| risk factors for the development of clostridium difficile-associated diarrhea during a hospital outbreak. | to evaluate the risk factors associated with a nosocomial outbreak of clostridium difficile-associated diarrhea. | 1991 | 2071877 |
| first, the bad news... | | 2004 | 15238469 |
| hospitals battling outbreaks of c. difficile. | | 2004 | 15238481 |
| risk of clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. | antibiotic disruption of the normal intestinal flora is a well-known risk factor for clostridium difficile-associated diarrhea. reduced gastric acidity has been suggested as a risk factor, and we hypothesized that proton pump inhibitors, because of their potency, may be an independent risk factor for this problem. | 2004 | 15238493 |
| clostridium difficile infection in hospitals: risk factors and responses. | | 2004 | 15238495 |
| clostridium difficile: a formidable foe. | | 2004 | 15238496 |
| c. difficile hits sherbrooke, que., hospital: 100 deaths. | | 2004 | 15337714 |
| quebec puts up 20 million dollars for c. difficile fight. | | 2005 | 15738479 |
| c. difficile: will lessons be learned? | | 2005 | 15851697 |
| clostridium difficile-associated diarrhea in 200 canadian children. | clostridium difficile-associated diarrhea is a major problem in adults. the present study was conducted to assess risk factors and outcomes in children with c difficile-associated diarrhea. | 2005 | 16107901 |
| emergence of fluoroquinolones as the predominant risk factor for clostridium difficile-associated diarrhea: a cohort study during an epidemic in quebec. | since 2002, an epidemic of clostridium difficile-associated-diarrhea (cdad) associated with a high case-fatality rate has involved >30 hospitals in the province of quebec, canada. in 2003, a total of 55% of patients with cdad at our hospital had received fluoroquinolones in the preceding 2 months. it has been suggested that massive use of proton pump inhibitors might have facilitated this epidemic. | 2005 | 16206099 |
| a predominantly clonal multi-institutional outbreak of clostridium difficile-associated diarrhea with high morbidity and mortality. | in march 2003, several hospitals in quebec, canada, noted a marked increase in the incidence of clostridium difficile-associated diarrhea. | 2005 | 16322602 |
| management and outcomes of a first recurrence of clostridium difficile-associated disease in quebec, canada. | during an epidemic of clostridium difficile-associated disease (cdad) caused by a strain that is a hyper-producer of toxins a and b, the frequency of a first recurrence after metronidazole treatment of the initial episode doubled in 2003-2004, compared with 1991-2002. | 2006 | 16477549 |
| treatment of first recurrences of clostridium difficile-associated disease: waiting for new treatment options. | | 2006 | 16477550 |
| in vitro susceptibility of clostridium difficile clinical isolates from a multi-institutional outbreak in southern québec, canada. | clostridium difficile isolates from a 2004 outbreak in québec, canada, were all found to be susceptible to metronidazole, vancomycin, rifampin, and meropenem but resistant to bacitracin, cefotaxime, ciprofloxacin, and levofloxacin, and most (>80%) were resistant to ceftriaxone, clarithromycin, gatifloxacin, and moxifloxacin. the predominant nap1 isolates were susceptible to clindamycin, while the nap2 isolates were resistant. | 2006 | 17005836 |
| a portrait of the geographic dissemination of the clostridium difficile north american pulsed-field type 1 strain and the epidemiology of c. difficile-associated disease in québec. | an increase in the incidence and severity of clostridium difficile-associated disease in québec and the united states has been associated with a hypervirulent strain referred to as north american pulsed-field type 1 (nap1)/027. | 2007 | 17173224 |
| impact of emergency colectomy on survival of patients with fulminant clostridium difficile colitis during an epidemic caused by a hypervirulent strain. | to determine whether emergency colectomy reduces mortality in patients with fulminant clostridium difficile-associated disease (cdad), and to identify subgroups of patients more likely to benefit from the procedure. | 2007 | 17245181 |
| clostridium difficile-associated diarrhoea rates and global antibiotic consumption in five quebec institutions from 2001 to 2004. | a massive outbreak of a new clostridium difficile clone affected the province of quebec between 2002 and 2004. there are several theories as to the exact cause of the emergence of this new clone, including the overuse of some classes of antibiotics. antibiotic prescription is associated with c. difficile-associated diarrhoea (cdad), but which class has the highest risk is still the subject of debate. we analysed the global antibiotic consumption patterns in five institutions in quebec, three in ... | 2007 | 17644347 |
| impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of clostridium difficile-associated disease caused by the hypervirulent nap1/027 strain. | a series of measures were implemented, in a secondary/tertiary-care hospital in quebec, to control an epidemic of nosocomial clostridium difficile-associated disease (n-cdad) caused by a virulent strain; these measures included the development of a nonrestrictive antimicrobial stewardship program. interrupted time-series analysis was used to evaluate the impact of these measures on n-cdad incidence. from 2003-2004 to 2005-2006, total and targeted antibiotic consumption, respectively, decreased b ... | 2007 | 17683015 |
| c. difficile outbreaks in gatineau, sault ste. marie. | | 2007 | 17698816 |
| risk of clostridium difficile-associated disease among patients receiving proton-pump inhibitors in a quebec medical intensive care unit. | our study was conducted to determine whether use of gastric acid-suppressive agents increased the risk of clostridium difficile-associated disease (cdad) in a medical intensive care unit of one of the first hospitals to be threatened by the current cdad epidemic in quebec, canada. our findings suggest that efforts to determine risk factors for cdad should focus on other areas, such as older age and antibiotic use. | 2007 | 17926283 |
| the changing face of clostridium difficile: what treatment options remain? | in this issue of the journal, an article by pepin et al. documents the shifting sands of the modern-day clostridium difficile epidemic as seen in quebec. pepin and coauthors' observation that the superior activity of vancomycin over metronidazole has been lost since the emergence there of the hypervirulent strain nap1/027 in 2003 has implications for the future treatment of c. difficile-associated diarrhea (cdad). this editorial explores these, particularly in complicated cases and high-risk pop ... | 2007 | 18042108 |
| risk of clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. | perioperative antibacterial prophylaxis (pap) is an important component of surgical site infection prevention but may be associated with adverse effects, such as clostridium difficile infection (cdi). since the emergence of a hypervirulent strain of c. difficile, the risk of development of cdi after pap has not been evaluated. the purpose of this study was to determine the risk of pap-induced cdi after selected surgical procedures and to compare such risk before with such risk after the emergenc ... | 2008 | 18462108 |
| outcomes of clostridium difficile-associated disease treated with metronidazole or vancomycin before and after the emergence of nap1/027. | to reassess the comparative efficacy of vancomycin versus metronidazole in the treatment of clostridium difficile-associated disease (cdad) after the emergence in 2003 of the hypervirulent nap1/027 strain. | 2007 | 17900327 |
| c. difficile inquest too narrow as "quebec strain" goes international. | | 2007 | 17389432 |
| multipronged intervention strategy to control an outbreak of clostridium difficile infection (cdi) and its impact on the rates of cdi from 2002 to 2007. | at the end of 2002, a new, more virulent strain of clostridium difficile, designated bi/nap1, was the cause of a massive outbreak of infection in the province of quebec. this particular strain was associated with a dramatic increase in morbidity and mortality among affected patients in 2003-2004. we tested and implemented a multipronged infection control approach to curtail the rate of c. difficile infection (cdi). | 2009 | 19125681 |
| narrative review: the new epidemic of clostridium difficile-associated enteric disease. | antibiotic-associated diarrhea and colitis were well established soon after antibiotics became available. early work implicated staphylococcus aureus, but in 1978 clostridium difficile became the established pathogen in the vast majority of cases. in the first 5 years (1978 through 1983), the most common cause was clindamycin, the standard diagnostic test was the cytotoxin assay, and standard management was to withdraw the implicated antibiotic and treat with oral vancomycin. most patients respo ... | 2006 | 17116920 |
| lack of increased colonization with vancomycin-resistant enterococci during preferential use of vancomycin for treatment during an outbreak of healthcare-associated clostridium difficile infection. | to assess whether use of oral vancomycin for treatment during an outbreak of clostridium difficile infection (cdi) was associated with increased rates of colonization with vancomycin-resistant enterococci (vre). | 2010 | 20518636 |
| epidemiological patterns and hospital characteristics associated with increased incidence of clostridium difficile infection in quebec, canada, 1998-2006. | to explore epidemiological patterns of the incidence of clostridium difficile infection (cdi) and hospital characteristics associated with increased incidence during nonepidemic and epidemic years. | 2010 | 20677973 |
| fluoroquinolones and risk for methicillin-resistant staphylococcus aureus, canada. | receipt of fluoroquinolones was the predominant risk factor for clostridium difficile-associated disease (cdad) during an epidemic in quebec, canada. to determine the role of antimicrobial drugs in facilitating healthcare-associated methicillin-resistant staphylococcus aureus (mrsa) colonization and infection and to compare this role with their effects on methicillin-susceptible s. aureus infection and cdad, we conducted a retrospective cohort study of patients in a quebec hospital. for 7371 epi ... | 2006 | 17073089 |
| infection acquisition following intensive care unit room privatization. | patients in intensive care units (icus) often acquire infections, which impose a heavy human and financial burden. the use of private rooms may reduce the acquisition of certain pathogens, but the limited evidence on this topic is inconsistent. | 2011 | 21220658 |
| molecular analysis of clostridium difficile pcr ribotype 027 isolates from eastern and western canada. | the prevalence and characteristics of pcr ribotype 027 strains of clostridium difficile have come into question following recent outbreaks in eastern canada and elsewhere. in order to determine the distribution of this strain in other regions in canada, we screened a bank of 1,419 isolates recovered from three different canadian health regions between 2000 and 2004. among isolates from a montreal area hospital, pcr ribotype 027 strains represented 115/153 strains (75.2%) from 2003 to 2004, but r ... | 2006 | 16757612 |
| epidemic clostridium difficile. | | 2006 | 16544388 |
| antibacterial properties of a glycolipid-rich extract and active principle from nunavik collections of the macroalgae fucus evanescens c. agardh (fucaceae). | this study investigated the antibacterial activity of glycolipid-rich extracts of the brown macroalga fucus evanescens in cell culture. accessions were collected on the arctic coast of ungava bay, nunavik, quebec. the crude ethyl acetate extract of these accessions showed strong antibacterial activity (≥4 log(10) cfu) against hemophilus influenzae , legionella pneumophila , propionibacterium acnes (atcc and clinical isolate), and streptococcus pyogenes at 100 µg/ml. this algal extract inhibited ... | 2011 | 21859295 |
| quebec strain of c. difficile in 7 provinces. | | 2006 | 16505449 |
| seasonal variations in clostridium difficile infections are associated with influenza and respiratory syncytial virus activity independently of antibiotic prescriptions: a time series analysis in quebec, canada. | seasonal variations in clostridium difficile-associated diarrhea (cdad), with a higher incidence occurring during winter months, have been reported. although winter epidemics of respiratory viruses may be temporally associated with an increase in cdad morbidity, we hypothesized that this association is mainly due to increased antibiotic use for respiratory infections. the objective of this study was to evaluate the effect of the two most frequent respiratory viruses (influenza virus and respirat ... | 2011 | 22106208 |
| poor infection control, not fluoroquinolones, likely to be primary cause of clostridium difficile-associated diarrhea outbreaks in quebec. | | 2006 | 16447121 |
| quebec's official numbers: 409 c. difficile deaths. | | 2005 | 16301691 |
| toxin production by an emerging strain of clostridium difficile associated with outbreaks of severe disease in north america and europe. | toxins a and b are the primary virulence factors of clostridium difficile. since 2002, an epidemic of c difficile-associated disease with increased morbidity and mortality has been present in quebec province, canada. we characterised the dominant strain of this epidemic to determine whether it produces higher amounts of toxins a and b than those produced by non-epidemic strains. | 2005 | 16182895 |
| mortality attributable to nosocomial clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in quebec. | since 2002 an epidemic of clostridium difficile-associated disease (cdad) caused by a hypervirulent toxinotype iii ribotype 027 strain has spread to many hospitals in quebec. the strain has also been found in the united states, the united kingdom and the netherlands. the effects of this epidemic on mortality and duration of hospital stay remain unknown. we measured these effects among patients admitted to a hospital in quebec during 2003 and 2004. | 2005 | 16179431 |
| c. difficile may have killed 2000 in quebec: study. | | 2005 | 16179430 |
| uk launches inquiry into clostridium difficile outbreak. | | 2005 | 16027424 |
| quebec reports c. difficile mortality statistics. | | 2005 | 15956018 |
| increasing risk of relapse after treatment of clostridium difficile colitis in quebec, canada. | clinicians who treat patients with clostridium difficile-associated diarrhea (cdad) in quebec, canada, have noted an apparent increase in the proportion of patients who experience relapse. | 2005 | 15889355 |
| c. difficile strain 20 times more virulent. | | 2005 | 15883397 |
| clarification of article on clostridium difficile--associated colitis. | | 2005 | 15751556 |
| [what is so difficult ... with c. difficile?]. | | 2005 | 15686207 |
| quebec to report on clostridium difficile in 2005. | | 2004 | 15451825 |
| clostridium difficile-associated diarrhea in a region of quebec from 1991 to 2003: a changing pattern of disease severity. | recent reports suggest that clostridium difficile colitis may be evolving into a more severe disease. during the second half of 2002 we noted an increase in the number of patients with severe c. difficile-associated diarrhea (cdad) in our institution. we describe cases of cdad at our institution over a 13-year period and investigate changes in illness severity. | 2004 | 15337727 |
| quebec strikes committee on clostridium difficile. | | 2004 | 15262874 |
| clostridium difficile disease in a department of surgery. the significance of prophylactic antibiotics. | a clustering of clostridium difficile-associated disease in a department of surgery prompted a program of infection control and the evaluation of contributing factors. fifty patients had diarrhea and positive assays for c difficile cytotoxin during the study period. twenty-one of the 36 cases that developed among patients admitted to the surgical services occurred on two adjacent general surgery wards that shared attending surgeons and house staff. perioperative prophylactic antibiotics predated ... | 1991 | 1992999 |
| clostridium difficile infections in a canadian tertiary care hospital before and during a regional epidemic associated with the bi/nap1/027 strain. | since 2002, an epidemic of clostridium difficile infections has occurred in southern quebec, canada. at hôpital maisonneuve-rosemont, montreal, quebec, canada, the incidence of c. difficile infections increased from 11/1,000 admissions (1999 to 2002) to 27/1,000 admissions (2003 to 2005). we compared the exposures and outcomes for patients infected with strains with different ribopatterns isolated before (n = 55) and during (n = 175) the epidemic, as well as the in vitro activities of antibiotic ... | 2008 | 18573937 |
| ontario's hospitals surpass those of quebec in c. difficile rates. | | 2008 | 18559796 |
| [clostridium difficile infections: an unexpected re-emergence]. | | 2008 | 18178330 |
| patterns of antibiotic use and risk of hospital admission because of clostridium difficile infection. | previous observations have indicated that infection with clostridium difficile occurs almost exclusively after exposure to antibiotics, but more recent observations have suggested that prior antibiotic exposure may be less frequent among cases of community-acquired disease. | 2008 | 18838451 |
| established and potential risk factors for clostridum difficile infection. | clostridium difficile is the aetiological agent for almost all cases of pseudo membranous colitis and 15-25% of antibiotic associated diarrhoea. in recent years, c. difficile associated disease (cdad) has been increasing in frequency and severity due to the emergence of virulent strains. severe cases of toxic mega colon may be associated with mortality rates of 24-38%. the prevalence of cdad is global and the incidence varies considerably from place to place. in the initial stages of its discove ... | 2009 | 19736396 |
| comparative metagenomic study of alterations to the intestinal microbiota and risk of nosocomial clostridum difficile-associated disease. | this study investigated the relationship between hospital exposures, intestinal microbiota, and subsequent risk of clostridium difficile-associated disease (cdad), with use of a nested case-control design. the study included 599 patients, hospitalized from september 2006 through may 2007 in montreal, quebec, from whom fecal samples were obtained within 72 h after admission; 25 developed cdad, and 50 matched controls were selected for analysis. nonsteroidal anti-inflammatory drugs and antibiotic ... | 2010 | 21050115 |
| evaluation of automated repetitive-sequence-based pcr (diversilab) compared to pcr ribotyping for rapid molecular typing of community- and nosocomial-acquired clostridium difficile. | automated repetitive pcr (rep-pcr; diversilab) was compared to pcr ribotyping of the 16s-23s rna intergenic spacer of clostridium difficile (cd) as the "gold standard" method for cd typing. pcr products were separated on diversilab labchips (biomérieux, st. laurent, quebec, canada) utilizing a 2100 bioanalyzer (agilent technologies, santa clara, ca) operating the diversilab v1.4 assay. bioanalyzer data were exported to a secure diversilab website and analyzed with diversilab v3.4 software. repli ... | 2011 | 21596222 |
| impact of a multipronged education strategy on antibiotic prescribing in quebec, canada. | background. antibiotic overuse and resistance have become a major threat in the last 2 decades. many programs tried to optimize antibiotic consumption in the inpatient setting, but the outpatient environment that represents the bulk of antibiotic use has been challenging. following a significant rise of clostridium difficile infections, all the health care stakeholders in the province of quebec, canada initiated a global education program targeting physicians and pharmacists. methods. a bundle a ... | 2011 | 21791439 |
| community-acquired clostridium difficile-associated diarrhea, montréal, 2005-2006: frequency estimates and their validity. | a retrospective search for community-acquired clostridium difficile-associated diarrhea in 15 hospitals revealed important discrepancies with numbers for the same period reported in real time to the surveillance system. several of the observed problems could be solved by implementing case-by-case notification with subsequent investigation by local public health, as for other reportable diseases. | 2011 | 21931255 |
| the effects of the transforming care at the bedside program on perceived team effectiveness and patient outcomes. | the objective of the study was to document the impact of transforming care at the bedside (tcab) program on health care team's effectiveness, patient safety, and patient experience. a pretest and posttest (team effectiveness) and a time-series study design (patient experience and safety) were used. the intervention (the tcab program) was implemented in 8 units in a multihospital academic health science center in montreal, quebec, canada. the impact of tcab interventions was measured using the te ... | 2017 | 28027197 |
| a decade of experience in primary prevention of clostridium difficile infection at a community hospital using the probiotic combination lactobacillus acidophilus cl1285, lactobacillus casei lbc80r, and lactobacillus rhamnosus clr2 (bio-k+). | in august 2003, the 284-bed community hospital pierre-le gardeur (plgh) in quebec experienced a major outbreak associated with the clostridium difficile nap1/027/bi strain. augmented standard preventive measures (spms) were not able to control this outbreak. it was decided in february 2004 to give to every adult inpatient on antibiotics, without any exclusion, a probiotic (bio-k+: lactobacillus acidophilus cl1285, lactobacillus casei lbc80r, and lactobacillus rhamnosus clr2) within 12 hours of t ... | 2015 | 25922400 |
| [include representations of caregivers coping with nosocomial clostridium difficile in quebec to promote better health]. | | 2013 | 23986384 |
| impact of adding prophylactic probiotics to a bundle of standard preventative measures for clostridium difficile infections: enhanced and sustained decrease in the incidence and severity of infection at a community hospital. | in 2003, hospitals in quebec, canada experienced an increase of nap1/027 clostridium difficile infections following antibiotic administration (cdiaa). at pierre-le gardeur hospital (plgh), the incidence increased from 10 to over 25 cases per 1000 patient admissions. | 2013 | 23931498 |
| trends in the use of laboratory tests for the diagnosis of clostridium difficile infection and association with incidence rates in quebec, canada, 2010-2014. | several clostridium difficile infection (cdi) surveillance programs do not specify laboratory strategies to use. we investigated the evolution in testing strategies used across quebec, canada, and its association with incidence rates. | 2017 | 28549882 |