| new trends in clostridium difficile virulence and pathogenesis. | the disease spectrum caused by clostridium difficile infection ranges from antibiotic-associated diarrhoea to life-threatening clinical manifestations such as pseudomembranous colitis. c. difficile infection is precipitated by antimicrobial therapy that causes a disruption of the normal colonic microbiota, predisposing to c. difficile intestinal colonisation. the pathogenicity of c. difficile is mediated by two exotoxins, tcda and tcdb, both of which damage the human colonic mucosa and are poten ... | 2009 | 19303565 |
| clostridium difficile and fluoroquinolones: is there a link? | clostridium difficile infection has become one of the most significant threats to hospitalised patients and represents an increasingly important issue in terms of morbidity and mortality within our institutions. the arrival of a new, more virulent strain coincided with the introduction of several new respiratory fluoroquinolones, and several studies have reported a potential link between the use of fluoroquinolones and the occurrence of c. difficile infection. after reviewing the available publi ... | 2009 | 19303566 |
| recurrent clostridium difficile infection: causality and therapeutic approaches. | recurrent diarrhoea after successful treatment of the primary episode is a common complication of clostridium difficile infection (cdi) and may be increasing in frequency. evidence suggests that persistent alterations in the indigenous bowel flora and failure to mount an effective antibody response to c. difficile toxins are the main mechanisms whereby recurrent cdis occur. treatment of the first recurrence with the same agent used for the treatment of the primary episode is reasonable, but a di ... | 2009 | 19303567 |
| nosocomial and antibiotic-associated diarrhoea caused by organisms other than clostridium difficile. | most cases of nosocomial and antibiotic-associated diarrhoea are caused by alteration of the physiological gut microflora. this alteration leads to reduced microbial metabolism of carbohydrates and primary bile acids, resulting in osmotic or secretory forms of diarrhoea. moreover, facultative enteropathogens may experience a growth advantage due to the antibiotic-induced microflora alteration that, in turn, can harm the gut mucosa by the toxins they produce. clostridium difficile is the major in ... | 2009 | 19303568 |
| clostridium difficile is no longer just a nosocomial infection or an infection of adults. | clostridium difficile is the main cause of nosocomial gastrointestinal disorders. historically, c. difficile has usually affected older patients, hospital inpatients, and long-term care facility residents. recent reports suggest that the occurrence and severity of c. difficile-associated disease (cdad) is increasing in populations previously considered to be at low risk of the infection, and increasing numbers of community-acquired cases of cdad are being reported. risk factors for cdad in paedi ... | 2009 | 19303569 |
| new approach to the management of clostridium difficile infection: colonisation with non-toxigenic c. difficile during daily ampicillin or ceftriaxone administration. | non-toxigenic strains of clostridium difficile are highly effective in preventing toxigenic c. difficile infection in hamsters when given following a single dose of an antimicrobial agent. the goal of this study was to determine the ability of non-toxigenic c. difficile to colonise hamsters during administration of an antibiotic to which the organisms are resistant - ceftriaxone - and an antibiotic to which they are susceptible - ampicillin - and to determine if non-toxigenic colonisation is pro ... | 2009 | 19303570 |
| alternative strategies for clostridium difficile infection. | although antibiotics are generally effective in achieving symptomatic recovery from clostridium difficile infection, the disease frequently relapses, partly because antibiotics not only kill c. difficile, but also disrupt colonisation resistance of the gut microflora. non-antibiotic strategies for the prevention and treatment of the infection include probiotics, deliberate colonisation by non-toxigenic c. difficile strains, toxin-binding agents, active immunisation, passive immunotherapy with in ... | 2009 | 19303571 |
| what is the role of antimicrobial resistance in the new epidemic of clostridium difficile? | the epidemiology of clostridium difficile infection (cdi) has changed in recent years, with the occurrence of large outbreaks of infection associated with the emergence of 'hypervirulent' strains, particularly pcr ribotype 027. there has been much speculation as to the nature of the factors responsible for driving the new epidemic of cdi, and various hypotheses have been proposed. these include increases in the size of the population at risk of cdi and/or their susceptibility to infection, incre ... | 2009 | 19303572 |
| antibody-enhanced, fc gamma receptor-mediated endocytosis of clostridium difficile toxin a. | toxin a (tcda) and toxin b (tcdb) are major virulence factors of clostridium difficile. these two toxins intoxicate cultured cells by similar mechanisms, and tcdb generally is more potent than tcda in cultured cells. the exact reason for this difference is unclear. here, we report that the cellular effects of tcda can be substantially enhanced via an opsonizing antibody through fc gamma receptor i (fcgammari)-mediated endocytosis. a tcda-specific monoclonal antibody, a1h3, was found to significa ... | 2009 | 19307220 |
| cpdadh: a new peptidase family homologous to the cysteine protease domain in bacterial martx toxins. | a cysteine protease domain (cpd) has been recently discovered in a group of multifunctional, autoprocessing rtx toxins (martx) and clostridium difficile toxins a and b. these cpds (referred to as cpdmartx) autocleave the toxins to release domains with toxic effects inside host cells. we report identification and computational analysis of cpdadh, a new cysteine peptidase family homologous to cpdmartx. cpdadh and cpdmartx share a rossmann-like structural core and conserved catalytic residues. in b ... | 2009 | 19309740 |
| late endocytic dysfunction as a putative cause of amyloid fibril formation in alzheimer's disease. | the assembly of amyloid beta-protein to amyloid fibrils is a critical event in alzheimer's disease. evidence exists that endocytic pathway abnormalities, including the enlargement of early endosomes, precede the extraneuronal amyloid fibril deposition in the brain. we determined whether endocytic dysfunction potently promotes the assembly of amyloid beta-protein on the surface of cultured cells. blocking the early endocytic pathway by clathrin suppression, inactivation of small gtpases, removal ... | 2009 | 19317854 |
| the vexed relationship between clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission. | comorbidity with clostridium difficile may cause diagnostic delay in newly presenting inflammatory bowel disease (ibd) patients, trigger relapse in established disease, confound therapies, and serve as an indicator of an underlying defect in innate immunity. retrospective analyses have suggested community acquisition; to address this we conducted a prospective analysis of c. difficile carriage in ibd patients using molecular methods specifically in an outpatient setting. | 2009 | 19319128 |
| essential role of the glucosyltransferase activity in clostridium difficile toxin-induced secretion of tnf-alpha by macrophages. | clostridium difficile causes serious and potentially fatal inflammatory diseases of the colon. two large protein toxins, tcda and tcdb, have been clearly implicated in pathogenesis. the goal of this study was to determine whether the glucosyltransferase activity of the toxins is critical for the induction of tumor necrosis factor-alpha (tnf-alpha), an important cytokine mediating both local and systematic inflammatory response. a dose-dependent tnf-alpha secretion was demonstrated in murine macr ... | 2009 | 19324080 |
| presence of the epidemic north american pulsed field type 1 clostridium difficile strain in hospitalized children. | a hypervirulent strain of clostridium difficile-labeled north american pulsed field type 1 causes severe disease in adults. to determine the prevalence of nap1 c. difficile in children, organisms from consecutive c. difficile toxin-positive stool samples at 2 children's hospitals microbiology laboratories were characterized. we found that 19.4% of these samples were nap1. | 2009 | 19324222 |
| the mechanisms and efficacy of probiotics in the prevention of clostridium difficile-associated diarrhoea. | the proportion and severity of clostridium difficile-associated diarrhoea (cdad) is increasing in health-care settings. antibiotics remain the most important risk factor for cdad, due to their limiting the ability of the gastrointestinal flora to inhibit c difficile colonisation. probiotics have therefore been investigated for primary and secondary prophylaxis against cdad, with varying success. this review looks at the current literature for in-vitro and clinical evidence for probiotic use in t ... | 2009 | 19324296 |
| [re-emergent etiologies: clostridium difficile]. | clostridium difficile-associated disease (cdad) can range from uncomplicated diarrhea to sepsis and even death. cdad rates and severity are increasing, possibly due to a new strain. transmission of c. difficile occurs primarily in health care facilities via the fecal-oral route following transient contamination of the hands of health care workers and patients; contamination of the patient care environment also plays an important role. education of hospital staff appropriate diagnostic testing, e ... | 2007 | 19326731 |
| infectious complications in three double hand recipients: experience from a single center. | composite tissue allograft (cta) recipients require high level of immunosuppression and, therefore, are at significant risk to acquire opportunistic infections. | 2009 | 19328916 |
| contamination of pet therapy dogs with mrsa and clostridium difficile. | | 2009 | 19329224 |
| risk factors for mortality following emergency colectomy for fulminant clostridium difficile infection. | this study evaluated risk factors for mortality after emergency colectomy for fulminant clostridium difficile infection. | 2009 | 19333038 |
| rapid detection of the clostridium difficile ribotype 027 tcdc gene frame shift mutation at position 117 by real-time pcr and melt curve analysis. | the emergence of the hypervirulent strain clostridium difficile pcr ribotype 027 has increased the necessity for rapid c. difficile typing tests for clinical and epidemiological purposes. we developed a rapid real-time polymerase chain reaction (pcr) test for the detection of c. difficile. as the target, we chose the tcdc gene, which encodes for a negative regulator in toxin production. a deletion at position 117 of the tcdc gene, which is associated with severe tcdc truncation, is well conserve ... | 2009 | 19333630 |
| do nsaids, antibiotics, infections, or stress trigger flares in ibd? | non-steroidal anti-inflammatory drugs (nsaids), antibiotics, enteric or other systemic infections, and stress have all been reported to be potential triggers of inflammatory bowel disease (ibd). although a mechanism of triggering a flare of ibd can be hypothesized for each factor, the associations of these factors with flares of ibd remains confusing. in this review, we analyze the literature that explores these associations. there is some evidence to support an association between nsaid use and ... | 2009 | 19337242 |
| thinking beyond the colon-small bowel involvement in clostridium difficile infection. | small intestinal clostridium difficile seems to be increasing in incidence. the spectrum of clostridium difficile infection (cdi) has definitely expanded with small bowel involvement. they are more frequently reported in patients with inflammatory bowel disease (ibd) who have undergone total colectomy or patients with ileal anal pouch anastomosis. the most common presentation is increased ileostomy output with associated dehydration. high clinical suspicion, early recognition and appropriate tre ... | 2009 | 19338685 |
| clostridium difficile associated infection, diarrhea and colitis. | a new, hypervirulent strain of clostridium difficile, called nap1/bi/027, has been implicated in c. difficile outbreaks associated with increased morbidity and mortality since the early 2000s. the epidemic strain is resistant to fluoroquinolones in vitro, which was infrequent prior to 2001. the name of this strain reflects its characteristics, demonstrated by different typing methods: pulsed-field gel electrophoresis (nap1), restriction endonuclease analysis (bi) and polymerase chain reaction (0 ... | 2009 | 19340897 |
| [interaction of clostridium difficile with bacterial associations of parietal biofilm in colon of mice]. | using electron microscopy, ultrastructural organization of microbial parietal biofilm in colon of immunodeficient mice line b10-hr(rhy) was studied before and after peroral inoculation with enteropathogenic strain of clostridium difficile. it was shown that infection leads to dispersion of normal biofilm in various sites and imbalance in natural proportions of different bacterial associations. also, clear ultrastructural signs of involution of gram-negative microorganisms were observed. in the r ... | 2009 | 19340962 |
| activation of a c-jun-nh2-terminal kinase pathway by the lethal toxin from clostridium sordellii, tcsl-82, occurs independently of the toxin intrinsic enzymatic activity and facilitates small gtpase glucosylation. | in the present study, we show that lethal toxin from clostridium sordellii (tcsl-82) activates the three map kinase pathways, but that only a permeable and specific c-jun-nh2-terminal kinase (jnk) inhibitor, jnk inhibitor ii, prevents toxin-dependent actin depolymerization and cell rounding. we show that jnk activation is dependent on entry of the toxin n-terminal domain into the cytosol as bafilomycin a1, which prevents acidification of endocytic vesicle and subsequent cytosolic translocation o ... | 2009 | 19341436 |
| health care-associated infections: is there an end in sight? | overview: health care-associated infections (hais) have emerged as a significant concern in policy as well as clinical circles. an hai is an infection acquired during treatment for another condition. some of the hai-causing bacteria have become drug-resistant; methicillin-resistant staphylococcus aureus, or mrsa, is a familiar example. tied to perhaps 100,000 deaths and $20 billion in health care costs each year, hais have given rise to state laws, legislative proposals at the federal level, pub ... | 2009 | 19343832 |
| high profile outbreaks inform new guidance. | while the nhs appears to be making progress in reducing the number of outbreaks of the bacterium, the need for continuing prudence and sound practical measures in preventing and managing c. difficile infection cases is highlighted in new guidance compiled by the health protection agency for the department of health. drawing on healthcare commission (hcc) reports into outbreaks at several trusts and a joint healthcare commission/health protection authority (hpa) review, a new publication, "clostr ... | 2009 | 19343998 |
| is the war being won?--an expert's view. | with new dh guidance on dealing effectively with clostridium difficile in healthcare settings recently published (see p40-43), health estate journal spoke to department of health inspector of microbiology and infection control professor brian duerden, asking him how much progress has been made in preventing outbreaks and containing spread, what lessons have been learned from some of the more high profile outbreaks, and what innovations, if any, are on the horizon to help eradicate the bacterium ... | 2009 | 19344002 |
| clostridium difficile infection in a health care worker. | | 2009 | 19344257 |
| laboratory diagnosis of clostridium difficile infection. an evaluation of tests for faecal toxin, glutamate dehydrogenase, lactoferrin and toxigenic culture in the diagnostic laboratory. | faecal samples from 1007 patients suspected of having diarrhoea caused by clostridium difficile infection are investigated for the presence of toxins a and b and for the presence of c. difficile-specific glutamate dehydrogenase (gdh). toxigenic culture is performed on all samples and is used as the 'gold standard' for the purpose of the study. a marker for intestinal inflammation, faecal lactoferrin, is used on any samples that give a positive result in any of the above tests. part of the study ... | 2009 | 19348118 |
| the evolving epidemiology of inflammatory bowel disease. | epidemiologic studies in inflammatory bowel disease (ibd) include assessments of disease burden and evolving patterns of disease presentation. although it is hoped that sound epidemiologic studies provide aetiological clues, traditional risk factor-based epidemiology has provided limited insights into either crohn's disease or ulcerative colitis etiopathogenesis. in this update, we will summarize how the changing epidemiology of ibd associated with modernization can be reconciled with current co ... | 2009 | 19349861 |
| advances in inflammatory bowel diseases. | the annual clinical and research conference of the crohn's and colitis foundation of america, advances in inflammatory bowel diseases, provided a comprehensive overview of the year's newest developments regarding inflammatory bowel diseases (ibd). the program was again successful. attracting a wide range of participants including leaders in the field from around the world, the program offered a unique opportunity to review and debate the most important clinical studies, current controversies in ... | 2009 | 19351281 |
| recent advances in clostridium difficile-associated disease. | the main purpose of this article is to review recent developments in the management of acute and recurrent clostridium difficile-associated disease, with consideration of existing and new antibiotic and non-antibiotic agents for treatment. details of the current developmental stage of new agents are provided and the role of surgery in the management of severe disease is discussed. infection control measures considered comprise prudent use of antimicrobials, prevention of cross-infection and surv ... | 2009 | 19351643 |
| accounting for regression-to-the-mean in tests for recent changes in institutional performance: analysis and power. | recent changes in individual units are often of interest when monitoring and assessing the performance of healthcare providers. we consider three high profile examples: (a) annual teenage pregnancy rates in english local authorities, (b) quarterly rates of the hospital-acquired infection clostridium difficile in national health service (nhs) trusts and (c) annual mortality rates following heart surgery in new york state hospitals. increasingly, government targets call for continual improvements, ... | 2009 | 19358144 |
| [comparison of susceptibility of spores of bacillus subtilis and czech strains of clostridium difficile to disinfectants]. | an important factor in the prevention of nosocomial outbreaks caused by clostridium difficile ribotype 027 is the disinfection of a patient environment by reliable sporicidal disinfectants. sporicidal activity of particular agents is tested on spores of bacillus subtilis. questions are brought up if the disinfectant which works on b. subtilis spores will be equally effective on the spores of c. difficile. therefore we have compared the effects of five disinfectants available on the czech market ... | 2009 | 19358452 |
| lactobacillus and bifidobacteria combinations: a strategy to reduce hospital-acquired clostridium difficile diarrhea incidence and mortality. | incidence and virulence of clostridium difficile-associated disease (cdad) is increasing, particularly in institutional settings. morbidity, mortality, and costs associated with this condition are high. broad-spectrum antibiotics have long been recognized as the primary risk factor for cdad due to disruption of protective normal gastrointestinal flora. we suggest that administration of appropriate lactobacilli and bifidobacteria probiotics could be employed as a strategy to protect hospitalized ... | 2009 | 19359104 |
| medical staff at a london district hospital are not chronic vectors of mrsa or clostridium difficile. | | 2009 | 19362741 |
| molecular analysis of the gyra and gyrb quinolone resistance-determining regions of fluoroquinolone-resistant clostridium difficile mutants selected in vitro. | recent studies have suggested that exposure to fluoroquinolones represents a risk factor for the development of clostridium difficile infections and that the acquisition of resistance to the newer fluoroquinolones is the major reason facilitating wide dissemination. in particular, moxifloxacin (mx) and levofloxacin (le) have been recently associated with outbreaks caused by the c. difficile toxinotype iii/pcr ribotype 027/pulsed-field gel electrophoresis type nap1 strain. in this study, we evalu ... | 2009 | 19364867 |
| diagnostic value of repeated enzyme immunoassays in clostridium difficile infection. | there has been a significant increase in the prevalence, severity, and mortality of clostridium difficile infection (cdi), with an estimated three million new cases per year in the united states. yet diagnosing cdi remains problematic. the most commonly used test is stool enzyme immunoassay (eia) detecting toxin a and/or b, but there are no clear guidelines specifying the optimal number of tests to be ordered in the diagnostic workup, although multiple tests are frequently ordered. thus, we desi ... | 2009 | 19367273 |
| [clinical importance of clostridium difficile finding in hospitalized patients]. | clostridium difficile infections predominatelly occur among hospitalized patients. the aim of this study was to evaluate the importance of finding the isolate of clostridium difficile cultured from the stool of hospitalized patients. | 2008 | 19368285 |
| saccharomyces boulardii in a child with recurrent clostridium difficile. | | 2009 | 19371301 |
| nation-wide prospective surveillance of clostridium difficile infections in hospitals in belgium, july 2007-june 2008. | we report here baseline data from the first year of compulsory surveillance of clostridium difficile infections (cdi) in hospitals in belgium. between 1 july 2007 and 30 june 2008, 2,704 cdi were reported: 12% were recurrent and 66% were hospital-associated (half of which occurred 15 days or more after admission). cdi was considered the cause of death (direct or indirect) for 10% of the episodes. the median incidence of cdi was 1.5 per 1,000 admissions and 1.9 per 10,000 hospital-days for all ca ... | 2009 | 19371509 |
| the emergence of clostridium difficile pcr ribotype 027 in denmark--a possible link with the increased consumption of fluoroquinolones and cephalosporins? | increasing rates of clostridium difficile infection (cdi) with an unusual, severe course have been reported in several countries; this rise has partly been ascribed to the emergence of a virulent strain, c. difficile pcr ribotype 027 (cd027). an intriguing question is whether this could be related to increasing consumption of broadspectrum antibiotics. from 1997 to 2007, the number of hospital discharges in denmark with the diagnosis enterocolitis caused by c. difficile increased from eight to 2 ... | 2009 | 19371514 |
| temporal effects of antibiotic use and clostridium difficile infections. | we tested a previously published model for the analysis of the temporal relationship between antibiotic use and the incidence of clostridium difficile infection in a hospital with stable incidence of infection at >1 case per 1000 admissions per month. | 2009 | 19372170 |
| are vasopressor use and mechanical ventilation the only predictors of worse outcome for fulminant clostridium difficile infection? | | 2009 | 19375066 |
| a simple 3-step algorithm for improved laboratory detection of clostridium difficile toxin without the need for tissue culture cytotoxicity neutralization assays. | this report describes a 3-step algorithm for the detection of clostridium difficile using an enzyme immunoassay for glutamate dehydrogenase (gdh) antigen, a lateral flow assay for c. difficile toxin, and anaerobic broth culture. this method was found to detect more toxin-containing stool samples than the use of a combination gdh antigen plus toxin a/b testing alone. | 2009 | 19376666 |
| microarray identification of clostridium difficile core components and divergent regions associated with host origin. | clostridium difficile is a gram-positive, spore-forming enteric anaerobe which can infect humans and a wide variety of animal species. recently, the incidence and severity of human c. difficile infection has markedly increased. in this study, we evaluated the genomic content of 73 c. difficile strains isolated from humans, horses, cattle, and pigs by comparative genomic hybridization with microarrays containing coding sequences from c. difficile strains 630 and qcd-32g58. the sequenced genome of ... | 2009 | 19376880 |
| new approaches to decontamination of rooms after patients are discharged. | | 2009 | 19379097 |
| comparison of the efficacy of a hydrogen peroxide dry-mist disinfection system and sodium hypochlorite solution for eradication of clostridium difficile spores. | to compare a hydrogen peroxide dry-mist system and a 0.5% hypochlorite solution with respect to their ability to disinfect clostridium difficile-contaminated surfaces in vitro and in situ. | 2009 | 19379098 |
| clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors. | the present study investigates risk factors for onset of clostridium difficile-associated diarrhoea, specific ribotype and environmental spore contamination in a district general hospital in south east england. c. difficile isolates were ribotyped from 97 diarrhoeal cases, following detection of c. difficile toxin from faecal specimens by enzyme immunoassay (health protection agency, southampton). the isolates were tested for various antimicrobial susceptibilities by e-test. cases were assessed ... | 2009 | 19386381 |
| [epidemic risk of disease associated with a new strain of clostridium difficile]. | the incidence of clostridium difficile infection in north america and europe has increased in the last years, generating concern among health professionals. a new strain of c. difficile has been identified in recent nosocomial outbreaks and community-acquired infections. this new strain, characterized as toxigenic type iii, pcr ribotype 027 (c. difficile 027), presents higher pathogenicity because of increased exotoxin production, and a characteristic antibiotic resistance profile. since 2003, s ... | 2009 | 19386385 |
| outbreak of clostridium difficile 027 in north zealand, denmark, 2008-2009. | we report an outbreak of clostridium difficile pcr ribotype 027 in denmark. the outbreak includes to date 73 cases from the area north of copenhagen, but there may be related cases elsewhere in zealand. most infections are healthcare-associated and in patients who previously received antibiotic treatment. the strain is resistant to moxifloxacin, erythromycin, and clindamycin, and carries genes for toxin a, toxin b, and for the binary toxin. the antimicrobial pattern differs from that of the stra ... | 2009 | 19389341 |
| clostridium difficile infection in the "oldest" old: clinical outcomes in patients aged 80 and older. | clostridium difficile infection (cdi) represents a cause of substantial morbidity, particularly for older adults. although older age is a risk factor for cdi, few studies have specifically focused on clinical outcomes in older adults, particularly the "oldest" old. | 2009 | 19392957 |
| an ultrasensitive rapid immunocytotoxicity assay for detecting clostridium difficile toxins. | we describe a novel ultrasensitive cell-based immunocytotoxicity assay for detecting clostridium difficile toxin a and b. the assay is simple to perform with a turnaround time of approximately 3 h . it is particularly sensitive in detecting tcda at a level less then 1 pg/ml. using this assay, we were able to detect the presence of c. difficile toxins in the fecal and serum specimens of experimentally infected piglets. | 2009 | 19393695 |
| recurrent clostridium difficile infection: a review of risk factors, treatments, and outcomes. | episodes of recurrent clostridium difficile infection (cdi) are difficult to treat for several reasons. foremost, data are lacking to support any particular treatment strategy. in addition, treatment of recurrent episodes is not always successful, and repeated, prolonged treatment is often necessary. identification of subgroups at risk for recurrent cdi may aid in diagnosing and treating these patients. two likely mechanistic factors increasing the risk of recurrent cdi are an inadequate immune ... | 2009 | 19394704 |
| lactobacillus delbrueckii ssp. bulgaricus b-30892 can inhibit cytotoxic effects and adhesion of pathogenic clostridium difficile to caco-2 cells. | probiotic microorganisms are receiving increasing interest for use in the prevention, treatment, or dietary management of certain diseases, including antibiotic-associated diarrhea (aad). clostridium difficile is the most common cause of aad and the resulting c. difficile - mediated infection (cdi), is potentially deadly. c. difficile associated diarrhea (cdad) is manifested by severe inflammation and colitis, mostly due to the release of two exotoxins by c. difficile causing destruction of epit ... | 2009 | 19397787 |
| bacteremia due to clostridium difficile--review of the literature. | extracolonic clostridium difficile infections have been infrequently reported. extracolonic manifestations of c. difficile include bacteremia, intra-abdominal abscess, osteomyelitis, visceral abscess, empyema, reactive arthritis, and small bowel disease with formation of pseudomembranes on ileal mucosa. most cases of extracolonic c. difficile have been preceded by gastrointestinal disease, either c. difficile colitis or surgical and anatomical disruption of the colon. bacteremia due to c. diffic ... | 2009 | 19398213 |
| [clostridium difficile as a potential pathogen in preterm neonates]. | objective: to detect the presence of clostridium difficile toxins a and b in the stools of patients hospitalized in the university hospital olomouc who developed diarrhoea or other abdominal symptoms (abdominal pain, tympanites, indigestion, partial intestinal obstruction) related to antibiotic therapy. given occasional dyspepsia and necrotizing enterocolitis in preterm neonates, to consider the potential role of these toxins, in addition to that of the immature intestine, in the development of ... | 2009 | 19399727 |
| mlst analysis reveals a highly conserved core genome among poultry isolates of clostridium septicum. | clostridium septicum is a highly virulent, anaerobic bacterium capable of establishing necrotizing tissue infections and forming heat resistant endospores. disease is primarily facilitated by secretion of numerous toxic products including a lethal pore-forming cytolysin. spontaneously occurring clostridial myonecrosis involving c. septicum has recently reemerged as a concern for many poultry producers. however, despite its increasing prevalence, the epidemiology of infection and population struc ... | 2009 | 19402197 |
| hospitalizations and deaths associated with clostridium difficile infection, finland, 1996-2004. | to determine whether the rate of clostridium difficile-associated disease (cdad) and cdad-related deaths were increasing in finland, we analyzed registry data from 1996 through 2004. we determined the number of hospital discharges that had a diagnosis code specific for cdad from the international classification of diseases, 10th revision: "enterocolitis due to clostridium difficile" (a04.7) and "pseudomembranous enterocolitis associated with antimicrobial therapy" (k52.8), listed as any diagnosi ... | 2009 | 19402963 |
| possible seasonality of clostridium difficile in retail meat, canada. | we previously reported clostridium difficile in 20% of retail meat in canada, which raised concerns about potential foodborne transmissibility. here, we studied the genetic diversity of c. difficile in retail meats, using a broad canadian sampling infrastructure and 3 culture methods. we found 6.1% prevalence and indications of possible seasonality (highest prevalence in winter). | 2009 | 19402975 |
| clostridium difficile in ready-to-eat salads, scotland. | of 40 ready-to-eat salads, 3 (7.5%) were positive for clostridium difficile by pcr. two isolates were pcr ribotype 017 (toxin a-, b+), and 1 was pcr ribotype 001. isolates were susceptible to vancomycin and metronidazole but variably resistant to other antimicrobial drugs. ready-to-eat salads may be potential sources for virulent c. difficile. | 2009 | 19402979 |
| clostridium difficile in retail meat products, usa, 2007. | to determine the presence of clostridium difficile, we sampled cooked and uncooked meat products sold in tucson, arizona. forty-two percent contained toxigenic c. difficile strains (either ribotype 078/toxinotype v [73%] or 027/toxinotype iii [nap1 or nap1-related; 27%]). these findings indicate that food products may play a role in interspecies c. difficile transmission. | 2009 | 19402980 |
| rapid molecular characterization of clostridium difficile and assessment of populations of c. difficile in stool specimens. | our laboratory has developed testing methods that use real-time pcr and pyrosequencing analysis to enable the rapid identification of potential hypervirulent clostridium difficile strains. we describe a real-time pcr assay that detects four c. difficile genes encoding toxins a (tcda) and b (tcdb) and the binary toxin genes (cdta and cdtb), as well as a pyrosequencing assay that detects common deletions in the tcdc gene in less than 4 h. a subset of historical and recent c. difficile isolates (n ... | 2009 | 19403775 |
| surveillance and trends of antimicrobial resistance among clinical isolates of anaerobes in kuwait hospitals from 2002 to 2007. | the susceptibility trends for all anaerobes processed by the anaerobe reference laboratory against various antibiotics were determined by using data for 2557 isolates referred by all government hospitals in kuwait from 2002 to 2007. mic were determined for the following anti-anaerobic antibiotics: amoxicillin-clavulanic acid, clindamycin, imipenem, meropenem, metronidazole, penicillin, piperacillin, piperacillin-tazobactam and vancomycin (for gram-positive anaerobes only), using e-test method. t ... | 2010 | 19406247 |
| [increases in clostridium difficile-related mortality rates in spain (1999-2006)]. | | 2009 | 19406527 |
| equine colitis x associated with infection by clostridium difficile nap1/027. | a 14-year-old quarter horse with a 48-hr history of colic was euthanized after failure to respond to treatment. at necropsy, cecal and colonic mucosae were congested throughout, and there was segmental edema and significant thickening of the intestinal wall. excessive numbers of mononuclear cells were found in mucosal lamina propria. submucosal hemorrhage was diffuse and extensive, and clostridium difficile toxins a and b were detected. large numbers of c. difficile were isolated, and genetic ch ... | 2009 | 19407094 |
| clostridium difficile-associated diarrhea in crohn's disease patients with ostomy. | | 2010 | 19408324 |
| [comparison of two enzyme immunoassay for detection of clostridium difficile toxin a and toxin b]. | enzyme immunoassay (eia) capable of detecting both toxin a and toxin b is strongly recommended for the diagnosis of clostridium difficile associated disease. therefore, we evaluated two different eias for the detection of c. difficile toxin a/b. | 2009 | 19411778 |
| antimicrobial stewardship in acute care centres: a survey of 68 hospitals in quebec. | antimicrobial stewardship programs (asps) and quantitative monitoring of antimicrobial use are required to ensure that antimicrobials are used appropriately in the acute care setting, and have the potential to reduce costs and limit the spread of antimicrobial-resistant organisms and clostridium difficile. currently, it is not known what proportion of quebec hospitals have an asp and/or monitor antimicrobial use. | 2008 | 19412381 |
| not all pseudomembranous colitis is caused by clostridium difficile. | | 2008 | 19412385 |
| feasibility of routinely using hydrogen peroxide vapor to decontaminate rooms in a busy united states hospital. | during a 22-month period at a 500-bed teaching hospital, 1,565 rooms that had housed patients infected with multidrug-resistant pathogens were decontaminated using hydrogen peroxide vapor. hydrogen peroxide vapor decontamination required a mean time of 2 hours and 20 minutes, compared with 32 minutes for conventional cleaning. despite the greater time required for decontamination, hydrogen peroxide vapor decontamination of selected patient rooms is feasible in a busy hospital with a mean occupan ... | 2009 | 19415969 |
| successful combat of an outbreak due to clostridium difficile pcr ribotype 027 and recognition of specific risk factors. | in the period april-september 2005, an outbreak of clostridium difficile infection (cdi) due to pcr ribotype 027 occurred among 50 patients in a 341-bed community hospital in harderwijk, the netherlands. a retrospective case-control study was performed to identify risk factors specific for cdi, using a group of patients with cdi (n = 45), a group of randomly selected control patients without diarrhoea (n = 90), and a group of patients with non-infectious diarrhoea (n = 109). risk factors for cdi ... | 2009 | 19416295 |
| yeast, beef and pork extracts counteract clostridium difficile toxin a enterotoxicity. | clostridium difficile is responsible for a large proportion of nosocomial cases of antibiotic-associated diarrhoea and pseudomembranous colitis. the present study provides evidence that yeast, beef and pork extracts, ingredients commonly used to grow bacteria, can counteract c. difficile toxin a enterotoxicity in vitro and in vivo. in model intestinal epithelial cells the individual extracts could prevent the toxin a-induced decrease in epithelial barrier function and partially prevented actin d ... | 2009 | 19416358 |
| [nosocomial infections: mrsa und cdad as a challenge]. | inadequate antibiotic prescribing and poor adherence to infection control guidelines are the main reasons for the development and spread of methicillin-resistant staphylococcus aureus (mrsa) and clostridium difficile (cd), the most important cause of antibiotic-associated diarrhoea (ad) and colitis. both cdad and mrsa infection are associated with significant morbidity, excess mortality and substantial consumption of resources. increases in the incidence of both infections have been observed in ... | 2009 | 19418034 |
| multicenter study of the impact of community-onset clostridium difficile infection on surveillance for c. difficile infection. | to evaluate the impact of cases of community-onset, healthcare facility (hcf)-associated clostridium difficile infection (cdi) on the incidence and outbreak detection of cdi. | 2009 | 19419269 |
| clostridium difficile infection in ohio hospitals and nursing homes during 2006. | healthcare data suggest that the incidence and severity of clostridium difficile infection (cdi) in hospitals are increasing. however, the overall burden of disease and the mortality rate associated with cdi, including the contribution from cases of infection that occur in nursing homes, are poorly understood. | 2009 | 19419272 |
| [a new virulent clone of clostridium difficile is a challenge for danish hospitals]. | | 2009 | 19419636 |
| [first danish case of clostridium difficile ribotype 027]. | increasing rates of clostridium difficile-associated diarrhoea (cdad) with an unusual, severe course have been reported in canada, usa and several european countries since 2003. a new virulent strain, pcr ribotype 027 (cd027), is associated with this increase. we report the first danish case of cdad caused by cd027. a 85-year-old woman was admitted to hospital with pneumonia. following treatment initially with penicillin, secondly with moxifloxacin she developed bloody diarrhoea. a stool specime ... | 2009 | 19419637 |
| the role of surgery in clostridium difficile colitis. | | 2009 | 19420031 |
| outbreak of clostridium difficile 027 infection in vienna, austria 2008-2009. | from november 2008 to 15 april 2009, 36 isolates of cd027 identified in austria, all originating from four hospitals in vienna. all isolates were positive for toxin a, toxin b and the binary toxin, and showed a characteristic 18 bp deletion in the tcdc gene. clostridium difficile is an anaerobic spore-forming bacterium. some strains may cause diarrhoea due to formation of toxins. symptomatic c. difficile infection (cdi) is primarily linked with hospital admission and antibiotic treatment, althou ... | 2009 | 19422768 |
| control of antibiotic-resistant bacteria in the office and clinic. | | 2009 | 19433821 |
| rehospitalizations: packaging discharge and transition services to prevent "bounce backs". | there are many factors that can reduce the rates of rehospitalization, including transition or discharge coaches who work with the patient before, during, and after the discharge; better collaboration between hospitals and physicians to improve promptness and reliability of follow-up care; and earlier medical follow-up after surgical procedures. | 2009 | 19435389 |
| intravenous tigecycline as adjunctive or alternative therapy for severe refractory clostridium difficile infection. | clostridium difficile infection (cdi) has become more refractory to standard therapy. we describe 4 patients with severe refractory cdi who were successfully treated with tigecycline. symptoms improved within 1 week. no relapses were observed. this favorable outcome suggests that tigecycline might be a useful alternative for treating severe refractory cdi. | 2009 | 19435431 |
| genotypic investigation of clostridium difficile in prince edward island. | clostridium difficile is an important cause of disease in canada; however, little information is available about the disease in the maritime provinces. the objective of the present study was to characterize c difficile isolates obtained from people hospitalized with c difficile infection in prince edward island. one hundred twenty-six c difficile elisa toxin-positive stool samples were obtained and cultured using an enrichment protocol. c difficile was isolated from 105 of 126 (83%) samples. twe ... | 2008 | 19436570 |
| infliximab and other immunomodulating drugs in patients with inflammatory bowel disease and the risk of serious bacterial infections. | there remain concerns about the safety of infliximab therapy in patients with inflammatory bowel disease (ibd). | 2009 | 19438424 |
| application of multiple-locus variable-number tandem-repeat analysis to determine clonal spread of toxin a-negative clostridium difficile in a general hospital in buenos aires, argentina. | isolates from patients with clostridium difficile infection (cdi) usually produce both toxin a (tcda) and toxin b (tcdb), but an increasing number of reports from europe and asia mention infections with tcda-negative, tcdb-positive (a-/b+) strains, usually characterized as pcr ribotype 017 (type 017). incidence rates of cdi per 10 000 admissions in a 200-bed argentinean general hospital were 37, 84, 67, 43, 48 and 42 for the years 2000 to 2005, respectively. the annual percentages of type 017 cd ... | 2009 | 19438624 |
| prospective, observational, cross-sectional study of intestinal infections among acutely active inflammatory bowel disease patients. | intestinal infections have been claimed to precipitate or aggravate flares of inflammatory bowel disease (ibd). the reported incidence of such infections among ibd patients varies between 9 and 13%, but only a few prospective studies have been conducted. | 2009 | 19439968 |
| antibiotics and probiotics in inflammatory bowel disease: why, when, and how. | to summarize recent evidence on the role of intestinal bacteria in inflammatory bowel diseases, and of antibiotics and probiotics in their treatment. the implications connected with the use of antibiotics are also examined. | 2009 | 19444096 |
| [probiotics. a review]. | probiotics are defined viable microorganisms which in sufficient amount reach the intestine in an active state, to be able to exert positive health benefit on the host. thus far, they have shown particular promise on prevention or treatment of various pathologic conditions. our aim has been to report the most recent articles (until october 2008), resulting from randomized, double controlled trials, according to the conventional and molecular methods. in this review we have taken into considerati ... | 2009 | 19445282 |
| enteral clostridium difficile, an emerging cause for high-output ileostomy. | the loss of fluid and electrolytes from a high-output ileostomy (>1200 ml/day) can quickly result in dehydration and if not properly managed may cause acute renal failure. the management of a high-output ileostomy is based upon three principles: correction of electrolyte disturbance and fluid balance, pharmacological reduction of ileostomy output, and treatment of any underlying identifiable cause. there is an increasing body of evidence to suggest that clostridium difficile may behave pathologi ... | 2009 | 19447832 |
| clostridium difficile in hip fracture patients: prevention, treatment and associated mortality. | a series of infection control measures were introduced at the university hospitals of leicester nhs trust in 2006-2007 to reduce the incidence of clostridium difficile infection. | 2009 | 19450797 |
| fulminant clostridium difficile colitis: patterns of care and predictors of mortality. | there exist predictors of mortality and the need for colectomy among patients with fulminant clostridium difficile colitis. | 2009 | 19451485 |
| inflammatory bowel disease potpourri: a vignette-based discussion. | | 2009 | 19452754 |
| diagnosis and treatment of acute or persistent diarrhea. | studies of microbial pathogens and the toxins they produce are important for determining the mechanisms by which they cause disease and spread throughout a population. some bacteria produce secretory enterotoxins (such as cholera toxin or the heat-labile or stable enterotoxins produced by escherichia coli) that invade cells directly. others invade cells or produce cytotoxins (such as those produced by shigella, enteroinvasive e coli, or clostridium difficile) that damage cells or trigger host re ... | 2009 | 19457416 |
| treatment of clostridium difficile-associated disease. | clostridium difficile infection is an increasing burden to the health care system, totaling more than $1 billion/year in the united states. treatment of patients with c difficile infection with metronidazole or vancomycin reduces morbidity and mortality, although the number of patients that do not respond to metronidazole is increasing. despite initial response rates of greater than 90%, 15%-30% of patients have a relapse in symptoms after successful initial therapy, usually in the first few wee ... | 2009 | 19457418 |
| clostridium difficile infection caused by the epidemic bi/nap1/027 strain. | rates and severity of clostridium difficile infection (cdi) in hospitals in north america and europe have increased since 2000 and correlate with dissemination of an epidemic strain characterized by higher than usual toxin a and b production, the presence of a third toxin, binary toxin, and high-level resistance to fluoroquinolone antibiotics. the strain, which is restriction endonuclease analysis group bi, pulse-field gel electrophoresis type nap1, and polymerase chain reaction ribotype 027, is ... | 2009 | 19457419 |
| [clostridium difficile associated reactive arthritis]. | extracolonic manifestations of clostridium difficile infections have rarely been reported as a reactive arthritis. we report a 43-year-old woman who presented with a polyarthritis following pseudomembranous colitis. she was admitted for fever and polyarthritis, 10 days after the onset of a c. difficile enterocolitis. samples obtained from urine and blood cultures remained sterile. corticosteroids were prescribed and clinical manifestations resolved within 3 weeks. ten months later, there was no ... | 2010 | 19457598 |
| isolation precautions for antibiotic-resistant bacteria in healthcare settings. | emergence of drug-resistant bacteria and new or changing infectious pathogens is an important public health problem. transmission of these pathogens in an acute care setting may occur frequently if proper precautions are not taken. despite several guidelines and an abundance of literature on the prevention of transmission of epidemiologically important organisms in the healthcare setting, substantial controversy exists. this review focuses on recent data regarding the use of infection control an ... | 2009 | 19461513 |
| a dna vaccine targeting the receptor-binding domain of clostridium difficile toxin a. | clostridium difficile is a pathogen with increasing severity for which host antibody responses provide protection from disease. dna vaccination has several advantages compared to traditional vaccine methods, however no study has examined this platform against c. difficile toxins. a synthetic gene was created encoding the receptor-binding domain (rbd) of c. difficile toxin a, optimized for expression in human cells. gene expression was examined in vitro. mice were inoculated and then challenged w ... | 2009 | 19464540 |