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C difficile

Monique J T Crobach, Jonathan J Vernon, Vivian G Loo, Ling Yuan Kong, Séverine Péchiné, Mark H Wilcox, Ed J Kuijper
Clostridium difficile is the main causative agent of antibiotic-associated and health care-associated infective diarrhea. Recently, there has been growing interest in alternative sources of C. difficile other than patients with Clostridium difficile infection (CDI) and the hospital environment. Notably, the role of C. difficile -colonized patients as a possible source of transmission has received attention. In this review, we present a comprehensive overview of the current understanding of C. difficile colonization...
April 2018: Clinical Microbiology Reviews
Dale N Gerding, Ciaran P Kelly, Galia Rahav, Christine Lee, Erik R Dubberke, Princy N Kumar, Bruce Yacyshyn, Dina Kao, Karen Eves, Misoo C Ellison, Mary E Hanson, Dalya Guris, Mary Beth Dorr
Background: Bezlotoxumab is a human monoclonal antibody against C. difficile toxin B indicated to prevent CDI recurrence (rCDI) in adults at high risk for rCDI. This post-hoc analysis of pooled MODIFY I/II data assessed bezlotoxumab efficacy in participants with characteristics associated with increased risk for rCDI. Methods: The analysis population was the modified Intent-to-Treat population who received bezlotoxumab or placebo (n=1554) by risk factors for rCDI that were prespecified in the statistical analysis plan: age ≥65 years, history of CDI, compromised immunity, severe CDI, and ribotype 027/078/244...
March 10, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
A von Braun, C Lübbert
The incidence of clostridium difficile infections (CDI) remains on a high level globally. In Germany, the number of severe or even lethal cases continues to increase. The main risk factor for the development of CDI is exposure to broad spectrum antibiotics, which disturb the physiological microbiome and therefore enable colonization with C. difficile. According to the updated US and European guidelines, orally administered vancomycin is the treatment of choice. Fidaxomicin is as effective as vancomycin but has the advantage of a lower rate of recurrence...
March 13, 2018: Der Internist
C Diamond, T McNeilly
Clostridium Difficile represents one of the major challenges of the antimicrobial era with associated significant morbidity. Treatment options are limited to a number of specific antibiotics with significant failure rates. Faecal Microbiota Transplantation has been recognised as a possible treatment option when standard therapy fails. We report a local case of Clostridium Difficile Infection ultimately requiring Faecal Microbiota Transplantation with good success. While no formal service providing the treatment is available within Northern Ireland it is a feasible treatment option for Clostridium Difficile Infection...
May 2017: Ulster Medical Journal
Alan M McGovern, Grace O Androga, Peter Moono, Deirdre A Collins, Niki F Foster, Barbara J Chang, Thomas V Riley
Strains of Clostridium difficile producing only binary toxin (CDT) are found commonly in animals but not humans. However, human diagnostic tests rarely look for CDT. The Cepheid Xpert C. difficile BT assay detects CDT with equal sensitivity (≥92%) in human and animal faecal samples.
March 10, 2018: Anaerobe
Brunella Posteraro, Federico Pea, Luca Masucci, Patrizia Posteraro, Maurizio Sanguinetti
Clostridium difficile infection (CDI) is the most common healthcare-associated infection worldwide. As standard CDI antibiotic therapies can result in unacceptably high recurrence rates, novel therapeutic strategies for CDI are necessary. A recently emerged immunological therapy is a monoclonal antibody against C. difficile toxin B. Areas covered: In this review, the authors summarize the available pharmacological, preclinical, and clinical data for the CDI treatment based on anti-toxin A (actoxumab) and anti-toxin B (bezlotoxumab) human monoclonal antibodies (HuMabs), and discuss about the potentiality of a therapy that includes HuMab combined administration for CDI...
March 15, 2018: Expert Opinion on Biological Therapy
Natalia Blanco, Seth Walk, Anurag N Malani, Alexander Rickard, Michele Benn, Marisa Eisenberg, Min Zhang, Betsy Foxman
PURPOSE: This study aimed to describe the correlation between Clostridium difficile spore and toxin levels within the human host. In addition, we assessed whether overgrowth of Candida albicans modified this association. METHODOLOGY: We measured toxin, spore and Candida albicans levels among 200 successively collected stool samples that tested positive for C. difficile, and PCR ribotyped these C. difficile isolates. Analysis of variance and linear regression were used to test the association between spore and toxin levels...
March 13, 2018: Journal of Medical Microbiology
Joseph P Zackular, Eric P Skaar
Clostridium difficile in one of the most commonly reported nosocomial pathogens worldwide. Beyond antibiotic use, little is known about the host, microbiota, and environmental factors that contribute to susceptibility to and severity of C. difficile infection (CDI). We recently observed that in a mouse model of CDI, excess dietary zinc (Zn) alters the gut microbiota and decreases resistance to CDI. Moreover, we determined that high levels of Zn exacerbate C. difficile-associated disease and calprotectin-mediated Zn limitation is an essential host response to infection...
March 13, 2018: Gut Microbes
Myreen E Tomas, Thriveen S C Mana, Brigid M Wilson, Michelle M Nerandzic, Joussef Samira, Miguel Quinones-Mateu, Curtis J Donskey
Vancomycin taper regimens are commonly used for the treatment of recurrent Clostridium difficile infections. One rationale for tapering and pulsing of the dose at the end of therapy is to reduce the selective pressure of vancomycin on the indigenous intestinal microbiota. Here, we used a mouse model to test the hypothesis that the indigenous microbiota that provide colonization resistance against C. difficile and vancomycin-resistant enterococci (VRE) is re-populated during tapering courses of vancomycin. Mice were treated orally with vancomycin daily for 10 days, vancomycin in a tapering dose for 42 days, fidaxomicin for 10 days, or saline...
March 12, 2018: Antimicrobial Agents and Chemotherapy
Wolfgang Miehsler, Clemens Dejaco, Hans-Peter Gröchenig, Harry Fuchssteiner, Christoph Högenauer, Lili Kazemi-Shirazi, Harald Maier, Andreas Mayer, Alexander Moschen, Walter Reinisch, Wolfgang Petritsch, Reingard Platzer, Pius Steiner, Herbert Tilg, Harald Vogelsang, Heimo Wenzl, Gottfried Novacek
Anti-TNFα-antibodies have revolutionized the therapy of inflammatory bowel diseases and other immune-mediated inflammatory diseases. Due to the increasing application of these substances, the Working Group of Inflammatory Bowel Diseases of the Austrian Association of Gastroenterology and Hepatology intended to update their consensus report on the safe use of Infliximab (published in 2010) and to enlarge its scope to cover all anti-TNFα-antibodies. The present consensus report summarizes the current evidence on the safe use of anti-TNFα-antibodies and covers the following topics: general risk of infection, bacterial infections (i...
March 2018: Zeitschrift Für Gastroenterologie
Anna Maikova, Johann Peltier, Pierre Boudry, Eliane Hajnsdorf, Nicolas Kint, Marc Monot, Isabelle Poquet, Isabelle Martin-Verstraete, Bruno Dupuy, Olga Soutourina
Clostridium difficile, a major human enteropathogen, must cope with foreign DNA invaders and multiple stress factors inside the host. We have recently provided an experimental evidence of defensive function of the C. difficile CRISPR (clustered regularly interspaced short palindromic repeats)-Cas (CRISPR-associated) system important for its survival within phage-rich gut communities. Here, we describe the identification of type I toxin-antitoxin (TA) systems with the first functional antisense RNAs in this pathogen...
February 26, 2018: Nucleic Acids Research
Brintha Parasumanna Girinathan, Junjun Ou, Bruno Dupuy, Revathi Govind
Clostridium difficile is the primary cause of nosocomial diarrhea and pseudomembranous colitis. It produces dormant spores, which serve as an infectious vehicle responsible for transmission of the disease and persistence of the organism in the environment. In Bacillus subtilis, the sin locus coding SinR (113 aa) and SinI (57 aa) is responsible for sporulation inhibition. In B. subtilis, SinR mainly acts as a repressor of its target genes to control sporulation, biofilm formation, and autolysis. SinI is an inhibitor of SinR, so their interaction determines whether SinR can inhibit its target gene expression...
March 12, 2018: PLoS Pathogens
Klaus Aktories, Panagiotis Papatheodorou, Carsten Schwan
Clostridium difficile infection causes antibiotics-associated diarrhea and pseudomembranous colitis. Major virulence factors of C. difficile are the Rho-glucosylating toxins TcdA and TcdB. In addition, many, so-called hypervirulent C. difficile strains produce the binary actin-ADP-ribosylating toxin CDT. CDT causes depolymerization of F-actin and rearrangement of the actin cytoskeleton. Thereby, many cellular functions, which depend on actin, are altered. CDT disturbs the dynamic balance between actin and microtubules in target cells...
March 7, 2018: Anaerobe
Sara Andrés-Lasheras, Inma Martín-Burriel, Raúl Carlos Mainar-Jaime, Mariano Morales, Ed Kuijper, José L Blanco, Manuel Chirino-Trejo, Rosa Bolea
BACKGROUND: Clostridium difficile infection (CDI) is recognised as an emerging disease in both humans and some animal species. During the past few years, insights into human CDI epidemiology changed and C. difficile is also considered as an emerging community-acquired pathogen. Certain ribotypes (RT) are possibly associated with zoonotic transmission. The objective of this study was to assess the presence of C. difficile in a population of pets and to characterise the isolates. RESULTS: Faecal samples from a total of 90 diarrhoeic dogs and 24 from exotic animal species (both diarrhoeic and non-diarrhoeic) were analysed...
March 9, 2018: BMC Veterinary Research
Jeffrey Baron, Shuntao Cai, Natalie Klein, Burke A Cunha
OBJECTIVE: The clinical effectiveness of tigecycline depends on appropriate use, and PK/PD (pharmacokinetic/pharmacodynamic) parameters related to dose and dosing interval. METHODS: In our 600-bed university-affiliated teaching hospital, we conducted a tigecycline efficacy review over a three-month period in 34 evaluable patients. Parameters assessed included clinical response, cure or treatment failure, once daily as q12h dosing, maintenance dosing, high dose vs...
March 9, 2018: Journal of Clinical Medicine
Muthu Dharmasena, Xiuping Jiang
This study was to optimize the detection methods for Clostridium difficile from the animal manure-based composts. Both autoclaved and unautoclaved dairy composts were inoculated with a 12-h old suspension of a non-toxigenic C. difficile strain (ATCC 43593) and then plated on selected agar for vegetative cells and endospores. Six types of enrichment broths supplemented with taurocholate and L-cysteine were assessed for detecting a low level of artificially inoculated C. difficile (ca. 5 spores/g) from dairy composts...
March 5, 2018: Anaerobe
Majda Biasizzo, Stanka Vadnjal, Urska Henigman, Manja Krizman, Andrej Kirbis, Urska Jamnikar-Ciglenecki
There is no recommended protocol for detecting and isolating Clostridium difficile present in food samples. Here, we have evaluated the recovery of C. difficile in meat samples after incubating them in various enrichment broths. The media were as follows: cycloserine-cefoxitin fructose broth supplemented with taurocholic acid, d-cycloserine, cefoxitin, and lysozyme; cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme; and cycloserine-cefoxitin fructose broth supplemented with taurocholic acid, C...
March 8, 2018: Journal of Food Protection
Şiran Keske, Burak Zabun, Kahraman Aksoy, Füsun Can, Erhan Palaoğlu, Önder Ergönül
Background: We aimed to detect the etiological agents of acute diarrhea by molecular gastrointestinal pathogen test (MGPT) and to assess its impact on antimicrobial stewardship program (ASP). Methods: This is a prospective, observational study and was conducted between 1 January 2015 and 30 June 2017. We included consequent patients, who had acute diarrhea. At the end of 2015, we implemented ASP in acute diarrhea and we compared the outcomes in pre-ASP and post-ASP. An FDA-cleared multiplexed gastrointestinal PCR panel system, BioFire filmArray (Idaho Technology, Salt Lake City, UT) which detects twenty pathogens in stool was used...
March 7, 2018: Journal of Clinical Microbiology
Cynthia T Nguyen, Julius Li, Stephanie Anders, Julia Garcia-Diaz, Catherine Staffeld-Coit, Jonathan Hand
BACKGROUND: Current guidelines recommend metronidazole for the treatment of mild-to-moderate C. difficile associated diarrhea (CDAD), while oral vancomycin is preferred for severe disease. However, data are lacking among the solid organ transplant (SOT) population. METHODS: This single center, retrospective cohort study evaluated adult SOT recipients with mild-to-moderate CDAD. Analysis 1 evaluated patients receiving initial therapy with metronidazole versus oral vancomycin for at least 72 hours...
March 7, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Jiayi Cai, Chunyang Zhao, Yajie Du, Yaqiong Zhang, Mingyi Zhao, Qingchun Zhao
Background: Probiotics are commonly used for the prevention of antibiotic-associated diarrhea (AAD). However, the optimum regimen remains controversial. Objective: The objective of this article is to compare and rank the relative efficacy and tolerability among all available probiotic agents for AAD through a network meta-analysis. Methods: Eligible studies were identified by searching PubMed, Embase, Medline, Cochrane library and Web of Science for randomized controlled trials (RCTs) that examined the efficacy of probiotic therapy for AAD...
March 2018: United European Gastroenterology Journal
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