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Mario Vitali, Martino Mistretta, Giovanni Alessandrini, Giovanna Coriale, Marina Romeo, Fabio Attilia, Claudia Rotondo, Francesca Sorbo, Fabiola Pisciotta, Maria Luisa Attilia, Mauro Ceccanti
RIASSUNTO. BACKGROUND: Nonostante la rilevanza clinica ed epidemiologica della compresenza di disturbi psichiatrici nella popolazione di pazienti con disturbo da abuso di alcol (DUA), c'è un'importante lacuna nella definizione di metodi e strategie di intervento farmacologiche condivise. Tra le molteplici proposte terapeutiche, non esiste un modello che si sia rivelato valido ed efficace per la gestione farmacologica della doppia diagnosi (DD) in ambito alcologico. Il trattamento non ottimale del disturbo mentale in comorbilità con DUA può portare a un aumento nel rischio di ricadute, con maggiori difficoltà nel mantenere l'astensione da alcol...
May 2018: Rivista di Psichiatria
Rodrigo Duarte-Chavez, Thomas R Wojda, Thomas B Zanders, Berhanu Geme, Gloria Fioravanti, Stanislaw P Stawicki
Introduction: Clostridium difficile (CD) is a serious and increasingly prevalent healthcare-associated infection. The pathogenesis of CD infection (CDI) involves the acquisition of CD with a concurrent disruption of the native gut flora. Antibiotics are a major risk although other contributing factors have also been identified. Clinical management combines discontinuation of the offending antibiotic, initiation of CD-specific antibiotic therapy, probiotic agent use, fecal microbiota transplantation (FMT), and surgery as the "last resort" option...
April 2018: Journal of Global Infectious Diseases
Lan N Bui, Joshua T Swan, Beverly A Shirkey, Randall J Olsen, Scott W Long, Edward A Graviss
BACKGROUND: Clostridium difficile is the most common causative pathogen for hospital-acquired infections in the intensive care unit. This study evaluated the effect of chlorhexidine bathing every other day in preventing hospital-acquired C. difficile infection (CDI) using data from the CHlorhexidine Gluconate BATHing (CHG-BATH) randomized trial. METHODS: The primary endpoint was the proportion of patients acquiring CDIs among patients at risk for incident CDIs. Infections detected >48 h after randomization were classified as incident CDIs...
August 2018: Journal of Surgical Research
Łukasz Lis, Patryk Jerzak, Andrzej Konieczny, Michał Sroka, Barbara Noceń-Rychlewska, Paweł Podgórski, Wojciech Witkiewicz, Zbigniew Hruby
BACKGROUND: Clostridium difficile (C. difficile) is a Gram-positive bacillus responsible for diarrhea and colitis, mainly among hospitalized patients. It is a leading cause of nosocomial infections. OBJECTIVES: The main goal of the study was to assess the risk factors of the C. difficile infection in patients with chronic kidney disease (CKD). MATERIAL AND METHODS: We evaluated the medical records of all patients treated at the Department of Nephrology and Renal Transplantation of the Research and Development Center in the Provincial Specialist Hospital in Wrocław, Poland, between February 2009 and May 2012, who developed diarrhea, abdominal pain and/or fever within 72 h after admission...
June 15, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Lara-Antonia Beer, Helma Tatge, Nicole Reich, Michel Tenspolde, Alexandra Olling, Sebastian Goy, Klemens Rottner, Alexi Kirilov Alekov, Ralf Gerhard
Toxin A and Toxin B (TcdA/TcdB) are large glucosyltransferases produced by Clostridium difficile. TcdB but not TcdA induces reactive oxygen species (ROS)-mediated early cell death when applied at high concentrations. We found that non-glucosylated Rac1 is essential for induction of early cell death since inhibition of Rac1 impedes this effect. Early cell death only occurs when TcdB is rapidly endocytosed. This was shown by generation of chimeras using the trunk of TcdB from a hypervirulent strain. TcdB from hypervirulent strain has been described to translocate from endosomes at higher pH values and thus, meaning faster than reference type TcdB...
June 14, 2018: Cellular Microbiology
Luis G Arroyo, Diego E Gomez, Candace Martins
Duodenitis-proximal jejunitis (DPJ) is an inflammatory process of the proximal part of the small intestine and occurs sporadically in horses. It is clinically characterized by an acute onset of ileus and nasogastric reflux leading to systemic signs of toxemia. This review discusses the definition of the disease, potential etiologic agents, clinical findings, epidemiological features, histopathologic and clinico-pathological findings, and medical management of this condition. Salmonella spp., mycotoxins, Clostridium perfringens, and Clostridium difficile have all been associated with the disease but there is limited supporting evidence for any agent other than C...
May 2018: Canadian Veterinary Journal. la Revue Vétérinaire Canadienne
Diana C Ford, Mary C Schroeder, Dilek Ince, Erika J Ernst
PURPOSE: The cost-effectiveness of initial treatment strategies for mild-to-moderate Clostridium difficile infection (CDI) in hospitalized patients was evaluated. METHODS: Decision-analytic models were constructed to compare initial treatment with metronidazole, vancomycin, and fidaxomicin. The primary model included 1 recurrence, and the secondary model included up to 3 recurrences. Model variables were extracted from published literature with costs based on a healthcare system perspective...
June 14, 2018: American Journal of Health-system Pharmacy: AJHP
Ellie J C Goldstein, Diane M Citron, Kerin L Tyrrell, Eliza Leoncio
Oral vancomycin is used to treat Clostridioides (Clostridium) difficile infection. Several different preparations are available including reconstituted IV solutions, vancomycin capsules, and grape flavored Vancomycin oral solution kit (CutisPharma). The shelf life for IV after reconstitution varies between 7-14 days under refrigeration, and a standard 30 days for vancomycin oral solution kit (CutisPharma). The impact of storage on the in vitro potency was determined in 3 different vancomycin preparations by measuring MICs for 100 strains of C...
June 11, 2018: Anaerobe
Emily C Bulik-Sullivan, Sayanty Roy, Ryan J Elliott, Zain Kassam, Steven N Lichtman, Ian M Carroll, Ajay S Gulati
Fecal microbiota transplantation (FMT) involves the transfer of stool from a healthy individual into the intestinal tract of a diseased recipient. Although used primarily for recurrent Clostridium difficile infection, FMT is increasingly being attempted as an experimental therapy for other illnesses, including metabolic disorders. D-lactic acidosis (D-LA) is a metabolic disorder that may occur in individuals with short bowel syndrome when lactate-producing bacteria in the colon overproduce D-lactate. This results in elevated systemic levels of D-lactate, metabolic acidosis, and encephalopathy...
June 12, 2018: Journal of Pediatric Gastroenterology and Nutrition
Claire Aguilar, Shahid Husain, Olivier Lortholary
Background: Undergoing solid organ transplantation (SOT) exposes the recipient to various infectious risks, including possible transmission of pathogen by the transplanted organ, post-surgical infections, reactivation of latent pathogens, or novel infections. Recent advances: In the last few years, the emergence of Zika virus has raised concerns in the transplant community. Few cases have been described in SOT patients, and these were associated mainly with moderate disease and favorable outcome; the notable exception is a recent case of fatal meningo-encephalopathy in a heart transplant recipient...
2018: F1000Research
Alice Banz, Aude Lantz, Brigitte Riou, Agnès Foussadier, Mark Miller, Kerrie Davies, Mark Wilcox
Background: Guidelines recommend the use of an algorithm for the laboratory diagnosis of Clostridium difficile infection (CDI). Enzyme immunoassays (EIAs) detecting C. difficile (CD) toxins cannot be used as standalone tests due to sub-optimal sensitivity and molecular tests suffer from non-specificity by detecting colonization. Sensitive immunoassays have recently been developed to improve and simplify CDI diagnosis. Methods: Assays detecting CD toxins have been developed using single molecule array technology (SIMOA)...
June 13, 2018: Journal of Clinical Microbiology
Maria-Jose Valenzuela, Mario Caruffo, Yoani Herrera, Daniel A Medina, Maximo Coronado, Carmen G Feijóo, Salomé Muñoz, Daniel Garrido, Miriam Troncoso, Guillermo Figueroa, Magaly Toro, Angelica Reyes-Jara, Fabien Magne, Paola Navarrete
In this study we evaluated if zebrafish larvae can be colonized by human gut microorganisms. We tested two strategies: (1) through transplantation of a human fecal microbiota and (2) by successively transplanting aerotolerant anaerobic microorganisms, similar to the colonization in the human intestine during early life. We used conventionally raised zebrafish larvae harboring their own aerobic microbiota to improve the colonization of anaerobic microorganisms. The results showed with the fecal transplant, that some members of the human gut microbiota were transferred to larvae...
2018: Frontiers in Microbiology
Sandra Wydau-Dematteis, Imane El Meouche, Pascal Courtin, Audrey Hamiot, René Lai-Kuen, Bruno Saubaméa, François Fenaille, Marie-José Butel, Jean-Louis Pons, Bruno Dupuy, Marie-Pierre Chapot-Chartier, Johann Peltier
Clostridium difficile is the major etiologic agent of antibiotic-associated intestinal disease. Pathogenesis of C. difficile is mainly attributed to the production and secretion of toxins A and B. Unlike most clostridial toxins, toxins A and B have no signal peptide, and they are therefore secreted by unusual mechanisms involving the holin-like TcdE protein and/or autolysis. In this study, we characterized the cell surface protein Cwp19, a newly identified peptidoglycan-degrading enzyme containing a novel catalytic domain...
June 12, 2018: MBio
Karin Pichler, Benjamin Bausenhardt, Steliana Huhulescu, Claudia Lindtner, Alexander Indra, Franz Allerberger, Angelika Berger
BACKGROUND: Clostridium difficile is a gram-positive, anaerobic spore-forming, toxin-producing bacillus, which is one of the most common causes for health care-associated infections. High colonization rates in clinically asymptomatic neonates and infants have been described, although most studies go back to the early 1980 and 1990s, and were carried out in term and late preterm infants. OBJECTIVES: The aim of our study was to determine both the impact and time course of C...
June 12, 2018: Neonatology
Johan A Kers, Anthony W DeFusco, Jae H Park, Jin Xu, Mark E Pulse, William J Weiss, Martin Handfield
Lantibiotics continue to offer an untapped pipeline for the development of novel antibiotics. We report here the discovery of a novel lantibiotic for the treatment of C. difficile infection (CDI). The leads were selected from a library of over 300 multiple substitution variants of the lantibiotic Mutacin 1140 (MU1140). Top performers were selected based on testing for superior potency, solubility, manufacturability, and physicochemical and/or metabolic stability in biologically-relevant systems. The best performers in vitro were further evaluated orally in the Golden Syrian hamster model of CDAD...
2018: PloS One
Eric Yanke, Helene Moriarty, Pascale Carayon, Nasia Safdar
OBJECTIVES: Using a novel human factors engineering approach, the Systems Engineering Initiative for Patient Safety model, we evaluated environmental service workers' (ESWs) perceptions of barriers and facilitators influencing adherence to the nationally mandated Department of Veterans Affairs Clostridium difficile infection (CDI) prevention bundle. METHODS: A focus group of ESWs was conducted. Qualitative analysis was performed employing a visual matrix display to identify barrier/facilitator themes related to Department of Veterans Affairs CDI bundle adherence using the Systems Engineering Initiative for Patient Safety work system as a framework...
June 11, 2018: Journal of Patient Safety
Mona Rezapour, Artin Galoosian, Benny Liu, Taft Bhuket, Robert J Wong
OBJECTIVE: Inflammatory bowel disease (IBD) patients with Clostridium difficile co-infection (CDCI) have an increased risk of morbidity and mortality. We aim to evaluate the impact of CDCI on in-hospital outcomes among adults with IBD hospitalized in the USA. PATIENTS AND METHODS: Using the 2007-2013 Nationwide Inpatient Sample, hospitalizations among US adults with Crohn's disease (CD), ulcerative colitis (UC) and CDCI were identified using ICD-9 coding. Hospital charges, hospital length of stay (LOS), and in-hospital mortality was stratified by CD and UC and compared using χ-testing and Student's t-test...
June 11, 2018: European Journal of Gastroenterology & Hepatology
Dakshika Jeyaratnam, Timothy Planche
Routine diagnostic laboratory results, e.g. numbers of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias, have been used as health-care-associated infection quality indicators for decades. The English health-care-associated infection quality indicator system was one of the earliest in the world to mandate the collection and public reporting of such data and has been associated with a reduction of MRSA bacteraemias and Clostridium difficile infections but has shown mixed results for other infections...
June 2, 2018: British Journal of Hospital Medicine
Kathleen M Mullane, Drew J Winston, Ajay Nooka, Michele I Morris, Patrick Stiff, Michael J Dugan, Henry Holland, Kevin Gregg, Javier A Adachi, Steven A Pergam, Barbara D Alexander, Erik R Dubberke, Natalya Broyde, Sherwood L Gorbach, Pamela S Sears
Background: Clostridium difficile-associated diarrhea (CDAD) is common during hematopoietic stem-cell transplantation (HSCT) and is associated with increased morbidity and mortality. We evaluated fidaxomicin for prevention of CDAD in HSCT patients. Methods: In this double-blind study, subjects undergoing HSCT with fluoroquinolone prophylaxis stratified by transplant type (autologous/allogeneic) were randomized to once-daily oral fidaxomicin 200mg or matching placebo...
June 9, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Jan Bruensing, Lukas Buendgens, Christoph Jochum, Ulf Herbers, Ali Canbay, Georg Braun, Christian Trautwein, Wolfgang Huber, Alexander Koch, Frank Tacke
BACKGROUND:  Clostridium difficile associated colitis is a frequent cause of nosocomial diarrhea at the intensive care unit (ICU) and is associated with poor prognosis in critically ill patients. Few studies have evaluated the efficacy of treatment options or adherence to guideline recommendations of Clostridium difficile infections at the ICU. METHODS:  Therefore, on behalf of the Gastroenterology Intensive Care Medicine working group of the DGVS, we have conducted an online-based survey among leading intensivists in Germany...
June 2018: Zeitschrift Für Gastroenterologie
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