...19892691480
severe pseudomembranous enterocolitis in a child: case report and literature review.antibiotic-associated pseudomembranous enterocolitis (pmc), an inflammatory gastrointestinal disease mediated by toxins produced by clostridium difficile, is increasingly recognized in the pediatric population. we report a case of fulminant pmc in an otherwise normal 2 1/2-year-old child after antibiotic therapy given for a routine childhood illness. the patient had debilitating colitis marked by severe diarrhea, a generalized electrolyte derangement, an extreme protein-losing enteropathy state, ...19892696928
demonstration of capsules in clostridium difficile.in four strains of clostridium difficile the formation of capsules was demonstrated by light and electron microscopy.19892711788
diagnostic studies of nosocomial diarrhea in children: assessing their use and value.during a 17-month period (01/11/85-05/31/86) 225 cases of nosocomial diarrhea were identified in a children's hospital. diarrhea was considered to be nosocomial if it began at least 72 hours after the patient's hospital admission or within 3 days after discharge. one or more routine diagnostic studies for identification of a pathogen were performed in 195 (87%) cases. the most commonly performed test was the bacterial stool culture. none of these samples yielded a bacterial pathogen. the only pa ...19892729660
antibacterial activity of the new glycopeptide antibiotic skf104662.the inhibitory activity of the new glycopeptide antibiotic skf104662 was generally equivalent (+/- 1 concentration increment) to the activities of vancomycin, teicoplanin, and daptomycin against selected gram-positive bacteria. however, skf104662 demonstrated greater activity against staphylococcus epidermidis and s. haemolyticus than did teicoplanin and was more active than the other drugs against clostridium difficile isolates. skf104662 possessed bactericidal activity quite similar to that of ...19892729947
typing of clostridium difficile causing diarrhoea in an orthopaedic ward.in an outbreak of diarrhoeal disease in an orthopaedic ward clostridium difficile was isolated from all six patients with diarrhoea. attempts were made to type these isolates by means of antibiogram, detection of pre-formed enzymes, analysis of surface proteins by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (sds-page) and immunoblotting, and plasmid profile analysis. this showed that a single strain (type e) indistinguishable by the four distinct methods of typing, was isolated fr ...19892732346
[preparation of diagnostic antitoxic serum to clostridium difficile].the results of the studies on the preparation of diagnostic antitoxic sera to c. difficile, intended for use in biological assays with the aim of the laboratory diagnosis of clostridial enteric infections, are presented. the conditions for the detoxification of c. difficile native toxin have been established, the optimum schedules for the immunization of rabbits have been selected and specific antitoxic sera to c. difficile have been obtained. the neutralizing activity of these sera has been eva ...19892735166
comparison of two oral formulations of vancomycin for treatment of diarrhoea associated with clostridium difficile. 19892745253
evaluation of a latex agglutination test for clostridium difficile in two nursing home outbreaks.the culturette brand clostridium difficile test (cdt; marion laboratories, inc., kansas city, mo.) is a latex agglutination test for c. difficile. the recent controversy involving the identity of antigens detected by cdt has made decisions on its use difficult. we compared the test results with those of selective culture and stool cytotoxin assays in investigations of two nursing home outbreaks of c. difficile-associated disease in order to formulate usage recommendations. selective culture for ...19892745696
nosocomial clostridium difficile infections. 19892747751
nucleotide sequence of a chloramphenicol acetyl transferase gene from clostridium difficile. 19892748343
clostridium difficile in the intensive care unit: management problems and prevention issues.several patients hospitalized in our 12-bed medical icu were found to have clostridium difficile associated colitis. stool cultures of all patients identified eight cases (three culture positive, and five culture and cytotoxin positive), seven of which were geographically and temporarily clustered within a 2-wk period. at least one patient appeared to contract the disease after hospitalization and in the absence of antibiotic therapy or other known major risk factors. the outbreak highlights the ...19892752778
extended spectrum cephalosporins and clostridium difficile.there is little information about how commonly the newer cephalosporins cause diarrhoea due to clostridium difficile. in this study of 111 patients with c. difficile-associated diarrhoea, 106 had received antimicrobial agents in the four weeks before detection of c. difficile. the relative risk for each antimicrobial agent was greatest with clindamycin, followed by cefotaxime, cephamandole and ceftriaxone. there was no statistically significant difference in risk between the cephalosporins evalu ...19892759933
relapsing clostridium difficile toxin-associated colitis in ovarian cancer patients treated with chemotherapy.symptomatic relapse of clostridium difficile toxin-associated colitis occurred in three patients with ovarian cancer. in two patients, c difficile toxin-positive diarrhea initially appeared in association with antibiotic therapy. the third patient developed diarrhea after chemotherapy, without recent antecedent antibiotic administration. patients were initially treated with oral metronidazole and became asymptomatic and toxin-negative. a symptomatic toxin-positive recurrence then developed after ...19892761938
in vitro and in vivo antibacterial activities of bmy 40062, a new fluoronaphthyridone.the in vitro and in vivo activities of a new naphthyridone, bmy 40062, were compared with those of ciprofloxacin and ofloxacin. bmy 40062 showed about threefold more activity than ciprofloxacin showed and four- to eightfold more activity than ofloxacin showed against staphylococci, streptococci, and enterococci. bmy 40062 showed generally twofold less activity than ciprofloxacin showed against most species of the family enterobacteriaceae, pseudomonas aeruginosa, and acinetobacter spp. but twofo ...19892764541
characterization and reassembly of a regular array in the cell wall of clostridium difficile gai 4131.the cell wall of clostridium difficile gai 4131 was revealed by electron microscopy to have an outer layer composed of a nearly square array and contained the two major proteins with molecular weights of 38 kda and 42 kda. the properties and reassembly of the two major proteins into the regular array were investigated. when the isolated cell walls were treated with hydrophobic bond-disrupting agents or a chelating agent specific for ca2+, the two major proteins were effectively removed and the r ...19892770560
fulminant idiopathic pseudomembranous colitis.pseudomembranous colitis is characterized by inflammatory plaques and pseudomembranes on the colonic mucosa. the disorder most commonly occurs after the use of antibiotics, which allow overgrowth of clostridium difficile, a spore-forming, gram-positive rod that produces a toxin. overgrowth of staphylococcus aureus can also produce pseudomembranous colitis. in rare cases, pseudomembranous colitis is not associated with antibiotic use. when c. difficile is present, vancomycin or metronidazole usua ...19892773757
comparison of media for screening of diarrheic stools for the recovery of clostridium difficile.recoveries of clostridium difficile from stool specimens by using three media, cycloserine-mannitol agar (m-cma), cycloserine-mannitol-blood agar (m-cmba), and cycloserine-cefoxitin agar (m-cca), were compared. of 321 clinical specimens, 37 yielded c. difficile. thirty-four were positive on m-cca, 21 were positive on m-cma, and 20 were positive on m-cmba. m-cca recovered significantly more c. difficile than did m-cmba or m-cma.19892778074
purification and characterisation of clostridium difficile toxin a by bovine thyroglobulin affinity chromatography and dissociation in denaturing conditions with or without reduction.highly purified toxin a of clostridium difficile was obtained by bovine thyroglobulin affinity chromatography followed by two sequential anion-exchange chromatography steps on q sepharose ff and mono q. after q sepharose ff chromatography of a thyroglobulin affinity-purified toxin a preparation, two major peaks of cytotoxicity representing toxins a and b were detected. the homogeneity of the final toxin a preparation obtained from mono q anion-exchange fast protein liquid chromatography was asce ...19892778794
reactive oligoarthritis associated with clostridium difficile colitis. 19892784867
fixation of clostridium difficile toxin a and cholera toxin to intestinal brush border membranes from axenic and conventional mice.we have tested the in vitro binding of clostridium difficile toxin a (enterotoxin) and cholera toxin to intestinal brush border membranes prepared from either conventional or axenic mice. membranes from axenic mice were shown to be saturated at a lower toxin a concentration (at least 2.5 times lower). because there were no significant differences between membranes from axenic and conventional mice in binding at low toxin a concentrations, the presence of the normal microflora seems to increase t ...19892785961
origin and fate of ige-bearing lymphocytes. ii. modulation of ige isotype expression on peyer's patch cells by feeding with certain bacteria and bacterial cell wall components or by thymectomy.mechanisms regulating the appearance of sige+ b lymphocytes appear to be lacking in adult germfree (gf) rats in that their peyer's patches (pp) contain high numbers of cells with sige (approximately 15% of total cells), one-half of which simultaneously express siga, whereas sige+ cells are absent from pp of conventional rats (less than 1%). gf rat pp also contain elevated numbers of siga+ cells and decreased numbers of sigm+ cells, with elevated numbers of sthy-1+ rt 7.1+ ig- t cells, and reduce ...19892789249
comparative in vitro activity of lomefloxacin, a difluoro-quinolone.lomefloxacin is a new difluoro-quinolone. in this study, we have determined the in vitro activity of lomefloxacin against a wide range of clinical bacterial isolates and compared it with that of other fluoro-quinolones and some unrelated antimicrobials. lomefloxacin was very active against enterobacteriaceae (mic90, 0.5 micrograms/ml) with activity comparable to that of ofloxacin (mic90, 0.25 micrograms/ml). lomefloxacin was moderately active against isolates of pseudomonas aeruginosa (mic90, 4 ...19892791500
feacal carriage of cytotoxigenic strains of clostridium difficile by adult nigerians.the isolation rate of clostridium difficile and the presence of its cytotoxin in stool were studied in adults with diarrhoea and healthy normal individuals over a period of one year. c. difficile was isolated from 23(56%) out of 41 patients with diarrhoea who gave history of antibiotic exposure prior to the development of the disease from 12(31.6%) of the 38 healthy controls with no history of antibiotic exposure. of the 23(31.6%) c. difficile isolated from the patients, 16(69.6%), and only 8(66 ...19892791928
diarrhoea associated with ceftriaxone and its implications in paediatric patients.we prospectively studied 50 paediatric patients (3 months-12 years) who received 50 mg/kg ceftriaxone, i.v. over 20 min every 12 h for 3-14 days. diarrhoea, as defined by four bowel movements/day for two consecutive days, occurred in 34% (17) of 50 patients. an additional two patients with diarrhoea were excluded due to the presence of enteroviruses. diarrhoea occurred after 2-14 (8.7 +/- 3.2) doses and persisted for 2-8 (3.1 +/- 1.7) days. the mean number of bowel movements was 1.2/days before ...19892793955
treatment of clostridium difficile diarrhea. 19892796843
clostridium difficile colitis associated with ofloxacin therapy. 19892801739
effect of clostridium difficile enterotoxin a on ultrastructure of chinese hamster ovary cells.electron microscopical immunocytochemistry and light microscopy were used to study the effect of clostridium difficile enterotoxin a (ea) on cultured chinese hamster ovary (cho) cells. at 4 degrees c, immunocytochemically detected ea was randomly distributed along the plasma membrane; when cells were subsequently transferred to 37 degrees c, the ea moved into coated pits and coated vesicles within 2 min. within 2 h of incubation at 37 degrees c with ea, the perinuclear cytoplasm of the cho cells ...19892807554
comparative in-vitro activity of meropenem on clinical isolates from the united kingdom.mics of meropenem were determined for a wide range of common bacteria of clinical importance. for enterobacteriaceae, aeromonas spp., haemophilus influenzae, branhamella catarrhalis, neisseria gonorrhoeae, gardnerella vaginalis, campylobacter coli/jejuni, beta-haemolytic streptococci and anaerobes other than clostridium difficile, mics were almost always within the range 0.002-0.5 mg/l. the activity of meropenem for these organisms was always greater than that of imipenem and piperacillin, and w ...19892808214
immunoblot analysis of serum immunoglobulin g response to surface proteins of clostridium difficile in patients with antibiotic-associated diarrhea.we examined by immunoblot analysis the serum immunoglobulin g antibody response to edta-extracted surface proteins of clostridium difficile in 16 patients with antibiotic-associated diarrhea. for each patient, paired serum samples were tested against proteins of the infecting strain and of a collection strain (c253) known to belong to the electrophoretic group 2 pattern. eight patients, all harboring group 2 c. difficile strains, exhibited responses to the proteins of the infecting strain; six p ...19892808681
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