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evidence for cross-infection in an outbreak of clostridium difficile-associated diarrhoea in a surgical unit.environmental studies were performed in a hospital outbreak of clostridium difficile-associated diarrhoea. transmission was associated with the sluice room and the storage room where medical equipment was found to be contaminated with c.difficile. typing of isolates by antibiotic-susceptibility patterns and profiles of edta-extracted proteins showed the presence of an "epidemic" strain common to the majority of patients and environmental sites. control of the outbreak was achieved by improvement ...19883385765
clostridium difficile and acute enterocolitis.clostridium difficile belonging to groups not normally detected in infancy was the only potential pathogen detected in the stools of two infants with severe enterocolitis. further information regarding the virulence of this organism was obtained by use of a recently introduced typing scheme.19883389873
effect of a single dose of cefotaxime or ceftriaxone on human faecal flora. a double-blind study.the effect of cefotaxime and ceftriaxone on faecal flora was investigated in women undergoing routine vaginal or abdominal hysterectomy. three groups of 9 patients received, in a double-blind fashion and just before surgery, cefotaxime 2g intravenously, ceftriaxone 2g intravenously or no antibiotic (controls). stools were collected before prophylaxis (sample 1) and after surgery (samples 2 and 3). the only alteration after cefotaxime was a decrease of non-fastidious aerobic gram-negative flora i ...19883396490
pathogenesis of postantibiotic diarrhoea caused by clostridium difficile: an in vitro study in the rabbit intestine.to elucidate the pathophysiological changes leading to postantibiotic diarrhoea caused by clostridium difficile and its cytotoxin, oral ampicillin was given to rabbits, and jejunal, ileal, and caecal segments of those that developed diarrhoea were investigated in vitro. the rabbits that, in response to treatment, harboured clostridium difficile in their colonic lumen were studied, and the results expressed according to the presence or absence of clostridium difficile and/or its cytotoxin. thus, ...19883396947
pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery.we report 16 orthopaedic patients who had antibiotic-associated diarrhoea (pseudomembranous colitis) after operation. there was an association with the use of cephradine and with the prolongation of prophylaxis for more than three peri-operative doses. five cases occurred as a cluster, suggesting that the causative agent, clostridium difficile, may be infectious in some situations.19883403605
epidemiology of clostridium difficile colonization in newborns: results using a bacteriophage and bacteriocin typing system.we used a typing system based on bacteriophage and bacteriocin susceptibility to study the epidemiology of clostridium difficile colonization of newborn infants. c. difficile was found in the stools of 30 (16.0%) of 187 infants who were screened. increased length of stay in the nursery (p less than .001) and delivery by cesarian section (p less than .001) were associated with higher rates of colonization. the isolates initially detected from the environment and the infants were strain b1811-1700 ...19883403992
acute diarrhoea in adults: aetiology, clinical appearance and therapeutic aspects.a prospective study of acute diarrhoea was performed during 15 months 1981/1982 and included 731 patients and 240 controls. 43% had been infected abroad. a cluster of travellers with bacterial pathogens was diagnosed in july-august. the following pathogens were found: campylobacter (18%), enterotoxigenic e. coli (6%), salmonella spp. (5%), rotavirus (4%), yersinia enterocolitica (3%), giardia lamblia (3%), shigella spp. (2%), clostridium difficile (2%), enteroviruses (2%) and entamoeba histolyti ...19883406670
clostridium difficile in an oncology unit.in one year 21 new cases of clostridium difficile infection occurred on a paediatric oncology unit. eleven cases were in a two month period. this infection should be regarded as a communicable disease. investigations to detect c difficile should be carried out in children with malignant disease who have diarrhoea.19883415338
role of competition for nutrients in suppression of clostridium difficile by the colonic microflora.the cecal flora of mice is able to eliminate clostridium difficile from the mouse cecum even when c. difficile is the first organism established. we used a continuous-flow (cf) culture model of the cecal flora to investigate the possibility that competition for nutrients is one mechanism for this antagonism. the medium for the cf cultures consisted of homogenates of fecal pellets from germfree mice. carbohydrate analysis showed that mouse flora depleted 74 to 99.8% of the various carbohydrates f ...19883417352
retardation of growth in syrian hamsters associated with prolonged colonization with clostridium difficile. 19873426356
in vitro antibacterial activity of rifaximin against clostridium difficile, campylobacter jejunii and yersinia spp.fifty-four isolates of campylobacter jejunii, 91 isolates of yersinia spp. and 56 isolates of clostridium difficile, recovered from stools of patients with diarrhoea or other intestinal disturbances and from stools of asymptomatic patients receiving antibiotic therapy, were tested in vitro for susceptibility to rifaximin, rifampicin and neomycin. the in vitro antibacterial activities were found to be comparable against the aerobic bacterium; on the contrary, against microaerophilic and anaerobic ...19873428130
in-vitro comparison of roxithromycin and erythromycin against 900 anaerobic bacterial strains.the in-vitro antibacterial activity of roxithromycin was assessed by an agar dilution method against 900 recent clinical anaerobic isolates by five laboratories in england, france, germany and japan. roxithromycin had similar activity to erythromycin against most anaerobic bacteria, the latter being slightly more active against gram-negative bacilli. roxithromycin inhibited 53% of the bacteroides fragilis group strains; the noticeable exception was bact. thetaiotaomicron, only 17% of strains of ...19873429381
effect of streptococcus parvulus and peptostreptococcus magnus on cytotoxin levels of clostridium difficile in anaerobic continuous flow culture.an anaerobic continuous flow (cf) culture method was used in order to study the effect of peptostreptococcus magnus and streptococcus parvulus, anaerobic gram-positive cocci which are members of intestinal bacterial flora, on growth and cytotoxin-activity of clostridium difficile. the growth- and the cytotoxin activity-patterns of c. difficile in an established cf culture of p. magnus were similar to those of c. difficile alone. on the other hand, in the mixed culture system of c. difficile and ...19873431487
ability of two clostridium difficile strains from man and hare to produce cytotoxin in vitro and in gnotobiotic rodent intestines.cytotoxin production by human (vp1) and hare (fd) strains of clostridium difficile were compared both in vitro in a broth culture and in vivo in intestinal contents of gnotobiotic rodents. strain vp1 produced about 1,000 times more cytotoxin than the fd strain, both in vitro and in vivo, although the population levels of the two strains were not significantly different either in vitro or in vivo. ninety percent of gnotobiotic rats and 100% of gnotobiotic mice established with the vp1 strain died ...19863435052
epidemiological aspects of clostridium difficile in a pediatric hospital and its role in diarrheal disease.the influence of antibiotics on the frequency of colonization by clostridium difficile and the presence of its cytotoxin in infants and older children was examined to determine its role in diarrheal disease. cytotoxin was more closely associated with cases of diarrhea, both in infants and in children than the microorganism, although not significantly. the isolates were typed by means of sensitivity to bacteriophages and bacteriocins and their cytotoxigenic potential was also determined. less tha ...19873436315
epidemiology and prevention of clostridium difficile infections in a leukemia unit.a 29-month prospective study was carried out in a leukemia unit with the aim of investigating the epidemiology of clostridium difficile infections and limiting their spread. systematic cultures of stools and assays for cytotoxin were performed on patient admission and at weekly intervals, yielding 1,355 cultures and assays. the study period was divided in period a, before total unit renovation, and period b, afterwards. during period b all patient carriers of clostridium difficile received vanco ...19873440454
effect of various sodium taurocholate preparations on the recovery of clostridium difficile spores.the effect of four sodium taurocholate preparations, which are easily available in japan, on recovery of clostridium difficile spores was examined. all preparations, except for one, enabled the recovery of nearly all spores counted microscopically. moreover, by using 69 toxigenic and 34 nontoxigenic c. difficile strains, the relationship between the recovery of spores in the medium with sodium taurocholate and toxigenicity of c. difficile was analyzed. it was noted that the number of strains wit ...19873444427
effect of age on the sensitivity of cell cultures to clostridium difficile toxin.the effect of age on the sensitivity of four cell lines, human foreskin fibroblasts (hfs), cho-k1, hep-2, and wi-38 to detect clostridium difficile toxin was tested. this study also addressed the sensitivity of these cell lines as expressed by early toxin detection. twenty-eight positive and 13 negative patient specimens were tested. cell cultures were inoculated at ages 3, 4, 5, 6, 7, 9 and 14 days and examined for cytopathic effects at 4, 24, and 48 hours post-inoculation. the sensitivity of t ...19873449315
clostridium difficile colitis following treatment with metronidazole and vancomycin.a 25 year old woman developed clostridium difficile colitis following a course of vancomycin and metronidazole prescribed for pelvic inflammatory disease. the condition resolved after treatment with vancomycin given alone. colitis following this combination of antibiotics has not been described previously.19873451227
neutralization of cytotoxic activity of clostridium difficile with fecal flora. 19873453624
cytotoxicity and antibiotic-associated diarrhea related to clostridium difficile. 19863465839
in vitro activity of imipenem against gram-positive anaerobic bacteria.the in vitro activity of imipenem, a new penem antibiotic, was determined against 210 clinical gram-positive anaerobic isolates and compared with the activities of metronidazole, clindamycin, cefoxitin, moxalactam, ceftizoxime, ceftriaxone and cefotiam. all investigated strains were inhibited by a 4-mg/l concentration of imipenem. cefoxitin demonstrated good activity against most strains with exception of some clostridium difficile and clostridium ramosum strains. cephalosporins were classed in ...19873473047
clostridium difficile colitis induced by cytarabine.pseudomembranous enterocolitis (pmc) has become a widely recognized syndrome of nausea, abdominal distention, and severe (frequently bloody) diarrhea (1). while this syndrome was first associated with the administration of clindamycin, almost all antimicrobial drugs can serve as predisposing agents (2). we wish to report a patient with typical pmc induced by the administration of cytarabine.19873477943
recovery of pefloxacin in saliva and feces and its action on oral and fecal floras of healthy volunteers.pefloxacin, a new fluoroquinolone, was given to 10 volunteers in single 400-mg oral doses repeated at 12-h intervals during 7 days. serum, saliva, and feces samples were collected before and at appropriate intervals after the initiation of treatment. drug concentrations were determined by bioassay. qualitative and quantitative analyses of the saliva and fecal floras were performed. mean concentrations in saliva (3.46 micrograms/ml on day 1 and 7.54 micrograms/ml on day 7) were closely related to ...19873481248
in vitro activity and beta-lactamase stability of the oral cephalosporin bmy-28100.bmy-28100 was compared with cephalexin, cefaclor, cefixime, and cefteram and found to be more active than the reference cephalosporins against staphylococcus aureus, staphylococcus epidermidis, streptococcus faecalis, and clostridium difficile. bmy-28100 was the next most active, after cefteram, against streptococcus pyogenes and streptococcus pneumoniae. against gram-negative bacteria, bmy-28100 showed similar activity to that of cefaclor. the antimicrobial activity of bmy-28100, including bact ...19873501756
[antimicrobial sensitivity of clostridium difficile]. 19873506279
lysosomal involvement in cellular intoxication with clostridium difficile toxin b.the process of internalisation of clostridium difficile toxin b into human lung fibroblasts was further studied, with the aim of elucidating the fate of endocytosed toxin. development of the toxin-induced cytopathogenic effect was reversibly inhibited at 18 degrees c and in the presence of 200 mm kcl or 1-20 mm benzyl alcohol, i.e. at conditions when the fusion between endosomes and lysosomes is prevented. fibroblasts treated with toxin at 37 degrees c but transferred to 18 degrees c within 10 m ...19863508493
in vitro activity of coumermycin in comparison to other non-beta-lactam antibiotics against staphylococci, streptococci, and clostridium difficile. 19873509379
enterocolitis in hirschsprung's disease: a controlled study of the etiologic role of clostridium difficile.cytopathic toxin neutralized by clostridium sordellii antiserum was found in the feces of seven out of 13 children with hirschsprung's disease complicated by enterocolitis (54%). clostridium difficile was isolated from ten of these 13 children (77%). the frequency of fecal toxin positivity, the magnitude of toxin titers, and the isolation rate of c difficile were all significantly greater in children with hirschsprung's enterocolitis than in children whose hirschsprung's disease was not complica ...19863511213
gnotobiotic models for study of the microbial ecology of clostridium difficile and escherichia coli.hamster flora introduced into germfree mice reduced the cecum to conventional size, suppressed populations of escherichia coli and clostridium difficile to the same degree that mouse flora did, and corrected the hypocellularity that is characteristic of the small bowel of germfree mice. a highly toxigenic strain of c. difficile readily induced cecitis in germfree and antibiotic-treated conventional mice, and histological examination frequently revealed pseudomembranes. toxins a and b were both d ...19863512730
bacterial diarrhoea.bacterial infections are important causes of diarrhoea in infants and children, particularly in developing countries and in other settings where standards of personal and community hygiene are low. knowledge of bacterial diarrhoeas has been significantly expanded in recent years by the finding that many episodes of acute diarrhoea are due to infections with bacteria which produce enterotoxins that interfere with intestinal fluid and electrolyte transport (the 'enterotoxigenic' diarrhoeas). sever ...19863514008
effect of clindamycin on the ability of a continuous culture of colonic bacteria to ferment carbohydrate.a continuous culture model of the proximal colon was used to study the effect of clindamycin on the ability of colonic bacteria to ferment carbohydrate. six steady state anaerobic cultures of human faeces, in a medium simulating ileostomy effluent, were treated with 26 micrograms/ml clindamycin. they were paired with six untreated cultures, run under identical conditions. clindamycin treatment eliminated the anaerobic bacteria, significantly decreased osmolality and the output of volatile fatty ...19863514388
[transfer of the cecal flora of the hamster to the germfree c3h mouse: use of this model to study the flora of the anti-clostridium difficile barrier].the purpose of this work was the research and development of an experimental model to study anti-clostridium difficile caecal microflora in the hamster. first the existence of this "barrier" was verified in conventional hamsters. then, the caecal flora from these animals was orally transferred to c3h germfree mice. the barrier effect was maintained in the axenic mice. the comparative bacteriological analysis of hamster and mouse feces did not reveal important variations in the dominant anaerobic ...19863516351
considerations in the laboratory diagnosis of antibiotic-associated gastroenteritis.clostridium difficile has been shown to be the major cause of antibiotic-associated gastroenteritis in both humans and experimental animals. during the past few years an increasing number of laboratories have attempted to detect, isolate, and identify this organism and its toxin from clinical samples. direct visualization of c. difficile in patient specimens using immunofluorescent microscopy has been proposed. the major disadvantage of this method was its lack of specificity due to crossreactio ...19863516548
detection of clostridium difficile toxin a by immunoblotting.a clinical isolate of clostridium difficile has been tested for its toxin production. both toxins, toxin a and toxin b, could be detected by tissue culture and in animal models as well. antibodies against a crude toxin a preparation have been prepared. these antibodies are able to neutralize the toxin both in the mouse lethality test and tissue culture test systems. the specificity of this antiserum has been analysed by electroimmunoprecipitation methods. using immunoblotting, it could be demons ...19863518293
comparison of minitek anaerobe ii, api an-ident, and rapid ana systems for identification of clostridium difficile.three commercial anaerobic systems, minitek (bbl microbiology systems, cockeysville, md), api an-ident (analytab products, plainview, ny), and rapid ana (innovative diagnostic systems, decatur, ga) were evaluated for ability to identify 45 clostridium difficile isolates accurately. minitek correctly identified 66% of c. difficile isolates to species, 27% were incompletely identified, and 7% were misidentified. most of the discrepancies with minitek were due to false negative biochemical results. ...19863518405
[clostridium difficile-induced enterocolitis: pathogenesis, clinical course, epidemiology and laboratory diagnosis].clostridium difficile-induced enterocolitis almost exclusively occurs associated with antibiotic exposure. the organisms produce several exotoxins of which toxins a (enterotoxin) and b (cytotoxin) are of primary importance. it is assumed that preceding antibiotic therapy creates an ecological niche allowing massive proliferation of the organisms and production of their toxins. the clinical course varies from mild diarrhoea to severe pseudomembranous colitis. patients over 40 years of age are pri ...19863519433
antibiotic-associated colitis caused by clostridium difficile: relapse and risk factors.relapse is a common sequel of antibiotic-associated colitis due to clostridium difficile. it has been suggested that cl. difficile may persist in the stools in spite of the resolution of symptoms after treatment and this may cause the relapse. our study was designed to define the factors that predispose to relapse and to determine if prolonging treatment to clear cl. difficile from the stools might prevent relapse. of 60 consecutive patients, 36 with more severe disease required treatment. treat ...19863520264
oral bacitracin vs vancomycin therapy for clostridium difficile-induced diarrhea. a randomized double-blind trial.the effectiveness of a ten-day course of either oral bacitracin or oral vancomycin hydrochloride for treatment of clostridium difficile-induced antibiotic-associated diarrhea was compared in a randomized double-blind study. bacitracin was as effective as vancomycin in resolving diarrhea; most patients responded within five days of therapy with either drug. three patients receiving bacitracin worsened during therapy; two of these were considered treatment failures. neither c difficile nor its tox ...19863521518
clostridium difficile in habitats other than the human gastro-intestinal tract. 19863522751
review of clostridium difficile-associated diseases.clostridium difficile has recently become recognized as an important nosocomial pathogen. this review summarizes what is known about the isolation of the organism, the spectrum of clinical disease, virulence factors, treatments, and methods of prevention. risk factors for c. difficile disease are also discussed. the most important risk factor is the use of certain antibiotics (ampicillin, cephalosporins, and clindamycin). c. difficile is associated with 96% to 100% of cases of pseudomembraneous ...19863524319
[adverse effects of antimicrobiological agents and countermeasures--clostridium difficile enteritis: with special reference to early diagnosis]. 19863531585
interaction of clostridium difficile and escherichia coli with microfloras in continuous-flow cultures and gnotobiotic mice.we studied the interactions between the entire cecal flora of hamsters and the pathogens clostridium difficile and escherichia coli in gnotobiotic mice and in a continuous-flow (cf) culture system in which the growth medium consisted of an extract of fecal pellets from germfree mice. cf cultures and germfree mice were colonized first with c. difficile and e. coli and then with the cecal flora of hamsters. both in vivo and in vitro hamster flora markedly suppressed the potential pathogens. conten ...19863533778
review of frequency-pulsed electron-capture gas-liquid chromatography studies of diarrheal diseases caused by members of the family enterobacteriaceae, clostridium difficile, and rotavirus. 19863533981
[isolation of clostridium difficile from the stools of hospitalized patients with diarrhea].408 stool samples from 354 hospitalized patients with diarrhea were evaluated for the presence of clostridium difficile. c. difficile was detected in stools of 42 patients (12%), 19 of them being hospitalized in neurosurgery units. the strains were cytotoxigenic in 31 cases and non cototoxigenic in 11 cases. the diagnosis of c. difficile induced diarrhea was based on the clinical setting [presence of diarrhea that could be attributed to antimicrobial therapy and endoscopy for detection of pseudo ...19863534766
[clostridium difficile--one of the causes of enterocolitis in man]. 19863538722
diagnosis of clostridium difficile-associated intestinal disease.toxigenic clostridium difficile is the major cause of antimicrobial agent-associated pseudomembranous colitis and is the etiological agent of approximately 30% of cases of nonspecific colitis and diarrhea (without colitis) induced by antimicrobial agents. in addition, c. difficile has been implicated in certain intestinal diseases not related to prior antimicrobial administration. c. difficile has been reported to be one of the most common enteropathogens isolated from stool specimens submitted ...19863539522
[clostridium difficile and its cytotoxin in the stools of young hospitalized children. influence of antibiotic treatment].clostridium difficile has been searched in 153 stool samples from 138 children aged 0 to 12 months. we divided the population in two groups depending on the antibiotic treatment. we have found c difficile in 39 samples (25%). the colonization rate increases with age ranging from 5% before 1 month, to 36% between 1 and 6 months and 54% between 6 and 13 months. an environmental sampling yielded once c difficile. contamination may be related to the environment. 29% of the isolates produced a cytopa ...19863543815
comparison of clostridium difficile detection by monolayer and by inhibition of nucleoside uptake.detection and identification of clostridium difficile toxin by traditional monolayer assay were compared with results obtained by a new procedure based on toxin-dependent inhibition of target cell uptake of a radioactive nucleoside. a high degree of correlation was noted between the two determinations. although the new procedure was quantitative and objective, its value is seen at present as a rapid screen that may support results obtained in monolayers and as a potential assay for other, curren ...19873544801
evaluation of aztreonam, cefoperazone, latamoxef and ceftazidime in the hamster colitis model.aztreonam, ceftazidime, cefoperazone and latamoxef (moxalactam) were evaluated in a hamster model for antibiotic-associated colitis. aztreonam, a novel monocyclic beta-lactam antibiotic specifically directed against aerobic gram-negative bacteria with limited activity against gram-positive and anaerobic bacteria did not cause haemorrhagic caecitis and death in hamsters when administered intraperitioneally or orally. quantitative caecal cultures showed no changes in the anaerobic caecal microflor ...19863546243
anaerobic infections and clostridium difficile colitis emerging during antibacterial therapy.almost all cases of clostridium difficile-related pseudomembranous colitis are related to antimicrobial therapy. virtually all antibacterial agents have been implicated, notable exceptions being vancomycin and parenterally administered aminoglycosides. the most prominent causes of colitis are ampicillin, clindamycin and various cephalosporins. in general, this complication is related to suppression of indigenous flora and overgrowth of c. difficile. in the case of ampicillin, however, c. diffici ...19863547621
effect of beta-lactam prodrugs on human intestinal microflora.the ampicillin prodrugs bacampicillin, pivampicillin, and talampicillin, the mecillinam prodrug pivmecillinam and the sulbactam prodrug sulbactam pivoxil all have a greatly improved oral availability compared to the parent drug. they show no antibacterial activity themselves until transformed into active drugs after absorption. this double advantage makes them less likely to influence the intestinal microbial ecosystem. ampicillin has been reported to cause marked changes in the colon microflora ...19863547627
pharmacokinetic differentiation and consequences for normal microflora.the pharmacokinetic properties of a drug are decisive for effective antibacterial therapy, the ability of the drug to reach a site of infection, but they also contribute to whether concentrations become undesirably high in places where the antibiotics are not wanted but where they may interfere with the normal microflora. the microflora in the intestines is particularly important because of the sheer numbers of bacteria present there and the consequences of imbalance such as diarrhoea and select ...19863547629
successful pregnancy in a renal transplant recipient taking cyclosporin a.a 27 year old woman with a fourth cadaveric renal transplant successfully completed a 33 week pregnancy whilst taking cyclosporin a and prednisolone. her renal function remained stable despite recurrent urinary tract infections, hypertension, gestational diabetes, and clostridium difficile associated diarrhea. the infant, delivered electively at 33 weeks, was small for gestational age but otherwise normal.19863551903
monospecific antibodies for detection of clostridium difficile enterotoxin.tests of polyclonal antisera to homogeneous enterotoxin preparations of clostridium difficile by immunoblotting demonstrated that cross-reactions occurred with proteins from cell lysates of nearly all clostridium species. there was a notable reduction in the amount of crossreaction when only culture supernatants were analysed. the enterotoxin could be easily identified by its unique high molecular weight of 230,000. the findings suggest that care must be taken when immunological tests other than ...19873552665
pseudomembranous colitis: a lethal complication of hirschsprung's disease unrelated to antibiotic usage.seventy-two new cases of hirschsprung's disease were seen between 1980 and 1985. twenty-six patients (36%) developed the clinical features of enterocolitis and, of nine patients who died, colitis was the immediate cause of death in six. histologic material was available from 20 patients with colitis; this showed nonspecific inflammation typical of hirschsprung's colitis in 13 cases but seven had pseudomembranous colitis (pmc). five of the patients with pmc had not recently been exposed to antibi ...19873559870
intestinal bacteria antagonistic to clostridium difficile in mice.overgrowth by clostridium difficile has been reported in conventional mice injected intraperitoneally with ampicillin. in this study, we aimed to determine which types of indigenous intestinal bacteria were eliminated by ampicillin to allow overgrowth by c. difficile. c. difficile overgrowth was associated with a decrease in the numbers of lactobacilli, an increase in bacteroidaceae and a slight decrease in the frequency of isolation of fusiform-shaped bacteria (clostridia). c. difficile cytotox ...19873560860
splenic abscess due to clostridium difficile and pseudomonas paucimobilis.extraintestinal infection by clostridium difficile is a rare entity. herein we describe a 62-yr-old man with c. difficile bacteremia complicated by a splenic abscess. of particular interest was the isolation of c. difficile and pseudomonas paucimobilis from the splenic abscess. prompt antibiotic therapy and splenectomy resulted in a favorable outcome. although rare, these organisms should be considered in the differential diagnosis of a splenic abscess.19873565349
suppression by saccharomyces boulardii of toxigenic clostridium difficile overgrowth after vancomycin treatment in hamsters.saccharomyces boulardii prevented the development of high counts of clostridium difficile, high titers of toxin b, and positive latex agglutination tests after cessation of vancomycin treatment for hamsters. the protocol used was designed to stimulate relapse of human c. difficile-associated colitis. s. boulardii was protective in this model.19873566236
comparative activity of metronidazole and tinidazole against clostridium difficile and peptostreptococcus anaerobius.broth dilution mics of metronidazole against 38 strains of clostridium difficile (0.13 microgram/ml) and 11 strains of peptostreptococcus anaerobius (0.11 microgram/ml) were lower than those of tinidazole (0.16 and 0.17 microgram/ml, respectively). as molar concentrations the nitroimidazoles were equally active. the mics of the two drugs correlated positively, and the relative activity of tinidazole increased with decreasing susceptibility of both species.19873566248
treatment of relapsing clostridium difficile diarrhoea by administration of a non-toxigenic strain.two patients with relapsing clostridium difficile diarrhoea following metronidazole and vancomycin therapy were colonised with a non-toxigenic avirulent clostridium difficile strain given orally in three doses. both patients appeared to respond without side-effects. oral bacteriotherapy with a defined nontoxigenic strain of clostridium difficile would appear to represent an acceptable, alternative and novel way to treat hospitalised patients who relapse with clostridium difficile diarrhoea after ...19873569251
therapy of relapsing clostridium difficile-associated diarrhea and colitis with the combination of vancomycin and rifampin.seven patients with multiple bacteriologic and symptomatic relapses of clostridium difficile-associated diarrhea and/or colitis were treated with vancomycin and rifampin in combination. diarrhea and abdominal pain promptly resolved in all, and neither c. difficile nor its toxin could be recovered from their stools shortly after therapy. however, stools of all patients subsequently became culture-positive for c. difficile and occasionally had demonstrable cytotoxin. except in one instance followi ...19873571889
correlation between susceptibility to chloramphenicol, tetracycline and clindamycin, and serogroups of clostridium difficile.a total of 114 clostridium difficile strains were analysed for a possible correlation between serological susceptibility to chloramphenicol, tetracycline and clindamycin, and serogrouping. all 17 chloramphenicol-resistant strains belonged to serovar i, while none of 32 tetracycline-resistant strains belonged to serovar i. all strains included in serovar iii were tetracycline- and clindamycin-resistant.19873574240
fatal clostridium difficile cellulitis. 19873575013
bowel flora changes in humans receiving cefixime (cl 284,635) or cefaclor.twelve healthy young male subjects received either cefixime, a new oral cephalosporin (cl 284,635), or cefaclor (six subjects on each drug) orally for 2 weeks. in the case of cefixime, single daily doses of 400 mg were taken; with cefaclor, the dosage was 250 mg three times daily. modest changes in the fecal flora were noted in both drug groups, but the changes were of different types. in the case of cefixime, there was more of an impact on the indigenous flora, and in the case of cefaclor, ther ...19873579262
clostridium difficile diarrhea in critically ill burned patients.we followed up 112 patients in the university of washington burn center, seattle, for the development of clostridium difficile diarrhea. diarrhea developed in 20 patients with a mean burn size of 42%, mean age of 38 years, and 49 mean total antibiotic days, for an incidence of 17%. eleven patients had 16 episodes of nonspecific diarrhea. nine patients had 11 episodes of c difficile-positive diarrhea and 15 episodes of nonspecific diarrhea for an incidence of 45% of all patients with diarrhea. th ...19873579579
prevalence of clostridium difficile in pseudomembranous and antibiotic-associated colitis in north india. 19863584906
the effects of clostridium difficile toxins a and b on membrane integrity and protein synthesis in intestinal cells in vivo and in vitro and in mccoy cells in vitro.clostridium difficile toxins a and b inhibited protein synthesis in mccoy tissue-culture cells but not in intestinal cells in vitro or in vivo. toxins a and b had no effect on membrane permeability of either intestinal cells or mccoy cells.19873585957
biological mode of action of clostridium difficile toxin a: a novel enterotoxin.antibody neutralisation and toxin a elution experiments showed that toxin a uptake from rabbit intestinal lumen was a continuous process. the kinetics of the ileal and colonic responses were significantly different; a much longer incubation (4 h) with toxin was required for colon, compared with 45 min for the ileum, to induce fluid accumulation at 12 h. fluid secretion was induced only when toxin had gained access to deeper tissues, probably achieved by several toxin uptake-tissue damage cycles. ...19873585958
pediatric gastroenteritis in primary care and in hospitalized patients.one-hundred and fifty-seven consecutive children below seven years of age (primary care n = 48, hospitalized patients n = 109) with acute gastroenteritis of assumed infectious origin were studied. rotavirus was demonstrated by electron microscopy of faeces in 44% of all patients. the occurrence of rotavirus among patients in primary care, 15%, was significantly lower than among hospitalized patients, 57% (p less than 0.01). adenovirus was isolated in six per cent and enterovirus in two per cent ...19873589234
differential effects of clostridium difficile toxins a and b on rabbit ileum.the pathogenesis of clostridium difficile enterocolitis appears to involve colonization of the bowel followed by release of toxin a, an enterotoxin, and toxin b, a cytotoxin. the purpose of this study was to determine the effect of purified toxins a and b on intestinal secretion, epithelial permeability, and morphology in perfused rabbit ileal loops. intestinal permeability after toxin exposure was assessed by blood-to-lumen clearance of [3h]mannitol. toxin a at doses of 5-100 micrograms/10 cm i ...19873596162
role of clostridium difficile toxins in disease. 19873596176
factors influencing the phagocytosis of clostridium difficile by human polymorphonuclear leukocytes.phagocytosis of clostridium difficile by human polymorphonuclear leukocytes (pmns) and the possible role of the clostridial toxins in this process were investigated. phagocytosis of c. difficile was independent of aerobiosis and clearly depended on opsonization. either complement or antibodies to c. difficile could serve as opsonins. toxigenic strains of c. difficile were more resistant to phagocytosis than were nontoxigenic strains. pretreatment of pmns with as much as 10,000 units of toxins fr ...19873596798
biochemical studies on the effect of clostridium difficile toxin b on actin in vivo and in vitro.we describe a simplified procedure for purification of clostridium difficile toxin b. in this procedure, cytotoxicity is associated with a single protein band with a molecular mass of 230 kilodaltons. we used direct fluorescent staining of actin filaments to study the effect of this toxin on cultured cells. morphologic changes were preceded by a decrease in the number and length of stress fibers followed by their disappearance with condensation of cellular actin around the nucleus. we then showe ...19873596804
role of volatile fatty acids in colonization resistance to clostridium difficile in gnotobiotic mice.clostridium difficile is an agent involved in the development of antibiotic-associated pseudomembranous colitis. the purpose of this work was to investigate the role of volatile fatty acids (vfas) in resistance to colonization by c. difficile by using a gnotobiotic animal model. accordingly, germfree mice were associated with different hamster flora, and the vfas in their cecal contents were measured by gas chromatography. the results showed that vfas were produced mainly by the intestinal flora ...19873596806
calcium and calmodulin in cellular intoxication with clostridium difficile toxin b.in cultured human lung fibroblasts treated with clostridium difficile toxin b, the development of the cytopathogenic effect was inhibited by the proton ionophore monensin but was not affected by some other ionophores. the calcium channel blockers verapamil and lacl3 protected the cells against intoxication, as did the calmodulin antagonists trifluoperazine, amitriptyline, r 24571, and dansylcadaverine. since these agents could not prevent intoxication when added after the toxin internalization w ...19873597551
the effects of acute clostridium difficile diarrhea on fecal nitrogen content in adult hospitalized patients.clostridium difficile diarrhea (cdd) is a frequent cause of hospital-associated infectious diarrhea and a common reason for nutritional consultation. limited data are available on fecal nitrogen losses during infectious diarrhea in adults. eleven patients with acute cdd were studied for stool volume and fecal nitrogen. the mean stool output was 630 +/- 110 g/day and fecal nitrogen 2.5 +/- 0.3 g per 24 hour period (mean +/- sem). fecal nitrogen loss was increased from the predicted 12.0 mg/kg bw/ ...19873598023
effect of various diets on toxin production by two strains of clostridium difficile in gnotobiotic mice.when axenic mice fed a commercial diet were monoassociated with two toxigenic strains of clostridium difficile, 100% of them died 3 days after inoculation and both enterotoxin and cytotoxin were produced in their intestinal tract. however, when axenic mice were fed various semisynthetic diets before c. difficile challenge, some of them survived and their fecal cytotoxin and enterotoxin productions were highly reduced, whereas the c. difficile population level did not decrease to a great extent. ...19873610315
commercial latex agglutination test for detection of clostridium difficile-associated diarrhea.a commercially available latex agglutination test for clostridium difficile was compared with a cell culture cytotoxin assay and bacteriological culture for the laboratory diagnosis of c. difficile-associated diarrhea and colitis (cad). stool specimens from 626 patients were tested by the three methods, and specimens from 118 patients (19%) were positive by at least one of the methods. the results of the three tests agreed in 88% of the specimens tested, overall, but they agreed in only 34% of t ...19873611316
the effects of clostridium difficile crude toxins and toxin a on ileal and colonic loops in immune and non-immune rabbits.rabbits were solidly immunised by parenteral injection of purified clostridium difficile toxin a such that they resisted an intravenous challenge with a normally lethal dose of toxin a. ileal and colonic loops constructed in non-immune and immune animals received challenge injections of crude culture filtrate or purified toxin a of c. difficile. protection of ileum was manifest after sufficient initial mucosal damage resulted in release of high levels of antitoxin a into the loop lumen of immune ...19873612743
clostridium difficile--a spectrum of virulence and analysis of putative virulence determinants in the hamster model of antibiotic-associated colitis.each of nine different toxigenic strains of clostridium difficile was administered orally to groups of hamsters pre-treated with clindamycin and housed individually in sterile isolator boxes. faecal pellets and caecal contents from well, diarrhoeic, moribund and freshly dead animals were analysed for c. difficile and toxins a (enterotoxin) and b (cytotoxin), and tissue obtained when animals were killed was examined histologically. not all strains were equally virulent in this model. four strains ...19873612744
[detection of clostridium difficile toxin by latex agglutination reaction]. 19873613165
[clostridium difficile and its cytotoxin in stools of hospitalized infants. effects of antibiotic treatment]. 19873619318
utility of a rapid latex test for the detection of clostridium difficile in fecal specimens.currently, the method of choice for the laboratory diagnosis of clostridium difficile disease is the detection of cytotoxin in stool filtrates by tissue culture. since many hospital laboratories do not have tissue culture facilities, there is a need for a rapid test which is both sensitive and specific to diagnose c. difficile disease. a commercial latex agglutination was compared with the conventional cytotoxin tissue culture assay for the detection of c. difficile or its toxin(s) in fecal spec ...19873619398
clostridium difficile. 19873620589
clostridium difficile-associated diarrhoea in uremic patients.an outbreak of 94 episodes of clostridium difficile-associated diarrhoea in 62 patients in a nephrology ward over a two-year period was investigated. quantitative stool cultures were performed on ten uremic patients not on antibiotics and without diarrhoea and on ten healthy controls. all diarrhoeal episodes were associated with clostridium difficile, and no other bacterial pathogens were isolated. thirty-two relapses occurred in 16 patients, fourteen of the relapses without preceding antibiotic ...19873622506
rapid detection of clostridium difficile toxin in faeces. 19873626930
[determination of the biological activity of clostridium difficile toxins in in vivo and in vitro experiments].the biological activity of the filtrates of 29 c. difficile strains was studied in vivo (suckling white mice) and in vitro (cell cultures of different species and origin). the action of the filtrates on the experimental models in vivo was evaluated from the cytotoxic effect index, while in vitro the intensity of the cytotoxic effect was evaluated from the percentage of dead cells in the monolayer. the results of the comparative determination of toxicity characteristics in vivo and in vitro demon ...19873630480
care study--clostridium difficile: enteric spread of infection. 19863635777
[medical topics: clostridium difficile diarrhea of patients with chronic disease; rounded blood cells of runners]. 19863650465
evaluation of gamma radiation levels for reducing pathogenic bacteria and fungi in animal sewage and laboratory effluents.sewage samples collected from animal wastes and from effluents at an animal disease laboratory were inoculated with known numbers of pathogenic organisms and subjected to various doses of gamma radiation from a 60co source. surviving test organisms were quantitatively determined by selective and enrichment techniques. the experiment was modeled as a quantal assay in which probit analysis was applied to obtain d10 values. the d10 value represents the irradiating dose required to reduce the popula ...19873651881
production of a unique cytotoxin by campylobacter jejuni.campylobacter jejuni is an important diarrheal pathogen worldwide; the mechanisms by which it causes disease remain unclear. because of its association with inflammatory diarrhea, we postulated that c. jejuni might produce a cytotoxin similar to that produced by shigella sp., enterohemorrhagic escherichia coli o157, or clostridium difficile. filtrates of 12 polymyxin-treated isolates of c. jejuni were placed on hela cells (sensitive to shiga toxin cytotoxicity) and chinese hamster ovary (cho) ce ...19873653987
isolation of clostridium difficile from diarrhoea patients in bangladesh.an attempt was made to detect clostridium difficile and its toxin from the stools of 20 patients with antibiotic-associated diarrhoea (aad), 35 with colitis, six with chronic diarrhoea and 300 with watery diarrhoea. two toxigenic and three non-toxigenic strains were isolated from patients associated with antimicrobial therapy. all 300 stools from watery diarrhoea patients, not associated with antibiotics, were negative for cl. difficile and its toxin. we conclude that cl. difficile might be a ca ...19873656496
vancomycin.vancomycin is a narrow-spectrum bactericidal antibiotic used primarily for treatment of serious staphylococcal infections. it is the alternative therapy of choice when the penicillins and cephalosporins cannot be used. vancomycin is also used in (1) methicillin-resistant staphylococcus aureus infections; (2) streptococcal endocarditis in conjunction with an aminoglycoside in patients intolerant of penicillin or ampicillin; (3) infections, including those involving prosthetic devices, caused by g ...19873657307
acute gastroenteritis in children attending day-care centres with special reference to rotavirus infections. i. aetiology and epidemiologic aspects.acute gastroenteritis (ge) among 214 children (aged 6 months-7 years) attending day-care centres (ddcs) in the copenhagen county was studied during a 12-month period. a total of 197 cases of ge was observed in 109 children (i.e. 51% of the participants). the aetiology was as follows: rotavirus (n = 48) (24%), pathogenic bacteria (n = 11) (6%), giardia lamblia (n = 3) (2%), while the aetiology of 68% remains unknown. the pathogenic bacteria included yersinia enterocolitica, thermophilic campyloba ...19873661178
susceptibility of clostridium difficile to metronidazole, its bioactive metabolites and tinidazole. 19873665909
detection of clostridium difficile toxin in various tissue culture monolayers.thirty stool filtrates known to contain clostridium difficile toxin based on previous testing on mccoy cells were tested for toxicity on primary african green monkey kidney (agmk), mccoy, mrc-5, primary rhesus monkey kidney (rmk), and vero cells. all 30 filtrates showed cytotoxic effect at greater than or equal to 1:100 dilution on mccoy and vero cells. a total of 22 filtrates were positive on mrc-5 monolayers, while only 16 and 10 filtrates showed positive cytotoxic effect on agmk and rmk cells ...19873667920
quantitative cell-adhesion assay for clostridium difficile cytotoxin.a quantitative assay for clostridium difficile cytotoxin has been developed, based on the observation that suspended fibroblasts exposed to cytotoxin fail to adhere to plastic. a dye-binding technique was used to quantitate adherent cells, in order to obviate microscopy. adherent bhk cells were fixed with glutaraldehyde and cell protein was stained with coomassie blue r-250. cell-bound dye was eluted and estimated spectrophotometrically. the amount of eluted dye was proportional to the number of ...19873669053
diarrhoea associated with clostridium difficile. 19873672820
[evaluation of an experimental animal model allowing the study of the cecal microflora in the hamster, antagonistic to clostridium difficile].the purpose of this study was the development and evaluation of an experimental model allowing the investigation of hamster anti-clostridium difficile coecal microflora. the existence of this "barrier" was verified in conventional hamsters. such hamster coecal flora was then orally transferred to c3h germ-free mice. in such animals, the "barrier effect" was maintained. after treatment with erythromycin, the colonization resistance was always maintained; despite two subsequent processes, dilution ...19863674782
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