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pharmacokinetic properties of the cephalosporins.most cephalosporins can only be administered parenterally. among agents that are absorbed from the gastrointestinal tract, those with bioavailabilities of 85 to 90% include cefroxadine, cefadroxil, cefsumide, cephalexin, cephradine, cephacetrile, and cefazaflur. most cephalosporins are eliminated rapidly, with serum half-lives (t1/2s) of 1 to 2 hours. exceptions are cefonicid with a t1/2 of 4.4 hours, cefpiramide with a t1/2 of 5.0 hours, and cefotetan with a t1/2 of 3.5 hours. the longest half- ...19873319507
diarrhea in the intensive care unit: the role of hypoalbuminemia and the response to a chemically defined diet (case reports and review of the literature).we describe five patients who developed acute kwashiorkor-like hypoalbuminemia during their hospitalization in the intensive care unit. with the initiation of enteral alimentation, diarrhea ensued and continued for at least 48 hours. routine evaluation for the cause of diarrhea including stool culture for enteric pathogens, white blood cells, ova and parasites, clostridium difficile cytotoxin, and flexible sigmoidoscopy was negative. when a peptide based formula (vital hn, ross laboratories, col ...19873121713
cellular internalisation of clostridium difficile toxin a.the cytopathogenic effect of toxin a from clostridium difficile was studied in cultured human lung fibroblasts. the final effect was dependent on toxin concentration and exposure time. binding of the toxin to cells occurred at 0 degrees c as well as at 37 degrees c. the latency before appearance of the cytopathogenic effect was dose-dependent with a minimum of 45 min. the appearance of a cytopathogenic effect in toxin-treated cells was prevented by the addition of trypsin, antitoxin, lysosomotro ...19873148814
extra-intestinal clostridium difficile. 19873153598
[activity of fusidic acid on strictly anaerobic bacteria].fusidic acid is a well known antimicrobial agent due to its narrow spectrum of activity against gram positive bacteria and especially staphylococci. therefore, it is after used preventively against bacterial infection in traumatology, but the susceptibility of anaerobic bacteria is not well known. we have studied, the in vitro activity of sodium fusidate against 147 strains of anaerobic bacteria. this antibiotic has a moderate activity against bacteroides, more significant against clostridium, p ...19873302863
[implantation of clostridium difficile in infants during antibiotherapy].in the adults, it is known that antibiotics allow colonization by c. difficile and its multiplication, in infants this facts is discussed. to study the influence of antibiotic treatment on the colonization of infants' intestinal tract by c. difficile, we searched this bacteria twice a week in hospitalized newborns since their birth. the population was divided in 2 groups: one never received any antibiotic, the other was treated with beta-lactams. c. difficile was isolated on appropriated selecti ...19873302865
[experiences with ceftazidime in the therapy of neonatal infections].our experience of ceftazidime during the last three years has in almost every respect been favourable. as monotherapy it has resulted in clinical responses at least as good as those from gentamicin and ampicillin. the pharmacokinetics and activity of ceftazidime are far superior to those of gentamicin. we have not been able to demonstrate any significant haematological or biochemical side effects of ceftazidime therapy nor does it adversely affect neonatal blood clotting mechanisms. the incidenc ...19873312037
automation in clinical microbiology: a new approach to identifying micro-organisms by automated pattern matching of proteins labelled with 35s-methionine.a new rapid automated method for the identification and classification of microorganisms is described. it is based on the incorporation of 35s-methionine into cellular proteins and subsequent separation of the radiolabelled proteins by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (sds-page). the protein patterns produced were species specific and reproducible, permitting discrimination between the species. a large number of gram negative and gram positive aerobic and anaerobic orga ...19873312300
symposium on antimicrobial agents. metronidazole.metronidazole, a nitroimidazole derivative, is a unique antimicrobial agent that is active against both bacterial and parasitic organisms, although only the anaerobic members of these groups are susceptible. it has been used for the treatment of trichomoniasis for almost 30 years and is also effective in amebiasis and giardiasis. more recently, metronidazole has emerged as a principal agent for the treatment of anaerobic infections. it is highly effective against all species of anaerobes except ...19873312851
[reactive arthritis in enteral infections].certain gastrointestinal tract infections can trigger reactive arthritis. the best known triggering agents are yersinia, salmonella, shigella, campylobacter jejuni, and possibly clostridium difficile. the clinical findings show a subacute onset of mono- or oligoarthritis, less often of asymmetric polyarthritis with predominance of the lower limbs. the clinical picture is somewhat modified by the genetic constitution (hla type) of the patient. hla-b27-positive patients appear to have more severe ...19873326361
application of whole-cell dna restriction endonuclease profiles to the epidemiology of clostridium difficile-induced diarrhea.two patients in one hospital room acquired pseudomembranous colitis, one shortly after the other. the dna restriction patterns of isolates from the patients and of four isolates from the environment were indistinguishable from one another and differed from isolates of other patients. restriction endonuclease digest analysis appears to be a useful method for studying the epidemiology of clostridium difficile.19873033017
susceptibility of clostridium difficile to ly146032. 19873036501
application of chromosomal restriction endonuclease digest analysis for use as typing method for clostridium difficile.the usefulness of restriction endonuclease analysis of chromosomal dna as a typing method for clostridium difficile was tested. over four months all faecal samples were routinely cultured for c difficile. dna of all isolated strains was isolated and tested with the restriction endonuclease hind iii. the patterns obtained after electrophoresis in agarose gels seemed to be strain specific. antibiotic susceptibility profiles agreed with the results of the restriction endonuclease analysis, though t ...19873040811
bmy 28100, a new oral cephalosporin.bmy 28100, a new oral cephalosporin with a (z)-propenyl side chain at the 3 position and a p-hydroxyphenylglycyl substituent at the 7 position, was evaluated in comparison with cefaclor and cephalexin and, when appropriate, ampicillin and vancomycin. in vitro, bmy 28100 was more active than the reference cephalosporins against streptococci, staphylococcus aureus, staphylococcus epidermidis, listeria monocytogenes, haemophilus influenzae, propionibacterium acnes, clostridium perfringens, and clos ...19873105449
isolation of clostridium difficile and detection of cytotoxin in the feces of diarrheic foals in the absence of antimicrobial treatment.clostridium difficile was isolated from the feces of 27 of 43 diarrheic foals (63%), and cytotoxin was detected in feces from 28 diarrheic foals (65%). the foals had not received any antimicrobial treatment before the onset of diarrhea. c. difficile was not isolated from feces of 18 normal foals without diarrhea and 62 adult horses (p less than 0.005). this finding of c. difficile and its toxins in association with diarrhea in foals adds another possible cause to the list of infectious agents wh ...19873112178
susceptibility of anaerobic bacteria to fce 22101.the activity of fce 22101 against 675 strains of anaerobic bacteria was determined by an agar dilution method. its activity was compared with those of benzylpenicillin, piperacillin, cefoxitin, imipenem, clindamycin, metronidazole, chloramphenicol, vancomycin, fusidic acid, and bacitracin. fce 22101 and imipenem (mic, less than or equal to 0.5 mg/liter) were the most active agents against the anaerobic strains tested, except against clostridium difficile strains. on the basis of these results, f ...19873038012
is clostridium difficile endemic in chronic-care facilities? 19872886846
investigation of clostridium difficile diarrhoea in a district general hospital: room for improvement?a retrospective survey of case-notes was carried out on all patients investigated for possible clostridium difficile diarrhoea during a 1-month period at a district general hospital. seven of 29 patients probably had the disease, but no case of pseudomembranous colitis was documented. delay in reporting and discrepancies between culture and cytotoxin results contributed in several cases to mismanagement. in 14 of 16 cases negative by culture and cytotoxin, a plausible non-microbiological case fo ...19872891751
successful treatment of relapsing clostridium difficile colitis with lactobacillus gg. 19872892070
clostridium difficile, sulphasalazine, and ulcerative colitis.clostridium difficile has been implicated in the relapse of ulcerative colitis. controversy exists over this role and its relationship to sulphasalazine exposure. sixty two of 77 patients with a documented relapse of ulcerative colitis were investigated for the presence of clostridium difficile, or its toxin, prior to hospitalization. there was a low incidence of detection which was related to antibiotic exposure (2/62). sampling during the treatment period showed that the occurrence of clostrid ...19872897683
association between production of toxins a and b and types of clostridium difficile.one hundred and seventy two strains of clostridium difficile isolated from 62 patients with antibiotic associated diarrhoea or pseudomembranous colitis were analysed for the production of toxins a and b and typed using 35s-methionine labelling followed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (sds-page). there was a correlation between production of toxins a and b and the type of c difficile. one hundred and forty four of 172 strains were either high or low producers of both ...19873123524
surveillance cultures and benefit of laminar airflow units in patients undergoing bone marrow transplantation.the effectiveness of gastrointestinal and topical decontamination, as well as isolation in laminar airflow (laf) units were investigated in 20 patients. on a weekly basis, surveillance cultures were taken. environmental controls were taken on the medical ward outside the two laf units and from the laf unit itself when being used by a patient. the use of laf units seems to be of benefit in preventing exogenous infections, but there are two weak points in the isolation techniques: the opening of t ...19873121516
prophylactic antibiotics for patients undergoing elective biliary tract surgery: a prospective randomized study of cefotiam and cefoperazone.cefotiam, a second generation cephalosporin and cefoperazone, a third generation cephalosporin have a broad spectrum of activity against a majority of organisms commonly found in the bile. although cefoperazone is excreted into the human bile to a greater extent than is cefotiam, there are no comparative data available that cefoperazone prophylaxis is safer and more effective than cefotiam for patients undergoing biliary tract surgery. a prospective randomized study was performed to compare the ...19872952826
[isolation and diagnosis of clostridium difficile]. 19872961468
molecular cloning and expression of clostridium difficile toxin a in escherichia coli k12.clostridium difficile toxin a was purified to homogeneity and was used to raise monospecific antiserum in rabbits. a gene bank of c. difficile dna in escherichia coli was constructed by cloning sau3a-cleaved clostridial dna fragments into the bacteriophage vector lambda embl3. out of 4500 plaques screened with antitoxin a, 9 clones were positively identified. one of these clones lambda ta5 expressed a 235 kda protein which exhibited a cytotonic effect on chinese hamster ovary cells, and had the ...19872961615
molecular cloning of clostridium difficile toxin a gene fragment in lambda gt11.toxin a of clostridium difficile has been purified and monospecific antiserum produced. a reliable procedure for isolation and restriction of c. difficile chromosomal dna was developed which allowed for the construction of a genomic library in lambda gt11. approx. 35,000 plaques were screened using anti-toxin a which resulted in the identification of one stable positive clone, lambda cd19. verification of the immunological identity of the isolated toxin a gene fragment in lambda cd19 was determi ...19873030812
hypoalbuminemia as an indicator of diarrheal incidence in critically ill patients.recently, we noted that substantial numbers of critically ill patients admitted to a medical icu developed diarrhea. we checked them for infectious, metabolic, and untoward medication effects, which were negative. we next considered a possible causal relation between reduced serum albumin and diarrhea. to document the frequency of diarrhea in this population, explore the relation between hypoalbuminemia and diarrhea, and make a preliminary assessment of a peptide-based, chemically defined diet i ...19873105959
comparative in vitro activity of ly146032 (daptomycin), a new lipopeptide antimicrobial.the in vitro activity of ly146032, a new cyclic lipopeptide antibiotic, was compared with those of vancomycin, teicoplanin, and either oxacillin or ampicillin by determining agar dilution mic values for 304 clinical gram-positive isolates. ly146032 had superior in vitro activity against oxacillin-resistant staphylococci when compared to vancomycin or teicoplanin. against oxacillin-sensitive staphylococci, group jk-diphtheroids, streptococci, listeria monocytogenes and clostridium difficile, ly14 ...19873032607
purification of clostridium difficile toxin a by affinity chromatography on immobilized thyroglobulin.an efficient, single-step method for isolating highly purified toxin a from clostridium difficile culture filtrates is described. the purification procedure was based on the affinity binding and release of toxin a to bovine thyroglobulin conjugated to agarose beads. the toxin strongly bound at 4 degrees c to the carbohydrate binding determinant gal alpha 1-3gal beta 1-4glcnac, a carbohydrate sequence which occurs on bovine thyroglobulin. toxin bound to thyroglobulin at 4 degrees c, allowing its ...19873112015
detection of clostridium difficile toxins a and b. 19873115085
toxin a from clostridium difficile binds to rabbit erythrocyte glycolipids with terminal gal alpha 1-3gal beta 1-4glcnac sequences.the binding of toxin a isolated from clostridium difficile to rabbit erythrocyte glycolipids has been studied. total lipid extracts from rabbit erythrocytes were subjected to thin-layer chromatography and toxin-binding glycolipids detected by using 125i-labeled toxin a in a direct binding overlay technique. two major and several minor toxin-binding glycolipids were detected in rabbit erythrocytes by this method. the results of structural analyses of the major toxin-binding glycolipids were consi ...19873115180
clostridium difficile toxin b induces reorganization of actin, vinculin, and talin in cultured cells.clostridium difficile toxin b is a powerful cytopathic agent which causes animal cells in culture to become rounded and arborized, an effect similar to that induced by the cytochalasins. in this study, we demonstrated that the morphological effects of the toxin are directed specifically against the actin and related components of the cytoskeleton. dramatic disruption and reorganization of the actin stress fibers were detectable prior to significant changes in cell shape and alterations in the mi ...19883121372
efficacy and safety of cefpirome (hr810).sixty adult patients with suspected systemic bacterial infections were treated with cefpirome 1 g or 2 g twice daily for 5-22 days. forty-seven patients were evaluable for clinical efficacy. diagnoses in evaluable patients were urinary tract infections (20), pneumonia (10), soft tissue infections (17), and bone and joint infections (4); four patients had two infections each. nine patients were bacteraemic and all were cured; the responsible bacteria were escherichia coli (6), streptococcus pneum ...19883204079
ciprofloxacin in combination with metronidazole.ciprofloxacin has a reduced activity against anaerobic pathogens. therefore, a combination of ciprofloxacin with an antimicrobial agent active against anaerobes, such as metronidazole, seems to be interesting for the treatment of mixed aerobic/anaerobic infections. high metronidazole concentrations (10 mg/l or 40 mg/l) neither affected the bactericidal efficacy of ciprofloxacin on aerobic pathogens, such as escherichia coli, staphylococcus aureus, pseudomonas aeruginosa and enterococcus faecalis ...19883182096
the in-vitro activity of pd127,391, a new quinolone.mics of pd127,391 a new 4-quinolone, and of ci934 and ciprofloxacin, two previously reported 4-quinolones, were determined for common clinical bacterial isolates by an agar-dilution method. pd127,391 was the most active drug against enterobacteriaceae and acinetobacter spp (mics less than 0.12 mg/l) and as active as ciprofloxacin against aeromonas spp. (mics less than 0.008 mg/l) and pseudomonas aeruginosa (mics less than 1 mg/l). it was more active than ciprofloxacin against pseudomonas spp. in ...19883182416
clostridium difficile colitis following antiviral therapy in the acquired immunodeficiency syndrome. 19883163893
a multicenter study of the in vitro antianaerobic activity of cefotetan compared with other antimicrobial agents.the in vitro antianaerobic activity of cefotetan was compared with that of chloramphenicol, clindamycin, cefoxitin, and penicillin in a multicenter study. both agar dilution and broth microdilution testing procedures, as described by the national committee for clinical laboratory standards (nccls), were employed; a total of 1,377 strains were examined. results were interpreted using the u.s. food and drug administration- and nccls-recommended criteria. this study indicates that bacteroides fragi ...19883163901
in vitro activity of cefotetan compared with that of other antimicrobial agents against anaerobic bacteria.the activity of cefotetan against 430 strains of anaerobic bacteria was compared with that of cefoxitin, ceftizoxime, clindamycin, metronidazole, and chloramphenicol. percent susceptible values for the bacteroides fragilis group were 60, 80, 29, 86, 100, and 100%, respectively. percent susceptible values for the b. fragilis species were 91, 92, 46, 98, 100, and 100%, respectively. non-b. fragilis-group bacteroides species were inhibited very well (90 to 100%) by all drugs except ceftizoxime (80% ...19883163908
[clostridium difficile in the colon of patient with pseudomembranous colitis and contamination of environment]. 19883150408
[bacteriologic and serologic diagnosis of enteral infections].infections of the gastrointestinal tract still are numerous, ranging on the second place after infections of the respiratory tract. some of them show quite severe or prolonged course. in contrast to other infections, especially those of the urinary tract, laboratory diagnostic of enteritis is only scarcely ordered. during the last ten years new methods and knowledge of etiologic germs like campylobacter, yersinia, various types of e. coli, clostridium difficile, rotavirus, adenovirus, giardia, b ...19883054377
actin-specific adp-ribosyltransferase produced by a clostridium difficile strain.by screening possible adp-ribosyltransferase activities in culture supernatants from various clostridium species, we have found one clostridium difficile strain (cd196) (isolated in our laboratory) that is able to produce, in addition to toxins a and b, a new adp-ribosyltransferase that was shown to covalently modify cell actin as clostridium botulinum c2 or clostridium perfringens e iota toxins do. the molecular weight of the cd196 adp-ribosyltransferase (cdt) was determined to be 43 kilodalton ...19883137166
[fundamental studies on the growth of clostridium difficile--the effect of medium ph on the germination & proliferation of spores]. 19883138331
pancreatic abscess caused by clostridium difficile.the first known case of pancreatic abscess caused by clostridium difficile in a patient with no history of diarrhea or previous antibiotic therapy is presented. after surgical intervention and antibiotic therapy with metronidazole (500 mg every 8 h) and cefotaxime (1 g every 8 h) the patient recovered completely.19883141163
clostridium difficile toxin a perturbs cytoskeletal structure and tight junction permeability of cultured human intestinal epithelial monolayers.toxin a of clostridium difficile causes severe inflammatory enterocolitis in man and animals that appears to be mediated in part by acute inflammatory cells that migrate into the toxin a-exposed mucosa. to determine the direct effects of toxin a on intestinal epithelial permeability and structure in the absence of other modulating factors, we used cultured monolayers of a human intestinal epithelial cell line (t84). a toxin a concentration of 7 x 10(-1) micrograms/ml (3 x 10(-9) m) nearly abolis ...19883141478
advances in ulcerative colitis.ulcerative colitis is one of the two common chronic inflammatory bowel diseases which affect the colon of children. the disease can occur at any time during infancy and childhood and is far commoner than crohn's disease of the colon in children less than 6 years old. the jewish population outside of israel is at far greater risk of developing the condition than any other ethnic group. the reason for this is unknown. the chances of a family member developing the condition is 2-3 times as great as ...19883050919
pseudomembranous colitis induced by clostridium difficile. 19883077615
incidence and significance of clostridium difficile in hospitalized cancer patients.the aim of the study was to assess the incidence and clinical significance of clostridium difficile in patients in our cancer center. over a period of seven consecutive months, 557 stools samples obtained from 156 hospitalized cancer patients (37 leukemic patients receiving oral antimicrobial prophylaxis and 119 patients from whom a stool sample was sent to the laboratory) were analyzed for the presence of clostridium difficile. clostridium difficile and/or its toxin was recovered from 13 (35%) ...19883134231
computer-aided densitometric analysis of protein patterns of clostridium difficile.the applicability of whole-cell protein patterns obtained by sodium dodecylsulfate-polyacrylamide gel electrophoresis as a typing method for clostridium difficile was examined using a total of 227 strains isolated from 191 patients and their surroundings. computer-aided densitometric analysis was used to establish a reliable standardization technique with which a large number of protein patterns could be efficiently classified. the normalized tracks could be electronically superimposed and compa ...19883134233
characterization of cross-reactive proteins detected by culturette brand rapid latex test for clostridium difficile.clostridium sporogenes, peptostreptococcus anaerobius, and bacteroides asaccharolyticus have been reported to react in the culturette brand rapid latex test (marion scientific, div. marion laboratories, inc., kansas city, mo.) for clostridium difficile. from the results of this study we showed that c. sporogenes and p. anaerobius produce a protein which is very similar biochemically and immunologically to the protein of c. difficile that is detected by the test. thus, the positive latex reaction ...19883128574
[domestic animals as excreters of clostridium difficile]. 19883048969
diagnosis of infectious diarrheal diseases.for many years, microbiologic examination of feces was focused on the isolation of two members of the family enterobacteriaceae--salmonellae and shigellae. over the past two decades, other enteric pathogens such as the various classes of diarrheagenic e. coli, campylobacter, vibrio spp., yersinia enterocolitica, and clostridium difficile have gained prominence. a newly recognized protozoan parasite, cryptosporidium is now known to infect both immunocompetent and immunodeficient individuals. adde ...19883074126
correlation between serogroup and susceptibility to chloramphenicol, clindamycin, erythromycin, rifampicin and tetracycline among 308 isolates of clostridium difficile.the susceptibility to chloramphenicol, clindamycin, erythromycin, rifampicin and tetracycline of 308 isolates of clostridium difficile from various origins was determined by a disc diffusion susceptibility testing and the results were compared with the serogroup of the strains. for the five antimicrobials, there was a clear-cut separation between susceptible and resistant strains. some correlation between resistance and serogroup was found. almost all of the 161 isolates of serogroups a, f, g, h ...19883053559
isolation of shiga toxin-resistant vero cells and their use for easy identification of the toxin.shiga toxin-resistant vero cells were isolated by treatment of the cells with nitrosoguanidine. these mutant cells were not affected by shiga toxin at more than 1 microgram/ml, although the parent vero cells were sensitive to 25 pg of the toxin per ml. immunofluorescence studies showed that all the mutant cells had lost toxin-binding capacity. the cytotoxic activities of various bacterial cultures against the parent and mutant cells were compared. all samples from 10 strains of shigella dysenter ...19883045003
[in vitro activity of a combination of amoxicillin-clavulanic acid on anaerobic bacteria].one hundred and one anaerobes isolated from clinical specimen were examined for their susceptibility to amoxicillin, alone or in combination with clavulanic acid, cefoxitin, cefotetan, cefotaxime, piperacillin and metronidazole. tested strains were as follow: 90 bacteroides fragilis group, 16 bacteroides bivius and 5 clostridium difficile. for 54 strains combination amoxicillin-sulbactam were also studied. minimal inhibitory concentrations (mics) were determined by agar dilution method on wilkin ...19883054746
[in vitro activity of beta-lactams, clindamycin and metronidazole on clostridium difficile].in one year and a half period 47 clostridium difficile were isolated from stool samples. isolates with questionable morphologic features were identified using sugars fermentation, gaz liquid chromatography (glc). cytotoxin assay was performed on mac coy cells. the comparative susceptibilities to amoxicillin-clavulanic acid (amc), cefotetan (ctt), cefoxitin (fox), cefotaxime (ctx), latamoxef (mox), mezlocillin (mez), piperacillin (pip), clindamycin (clin) and metronidazole was tested using minima ...19883054747
[clostridium difficile in children and adolescents undergoing anticancer and antimicrobial chemotherapy. the possibility of nosocomial acquisition].we looked for c. difficile and its cytotoxin among children and adolescents treated with diverse kinds of cancer chemotherapy in an oncologic ward of a pediatric hospital. most of them were also given multiple antibiotic treatments, susceptible of making c. difficile colonization easier due to the modification of the intestinal ecosystem. as the colonization may have an external origin, we also looked for c. difficile in the environment. 14 patients have been studied and we found cytotoxic strai ...19883054763
evaluation of a computer-assisted method of analysing sds-page protein profiles in tracing a hospital outbreak of serratia marcescens.sodium dodecyl sulphate-polyacrylamide gel electrophoresis (sds-page) profiles of bacterial proteins have been successfully used for taxonomical purposes. more recently this technique has been applied to epidemiological investigations in respect of various micro-organisms including neisseria meningitidis, staphylococcus aureus and clostridium difficile. the main limitations of the methods so far described are lack of standardisation in extraction and separation as well as in the analysis of resu ...19883060541
results of a prospective, 18-month clinical evaluation of culture, cytotoxin testing, and culturette brand (cdt) latex testing in the diagnosis of clostridium difficile-associated diarrhea.an 18-mo evaluation of culture, cytotoxin, and latex testing for clostridium difficile was performed between july 1, 1985, and december 31, 1986, on 1,536 specimens from 1,406 patients during evaluation of diarrhea. all cases with at least one test positive were investigated for clinical status. there were 144 clostridium difficile-associated diarrhea (cad) patients; 139 (97%) were positive by culture, 96 (67%) by cytotoxin, and 98 (68%) by latex testing. in the 1,262 non-cad patients with diarr ...19883066571
management and prevention of bacterial diarrhea.the etiology, pathogenesis, transmission and communicability, diagnosis, and management of infectious diarrhea are reviewed. infectious diarrhea is common in both industrialized and unindustrialized areas of the world. better understanding of the etiology and pathogenesis and identification of "new" enteric pathogens has resulted in the use of a variety of drugs to relieve symptoms or to effect a clinical cure. both host and microbial virulence factors are key in the acquisition of diarrheal ill ...19883069286
bacterial-induced diarrhoea.in diverse parts of the world, many bacterial strains have been recognised as the causative agents of diarrhoea. great achievements have been made in perceiving the varied mechanisms which explain their intestinal pathogenicity. these achievements include the elucidation of the 5 mechanisms of disease production by escherichia coli, the mechanisms of action of shigella, salmonella, campylobacter and yersinia, new information about antimicrobial-associated colitis caused by clostridium difficile ...19883069445
[nosocomial nature of antibiotic-induced intestinal clostridium infections caused by clostridium difficile]. 19883069610
the histopathology of the hemolytic uremic syndrome associated with verocytotoxin-producing escherichia coli infections.verocytotoxin-producing escherichia coli (vtec) infection was present in three cases of hemolytic uremic syndrome (hus), two fatal and one non-fatal, in which detailed histopathologic investigations were conducted. two patients had a prodrome of bloody diarrhea, one of whom required a hemicolectomy for severe bleeding. the renal histopathology was characterized primarily by glomerular thrombotic microangiopathy (tma) with greater than 95% of glomeruli showing changes of capillary wall thickening ...19883047052
partial characterization of the enzymatic activity associated with the binary toxin (type c2) produced by clostridium botulinum.clostridium botulinum produces a binary toxin that possesses a heavy chain (approximately 100,000 daltons) and a light chain (approximately 50,000 daltons). the heavy chain is a binding component that directs the toxin to vulnerable cells, and the light chain is an enzyme that has mono(adp-ribosyl)ating activity. a number of experiments have been done to help characterize the enzymatic activity of the toxin. the data reveal that the enzyme has a ph optimum within the range of 7.0 to 8.0. it is n ...19883121511
infectious complications in four long-term recipients of the jarvik-7 artificial heart.this article describes the infectious complications that occurred among four of the longest-term recipients of the jarvik-7 artificial heart. infection arising from the drive lines, with spread to the mediastinal periprosthetic space, was the major limiting factor in long-term use of the device in these patients. periprosthetic infections were due to coagulase-negative staphylococci, staphylococcus aureus, pseudomonas aeruginosa, and other pseudomonas species. other infectious complications incu ...19883336199
[comparative characterization of the morphologic changes induced by the cytotoxic action of a filtrate of clostridium difficile strain b in cell cultures].investigations carried out by the authors have demonstrated the possibility of the simultaneous evaluation of the results of the quantitative and qualitative characterization of the cytotoxic action of the filtrate of c. difficile strain b in the cultures of diploid human cells and cells fl. the action of the filtrate used in the same dilution (1:1,000) over equal incubation periods (15 minutes) has resulted in the appearance of different morphological changes in each of these cultures. the degr ...19883188732
diagnosis of clostridium difficile-related disease. 19883195507
yield of stool cultures, ova and parasite tests, and clostridium difficile determinations in nosocomial diarrheas.stool cultures for bacterial pathogens, ova and parasites, and clostridium difficile are usually ordered for patients with nosocomial diarrhea. in the interest of cost containment we undertook an 18-month retrospective study to assess the cost/benefit of performing each of these three tests. during the study period nosocomial diarrhea developed in 118 patients. of 452 bacterial stool cultures ordered, only one was positive for campylobacter jejuni and none for ova and parasites. however, of 126 ...19883207206
immunoblots and plasmid fingerprints compared with serotyping and polyacrylamide gel electrophoresis for typing clostridium difficile.two new methods for typing clostridium difficile, immunoblotting and plasmid fingerprinting, were compared with serotyping and polyacrylamide gel electrophoresis (page). of these methods, immunoblotting was found to be the most valuable for use in a comprehensive typing system. more groups could be distinguished by immunoblotting than by serotyping or page. immunoblotting results were also more reproducible and distinctive than results by page. plasmid fingerprinting was an excellent marker for ...19883343314
fast protein purification of clostridium difficile cytotoxin. 19883215944
impact of cefixime on the normal intestinal microflora.the ecological effects on the normal intestinal microflora after cefixime tablets in doses of 200 mg twice daily for 7 days were studied in 10 healthy volunteers. stool specimens were collected before and 2, 4, 7, 14 and 21 days after start of treatment. plasma samples were collected during 12 h after the first dose on day 1 and 1 sample was taken on day 7 for bioassay of cefixime concentration. peak plasma concentration of cefixime occurred after about 4 h with a mean of 3.0 mg/l. the mean auc0 ...19883222669
species-specific oligonucleotide probes for rrna of clostridium difficile and related species.the large copy number of rrna makes it an appealing target for oligonucleotide probes designed to identify microorganisms. given that nucleotide sequences in rrna are known to reflect phylogeny, species-specific rrna probes should be feasible if the sequences found in closely related species are different. we sequenced portions of the 16s rrna of three closely related clostridia found in the human colonic microflora: clostridium bifermentans, c. sordellii, and c. difficile. the rrnas of these th ...19883230127
electrophoretic characterization of clostridium difficile strains isolated from antibiotic-associated colitis and other conditions.clostridium difficile has been recognized as the cause of antibiotic-associated pseudomembranous colitis and of less severe diarrheal diseases associated with the use of antimicrobial agents. however, healthy carriers of this microorganism have been found, particularly healthy neonates and small children. various typing systems have been used to clarify the epidemiology of c. difficile. we used the electrophoretic patterns of edta-extracted proteins to characterize c. difficile strains from vari ...19883356792
[study of an epidemic of clostridium difficile-associated diarrhea].twenty three clostridium difficile strains isolated from diarrheic faecal samples of 22 patients in a neurosurgical department of the pellegrin hospital in bordeaux between january 1984 and may 1987 (15 isolated in 1984, 2 in 1985, 3 in 1986 and 3 in 1987) and 15 strains isolated from 15 patients in other departments of the same hospital in 1984 have been compared using their antimicrobial susceptibility, cytotoxin production and electrophoretic pattern. twelve of the 15 strains isolated in the ...19883231846
in vitro activity of flomoxef in comparison to other cephalosporins.flomoxef and cefazolin had nearly the same activity against staphylococci, which was stronger than that of other cephalosporins. against streptococcus pyogenes, streptococcus agalactiae and streptococcus pneumoniae, cefotaxime and cefazolin were more active than flomoxef, but the other cephamycins were less active than flomoxef. in comparison to the other cephalosporins, latamoxef and flomoxef had higher activity against branhamella catarrhalis, whereas cefotaxime, latamoxef and cefotetan were m ...19883372024
studies on the resistance of clostridium difficile to antimicrobial agents.the susceptibility of c. difficile isolated at the department of medical microbiology of the university of zurich to a wide selection of antibacterial, antimycobacterial and antifungal agents was tested in vitro. great differences in susceptibility were found against chloramphenicol, clindamycin, erythromycin, rifamycin, and tetracycline. resistance to clindamycin and erythromycin could always be transferred jointly to a susceptible c. difficile strain by mixed culture on filters at low frequenc ...19883376619
in vitro activities of two oxazolidinone antimicrobial agents, dup 721 and dup 105.the antibacterial activities of dup 105 and dup 721, new oxazolidinone antimicrobial agents, were compared with those of beta-lactams and glycopeptides. ninety percent of staphylococcus aureus and staphylococcus epidermidis isolates, including methicillin-resistant isolates, were inhibited by 4 micrograms of dup 105 and 1 microgram of dup 721 per ml. dup 721 inhibited hemolytic streptococcus groups a, b, c, f, and g at a concentration of less than or equal to 1 microgram/ml, and it inhibited vir ...19883377467
an evaluation of a rapid latex test for the diagnosis of clostridium difficile-associated diarrhea.we present here the results of an evaluation of a rapid latex test for detection of cl. stridium difficile-associated in comparison with our standard cytotoxin assay and culture for c. difficile. some 515 diarrheal stools were examined. c. difficile was cultured from 70 specimens (13.5%); 53 specimens (10.2%) were positive with the latex test, and 50 (9.6%) by cytotoxin assay. the latex test did not differ significantly from the cytotoxin assay in sensitivity or specificity compared to culture r ...19883241736
[occurrence of clostridium difficile in the feces of children of rio de janeiro, rj, brazil]. 19883252437
clostridium difficile toxins a and b inhibit human immune response in vitro.two clostridium difficile toxins isolated from strain vpi 10463 were tested for their effect on different human t-cell proliferation systems. in mitogen- and antigen-driven t-cell proliferation systems, toxins inhibited the proliferative response in a dose-dependent fashion. in interleukin-2-driven culture systems, no effect of toxins could be found on preactivated t cells. we suspected that monocytes were the influenced cells, since in antigen- and mitogen-driven systems monocytes were necessar ...19883128476
reactive arthritis associated with clostridium difficile enteritis.reactive arthritis of one or more peripheral joints developed after an enteric infection with clostridium difficile in 2 adult patients. other reactive signs such as conjunctivitis, mucous membrane lesions and urethritis were absent. one patient had the hla-b27 antigen. short term followup showed a benign course of the arthritis. three other cases of arthritis associated with c. difficile were reviewed.19883259987
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
identification and molecular cloning of a 70 kda species-specific antigen common to clostridium difficile.three common antigens (cb 1, 2 and 3), characteristic of clostridium difficile species were identified by immunoblot analysis using homologous and heterologous rabbit antisera, raised against whole cells from 9 distinct strains of c. difficile. a gene library of c. difficile genomic dna was constructed in escherichia coli by cloning in sau 3a-cleaved clostridial dna fragments into the bacteriophage vector lambda embl3. out of 3000 plaques screened using the whole cell antisera, 27 clones were po ...19883273466
prospective study comparing imipenem-cilastatin with clindamycin and gentamicin for the treatment of serious surgical infections.surgical infection remains a leading cause of hospital morbidity and mortality. we compared the efficacy and toxicity of imipenem-cilastatin sodium in 32 patients with that of clindamycin phosphate and gentamicin sulfate in 25 patients. in the imipenem-cilastatin group, 87.5% had a favorable outcome, with a 12.5% failure rate and 13 adverse reactions. in the clindamycin-gentamicin group, 80% had a favorable outcome, with a 20% failure rate and ten adverse reactions. two significant superinfectio ...19883277587
effect of inoculum size on detection and recovery of clostridium difficile in selective broth cultures. 19883278014
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
infections after experimental cadaver bone marrow transplantation in beagle dogs. transplantations with and without selective gastrointestinal decontamination.experimental transplantations of cadaver bone marrow (bmt) in beagle dogs were performed to evaluate the problems and potentials in a preclinical setting. the effectiveness of selective decontamination of the gut (sd) and gnotobiotic surveillance in preventing infections during longer aplastic periods was investigated. three groups of dogs were compared. group a: controls. group b: dogs with bmt, without sd and irregular gnotobiotic surveillance. group c: dogs with bmt, with sd and regular gnoto ...19883283036
cloning and expression of secreted antigens of clostridium difficile in escherichia coli.the feasibility of the cloning and expression of clostridium difficile antigens in escherichia coli was investigated. the expression of a limited number of cloned clostridial antigens under the control of clostridial promoter elements in e. coli was observed.19883286505
haemolytic uraemic syndrome and pseudomembranous colitis.two cases of haemolytic uraemic syndrome (hus) associated with pseudomembranous colitis (pmc) are described. the toxin of clostridium difficile was detected post mortem in the stool of one patient and the other patient showed a good therapeutic response to oral vancomycin, an antibiotic with established efficacy in the management of pmc. when associated with hus, pmc is probably an independent specific disease that, in common with many other infections, may activate hus.19883153053
evaluation of a commercial latex test for clostridium difficile for reactivity with c. difficile and cross-reactions with other bacteria.seventy-eight species of bacteria (739 isolates) were tested for reactivity with a commercial latex test for clostridium difficile. all noncytotoxic as well as cytotoxic strains of c. difficile reacted positively. immuno-specific cross-reactions were found only with c. sporogenes, proteolytic c. botulinum, and peptostreptococcus anaerobius.19883235677
clostridium difficile infection in patients with haematological malignant disease. risk factors, faecal toxins and pathogenic strains.two hundred and forty-eight patients from shared oncology and general medical wards were prospectively studied over a 6-month period for carriage of clostridium difficile during an outbreak of clinical disease with an epidemic strain of the organism. risk factors for infection were assessed. acute leukaemia and/or its treatment were identified as significantly increasing the risk of infection. the relationship between the type of c. difficile isolated (as defined by a typing system based on the ...19883123260
clostridium difficile associated diarrhoea: a report of seven cases. 19883241980
purification and characterization of clostridium sordellii hemorrhagic toxin and cross-reactivity with clostridium difficile toxin a (enterotoxin).hemorrhagic toxin (toxin ht) was purified from clostridium sordellii culture filtrate. the purification steps included ultrafiltration through an xm-100 membrane filter and immunoaffinity chromatography, using a monoclonal antibody to toxin a of clostridium difficile as the ligand. toxin ht migrated as a major band with a molecular weight of 525,000 and a minor band at 450,000 on nondenaturing gradient polyacrylamide gel electrophoresis. the molecular weight was estimated at 300,000 by sodium do ...19883128481
purification and characterisation of two forms of toxin b produced by clostridium difficile.toxin b from clostridium difficile was purified to homogeneity by gel filtration and high resolution ion exchange chromatography. two forms of toxin b were found. form 1 which seemed to consist of two identical subunits of 220-300 kda; femtogram amounts of this toxin induced rounding of fibroblast cells. form 2 contained subunits of 43 kda and 105 kda; the stoichiometric ratio probably being 4:1; picogram amounts were needed to induce rounding of fibroblast cells. immunological studies suggested ...19883133248
in vitro activity of cefotaxime against clinically significant pathogens.the present in vitro antibacterial activities of cefotaxime and 8 other cephalosporins (cefoperazone, cefmenoxime, cefpiramide, latamoxef, cefamandole, cefmetazole, cefotiam and cephazolin) were evaluated simultaneously in 384 strains of gram-positive cocci, 595 strains of enterobacteriaceae, 240 strains of non-fermenters and 143 strains of anaerobes and miscellaneous organisms. the results were expressed as minimum inhibitory concentration (mic) range, mic50 and mic90. of the beta-lactams, cefo ...19883260852
clostridium difficile plasmid isolation as an epidemiologic tool.a large hospital outbreak of clostridium difficile diarrhea at the minneapolis veterans administration medical center (mvamc) was studied by plasmid profile typing. plasmids were obtained from 30 (37%) of 82 clinical isolates from mvamc patients and 10 (67%) of 15 non-mvamc isolates. while bacteriophage plus bacteriocin typing and polyacrylamide gel electrophoresis (page) plus bacterial agglutination typing proved more universally applicable, plasmid profiles may be useful for tracing isolated e ...19883134239
antimicrobial susceptibility of clostridium difficile determined by disc diffusion and breakpoint methods.the susceptibility of 160 isolates of clostridium difficile to eight antimicrobial agents was studied by two methods. there was generally good agreement between the results obtained with the disc diffusion and breakpoint methods. more than 90% of isolates studied were considered sensitive by both methods. however there was a major difference between the results obtained with the two methods for penicillin g and clindamycin, resistance to both agents being overestimated by the disc diffusion meth ...19883263353
[epidemiological study of the pathogenicity of clostridium difficile using a new serogrouping method]. 19883272512
laboratory diagnosis of clostridium difficile-associated diarrhoea.this paper reviews the various laboratory procedures available for the isolation and identification of clostridium difficile and the detection of toxins produced by this organism. laboratories should be selective in determining which patients require investigation for clostridium difficile-associated diarrhoea. transport and storage of stool specimens at 4 degrees c is recommended when delays in processing may occur. tissue culture techniques are still the best method for detection of cytotoxin ...19883141153
effect of toxins produced by various clostridium difficile strains on cecum size reduction in gnotobiotic mice.inoculation of axenic mice with clostridium difficile strains induced a significant reduction in ceca weight (dry or wet), whereas a nontoxinogenic strain led to a partial reduction. a strain, which produces cytotoxin and no enterotoxin in vivo, caused a reduction similar to that observed with a nontoxinogenic strain. simultaneous cytotoxin and enterotoxin production by various c. difficile strains caused the cecum size to diminish to that observed for conventional control mice.19883143476
clostridium difficile: its disease and toxins.clostridium difficile is the etiologic agent of pseudomembranous colitis, a severe, sometimes fatal disease that occurs in adults undergoing antimicrobial therapy. the disease, ironically, has been most effectively treated with antibiotics, although some of the newer methods of treatment such as the replacement of the bowel flora may prove more beneficial for patients who continue to relapse with pseudomembranous colitis. the organism produces two potent exotoxins designated toxin a and toxin b. ...19883144429
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