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Clostridium difficile
.C. difficile colonies on a blood agar plate.^ Clostridium difficile Colonies on Specialized Agar .
  • Clostridium difficile - New Intestinal Superbug: Pseudomembranous Colitis and Resistant Strains of C. diff Bacteria 10 February 2010 13:33 UTC human-infections.suite101.com [Source type: Academic]

^ C. difficile colonies on blood agar .
  • Pathogenic Clostridia, Including Botulism and Tetanus 10 February 2010 13:33 UTC textbookofbacteriology.net [Source type: Academic]

^ Clostridium difficile colonies after 48hrs growth on a blood agar plate; Magnified 4.8X (Image provided by CDC/Dr.
  • Northern Ireland Region Infection Preventation and Control Manual - Clostridium difficile 10 February 2010 13:33 UTC www.infectioncontrolmanual.co.ni [Source type: Academic]

Scientific classification
Kingdom: Bacteria
Phylum: Firmicutes
Class: Clostridia
Order: Clostridiales
Family: Clostridiaceae
Genus: Clostridium
Species: C. difficile
Binomial name
Clostridium difficile
Hall & O'Toole, 1935
.Clostridium difficile (Greek kloster (κλωστήρ), spindle, and Latin difficile,[1] difficult), also known as "CDF/cdf", or "C. diff", is a species of Gram-positive bacteria of the genus Clostridium that causes diarrhea and other intestinal disease when competing bacteria are wiped out by antibiotics.^ Clostridium difficile , commonly called C. difficile , is a bacterium that causes diarrhea and other serious intestinal conditions.
  • It's Your Health - C. difficile (Clostridium difficile) 10 February 2010 13:33 UTC www.hc-sc.gc.ca [Source type: Academic]

^ Positive regulation of Clostridium difficile toxins.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ Update on Clostridium difficile associated disease.
  • ISPUB - Clostridium difficile: The new epidemic 10 February 2010 13:33 UTC www.ispub.com [Source type: Academic]

.Clostridia are anaerobic, spore-forming rods (bacilli).^ C difficile is an anaerobic, toxigenic, spore-forming, gram-positive rod.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ Clostridium difficile is a gram-positive, anaerobic, spore-forming bacillus that is responsible for the development of antibiotic-associated diarrhea and colitis.
  • Clostridium Difficile Colitis: eMedicine Gastroenterology 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]
  • Clostridium Difficile (C. difficile, C. diff, Antibiotic Related Infection) Causes, Symptoms, Diagnosis, and Treatment on eMedicineHealth.com 10 February 2010 13:33 UTC www.emedicinehealth.com [Source type: Academic]

^ C. difficile is an anaerobic spore-forming bacterium, present asymptomatically in approximately 60% of infants but only about 3% of healthy adults.
  • Sanofi Pasteur :: Sanofi Pasteur Starts a Phase II Study of a Vaccine Against Clostridium Difficile 10 February 2010 13:33 UTC mobile.prnewstoday.com [Source type: Academic]

[2] .C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics.^ It is a serious illness caused by infection of the inner lining of the colon by C. difficile bacteria, which produce toxins that cause inflammation of the colon, severe diarrhea and, in the most serious cases, death.
  • Additional Data From Fidaxomicin's Phase 3 Study for Clostridium Difficile Infection (CDI) Presented at IDSA... -- SAN DIEGO, Oct. 31 /PRNewswire-FirstCall/ -- 10 February 2010 13:33 UTC www.prnewswire.com [Source type: Academic]
  • Additional Data From Fidaxomicin's Phase 3 Study for Clostridium Difficile Infection (CDI) Presented at IDSA Annual Meeting | FreshNews.com 10 February 2010 13:33 UTC freshnews.com [Source type: Academic]
  • Stockwatch > News > News Item 10 February 2010 13:33 UTC www.stockwatch.com [Source type: Academic]
  • Optimer Pharmaceuticals Completes Enrollment in Second Fidaxomicin Phase 3 Clinical Trial in Patients With Clostridium difficile - FierceBiotech 10 February 2010 13:33 UTC www.fiercebiotech.com [Source type: Academic]
  • Additional Data From Fidaxomicin's Phase 3 Study for Clostridium Difficile Infection (CDI) Presented at IDSA Annual MeetingData Shows Faster Resolut - Yahoo! Canada Finance 10 February 2010 13:33 UTC ca.news.finance.yahoo.com [Source type: Academic]
  • Additional Data From Fidaxomicin's Phase 3 Study for Clostridium Difficile Infection (CDI) Presented at IDSA Annual Meeting 10 February 2010 13:33 UTC www.stockhouse.com [Source type: Academic]
  • Optimer Pharmaceuticals, Inc. - Optimer Announces Presentation of Additional Data From Fidaxomicin Phase 3 Study for the Treatment of Clostridium Difficile Infection (CDI) 10 February 2010 13:33 UTC investor.optimerpharma.com [Source type: Academic]

^ In 1977, C difficile and its toxins were established as the cause of antibiotic-associated colitis.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ C difficile is also referred to as an antibiotic-associated diarrhea.
  • Huron Perth Healthcare Alliance - Clostridium difficil-Associated Disease (CDAD) 10 February 2010 13:33 UTC www.hpha.ca [Source type: Academic]

[3] .The C. difficile bacteria, which naturally reside in the body, become overpopulated: The overpopulation is harmful because the bacterium releases toxins that can cause bloating, constipation, and diarrhea with abdominal pain, which may become severe.^ When the toxins are released, the colon becomes inflamed.
  • Clostridium Difficile Colitis-Overview 10 February 2010 13:33 UTC www.webmd.com [Source type: General]
  • Article Manager 10 February 2010 13:33 UTC www.umassmemorial.org [Source type: FILTERED WITH BAYES]
  • Exempla Healthcare Online Library 10 February 2010 13:33 UTC www.exempla.org [Source type: FILTERED WITH BAYES]
  • Clostridium difficile Colitis 10 February 2010 13:33 UTC www.healthlinkbc.ca [Source type: FILTERED WITH BAYES]
  • Clostridium difficile Colitis - Providence Health & Services 10 February 2010 13:33 UTC www.providence.org [Source type: FILTERED WITH BAYES]
  • Clostridium difficile Colitis - Overview - Health.com 10 February 2010 13:33 UTC www.health.com [Source type: General]
  • CIGNA - Clostridium difficile Colitis 10 February 2010 13:33 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Health Information, Drug and Herbal Information and Health News 10 February 2010 13:33 UTC www.cpmc.org [Source type: FILTERED WITH BAYES]
  • Health Library - 10 February 2010 13:33 UTC myhealth.ucsd.edu [Source type: FILTERED WITH BAYES]

^ A new test was approved by the FDA for the B toxin of C. difficile which caused severe diarrhea and dehydration.
  • Rapid DNA Test to Detect Clostridium difficile Infection Approved by FDA Today - Gerson Lehrman Group 10 February 2010 13:33 UTC www.glgroup.com [Source type: Academic]

^ C. diff overgrowth is harmful because the toxins released by the bacteria can cause: 1.
  • Clostridium Difficile: New Intestinal Superbug - Associated Content - associatedcontent.com 10 February 2010 13:33 UTC www.associatedcontent.com [Source type: General]

.Latent symptoms often mimic some flu-like symptoms.^ The later stages are commonly flu-like symptoms of weakness, dehydration, fever, nausea, vomiting.
  • Clostridium Difficile Hospital Infection Lawsuit 10 February 2010 13:33 UTC www.yourlawyer.com [Source type: FILTERED WITH BAYES]

.Often, it can be cured simply by discontinuing the antibiotics responsible.^ This approach is complicated since one cannot predict which patients will clear the infection spontaneously, and to discontinue systemic antibiotics is often not feasible.
  • Clostridium difficile Infection - SSHAIP - HPS 10 February 2010 13:33 UTC www.hps.scot.nhs.uk [Source type: Academic]

^ In noncomplicated patients with mild diarrhea, no fever, and modest lower abdominal pain, discontinuation of antibiotics (if possible) is often enough to alleviate symptoms and stop diarrhea.
  • LYSOL® | Germ Information Center | Clostridium 10 February 2010 13:33 UTC www.lysol.com [Source type: Academic]

[2] .In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice.^ Treatment is with oral metronidazole or vancomycin.
  • Clostridium difficile–Induced Diarrhea: Anaerobic Bacteria: Merck Manual Professional 10 February 2010 13:33 UTC www.merck.com [Source type: Academic]

^ Standard treatment is usually with oral metronidazole or vancomycin.
  • Intravenous immunoglobulin for resistant Clostridium difficile infection -- Murphy et al. 35 (1): 85 -- Age and Ageing 10 February 2010 13:33 UTC ageing.oxfordjournals.org [Source type: Academic]

^ If diarrhea and colitis are severe or persistent, oral metronidazole is the treatment of choice.
  • CLOSTRIDIUM DIFFICILE INFECTION - Annual Review of Medicine, 49(1):375 - Abstract 10 February 2010 13:33 UTC arjournals.annualreviews.org [Source type: Academic]

.Relapses of C. difficile AAD have been reported in up to 20% of cases.^ C. difficile is linked to up to 70% of cases of antibiotic-associated colitis, and this increases to more than 90% in cases of antibiotic-associated pseudomembraneous colitis.
  • News - Clostridium Difficile Toxin in Hospitalised Patients With Antibiotic-Associated Diarrhoea: Presented at ECCMID-ICC 10 February 2010 13:33 UTC www.docguide.com [Source type: Academic]

^ In 20-30% of cases patients suffer a relapse and other treatments may be tried, including good bacteria which help to re-balance the gut.
  • University Hospitals of Leicester - About clostridium difficile 10 February 2010 13:33 UTC www.uhl-tr.nhs.uk [Source type: FILTERED WITH BAYES]

^ The number of new hospital-acquired C. difficile cases associated with the reporting facility (count) separately for each hospital site.
  • St. Francis Memorial Hospital - About Us 10 February 2010 13:33 UTC www.sfmhosp.com [Source type: Academic]

[2]

Contents

Bacteriology

Individual, drumstick-shaped C. difficile bacilli seen through scanning electron microscopy.
.Clostridia are motile bacteria that are ubiquitous in nature and are especially prevalent in soil.^ EPIDEMIOLOGY: The clostridia are ubiquitous in the soil and some are part of the normal human flora.
  • Clostridium 10 February 2010 13:33 UTC www.cehs.siu.edu [Source type: Academic]

^ C. difficile is found everywhere in nature such as in water, air, human and animal feces, on most surfaces (especially in hospitals) and most prevalently in soil.
  • Clostridium difficile - MicrobeWiki 10 February 2010 13:33 UTC microbewiki.kenyon.edu [Source type: Academic]

.Under the microscope, clostridia appear as long, irregularly (often "drumstick" or "spindle") shaped cells with a bulge at their terminal ends.^ C. difficile shows optimum growth when at human body temperature and appears as long drumsticks with a bulge at each end.
  • Clostridium difficile - MicrobeWiki 10 February 2010 13:33 UTC microbewiki.kenyon.edu [Source type: Academic]

.Under Gram staining, Clostridium difficile cells are Gram-positive and show optimum growth on blood agar at human body temperatures in the absence of oxygen.^ Positive regulation of Clostridium difficile toxins.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ Clostridium difficile Colonies on Specialized Agar .
  • Clostridium difficile - New Intestinal Superbug: Pseudomembranous Colitis and Resistant Strains of C. diff Bacteria 10 February 2010 13:33 UTC human-infections.suite101.com [Source type: Academic]

^ Clostridium difficile is an anaerobic, spore-forming, gram-positive bacillus.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

.When stressed, the bacteria produce spores, which tolerate extreme conditions that the active bacteria cannot tolerate.^ Spores are what bacteria produce so they can multiply.
  • Clostridium difficile information from NHS Choices on TheFamilyGP.com 10 February 2010 13:33 UTC www.thefamilygp.com [Source type: FILTERED WITH BAYES]
  • Patient information leaflet - Clostridium difficile 10 February 2010 13:33 UTC www.cks.nhs.uk [Source type: FILTERED WITH BAYES]
  • Clostridium difficile information from NHS Choices on TheFamilyGP.com 10 February 2010 13:33 UTC health.virginmedia.com [Source type: FILTERED WITH BAYES]

^ Clostridium When the environment becomes stressed, the bacteria produce spores that tolerate the extreme conditions that the active bacteria cannot.

^ Clostridium bacteria are rod-shaped spore-forming bacteria that live under anaerobic conditions.

[2]
.C. difficile is a commensal bacterium of the human intestine in 2-5% of the population.^ A: C. difficile is a bacterium that is found in the intestines.
  • CGH Medical Center - C-Diff 10 February 2010 13:33 UTC www.cghmc.com [Source type: FILTERED WITH BAYES]

^ Clostridium difficile is a spore-forming, gram-positive bacterium that produces exotoxins that are pathogenic to humans.
  • Clostridium difficile - Clinical Laboratory Partners - Newington, CT 10 February 2010 13:33 UTC www.clpct.com [Source type: Academic]

^ Clostridium difficile is a common gram-positive anaerobic bacterium that inhabits the human colon, albeit in typically low numbers.
  • Microbelibrary - A Bioinformatics Problem Space to Study Clostridium difficile Outbreak 10 February 2010 13:33 UTC www.microbelibrary.org [Source type: Academic]

[2] .Long-term hospitalization or residence in a nursing home within the previous year are independent risk factors for increased colonization.^ Residing in a nursing home .
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ Clostridium difficile colonization in residents of long-term care facilities: prevalence and risk factors.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

^ Risk factors include residence in hospitals and long-term care facilities and the use of antimicrobial medications ( 1–3 ).
  • Clostridium difficile–related Mortality Rates | CDC EID 10 February 2010 13:33 UTC origin.cdc.gov [Source type: Academic]

[4] .In small numbers, C. difficile does not result in significant disease.^ Normally, C difficile does not cause disease.
  • Huron Perth Healthcare Alliance - Clostridium difficil-Associated Disease (CDAD) 10 February 2010 13:33 UTC www.hpha.ca [Source type: Academic]

^ Q: How does C. difficile cause disease?
  • CGH Medical Center - C-Diff 10 February 2010 13:33 UTC www.cghmc.com [Source type: FILTERED WITH BAYES]

^ In small numbers it does not cause disease.
  • NJ Clostridium Difficile Colitis Attorneys - New Jersey Personal Injury Lawyers 10 February 2010 13:33 UTC www.njatty.com [Source type: Academic]

.Antibiotics, especially those with a broad spectrum of activity, cause disruption of normal intestinal flora, leading to an overgrowth of C. difficile, which flourishes under these conditions.^ The most common risk factor for C. difficile-associated disease is exposure to antibiotics, especially those with broad-spectrum activity.
  • Clostridium difficile (C. difficile) - Another Foodborne Pathogen? : Marler Blog 10 February 2010 13:33 UTC www.marlerblog.com [Source type: News]

^ Normally, C difficile does not cause disease.
  • Huron Perth Healthcare Alliance - Clostridium difficil-Associated Disease (CDAD) 10 February 2010 13:33 UTC www.hpha.ca [Source type: Academic]

^ Antibiotic use, which suppresses the normal flora, allows proliferation of C difficile.
  • Clostridium Difficile Colitis: eMedicine Gastroenterology 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

.This can lead to pseudomembranous colitis (PMC), the generalized inflammation of the colon and the development of pseudomembrane, a viscous collection of inflammatory cells, fibrin, and necrotic cells.^ Colonic pseudomembranes of pseudomembranous colitis.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ CLOSE WINDOW ] Colonic pseudomembranes of pseudomembranous colitis.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ Colitis means inflammation of the colon.
  • Clostridium Difficile | Health | Patient UK 10 February 2010 13:33 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]
  • Clostridium Difficile 10 February 2010 13:33 UTC www.tripdatabase.com [Source type: FILTERED WITH BAYES]

[2] .Pathogenic C. difficile strains produce several known toxins.^ However, not all strains of C. difficile produce toxin.
  • CBC News - Health - Clostridium difficile FAQs 10 February 2010 13:33 UTC www.cbc.ca [Source type: FILTERED WITH BAYES]

^ Not all types of C. difficile produce toxins.
  • Clostridium difficile - questions and answers | Bupa UK 10 February 2010 13:33 UTC hcd2.bupa.co.uk [Source type: FILTERED WITH BAYES]

^ Toxin-producing strains of Cl.
  • Clostridium difficile - a food safety hazard? 10 February 2010 13:33 UTC www.foodsafetywatch.com [Source type: FILTERED WITH BAYES]

.The most well-characterized are enterotoxin (toxin A) and cytotoxin (toxin B), both of which are responsible for the diarrhea and inflammation seen in infected patients, although their relative contributions have been debated.^ Toxin A is an enterotoxin, and toxin B is a cytotoxin.
  • Clostridium Difficile Colitis: eMedicine Gastroenterology 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ The organism secretes both a cytotoxin and an enterotoxin.
  • Clostridium difficile–Induced Diarrhea: Anaerobic Bacteria: Merck Manual Professional 10 February 2010 13:33 UTC www.merck.com [Source type: Academic]

^ It is a serious illness caused by infection of the inner lining of the colon by C. difficile bacteria, which produce toxins that cause inflammation of the colon, severe diarrhea and, in the most serious cases, death.
  • Additional Data From Fidaxomicin's Phase 3 Study for Clostridium Difficile Infection (CDI) Presented at IDSA... -- SAN DIEGO, Oct. 31 /PRNewswire-FirstCall/ -- 10 February 2010 13:33 UTC www.prnewswire.com [Source type: Academic]
  • Stockwatch > News > News Item 10 February 2010 13:33 UTC www.stockwatch.com [Source type: Academic]
  • Optimer Pharmaceuticals, Inc. - Optimer Announces Presentation of Additional Data From Fidaxomicin Phase 3 Study for the Treatment of Clostridium Difficile Infection (CDI) 10 February 2010 13:33 UTC investor.optimerpharma.com [Source type: Academic]

[2] .Toxins A and B are glucosyltransferases that target and inactivate the Rho family of GTPases.^ Inside host cells, both toxins catalyse the transfer of glucose onto the Rho family of GTPases, leading to cell death 8, 11 .
  • Toxin B is essential for virulence of : Clostridium difficile : Abstract : Nature 10 February 2010 13:33 UTC www.nature.com [Source type: Academic]

^ Clostridium difficile toxins act as glucosyltransferases to inactivate small GTP-binding proteins of the Rho family which are involved in...
  • Sharing a hospital room increases risk of 'super bugs' 10 February 2010 13:33 UTC www.brightsurf.com [Source type: Academic]

^ Impact on GTPase Signaling Pathways The substrate targets of TcdA and TcdB, Rho, Rac, and Cdc42, also regulate cellular events outside the actin cytoskeleton (Fig.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

.Toxin A indcuses actin depolymerization by a mechanism correlated with a decrease in the ADP-ribosylation of the low molecular mass GTP-binding Rho proteins [5].^ The low molecular mass GTP-binding protein Rho is affected by toxin A from Clostridium difficile .
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ Monoglucosylation of low-molecular-mass GTP-binding rho proteins by clostridial cytotoxins.
  • Clostridium difficile Testing: after 20 Years, Still Challenging -- Wilkins and Lyerly 41 (2): 531 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

^ Clostridium difficile toxin B acts on the GTP-binding protein Rho.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

.Another toxin, binary toxin, has also been described, but its role in disease is not yet fully understood.^ The real significance of the binary toxin in C. difficile is not yet understood.
  • Clostridium difficile -- Poxton 54 (2): 97 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ The contribution of toxin B in the development of disease is not understood.
  • Children's of Minnesota - Clostridium difficileToxin A and B 10 February 2010 13:33 UTC www.childrensmn.org [Source type: Academic]

^ The pathogenic role of binary toxin has not been fully elucidated.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

[6]
.Antibiotic treatment of C. difficile infections can be difficult, due both to antibiotic resistance as well as physiological factors of the bacteria itself (spore formation, protective effects of the pseudomembrane).^ This is because C. difficile spores are often resistant to treatment with antibiotics and are difficult to destroy.
  • Clostridium difficile infection - information, symptoms and treatments 10 February 2010 13:33 UTC hcd2.bupa.co.uk [Source type: FILTERED WITH BAYES]

^ C difficile infection usually occurs during or after treatment with antibiotics.
  • Clostridium difficile Infection | HealthSheets | Wellness Library | Mount Nittany Medical Center 10 February 2010 13:33 UTC www.mountnittany.org [Source type: Academic]

^ Risk factors for Clostridium difficile infection.
  • Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review -- Thomas et al. 51 (6): 1339 -- Journal of Antimicrobial Chemotherapy 10 February 2010 13:33 UTC jac.oxfordjournals.org [Source type: Academic]

[2] .C. difficile is transmitted from person to person by the fecal-oral route.^ Colonization occurs by the fecal-oral route.
  • Clostridium Difficile Colitis: eMedicine Gastroenterology 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ It can be transferred from person to person through the fecal-oral route.
  • Clostridium difficile - MicrobeWiki 10 February 2010 13:33 UTC microbewiki.kenyon.edu [Source type: Academic]

^ C. difficile is transmitted through the fecal–oral route.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

.Because the organism forms heat-resistant spores, it can remain in the hospital or nursing home environment for long periods of time.^ The spores of Clostridium difficile are able to survive for long periods of time in the environment.

^ Clostridium difficile is an anaerobic, Gram-positive bacterium, which forms heat resistant spores that can survive for long periods in the environment.
  • Clostridium difficile Infection - SSHAIP - HPS 10 February 2010 13:33 UTC www.hps.scot.nhs.uk [Source type: Academic]

^ In addition, the ability of this bacterium to form spores enables it to survive for long periods in the environment (e.g.
  • MRSA Action UK 10 February 2010 13:33 UTC mrsaactionuk.net [Source type: Academic]
  • Clostridium difficile information 10 February 2010 13:33 UTC www.nbt.nhs.uk [Source type: Academic]

.It can be cultured from almost any surface in the hospital.^ C. difficile was not cultured from the air or surfaces of either hospital bay during the two days in March 2007.
  • BioMed Central | Full text | Aerial Dissemination of Clostridium difficile spores 10 February 2010 13:33 UTC www.biomedcentral.com [Source type: Academic]

.Once spores are ingested, they pass through the stomach unscathed because of their acid-resistance.^ C. difficile spores, however, are acid resistant and readily pass through the stomach; they may germinate in the small bowel upon exposure to bile acids.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

^ This is because while you still have diarrhoea and other symptoms, the C. difficile spores could be passed on to someone else.
  • Clostridium difficile - questions and answers | Bupa UK 10 February 2010 13:33 UTC hcd2.bupa.co.uk [Source type: FILTERED WITH BAYES]

^ The spores are able to survive for a long time outside of the body unless they are destroyed through very thorough cleaning.
  • Clostridium difficile information from NHS Choices on TheFamilyGP.com 10 February 2010 13:33 UTC www.thefamilygp.com [Source type: FILTERED WITH BAYES]
  • Patient information leaflet - Clostridium difficile 10 February 2010 13:33 UTC www.cks.nhs.uk [Source type: FILTERED WITH BAYES]
  • Clostridium difficile information from NHS Choices on TheFamilyGP.com 10 February 2010 13:33 UTC health.virginmedia.com [Source type: FILTERED WITH BAYES]

.They change to their active form in the colon and multiply.^ Although spores cannot cause infection directly, when they are ingested they transform into the active, infectious form.
  • Clostridium difficile colitis (C. difficile) Causes, Symptoms, Diagnosis and Treatment by MedicineNet.com 10 February 2010 13:33 UTC www.medicinenet.com [Source type: Academic]

.Pseudomembranous colitis caused by C. difficile is treated with specific antibiotics, for example, vancomycin (Vancocin®) or metronidazole (Flagyl®).^ In 1977, C difficile and its toxins were established as the cause of antibiotic-associated colitis.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ The colitis usually is caused by taking antibiotics.
  • Clostridium difficile–Induced Colitis: Digestive Disorders: Merck Manual Home Edition 10 February 2010 13:33 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Antibiotic-associated diarrhea, pseudomembranous enterocolitis, and Clostridium difficile -associated diarrhea and colitis.
  • Article Manager 10 February 2010 13:33 UTC www.umassmemorial.org [Source type: FILTERED WITH BAYES]
  • Exempla Healthcare Online Library 10 February 2010 13:33 UTC www.exempla.org [Source type: FILTERED WITH BAYES]

.Several disinfectants commonly used in hospitals may be ineffective against C. difficile spores, and may actually promote spore formation.^ Wilcox MH, Fawley WN: Hospital disinfectants and spore formation by Clostridium difficile.
  • BioMed Central | Full text | Aerial Dissemination of Clostridium difficile spores 10 February 2010 13:33 UTC www.biomedcentral.com [Source type: Academic]

^ Spores of C. difficile are resistant to alcohol-based antiseptics (alcohol hand-washing gels are ineffective), and chlorine-based disinfectants are only partially effective with the concentrations required not well tolerated by patients or cleaning staff.
  • Clostridium difficile-associated disease — an increasing burden (summary) – Behind the Medical Headlines 10 February 2010 13:33 UTC behindthemedicalheadlines.com [Source type: Academic]

^ Because of their resistance to heat and many disinfectants, C. difficile spores can remain in soil, air, water, and on most surfaces in hospitals and long-term care facilities for months and are difficult to eradicate.
  • Understanding CDI 10 February 2010 13:33 UTC www.cdiinfo.org [Source type: Academic]

.However, disinfectants containing bleach are effective in killing the organisms.^ C diff can remain on hospital surfaces and, unless they are cleaned sufficiently with disinfectants that contain bleach, the threat of infection spread remains.
  • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

^ Disinfectants containing bleach need to be used on surfaces and floors to ensure that the spread of infection is controlled.
  • Clostridium Difficle FAQs - Central Manchester and Manchester Children's University Hospitals - CMMC 10 February 2010 13:33 UTC www.cmft.nhs.uk [Source type: Academic]

[7]
Initially named bacillus difficilis by Hall and O'Toole in 1935 because it was resistant to early attempts at isolation and grew very slowly in culture, it was renamed in 1970.[8]

Cause

.
Micrograph of a colonic pseudomembrane in Clostridium difficile colitis, a type of pseudomembranous colitis.
^ Clostridium difficile associated colitis .
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ Clostridium difficile –Induced Colitis .
  • Clostridium difficile–Induced Colitis: Digestive Disorders: Merck Manual Home Edition 10 February 2010 13:33 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Clostridium difficile Colitis Topic Contents .
  • Exempla Healthcare Online Library 10 February 2010 13:33 UTC www.exempla.org [Source type: FILTERED WITH BAYES]

H&E stain.
.With the introduction of broad-spectrum antibiotics and chemotherapeutic antineoplastic drugs[citation needed] in the latter half of the twentieth century, antibiotic (and chemotherapy) associated diarrhea became more common.^ The spectrum of pseudomembranous enterocolitis and antibiotic-associated diarrhea.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ This is often called antibiotic-associated diarrhea.
  • gihealth.com - built for patient satisfaction 10 February 2010 13:33 UTC www.gihealth.com [Source type: FILTERED WITH BAYES]
  • gihealth.com - built for patient satisfaction 10 February 2010 13:33 UTC www.gihealth.com [Source type: FILTERED WITH BAYES]
  • gihealth.com - built for patient satisfaction 10 February 2010 13:33 UTC www.gihealth.com [Source type: FILTERED WITH BAYES]

^ Antibiotic-associated diarrhea.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]
  • Clostridium difficile Colitis: Reduced Time to Diagnosis in a Community-Based Outpatient Setting Between 1997 and 2004 10 February 2010 13:33 UTC xnet.kp.org [Source type: Academic]
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]
  • http://www.vancocin.com/HealthcareProfessionals/AboutCdifficile.aspx?p=1 10 February 2010 13:33 UTC www.vancocin.com [Source type: Academic]

.Pseudomembranous colitis was first described as a complication of C. difficile infection in 1978,[9] when a toxin was isolated from patients suffering from pseudomembranous colitis and Koch's postulates were met.^ Infection with C. difficile is diagnosed by detection of toxins A & B in the faeces of a symptomatic patient.
  • Northern Ireland Region Infection Preventation and Control Manual - Clostridium difficile 10 February 2010 13:33 UTC www.infectioncontrolmanual.co.ni [Source type: Academic]

^ Pseudomembranous colitis caused by a toxin A – B + strain of Clostridium difficile .
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ Toxic megacolon complicating pseudomembranous colitis.
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

.C. difficile infection (CDI) can range in severity from asymptomatic to severe and life-threatening, especially among the elderly.^ Infection with toxigenic C difficile is a potentially life-threatening disease process.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ Infection with toxin-producing C. difficile may result in a wide spectrum of clinical illness ranging in severity from diarrhea to inflammation of the colon and pseudomembranous colitis, to toxic megacolon, and death.
  • http://www.vancocin.com/HealthcareProfessionals/AboutCdifficile.aspx?p=1 10 February 2010 13:33 UTC www.vancocin.com [Source type: Academic]

^ Thus, C. difficile contributes significantly to hospital length of stay, and may be associated in some elderly adults with chronic diarrhea, and occasionally other serious or potentially life-threatening consequences.
  • LYSOL® | Germ Information Center | Clostridium 10 February 2010 13:33 UTC www.lysol.com [Source type: Academic]

.People are most often nosocomially infected in hospitals, nursing homes, or institutions, although C. difficile infection in the community, outpatient setting is increasing.^ Although most people become infected with C. difficile in the hospital, the infection has also become more common in the community.
  • Antibiotic-associated diarrhea (Clostridium difficile) 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ Nosocomial acquisition of Clostridium difficile infection.
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]
  • Clostridium difficile Testing: after 20 Years, Still Challenging -- Wilkins and Lyerly 41 (2): 531 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

^ AAD and colitis occur most often in hospital and nursing home environments rather than in the community setting.
  • Clostridium difficile Colitis Following Antibiotic Prophylaxis for DentalProcedures 10 February 2010 13:33 UTC www.cda-adc.ca [Source type: Academic]

.The rate of C. difficile acquisition is estimated to be 13% in patients with hospital stays of up to 2 weeks, and 50% in those with hospital stays longer than 4 weeks.^ The rate of C. difficile acquisition is estimated to be 13 percent in patients with hospital stays of up to two weeks and 50 percent in those with hospital stays longer than four weeks.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ As a result of the initiatives, the hospital has seen a decrease of 50% in the rates of C. difficile .
  • Enhancing Patient Safety through the Management of Clostridium difficile at Toronto East General Hospital :: Vol. 9 Special Issue | Patient Safety Papers :: Healthcare Quarterly :: Longwoods Publishing 10 February 2010 13:33 UTC www.longwoods.com [Source type: Academic]

^ Acquisition of Clostridium difficile from the hospital environment.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]
  • Clarification of article on Clostridium difficile–associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

.December 2008" style="white-space:nowrap;">[citation needed] C. difficile-associated diarrhea (aka CDAD) is most strongly associated with fluoroquinolones.^ It is a serious illness caused by infection of the inner lining of the colon by C. difficile bacteria, which produce toxins that cause inflammation of the colon, severe diarrhea and, in the most serious cases, death.
  • Optimer Pharmaceuticals Completes Enrollment in Second Fidaxomicin Phase 3 Clinical Trial in Patients With Clostridium difficile - FierceBiotech 10 February 2010 13:33 UTC www.fiercebiotech.com [Source type: Academic]

^ Acquisition of Clostridium difficile and Clostridium difficile-Associated diarrhea in hospitalized patients receiving tube feedings.
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ Abstract Hirschhorn LR, Trnka Y, Onderdonk A, Lee ML, Platt R. Epidemiology of community-acquired Clostridium difficile-associated diarrhea.
  • Clostridium difficile Infection: A Global Perspective of an Epidemic 10 February 2010 13:33 UTC cme.medscape.com [Source type: Academic]

.Fluoroquinolones are more strongly associated with C difficile infections than other antibiotics including clindamycin, 3rd generation cephalosporins and beta-lactamase inhibitors.^ C difficile is also referred to as an antibiotic-associated diarrhea.
  • Huron Perth Healthcare Alliance - Clostridium difficil-Associated Disease (CDAD) 10 February 2010 13:33 UTC www.hpha.ca [Source type: Academic]

^ Barlett JG. Management of Clostridium difficile infection and other antibiotic associated diarrhoea.
  • Antibiotic associated diarrhoea: Infectious causes A Ayyagari, J Agarwal, A Garg - Indian J Med Microbiol 10 February 2010 13:33 UTC www.ijmm.org [Source type: Academic]

^ Are hospital infections caused by C. difficile any more difficult to remove from the environment than other hospital infections?
  • Clostridium Difficle FAQs - Central Manchester and Manchester Children's University Hospitals - CMMC 10 February 2010 13:33 UTC www.cmft.nhs.uk [Source type: Academic]

.One study found that fluoroquinolones were responsible for 55% of C difficile infections.^ The study, which was conducted at Kingston General Hospital, found that roommates were exposed to methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and clostridium difficile (C. difficile).
  • Shutting out infections - The Whig Standard - Ontario, CA 10 February 2010 13:33 UTC www.thewhig.com [Source type: General]

^ The study, released by the Association for Professionals in Infection Control and Epidemiology (APIC), found that 13 out of every 1,000 patients or approximately 7,178 inpatients on any one given day were infected or colonized with C.-diff .
  • Infection Protection & Control » Clostridium difficile 10 February 2010 13:33 UTC www.care-mates.com [Source type: Academic]

^ A new type of C.difficile closely related to one previously found in North America has recently been detected in the UK , including at Stoke Mandeville Hospital .
  • MRSA Action UK 10 February 2010 13:33 UTC mrsaactionuk.net [Source type: Academic]

[10] .The European Center for Disease Prevention and Control recommend that fluoroquinolones and the antibiotic clindamycin be avoided in clinical practice due to their high association with clostridium difficile.^ Brazier JS. The diagnosis of Clostridium difficile-associated disease.
  • Antibiotic associated diarrhoea: Infectious causes A Ayyagari, J Agarwal, A Garg - Indian J Med Microbiol 10 February 2010 13:33 UTC www.ijmm.org [Source type: Academic]

^ Clostridium difficile associated colitis .
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ C difficile is also referred to as an antibiotic-associated diarrhea.
  • Huron Perth Healthcare Alliance - Clostridium difficil-Associated Disease (CDAD) 10 February 2010 13:33 UTC www.hpha.ca [Source type: Academic]

[11] .Frequency and severity of C. difficile colitis remains high and seems to be associated with increased death rates.^ Clostridium difficile associated colitis .
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ Clostridium difficile-associated diarrhoea and colitis.

^ Clostridium difficile-associated diarrhea and colitis.
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

.December 2008" style="white-space:nowrap;">[citation needed] Immunocompromised status and delayed diagnosis appear to result in elevated risk of death.^ Immunocompromised status and delayed diagnosis result in higher mortality in cases of toxic megacolon .
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

^ Among patients with positive C difficile toxin assay results, immunocompromise and delayed diagnosis no longer seem to be associated with higher risk for death.
  • Arch Surg -- Abstract: Clostridium difficile Colitis: An Increasingly Aggressive Iatrogenic Disease?, October 2002, Morris et al. 137 (10): 1096 10 February 2010 13:33 UTC archsurg.ama-assn.org [Source type: Academic]

^ Toxic megacolon, with a mortality of 6–30%, can also occur; narcotic use may increase its likelihood, and immunocompromised status and delayed diagnosis appear to result in higher mortality.
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

.Early intervention and aggressive management are key factors to recovery.^ Early intervention and aggressive management are key factors to recovery.
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

^ Early diagnosis and prompt aggressive treatment are critical in managing C. difficile –associated diarrhea.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

.Increasing rates of community-acquired C. difficile-associated infection/disease have also been linked to the use of medication to suppress gastric acid production: H2-receptor antagonists increased the risk twofold, and proton pump inhibitors threefold, mainly in the elderly.^ Furthermore, some studies suggest that the use of gastric acid-suppressive drugs, including proton pump inhibitors and H2-antagonists, increase the risk of acquiring CDI. .
  • Clostridium difficile Infection - SSHAIP - HPS 10 February 2010 13:33 UTC www.hps.scot.nhs.uk [Source type: Academic]

^ Binary toxin may be associated with increased disease severity, as well as with community-acquired disease.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ Clostridium difficile-associated disease — an increasing burden .
  • Clostridium difficile-associated disease — an increasing burden (summary) – Behind the Medical Headlines 10 February 2010 13:33 UTC behindthemedicalheadlines.com [Source type: Academic]

.It is presumed that increased gastric pH, (alkalinity), leads to decreased destruction of spores.^ It is presumed that increased gastric pH leads to decreased destruction of spores, but colonic receptors do exist for some proton pump inhibitors.
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

^ Drugs and conditions that decrease gastric acidity may also increase susceptibility, particularly proton pump inhibitor drugs.
  • Clostridium difficile–Induced Colitis: Digestive Disorders: Merck Manual Home Edition 10 February 2010 13:33 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Table 20 shows that increasing pH of NZ-Soy BL4 fermentation medium from 6.8 to 7.5 decreased Toxin A production.
  • Clostridium difficile culture and toxin production methods - Patent application 10 February 2010 13:33 UTC www.faqs.org [Source type: Reference]

[12]
.The emergence of a new, highly toxic strain of C. difficile, resistant to fluoroquinolone antibiotics, such as ciprofloxacin (Cipro®) and levofloxacin (Levaquin®), said to be causing geographically dispersed outbreaks in North America was reported in 2005.[13] The Centers for Disease Control in Atlanta has also warned of the emergence of an epidemic strain with increased virulence, antibiotic resistance, or both.^ The strain belongs to ribotype 027 and toxinotype III. It is resistant to fluoroquinolone antibiotics such as ciprofloxacin and moxifloxacin.
  • Clostridium difficile-associated disease — an increasing burden (summary) – Behind the Medical Headlines 10 February 2010 13:33 UTC behindthemedicalheadlines.com [Source type: Academic]

^ In the past five years a new group of highly virulent C. difficile strains has emerged to cause outbreaks of increased severity in North America and Europe.
  • Clostridium difficile Blog : Clostridium difficile Lawyer & Attorney : Marler Clark Law Firm : C. difficile Blog 10 February 2010 13:33 UTC www.cdifficileblog.com [Source type: Academic]

^ It caused disease," Johnson said.
  • What Makes Clostridium Difficile Superbug Deadly? 10 February 2010 13:33 UTC www.sciencedaily.com [Source type: Academic]

[14]

Diagnosis

Signs and Symptoms

.In adults, a clinical prediction rule found the best signs to be: significant diarrhea ("new onset of > 3 partially formed or watery stools per 24 hour period"); recent antibiotic exposure; colitis (abdominal pain); and foul stool odour.^ (Type 5 to 7 - Bristol Stool chart) per 24 hour period and a normal WCC. .
  • Northern Ireland Region Infection Preventation and Control Manual - Clostridium difficile 10 February 2010 13:33 UTC www.infectioncontrolmanual.co.ni [Source type: Academic]

^ Clinical signs Diarrhea: This is usually fairly mild, with 2-6 stools per day.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ Diarrhea is defined as watery or unformed stools, occurring > 3 times a day for at least 2 days, usually associated with abdominal cramping, fever, dehydration, white blood cells in the stool, and peripheral leukocytosis.
  • Clostridium difficile in Long Term Care Facilities 10 February 2010 13:33 UTC www.edcp.org [Source type: Academic]

.The presence of any one of these findings has a sensitivity of 86% and a specificity of 45%.^ Each of these tests is rapid and highly specific, but they all suffer from a lack of sensitivity (with up to 20% false negative results) (1,6).
  • CPS: Position Statement: Inf.Dis.Imm.Comm.: Clostridium difficile - Pathogen orpest? 10 February 2010 13:33 UTC www.cps.ca [Source type: Academic]

^ Although these assays can be quite sensitive at low dilution, specificity is low as many false positives are obtained.
  • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

^ The one-day-snapshot method is somewhat unusual, so it’s tough to compare these findings with C. diff numbers from earlier studies.
  • Forget MRSA for a Moment, Clostridium Difficile is a Growing Problem - Health Blog - WSJ 10 February 2010 13:33 UTC blogs.wsj.com [Source type: General]

[15] .In this study of hospitalized patients with a prevalence of positive cytotoxin assays of 14%, the positive predictive value was 20% and the negative predictive value was 95%.^ The sensitivity, specificity, and negative and positive prediction values of antigen and toxin assays are unknown for asymptomatic patients.
  • NGC - NGC Summary 10 February 2010 13:33 UTC www.guideline.gov [Source type: Academic]

^ These agents have been more commonly prescribed in recent years and may be linked with the increased rates of C. difficile -associated diarrhoea in the community, 14 although some case–control studies with hospital patients show no association.
  • eMJA: Epidemic Clostridium difficile 10 February 2010 13:33 UTC www.mja.com.au [Source type: Academic]

^ Hospitals and chronic care facilities are significant sources of C. difficile infection, with one study finding that 21% of patients acquired C. difficile infection during hospitalization.
  • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

Cytotoxicity assay

.C. difficile toxins have a cytopathic effect in cell culture, and neutralized with specific anti-sera is the practical gold standard for studies investigating new CDAD diagnostic techniques.^ Differential effects of Clostridium difficile toxins on tissue-cultured cells.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ Clostridium difficile toxin B induces apoptosis in intestinal cultured cells.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ Effects of toxin A from Clostridium difficile on mast cell activation and survival.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

[2] .Toxigenic culture, in which organisms are cultured on selective medium and tested for toxin production, remains the gold standard and is the most sensitive and specific test, although it is slow and labour-intensive.^ Tryptone in fermentation medium for Toxin A production.
  • Clostridium difficile culture and toxin production methods - Patent application 10 February 2010 13:33 UTC www.faqs.org [Source type: Reference]

^ Each of these tests is rapid and highly specific, but they all suffer from a lack of sensitivity (with up to 20% false negative results) (1,6).
  • CPS: Position Statement: Inf.Dis.Imm.Comm.: Clostridium difficile - Pathogen orpest? 10 February 2010 13:33 UTC www.cps.ca [Source type: Academic]

^ The standard test is run on 60 slides inoculated with a specific bug, and 59 of them treated with the product must exhibit the claimed rate of germ death.
  • Kills 99.9% of Germs -- Sometimes - WSJ.com 10 February 2010 13:33 UTC online.wsj.com [Source type: General]

[16]

Toxin ELISA

.Assessment of the A and B toxins by enzyme-linked immunoabsorbant assay (ELISA) for toxin A or B (or both) has a sensitivity of 63–99% and a specificity of 93–100%: at a prevalence of 15%, this leads to a positive predictive value (PPV) of 73% and a negative predictive value (NPV) of 96%.^ Samples that test positive in the ELISA assay are then tested in a toxin neutralization assay.
  • Passive immunization against Clostridium difficile disease - Patent 6214341 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

^ Specificity of the assay is high (93 to 100 percent), but sensitivity ranges from 63 to 99 percent.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ The results corresponded to a sensitivity of 52%, specificity of 93%, positive predictive value of 88%, and negative predictive value of 67%.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

.Experts recommend sending as many as three samples to rule out disease if initial tests are negative.^ A stool sample was negative for C. difficile toxin A (at tha t time the laboratory did not test for toxin B production) but this does not rule out the possibility of asymptomatic gut carriage with the bacterium [ 21 - 24 ].
  • BioMed Central | Full text | Aerial Dissemination of Clostridium difficile spores 10 February 2010 13:33 UTC www.biomedcentral.com [Source type: Academic]

^ However, many clinicians did not know the significance of a ‘toxin'-negative isolate: it was therefore thought more appropriate just to test for toxin.
  • Clostridium difficile -- Poxton 54 (2): 97 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ Even so, they offer smaller laboratories the option of performing C. difficile testing in-house rather than sending specimens out for testing.
  • Clostridium difficile Testing: after 20 Years, Still Challenging -- Wilkins and Lyerly 41 (2): 531 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

.C. difficile toxin should clear from the stool of previously infected patients if treatment is effective.^ The patient’s stool should be immediately tested for the presence of C. difficile toxins.
  • Infection Protection & Control » Clostridium difficile 10 February 2010 13:33 UTC www.care-mates.com [Source type: Academic]

^ To confirm the diagnosis, a stool sample will be tested to look for the toxins C. difficile produces.
  • Exempla Healthcare Online Library 10 February 2010 13:33 UTC www.exempla.org [Source type: FILTERED WITH BAYES]

^ Neither C difficile nor its toxin was detected in stool samples collected on the final day of therapy in 71% of patients (10/14) receiving vancomycin and in 30% (3/10) receiving bacitracin.
  • Arch Intern Med -- Abstract: Oral Bacitracin vs Vancomycin Therapy for Clostridium difficile--Induced Diarrhea: A Randomized Double-blind Trial, June 1986, Dudley et al. 146 (6): 1101 10 February 2010 13:33 UTC archinte.ama-assn.org [Source type: Academic]

.However, many hospitals test only for the prevalent toxin A. Strains that express only the B toxin are now present in many hospitals, and ordering both toxins should occur.^ However, new tools are now present: a collections of maps and a more detailed lists of topics.
  • A TIME'S MEMORY: Research Articles Abstracts - January 9, 2010 Issue 10 February 2010 13:33 UTC hygimia69.blogspot.com [Source type: FILTERED WITH BAYES]

^ A C. difficile toxin test may be ordered when a hospitalized patient has frequent loose stools, abdominal pain, fever, and/or nausea during or following a course of antibiotics or following a recent gastrointestinal surgery.
  • Clostridium difficile toxin: The Test 10 February 2010 13:33 UTC www.labtestsonline.org [Source type: Academic]

^ At the present time, however, suitable vaccines against the organism and its toxins have not been developed for individuals at high risk, and it is still unclear whether active immunization is appropriate.
  • Therapeutic treatment of clostridium difficile associated diseases - Patent 5773000 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

[17] .Not testing for both may contribute to a delay in obtaining laboratory results, which is often the cause of prolonged illness and poor outcomes.^ Patients may be diagnosed with C. difficile by hospital/clinic/reference microbiology laboratory test or by a rapid diagnostic test performed by the study staff and positive test result must be within 14 days of enrollment.
  • Study of the Clinical Effectiveness of a Human Monoclonal Antibody to C. Difficile Toxin A and Toxin B in Patients With Clostridium Difficile Associated Disease - Full Text View - ClinicalTrials.gov 10 February 2010 13:33 UTC clinicaltrials.gov [Source type: Academic]

^ This test may also help find the cause of bleeding or pain.
  • Clostridium Difficile Infection | Causes, Symptoms, Treatment | PDRHealth 10 February 2010 13:33 UTC www.pdrhealth.com [Source type: General]

^ Because the toxins produced by C difficile can cause intestinal cell water secretion, it seems logical that watery diarrhea may result.
  • CPS: Position Statement: Inf.Dis.Imm.Comm.: Clostridium difficile - Pathogen orpest? 10 February 2010 13:33 UTC www.cps.ca [Source type: Academic]

Other stool tests

.Stool leukocyte measurements and stool lactoferrin levels have also been proposed as diagnostic tests, but may have limited diagnostic accuracy.^ Immunity appears to be incomplete and predominantly mediated by serum IgG to toxin A. Measures for preventing the spread of the pathogen, appropriate diagnostic testing, and treatment may avert morbidity and mortality due to C difficile –associated diarrhea.
  • Arch Intern Med -- Abstract: Clostridium difficile-Associated Diarrhea: A Review, February 26, 2001, Mylonakis et al. 161 (4): 525 10 February 2010 13:33 UTC archinte.ama-assn.org [Source type: Academic]

^ C. difficile toxin analysis, culture and antibiotic susceptibility testing Stool samples from inpatients of hospitals A and B were collected between May 2006 and March 2007 and tested for C. difficile .

^ These estimates of community-acquired CDAD may be low due to limited fecal testing for Clostridium difficile or its toxins.
  • May 1999 CDA Journal, Copyright 1999 Journal of the California Dental Association 10 February 2010 13:33 UTC www.cda.org [Source type: Academic]

[18]

Computed tomography

.In a recent study, a patient who received a diagnosis of CDC on the basis of computed tomography (CT scan) had an 88% probability of testing positive on stool assay.^ In the 56 patients with negative stool assays, the diagnosis was made in four (7%).
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

^ This test is also called a CT or CAT scan.
  • Clostridium Difficile Infection | Causes, Symptoms, Treatment | PDRHealth 10 February 2010 13:33 UTC www.pdrhealth.com [Source type: General]

^ An abdominal computed tomographic (CT) scan was consistent with this diagnosis.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

[19] .Wall thickening is the key CT finding in this disease.^ Likewise, six patients in the control group who had ascites had clear coexistent diseases shown on CT that could explain this finding.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

^ Results for the distribution and diagnostic value of CT findings, the findings themselves, and colon wall measurements in both groups were those determined at the time of the retrospective review.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

^ Wall thickening is the key CT finding in this disease, and, except for the five patients who showed ascites explained by other coexistent diseases on their scans, all the patients in the group with positive assay results showing any abnormality suggestive of C. difficile had thickened colon walls.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

.Once colon wall thickening is identified as being >4 mm, the best ancillary findings were pericolonic stranding, ascites, and colon wall nodularity.^ Computed tomography scans may show thickening of the colon wall or obliteration of the lumen.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

^ April I was rushed for surgery to drain a good sized abscess from my belly I was told that it was a colon perforation ,, and that the colon wall had thickened as a natural body protection ..
  • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

^ When considered with the clinical history, the presence of ascites, colon wall thickening, or dilation can help categorize the severity of the colitis.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

.The presence of wall thickness plus any one of these ancillary findings is 70% sensitive and 93% specific.^ A wall thickness of 10 mm or greater is by itself a specific finding for C. difficile colitis, but not a sensitive one.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

^ Each of these tests is rapid and highly specific, but they all suffer from a lack of sensitivity (with up to 20% false negative results) (1,6).
  • CPS: Position Statement: Inf.Dis.Imm.Comm.: Clostridium difficile - Pathogen orpest? 10 February 2010 13:33 UTC www.cps.ca [Source type: Academic]

^ Using the criteria of either a wall thickness of 10 mm or greater or a wall thickness of greater than 4 mm and any of the more specific findings does not add significantly to the diagnosis based on our data (sensitivity, 72%; specificity, 91%) but gives equally satisfactory results.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

.Using criteria of ≥10 mm or a wall thickness of >4 mm and any of the more-specific findings does not add significantly to the diagnosis but gives equally satisfactory results.^ A wall thickness of 10 mm or greater is by itself a specific finding for C. difficile colitis, but not a sensitive one.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

^ Using the criteria of either a wall thickness of 10 mm or greater or a wall thickness of greater than 4 mm and any of the more specific findings does not add significantly to the diagnosis based on our data (sensitivity, 72%; specificity, 91%) but gives equally satisfactory results.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

^ At our center, the criteria used for diagnosis by our radiologists (based on prior studies) over the last 4 years have been a colon wall thickness of greater than 4 mm in conjunction with any findings of wall nodularity, the accordion sign, pericolonic stranding, or unexplained ascites [ 6 , 7 , 10 ].
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

.In this study with a prevalence of positive C. difficile toxin of 54%, the PPV was 88%.^ Positive regulation of Clostridium difficile toxins.
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ Prevalence of toxin A negative/B positive Clostridium difficile strains.
  • Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review -- Thomas et al. 51 (6): 1339 -- Journal of Antimicrobial Chemotherapy 10 February 2010 13:33 UTC jac.oxfordjournals.org [Source type: Academic]
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ C. difficile is a gram-positive spore-forming bacillus that produces toxins that can cause disease in healthy patients, often following the administration of antibiotics.
  • Enhancing Patient Safety through the Management of Clostridium difficile at Toronto East General Hospital :: Vol. 9 Special Issue | Patient Safety Papers :: Healthcare Quarterly :: Longwoods Publishing 10 February 2010 13:33 UTC www.longwoods.com [Source type: Academic]

.Patients who have antibiotic-associated diarrhea who have CT findings diagnostic of CDC merit consideration for treatment on that basis.^ Antibiotic treatment for Clostridium difficile -associated diarrhea in adults.
  • Exempla Healthcare Online Library 10 February 2010 13:33 UTC www.exempla.org [Source type: FILTERED WITH BAYES]

^ (See "Treatment of antibiotic-associated diarrhea caused by Clostridium difficile" .
  • Antibiotic-associated diarrhea (Clostridium difficile) 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ This is often called antibiotic-associated diarrhea.
  • gihealth.com - built for patient satisfaction 10 February 2010 13:33 UTC www.gihealth.com [Source type: FILTERED WITH BAYES]

.A weakness of this study was the lack of comparison with the accepted cytotoxicity assay.^ Comparison of three enzyme immunoassays, a cytotoxicity assay, and toxigenic culture for diagnosis of Clostridium difficile -associated diarrhea.
  • Evaluation of Two Rapid Assays for Detection of Clostridium difficile Toxin A in Stool Specimens -- Fedorko et al. 37 (9): 3044 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

^ Comparison of three enzyme immunoassays, a cytotoxicity assay, and toxigenic culture for diagnosis of Clostridium difficile -associated diarrhoea.
  • Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review -- Thomas et al. 51 (6): 1339 -- Journal of Antimicrobial Chemotherapy 10 February 2010 13:33 UTC jac.oxfordjournals.org [Source type: Academic]

^ Laboratory diagnosis of Clostridium difficile -associated gastrointestinal disease: comparison of a monoclonal antibody enzyme immunoassay for toxins A and B with a monoclonal antibody enzyme immunoassay for toxin A only and two cytotoxicity assays.
  • Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review -- Thomas et al. 51 (6): 1339 -- Journal of Antimicrobial Chemotherapy 10 February 2010 13:33 UTC jac.oxfordjournals.org [Source type: Academic]

Real-Time PCR

.As the menu of molecular methods expands, more infectious diseases will be able to be quickly diagnosed with a high degree of accuracy.^ More articles on Infectious diseases and parasitology .
  • eMJA: Epidemic Clostridium difficile 10 February 2010 13:33 UTC www.mja.com.au [Source type: Academic]

^ The infectious disease doctor ran various viral titers, and found an extremely high CMV level, which as I recall was over 12.
  • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

^ Click on any of the highlighted links below for more information about these horse-related infectious disease topics.
  • clostridium : Equid Blog 10 February 2010 13:33 UTC www.equidblog.com [Source type: FILTERED WITH BAYES]

.By the end of 2009, 3 different Real-Time PCR tests had achieved 510(k) clearance from the FDA. Cepheid's GeneXpert is by far the fastest and easiest of the three, but it is also the most expensive.^ Most of the time, if an animal has diarrhea and the test you perform tells you there is a known diarrhea-causing pathogen in the feces , you assume the diarrhea is due to that agent.
  • clostridium : Equid Blog 10 February 2010 13:33 UTC www.equidblog.com [Source type: FILTERED WITH BAYES]

^ Test code: B0042 - Ultrasensitive detection of Clostridium perfringens by real time PCR .
  • Clostridium PCR test for primates 10 February 2010 13:33 UTC www.zoologix.com [Source type: Academic]

^ No significant differences in CT sensitivity could likewise be seen on the basis of the time of CT in relation to the time of stool assay testing.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

.Cepheid uses a cartridge based kit that is tailored for small hospitals or labs without the ability to batch large numbers of samples together.^ To estimate the reliability of sample separation using our primer-tagging approach, we assessed the number of reads observed to have an illegitimate 4-mer tag (i.e., different from our set of 20 tags).
  • PLoS Pathogens: Like Will to Like: Abundances of Closely Related Species Can Predict Susceptibility to Intestinal Colonization by Pathogenic and Commensal Bacteria 10 February 2010 13:33 UTC www.plospathogens.org [Source type: Academic]

^ An excellent, up-to-date review of the topic with a specific discussion of the large number of children who carry Clostridium difficile in the stool without any specific symptomatology.
  • CPS: Position Statement: Inf.Dis.Imm.Comm.: Clostridium difficile - Pathogen orpest? 10 February 2010 13:33 UTC www.cps.ca [Source type: Academic]

^ Joe FitzPatrick made an important point about the small sample base for the statistics.
  • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

.In fact, batching is not required since the extraction occurs in the same vial as amplification of the target, positive, and negative controls.^ A low-positive control well and a negative control well were included with each test run.
  • Evaluation of Two Rapid Assays for Detection of Clostridium difficile Toxin A in Stool Specimens -- Fedorko et al. 37 (9): 3044 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

^ Third, since environmental contamination occurs with both these pathogens, successful control of these organisms may require enhanced disinfection procedures in some cases.
  • Chapter 14. Impact of Changes in Antibiotic Use Practices on Nosocomial Infections and Antimicrobial Resistance--Clostridium difficile and Vancomycin-resistant Enterococcus (VRE) 10 February 2010 13:33 UTC www.ahrq.gov [Source type: Academic]

^ The sensitivity and specificity in this case would have, in fact, been 70% and 93%, respectively, with a positive predictive value of 90% and negative predictive value of 76%.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

.The reported time from sample to result is ~45 minutes.^ Purity was assessed and quantification done using a NanoDrop1000 spectrophotometer and by running the samples on 1.0% agarose gel, 100 mV for 45 minutes.
  • Genome Biology | Full text | Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium 10 February 2010 13:33 UTC genomebiology.com [Source type: Academic]

^ Stool samples were tested and reported promptly by the laboratory and results were passed immediately to the ward at weekends and the Infection Control Nurse during the week.
  • Department of Public Health 10 February 2010 13:33 UTC www.abdn.ac.uk [Source type: Academic]

^ Obtaining stool specimens requires nursing time to collect and laboratory technician time to perform the test and report results.
  • NGC - NGC Summary 10 February 2010 13:33 UTC www.guideline.gov [Source type: Academic]

.Prodesse offers another kit based IVD Real-Time PCR test (Pro-Gastro) which uses an external extraction and purification on the Roche MagnaPure.^ The commercial GDH tests offer a turnaround time of 15 to 45 min, which is another reason the tests are used in many labs.
  • Clostridium difficile Testing: after 20 Years, Still Challenging -- Wilkins and Lyerly 41 (2): 531 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

^ His doctor told him to have another C-diff test and use immodium to avoid dehydration.

^ Other materials useful in the performance of the assays can also be included in the kits, including test tubes, magnets, transfer pipettes, and the like.
  • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

.Prodesse (GeneProbe) tech support claims this external separation produces higher yields than the BD GeneOhm.^ O27 and O1 may produce higher sporulation levels than other strains and these were even higher when non-chlorinated disinfectants were used.
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

^ This strain is considered to be more virulent than other strains and produces higher levels of toxins.
  • Northern Ireland Region Infection Preventation and Control Manual - Clostridium difficile 10 February 2010 13:33 UTC www.infectioncontrolmanual.co.ni [Source type: Academic]

^ C. difficile strains that were more sensitive to lactobacilli ( n = 9) usually produced higher toxin levels and more SCFAs, and were more resistant to antibiotics, than strains that were resistant to lactobacilli ( n = 14).
  • Inhibition of Clostridium difficile strains by intestinal Lactobacillus species -- Naaber et al. 53 (6): 551 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

.The Prodesse technique is similar in price to the BD GeneOhm technique after one includes the price of the extraction and takes about three hours from sample to result.^ One of the main advantages of these immunoassays is their rapidity, with results available within hours.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

^ The enzyme-linked immunosorbent assay test for toxin A or toxins A and B has excellent specificity, and results are usually available in about 2 hours.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

^ Of note, the toxins themselves are unstable at room temperature; therefore, false-negative results may occur in samples that are not tested within 2 hours of collection.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

.The final IVD C. diff Real Time PCR test on the market since 2009 is from BD GeneOhm.^ Test code: B0042 - Ultrasensitive detection of Clostridium perfringens by real time PCR .
  • Clostridium PCR test for primates 10 February 2010 13:33 UTC www.zoologix.com [Source type: Academic]

^ Test code: B0043 - Ultrasensitive qualitative detection of Clostridium piliforme (Tyzzer's disease) bacteria by real time PCR .
  • Clostridium PCR test for primates 10 February 2010 13:33 UTC www.zoologix.com [Source type: Academic]

^ Since there is a test out there that can really test for this we would like some more information on the bio feed back.
  • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

.The protocol uses a glass-bead lysis rather than an extraction, but results are reported to be good and the method shaves a little over an hour off the protocol time (about 1 hour 45 minutes from sample to result).^ The commercial GDH tests offer a turnaround time of 15 to 45 min, which is another reason the tests are used in many labs.
  • Clostridium difficile Testing: after 20 Years, Still Challenging -- Wilkins and Lyerly 41 (2): 531 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

^ Method Purified C. difficile toxin A was 3 H-labelled using a modified Bolton-Hunter protocol as previously described (C. Pothoulakis et al., J. Clin.
  • Therapeutic treatment of clostridium difficile associated diseases - Patent 5773000 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

^ In addition, a single dose of C. difficile immune globulin, administered percutaneously (e.g., intramuscularly, intravenously, or intraperitoneally), can be used in the methods of the invention, rather than the repeating dosing required for oral administration (Lyerly et al., Infect.
  • Passive immunization against Clostridium difficile disease - Patent 6214341 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

Total costs for the Prodesse and BD GeneOhm tests are approximately the same. .For each test, sensitivities are generally reported as 95-99% and specificities as 92-96%, depending on the tests and the size of the patient pool.^ Each of these tests is rapid and highly specific, but they all suffer from a lack of sensitivity (with up to 20% false negative results) (1,6).
  • CPS: Position Statement: Inf.Dis.Imm.Comm.: Clostridium difficile - Pathogen orpest? 10 February 2010 13:33 UTC www.cps.ca [Source type: Academic]

^ The main disadvantage however is its low sensitivity (63-99%).25 100 - 1000 pg of toxin A or B must be present for the test to be positive.
  • Antibiotic associated diarrhoea: Infectious causes A Ayyagari, J Agarwal, A Garg - Indian J Med Microbiol 10 February 2010 13:33 UTC www.ijmm.org [Source type: Academic]

^ The sensitivity of this Immunocard C. difficile test was reported to be 83%, with a larger number of false-positive results (37 of 139) than false-negative results (20 of 720).
  • Evaluation of Two Rapid Assays for Detection of Clostridium difficile Toxin A in Stool Specimens -- Fedorko et al. 37 (9): 3044 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

Prevention

.The most effective method for preventing CDAD is proper antimicrobial prescribing.^ The most important method of prevention, however, is hand washing using soap and water since alcohol-based sanitizers are unable to kill clostridia spores.
  • ISPUB - Clostridium difficile: The new epidemic 10 February 2010 13:33 UTC www.ispub.com [Source type: Academic]

^ This may be partly owing to its inclusion in the most recent American Heart Association guidelines for the prevention of endocarditis 1 and its attractive antimicrobial spectrum for the treatment of dental infections.
  • Clostridium difficile Colitis Following Antibiotic Prophylaxis for DentalProcedures 10 February 2010 13:33 UTC www.cda-adc.ca [Source type: Academic]

^ Three elements are required for prevention of CDAD: proper hand washing, contact isolation, and environmental measures.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

.In the hospital setting, where CDAD is most common, nearly all patients that develop CDAD are exposed to antimicrobials.^ It is the most common infection acquired by patients while they are in the hospital.
  • Clostridium difficile colitis (C. difficile) Causes, Symptoms, Diagnosis and Treatment by MedicineNet.com 10 February 2010 13:33 UTC www.medicinenet.com [Source type: Academic]

^ Although most people become infected with C. difficile in the hospital, the infection has also become more common in the community.
  • Antibiotic-associated diarrhea (Clostridium difficile) 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ Priorities of Care All patients with CDAD require monitoring of vital signs and hemodynamic status.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

.Although proper antimicrobial prescribing sounds easy to do, approximately 50% of antimicrobial use is considered inappropriate.^ Guidelines for antimicrobial use 8 —dissemination to physicians of guidelines describing appropriate and inappropriate use.
  • Chapter 14. Impact of Changes in Antibiotic Use Practices on Nosocomial Infections and Antimicrobial Resistance--Clostridium difficile and Vancomycin-resistant Enterococcus (VRE) 10 February 2010 13:33 UTC www.ahrq.gov [Source type: Academic]

^ D R K ELLY : Although most cases of CDI follow antibiotic use, the disease can occur in the absence of antimicrobials.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

^ Although stopping the antibiotic may be effective, the reason the antibiotic was prescribed in the first place should be considered, and monitoring for recurrence or worsening of the underlying infection is essential.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

.This is consistent whether in the hospital, clinic, community, or academic setting.^ AAD and colitis occur most often in hospital and nursing home environments rather than in the community setting.
  • Clostridium difficile Colitis Following Antibiotic Prophylaxis for DentalProcedures 10 February 2010 13:33 UTC www.cda-adc.ca [Source type: Academic]

^ (See "Clinical manifestations and diagnosis of Clostridium difficile infection" and "Prevention and control of Clostridium difficile in hospital and institutional settings" and "Treatment of antibiotic-associated diarrhea caused by Clostridium difficile" .
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ Although CDAD is seen mainly inside hospitals and other healthcare settings, community CDAD is also described, although more epidemiological information is required.
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

.Several studies have demonstrated a decrease in CDAD by limiting antibiotics most strongly associated with CDAD or by limiting unnecessary antimicrobial prescribing in general, both in outbreak and non-outbreak settings.^ Nine different C. difficile ribotypes were associated with severe CDI in our study.

^ Previous studies have demonstrated that the increased cost of these antibiotics can be offset by the saving in reduced mortality, morbidity and bed occupancy that result from controlling C. difficile .
  • Antibiotic prescribing policy and Clostridium difficile diarrhoea -- O'Connor et al. 97 (7): 423 -- QJM 10 February 2010 13:33 UTC qjmed.oxfordjournals.org [Source type: Academic]

^ Asymptomatic colonisation can occur and diarrhoea ( Clostridium difficile associated diarrhoea (CDAD)) which varies in severity from mild to extremely severe.
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

.The testing of all hospital inpatients over the age of 65 with diarrhea for CDiff became a compulsory NHS practice in January 2008, when it became evident that many outbreaks were being disguised as Norovirus in the UK, by hospital Risk Managers, who can be sacked by the Department of Health if CDiff infection rates are too high, but cannot be dismissed as a result of a Norovirus outbreak.^ Patients All patients were aged 65 years and over.
  • Antibiotic prescribing policy and Clostridium difficile diarrhoea -- O'Connor et al. 97 (7): 423 -- QJM 10 February 2010 13:33 UTC qjmed.oxfordjournals.org [Source type: Academic]

^ (Department of Health, 30 January 2007) .
  • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

^ (Department of Health, Dear Colleague letter, 30 January 2008) .
  • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

.December 2008" style="white-space:nowrap;">[citation needed] Patients most at risk are those with recent broad-spectrum antibiotic and proton-pump inhibitor treatments.^ C. difficile is not a major constituent of the microflora in colons of healthy adult humans or animals but can grow to large populations in people that are treated with antibiotics, especially broad-spectrum antibiotics.
  • Clostridium difficile - MicrobeWiki 10 February 2010 13:33 UTC microbewiki.kenyon.edu [Source type: Academic]

^ Clostridium difficile is a toxin-producing bacterium that flourishes when broad-spectrum antibiotics kill the normal flora of the colon.
  • When, if Ever, Is Colon Cleansing a Good Idea? - Health Advice (usnews.com) 10 February 2010 13:33 UTC www.usnews.com [Source type: General]

^ It is presumed that increased gastric pH leads to decreased destruction of spores, but colonic receptors do exist for some proton pump inhibitors.
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

.Infection control measures, such as wearing gloves when caring for patients with CDAD, have been proven to be effective at prevention.^ Introduction to infection control in care homes .
  • Clostridium difficile 10 February 2010 13:33 UTC www.nric.org.uk [Source type: Academic]

^ Infection Control Guidelines for Care Homes: The prevention and control of healthcare associated infection in care homes .
  • Clostridium difficile 10 February 2010 13:33 UTC www.nric.org.uk [Source type: Academic]

^ Doctors and nursing staff should wear disposable aprons and gloves and wash themselves after contact with each patient.
  • Q&A: Clostridium difficile, the latest superbug - Times Online 10 February 2010 13:33 UTC www.timesonline.co.uk [Source type: News]

.This works by limiting the spread of C. difficile in the hospital setting.^ Alteration of intestinal microbial balance with antibiotic use and increased exposure to the organism in a hospital setting allows C. difficile to colonize the gut in susceptible individuals.
  • Clostridium PCR tests 10 February 2010 13:33 UTC www.zoologix.com [Source type: Academic]
  • Clostridium PCR test for primates 10 February 2010 13:33 UTC www.zoologix.com [Source type: Academic]

^ (See "Clinical manifestations and diagnosis of Clostridium difficile infection" and "Prevention and control of Clostridium difficile in hospital and institutional settings" and "Treatment of antibiotic-associated diarrhea caused by Clostridium difficile" .
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ Previous work [ 13 , 14 ] has found surfaces within bathrooms and toilets to be among the most contaminated areas within hospitals, which is not surprising given that C. difficile colonises the colon.
  • BioMed Central | Full text | Aerial Dissemination of Clostridium difficile spores 10 February 2010 13:33 UTC www.biomedcentral.com [Source type: Academic]

.In addition, washing with soap and water will eliminate the spores from contaminated hands, but alcohol-based hand rubs are ineffective.^ Hand washing with soap and water .
  • Northern Ireland Region Infection Preventation and Control Manual - Clostridium difficile 10 February 2010 13:33 UTC www.infectioncontrolmanual.co.ni [Source type: Academic]

^ Wash your hands when necesary with soap & water.
  • Clostridium Difficile Is the New MRSA - Health Blog - WSJ 10 February 2010 13:33 UTC blogs.wsj.com [Source type: General]

^ Hands should be washed frequently with soap and water.
  • Clostridium difficile in Long Term Care Facilities 10 February 2010 13:33 UTC www.edcp.org [Source type: Academic]

[20]Treatment with various oral supplements containing live bacteria has been studied in efforts to prevent .Clostridium difficile-associated infection/disease.^ Clostridium difficile associated colitis .
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ Clostridium difficile-associated disease — an increasing burden .
  • Clostridium difficile-associated disease — an increasing burden (summary) – Behind the Medical Headlines 10 February 2010 13:33 UTC behindthemedicalheadlines.com [Source type: Academic]

^ The burden of Clostridium difficile associated disease in England (poster).
  • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

.A randomized controlled trial using a probiotic drink containing Lactobacillus casei, L bulgaricus, and Streptococcus thermophilus was reported to have some efficacy.^ A randomized, placebo-controlled trial.
  • Treatment of antibiotic-associated diarrhea caused by Clostridium difficile 10 February 2010 13:33 UTC www.uptodateonline.com [Source type: Academic]

^ However, a randomized placebo-controlled trial in 135 hospitalized patients, of whom 113 were followed up, found that a lactobacillus-containing probiotic mixture reduced the incidence of nosocomial CDI in antimicrobial recipients from 17% to 0% 35 (risk reduction, 17%; 95% confidence interval, 7%-27%), but further studies are needed to confirm or refute this finding.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

^ Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile- associated diarrhoea: a double-blind, placebo-controlled trial.
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

This study was sponsored by the company that produces the drink studied.[21] .Although intriguing, several other studies have been unable to demonstrate any benefit of oral supplements of similar bacteria at preventing CDAD.[citation needed] Of note, patients on the antibiotics most strongly associated with CDAD were excluded from this study.^ Biotherapy for antibiotic-associated and other diarrhoeas.
  • Inhibition of Clostridium difficile strains by intestinal Lactobacillus species -- Naaber et al. 53 (6): 551 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ Patients who have been prescribed antibiotics (which destroy the 'friendly' bacteria in the intestines crucial for fighting infection) and the elderly are most at risk, with over eighty percent of reported cases being in the over 65 age group.

^ Patients treated with tolevamer did suffer fewer relapses than patients treated with antibiotics, but because of the differential efficacies as a result of disease severity it is still uncertain whether the binding agent will have any role in prevention of relapses, either alone or in combination with an antibiotic.
  • Clostridium difficile-associated disease — an increasing burden (summary) – Behind the Medical Headlines 10 February 2010 13:33 UTC behindthemedicalheadlines.com [Source type: Academic]

.In a limited clinical trial, a C. difficile anti-toxoid vaccine was reported to improve patient outcomes.^ If C. difficile infection is detected early, studies show reduced length of stay, improved patient outcomes, and significant cost savings for hospitals.
  • Cepheid Launches First On-Demand Molecular Diagnostic Test for Clostridium Difficile Into European - Global Hospital & Healthcare Management 10 February 2010 13:33 UTC www.hhmglobal.com [Source type: Academic]

^ Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial.
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]
  • Evaluation of Two Rapid Assays for Detection of Clostridium difficile Toxin A in Stool Specimens -- Fedorko et al. 37 (9): 3044 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

^ Clinical characteristics and antibiotic utilization in surgical patients with Clostridium difficile -associated diarrhea.
  • Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review -- Thomas et al. 51 (6): 1339 -- Journal of Antimicrobial Chemotherapy 10 February 2010 13:33 UTC jac.oxfordjournals.org [Source type: Academic]

Further testing will be required to validate this trial.[22]

Treatment

.Asymptomatic colonization with C. difficile is common.^ Recurrent infection with epidemic Clostridium difficile in a peripartum woman whose infant was asymptomatically colonized with the same strain.
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ Shim and associates reported that diarrhea developed in only 1% of 192 patients asymptomatically colonized with C. difficile on admission to hospital compared with 3.6% of 618 patients not colonized with the organism on admission ( p = 0.02).
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

^ C difficile colonization results in a wide spectrum of clinical conditions, including an asymptomatic carrier state, mild self-limited diarrhea, pseudomembranous colitis, and fulminant colitis.
  • Clostridium Difficile Colitis: eMedicine Gastroenterology 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

.Treatment in asymptomatic patients is controversial, also leading into the debate of clinical surveillance and how it intersects with public health policy.^ I know that this has affected my self confidence (I try to stay out of the public as much as possible) and daily activities, but I am wondering how this can be affecting my general health.
  • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

^ The second bill strengthens the public health department’s surveillance efforts of hospitals and requires doctors and other medical professionals at hospitals to be trained in preventing the spread of infections.
  • Infection Protection & Control » Clostridium difficile 10 February 2010 13:33 UTC www.care-mates.com [Source type: Academic]

^ Overall, evidence from the limited number of studies investigating the treatment of asymptomatic carriers does not seem to warrant this policy.
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

.Mild cases generally do not require specific treatment.^ Patients with mild diarrhoea not caused by C. difficile may not need any specific treatment except substitution of lost fluid and electrolytes.
  • Antibiotic associated diarrhoea: Infectious causes A Ayyagari, J Agarwal, A Garg - Indian J Med Microbiol 10 February 2010 13:33 UTC www.ijmm.org [Source type: Academic]

^ However, treatment with specific antibiotics is needed in more severe cases.
  • Clostridium Difficile | Health | Patient UK 10 February 2010 13:33 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ Antibiotic therapy for first-episode infections is well established; however, treatment of relapsed cases is less well defined and multiple relapses could require lengthy therapy.
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

[2][23]
.Patients should be treated as soon as possible when the diagnosis of Clostridium difficile colitis (CDC) is made to avoid frank sepsis or bowel perforation.^ Clostridium difficile associated colitis .
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ Clostridium difficile Colitis Topic Contents .
  • Exempla Healthcare Online Library 10 February 2010 13:33 UTC www.exempla.org [Source type: FILTERED WITH BAYES]

^ Outcome after colectomy for Clostridium difficile colitis.
  • Treatment of antibiotic-associated diarrhea caused by Clostridium difficile 10 February 2010 13:33 UTC www.uptodateonline.com [Source type: Academic]

.To reduce complications, physicians often begin treatment based on clinical presentation before definitive results are available.^ Patients should wash their hands  or use an alcohol-based hand sanitizer before  (to reduce the risk of depositing something on the pet's coat) and after (to reduce the risk of picking something up from the pet's coat) touching a pet.
  • Clostridium difficile : Worms and Germs Blog 10 February 2010 13:33 UTC www.wormsandgermsblog.com [Source type: FILTERED WITH BAYES]

^ We believe that given this finding, it would be reasonable to consider initiating treatment based on the CT results alone, while a stool assay for confirmation is pending.
  • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

^ If there is a high suspicion that C. difficile is the cause of a person's symptoms, treatment may be started before the results of the tests are available.
  • Antibiotic-associated diarrhea (Clostridium difficile) 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

.Knowledge of the local epidemiology of intestinal flora of a particular institution can guide therapy.^ These conditions can occur when the normal intestinal flora is disrupted by, e.g., antibiotic or anti-neoplastic therapy.
  • Clostridium difficile culture and toxin production methods - Patent application 10 February 2010 13:33 UTC www.faqs.org [Source type: Reference]

^ Colonization of the intestinal tract occurs via the fecal-oral route and is facilitated by disruption of normal intestinal flora due to antimicrobial therapy.
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ C. difficile colonizes the human intestinal tract after the normal gut flora has been altered by antibiotic therapy and is the causative organism of antibiotic-associated pseudomembranous colitis.
  • Treatment of antibiotic-associated diarrhea caused by Clostridium difficile 10 February 2010 13:33 UTC www.uptodateonline.com [Source type: Academic]

.Saccharomyces boulardii Lyo is the only probiotic worldwide known to diminish levels of Clostridium difficile in the body.^ The effect of probiotics on Clostridium difficile diarrhea.
  • Inhibition of Clostridium difficile strains by intestinal Lactobacillus species -- Naaber et al. 53 (6): 551 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ Other therapies that have been employed include bacitracin, fusidic acid, teicoplanin, vancomycin plus rifampin, vancomycin in tapering doses, cholestyramine after vancomycin and re-establishment of the colonic flora with lactobacillus, nontoxigenic Clostridium difficile, and Saccharomyces boulardii .
  • May 1999 CDA Journal, Copyright 1999 Journal of the California Dental Association 10 February 2010 13:33 UTC www.cda.org [Source type: Academic]

^ [CrossRef] [Medline] Surawicz CM, McFarland LV, Elmer G, Chinn J. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii .
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

.S. boulardii Lyo can be found under the brand name Florastor; clinically proven as effective treatment alongside traditional medications.^ Several clinical trials and case reports have examined probiotics, usually in combination with vancomycin or metronidazole, for the treatment of recurrent CDAD. Saccharomyces boulardii .
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ The use of S. boulardii as an adjunctive treatment to therapy with metronidazole or vancomycin has been found in controlled studies to decrease further recurrences of Clostridium difficile-associated disease.
  • Clostridium difficile diarrhea - CareCure Forums 10 February 2010 13:33 UTC sci.rutgers.edu [Source type: Academic]

[24]

Pharmacotherapy

Three antibiotics are specifically effective against C. difficile in vivo :
.
  • Metronidazole (400–500 mg orally three times daily[25]) is the drug of choice, because of lower price and comparable efficacy.^ First-line therapy consists of metronidazole, 500 mg orally three or four times daily for 10 to 14 days.
    • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

    ^ Stool samples were positive for CD toxin detected by its cytopathic effect on Vero cell cultures and 7 days of oral metronidazole 400 mg tds was prescribed.
    • Intravenous immunoglobulin for resistant Clostridium difficile infection -- Murphy et al. 35 (1): 85 -- Age and Ageing 10 February 2010 13:33 UTC ageing.oxfordjournals.org [Source type: Academic]

    ^ The antibiotic of choice for CDAD or PMC that does not resolve is metronidazole (250 mg four times a day or 500 mg three times a day orally) for 10 days.
    • May 1999 CDA Journal, Copyright 1999 Journal of the California Dental Association 10 February 2010 13:33 UTC www.cda.org [Source type: Academic]

    [26]
  • .
  • Oral vancomycin (125 mg four times daily) is second-line therapy, but is often avoided due to concerns of converting intestinal flora into vancomycin-resistant organisms.^ Vancomycin (125 mg orally 4 times daily [for 10–14 days]) is the recommended second-line therapy.
    • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

    ^ Second-line therapy for treatment failure is vancomycin.
    • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

    ^ Oral metronidazole or oral vancomycin hydrochloride for 10 to 14 days are equally effective at resolving clinical symptoms; oral metronidazole is preferred in most cases because of lowered cost and less selective pressure for vancomycin-resistant organisms.
    • Arch Intern Med -- Abstract: Clostridium difficile-Associated Diarrhea: A Review, February 26, 2001, Mylonakis et al. 161 (4): 525 10 February 2010 13:33 UTC archinte.ama-assn.org [Source type: Academic]

    [27][28] .Vancomycin is the treatment of choice in the following cases: no response to oral metronidazole; the organism is resistant to metronidazole; the patient is allergic to metronidazole; the patient is either pregnant or younger than 10 years of age.^ Patients All patients were aged 65 years and over.
    • Antibiotic prescribing policy and Clostridium difficile diarrhoea -- O'Connor et al. 97 (7): 423 -- QJM 10 February 2010 13:33 UTC qjmed.oxfordjournals.org [Source type: Academic]

    ^ For severe cases of AAD, oral metronidazole is the first line of treatment, and oral vancomycin is the second choice.
    • Antibiotic associated diarrhoea: Infectious causes A Ayyagari, J Agarwal, A Garg - Indian J Med Microbiol 10 February 2010 13:33 UTC www.ijmm.org [Source type: Academic]

    ^ Standard treatment is usually with oral metronidazole or vancomycin.
    • Intravenous immunoglobulin for resistant Clostridium difficile infection -- Murphy et al. 35 (1): 85 -- Age and Ageing 10 February 2010 13:33 UTC ageing.oxfordjournals.org [Source type: Academic]

    Vancomycin must be administered orally because IV administration does not achieve gut lumen minimum therapeutic concentration.
A more recent study by Zar and others.[29] showed no difference between vancomycin and metronidazole in mild disease, but that vancomycin was superior to metronidazole for treating severe disease.^ Meta-analysis of four randomized clinical trials comparing different antibiotics for the treatment of CDAD showed no overall superiority of any antibiotic compared to vancomycin or metronidazole ( Fig.
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ The indications for using oral vancomycin to treat CDI include severe disease, metronidazole contraindications or intolerance, and inadequate response to metronidazole treatment.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

^ First, A - B + isolates are capable of causing disease that can be severe or fatal if not promptly diagnosed and treated.
  • Clostridium difficile Testing: after 20 Years, Still Challenging -- Wilkins and Lyerly 41 (2): 531 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

.In this study, severe disease was defined on a point score: One point each was given for age >60 years, temperature >38.3°C, albumin level <2.5 mg/dL, or peripheral WBC count >15,000 cells/mm3 within 48 h of enrollment.^ The variables used to define severe disease in the study by Zar et al 6 consisted of intensive care unit admission or pseudomembranous colitis at endoscopy or any 2 of the following: age older than 60 years, temperature higher than 101°F (38.4°C), serum albumin less than 2.5 g/dL, and peripheral white blood cell count greater than 15 000/µL. This grading system was established empirically but, nonetheless, was able to prospectively identify patients with CDI at greater risk of failure of metronidazole treatment.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

^ Thirteen of every 1,000 hospitalized patients are colonized with C. diff, and 94% of those patients show signs of C. diff disease, such as severe diarrhea.
  • Forget MRSA for a Moment, Clostridium Difficile is a Growing Problem - Health Blog - WSJ 10 February 2010 13:33 UTC blogs.wsj.com [Source type: General]

^ This bacterium causes severe liver disease and sudden illness in young, otherwise healthy foals between the ages of 1 and 6 weeks.
  • clostridium : Equid Blog 10 February 2010 13:33 UTC www.equidblog.com [Source type: FILTERED WITH BAYES]

.Two points were given for endoscopic evidence of pseudomembranous colitis or treatment in the intensive care unit.^ Admission to intensive care unit .
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ Experienced by patients in extended care facilities, acute care areas, and intensive care units, it has become increasingly prevalent in the United States since 2003, when 178000 cases were diagnosed.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

^ Endoscopic visualization of pseudomembranous colitis, a characteristic manifestation of full-blown Clostridium difficile colitis.
  • Clostridium Difficile Colitis: eMedicine Gastroenterology 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

.Severe disease was defined as 2 or more points on this score.^ For more complete details on C. difficile and C. difficile -associated disease, we recommend several excellent reviews ( 13 , 41 , 76 , 79 , 168 ).
  • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

^ In patients with more severe disease, these lesions enlarge to cover substantial portions of inflamed mucosa, but can be easily stripped off (thus the term pseudomembrane).
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ For more severe disease, antimicrobial therapy directed against C. difficile is required.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

.The main criticism of this study is that a low, non-standard dose of metronidazole (250 mg) was used instead of (500 mg).^ Alternatives: 250 mg every six hours for 10 to 14 days and 500 mg IV every eight hours for 10 to 14 days .
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ Those receiving metronidazole received 250 mg every 6 hours for 10 days.
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

^ The recommended antibiotic is metronidazole (Flagyl) in a dosage of 250 mg orally four times per day or 500 mg orally three times per day for 10 to 14 days.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

  • The use of linezolid may be considered, too.
.Newer drugs such as ramoplanin and fidaxomicin are in clinical development.^ The prescribing of such drugs for illnesses that are usually self-limiting has undoubtedly resulted in the development of resistant strains of bacteria, but still the pressure is on GPs to prescribe them.
  • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

.Drugs traditionally used to stop diarrhea frequently worsen the course of C. difficile-related pseudomembranous colitis.^ Antibiotic-associated diarrhea, pseudomembranous enterocolitis, and Clostridium difficile -associated diarrhea and colitis.
  • Exempla Healthcare Online Library 10 February 2010 13:33 UTC www.exempla.org [Source type: FILTERED WITH BAYES]

^ Clostridium difficile infection and pseudomembranous colitis.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ Clostridium difficile-associated diarrhea and colitis.
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

.Loperamide, diphenoxylate and bismuth compounds are contraindicated: slowing of fecal transit time is thought to result in extended toxin-associated damage.^ The amount of beads added is inversely proportional to the time required to obtain substantially complete association of the toxin A binding moiety with the capture moiety.
  • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

^ Toxin A had been shown to be a very potent enterotoxin that was capable of causing the diarrhea and mucosal damage associated with the disease.
  • Clostridium difficile Testing: after 20 Years, Still Challenging -- Wilkins and Lyerly 41 (2): 531 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

^ Toxin A is thought to play a more critical role than toxin B in the pathogenesis of C. difficile diarrhea because only it is associated with extensive tissue damage and fluid accumulation in experimental animal models.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

.Cholestyramine, a powder drink occasionally used to lower cholesterol, is effective in binding both Toxin A and B, and slows bowel motility and helps prevent dehydration.^ These preparations are prepared using the methods described above which involve reversible binding of the toxin A binding moiety to a capture moiety that is linked to a magnetic bead.
  • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

^ For example, one method of obtaining a toxin A binding moiety that includes a molecular tag is to use a heterobifunctional linker to link the toxin A binding moiety to the molecular tag.
  • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

^ Anti-filtrate BIC and anti-toxin A BIC both significantly attentuated the enteritis induced by the C. difficile filtrate as evidenced by a substantial lowering of Histology Scores.
  • Therapeutic treatment of clostridium difficile associated diseases - Patent 5773000 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

[30] .The dosage can be 4 grams daily, to up to four doses a day: Caution should be exercised to prevent constipation, or drug interactions, most notably the binding of drugs by cholestyramine, preventing their absorption.^ Diarrhea should resolve within two to four days.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ The recommended antibiotic is metronidazole (Flagyl) in a dosage of 250 mg orally four times per day or 500 mg orally three times per day for 10 to 14 days.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ Vancomycin, 125 mg every 6 hours orally, is given for 14 days, followed by a tapering dose of vancomycin (125 mg every 12 hours for 7 days, then 125 mg daily for a further 7 days), followed in turn by pulse-dosed vancomycin (125 mg once every 2 days for 4 doses, then once every 3 days for 5 doses).
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

.Powdered banana flakes given twice daily is an alternative to cholestyramine and allow for stool bulking.^ Oral metronidazole therapy (250 mg 4 times daily or 500 mg twice daily) given for 10–14 days is recommended as the initial treatment of choice.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

.Treatment with probiotics ("good" intestinal flora) has also been shown effective.^ The use of probiotics in combination with antibiotic treatments has shown promise.
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ The present invention provides an effective treatment which would not disturb the colonic flora.
  • Therapeutic treatment of clostridium difficile associated diseases - Patent 5773000 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

^ As well as reducing the level of C. difficile and its toxins in the intestine, treatment strategies should aim to restore the normal colonic flora.
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

[31] .Provision of Saccharomyces boulardii (Florastor) or Lactobacillus acidophilus twice daily times 30 days along with antibiotics has been clinically shown to shorten the duration of diarrhoea.^ Examples include Saccharomyces boulardii, Lactobacillus acidophilus, and Lactobacillus plantarum .
  • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

^ Lactobacillus species and Saccharomyces boulardii have been shown to reduce the occurrence of antibiotic-associated diarrhoea when given in conjunction with antibiotics ( McFarland, 2000a ).
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ Segarra-Newnham M. Probiotics for Clostridium difficile– associated diarrhea: focus on Lactobacillus rhamnosus GG and Saccharomyces boulardii .
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

.A last-resort treatment in immunosuppressed patients is intravenous immunoglobulin (IVIG).^ Is intravenous immunoglobulin a worthwhile treatment?
  • Clostridium difficile -- Poxton 54 (2): 97 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

^ Intravenous immunoglobulin therapy has been used with success in a small number of patients with fulminant disease.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

^ Wilcox MH. Descriptive study of intravenous immunoglobulin for the treatment of recurrent Clostridium difficile diarrhoea.
  • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

[30]

Colectomy

.In those patients that develop systemic symptoms of CDC, colectomy may improve the outcome if performed before the need for vasopressors.^ Patients who develop diarrhoea following a symptom free period may have been re-infected or have relapsed.
  • Northern Ireland Region Infection Preventation and Control Manual - Clostridium difficile 10 February 2010 13:33 UTC www.infectioncontrolmanual.co.ni [Source type: Academic]

^ If an alert system is implemented, patients with a history of CDI should be placed under contact precautions if they are readmitted only if they have symptoms consistent with CDI at admission.
  • NGC - NGC Summary 10 February 2010 13:33 UTC www.guideline.gov [Source type: Academic]

^ Help those others that need it & try to get it done real soon before it is too late.
  • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

Fecal bacteriotherapy

.Fecal bacteriotherapy, a procedure related to probiotic research, has been suggested as a potential cure for the disease.^ Patient information: Antibiotic-associated diarrhea (Clostridium difficile) Clinical manifestations and diagnosis of Clostridium difficile infection Clostridium difficile and probiotics Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection Fecal bacteriotherapy in the treatment of recurrent Clostridium difficile infection Prevention and control of Clostridium difficile in hospital and institutional settings Probiotics for gastrointestinal diseases Toxic megacolon Related Searches .
  • Treatment of antibiotic-associated diarrhea caused by Clostridium difficile 10 February 2010 13:33 UTC www.uptodateonline.com [Source type: Academic]

^ When researching the medical decision online, it is said that if left untreated it may cause severe health issues related to liver and pancreactic disease.
  • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

^ Increasing age and severe underlying illness have been determined to be independent risk factors and may reflect age-related or disease-related changes in fecal flora.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

.It involves infusion of bacterial flora acquired from the feces of a healthy donor in an attempt to reverse bacterial imbalance responsible for the recurring nature of the infection.^ The other method is the infusion of all the bacteria originating from a healthy donor.

^ Fecal transplantation uses a small amount of fresh feces (from a healthy donor), suspended in saline, filtered, and administered through a nasogastric tube.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

^ Indeed, some strains exist in healthy people as part of their normal gut bacterial flora, as Ian McKee pointed out.
  • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

.It has a success rate of nearly 95% according to some sources.^ That is all fine, but the stones I have been diagnosed with now according to sources will not just disappear without some sort of treatment.
  • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

^ A case series in 18 patients found a greater than 95% success rate in preventing recurrent CDI, but no randomized controlled trials have been performed.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

[32][33][34]

Recurrence

.The evolution of protocols for patients with recurrent C. difficile diarrhea also present a challenge: There is no known proper length of time or universally accepted alternative drugs with which one should be treated.^ Recurrence is common and patients should be re-treated with metronidazole first.
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ Recurrent C difficile diarrhea .
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ Diagnosis The diagnosis of C. difficile diarrhea should be considered in any patient with nosocomial diarrhea, especially if fever is also present.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

.However, re-treatment with metronidazole or vancomycin at the previous dose for 10 to 14 days is generally successful.^ Treatment is continued for 10 to 14 days.
  • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

^ I was only treated with 10 days of Vancomycin.
  • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

^ One case report of a patient with C. difficile colitis and non-Hodgkin's lymphoma reported success with rifampicin (600 mg twice a day) after previous treatment with vancomycin and metronidazole failed to resolve his diarrhoea ( Nomura et al., 2004 ).
  • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

The addition of rifampin to vancomycin also has been effective. Prophylaxis with competing, nonpathogenic organisms such as Lactobacillus spp. or .Saccharomyces boulardii has been found to be helpful in preventing relapse in small numbers of patients (see, for example, Florastor, or Lactinex).^ Adjunctive therapy with probiotic agents such as Saccharomyces boulardii 88 , 89 , 90 and Lactobacillus GG 91 has also been found to be effective in the management of a relatively small number of patients with recurrent C. difficile diarrhea.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

^ Treatment with rifampin in combination with vancomycin 86 or with anion-binding resins such as colestipol or cholestyramine has been found to be helpful for some patients.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

^ Surawicz et al., Prevention of Antibiotic-Associated Diarrhea by Saccharomyces boulardii: A Prospective Study, Gastroenterology, vol.
  • Therapeutic treatment of clostridium difficile associated diseases - Patent 5773000 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

.It is thought that these organisms, also known as probiotics, help to restore the natural flora in the gut and make patients more resistant to colonization by C. difficile.^ Normal gut flora resists colonization and overgrowth with C difficile.
  • Clostridium Difficile Colitis: eMedicine Gastroenterology 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ The diagnosis of C difficile colitis should be suspected in any patient with diarrhea who has received antibiotics within the previous 2 months and/or when diarrhea occurs 72 hours or more after hospitalization.
  • Clostridium Difficile Colitis: eMedicine Gastroenterology 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

^ Colonization resistance is transferred by re-association with a conventional gut microbiota .
  • PLoS Pathogens: Like Will to Like: Abundances of Closely Related Species Can Predict Susceptibility to Intestinal Colonization by Pathogenic and Commensal Bacteria 10 February 2010 13:33 UTC www.plospathogens.org [Source type: Academic]

[31]

Treatments in Development

  • Fidaxomicin, previously known as OPT-80 and PAR-101, is the first of a new class of antibiotics, the macrocyclics. .In clinical studies, fidaxomicin has demonstrated that it is narrow spectrum and minimally absorbed after oral administration.^ Teicoplanin The oral antibiotic teicoplanin showed initial promise in a clinical trial of 47 patients with CDAD ( Swedish CDAD Study Group, 1994 ).
    • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

    ^ Moxifloxacin, approved by the Food and Drug Administration in 1999, was available only as an oral preparation at the time of the study.
    • Antibiotic prescribing policy and Clostridium difficile diarrhoea -- O'Connor et al. 97 (7): 423 -- QJM 10 February 2010 13:33 UTC qjmed.oxfordjournals.org [Source type: Academic]

    [35] It is currently being evaluated in double-blind, randomized, multicenter international Phase III clinical trials vs. oral vancomycin. Results from the first phase III North American trial were presented publicly in November 2008. Fidaxomicin has received fast track designation from the FDA and is being developed by Optimer Pharmaceuticals
  • CDA-1 and CDB-1 (also known as MDX-066/MDX-1388 and MBL-CDA1/MBL-CDB1) is an investigational, monoclonal antibody combination co-developed by Medarex and Massachusetts Biologic Laboratories (MBL) to target and neutralize C. difficile toxins A and B, for the treatment of CDI. Merck & Co., Inc. gained worldwide rights to develop and commercialize CDA-1 and CDB-1 through an exclusive license agreement signed in April 2009. It is intended as an add-on therapy to one of the existing antibiotics to treat CDI.
  • Nitazoxanide is a synthetic nitrothiazolyl-salicylamide derivative indicated as an antiprotozoal agent (FDA-approved for the treatment of infectious diarrhea caused by Cryptosporidium parvum and Giardia lamblia) and is also currently being studied in C. difficile infections vs. vancomycin.
  • Rifaximin is a clinical-stage semi synthetic, rifamycin-based non-systemic antibiotic for CDI. It is FDA-approved for the treatment of infectious diarrhea and being developed by Salix Pharmaceuticals.

Prognosis

.After a first treatment with metronidazole or vancomycin C. dif recurs in about 20% of people.^ Metronidazole is first-line treatment with vancomycin as backup.
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

^ Unfortunately, recurrent C. difficile diarrhea occurs in about 5%–20% of patients after treatment with either metronidazole or vancomycin.
  • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

^ Recurrence rates following treatment with metronidazole or vancomycin are similar at approximately 20%.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

.This increase to 40% and 60% with subsequent recurrences.^ Patients with 1 prior episode of recurrent CDI have a greater than 40% risk of an additional recurrence, whereas those with 2 or more previous episodes have a greater than 60% risk.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

[36]

Society and culture

Pronunciation

Scientific names of organisms are Latin or Latinised Greek, in this case one of each. The anglicized pronunciation /klɒsˈtrɪdiəm dɨˈfɪsɨli/ is common, though a more Classical /dɨˈfɪkɨli/ is also used.
.A common practice has developed of pronouncing difficile as /diːfiˈsiːl, as though it were French.^ A variety of tests have been developed for testing diarrheal stools for C difficile , and their availability depends on local practice in various health regions.
  • Clostridium difficile�associated colitis 10 February 2010 13:33 UTC www.cfpc.ca [Source type: Academic]

Notable outbreaks

.
  • June 4, 2003, two outbreaks of a highly virulent strain of this bacterium were reported in Montreal, Quebec and Calgary, Alberta, in Canada.^ Since the symposium ended, news has broken of a major outbreak of CDAD in Quebec, Canada.
    • Clostridium difficile -- Poxton 54 (2): 97 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

    ^ The rapid international emergence of the C. difficile 027 strain lineage provides a unique opportunity to understand the recent emergence of a highly virulent bacterium.
    • Genome Biology | Full text | Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium 10 February 2010 13:33 UTC genomebiology.com [Source type: Academic]

    ^ The apparent increased severity of the disease in Canada has already suggested a strain of increased virulence ( Pepin et al., 2004 ).
    • Clostridium difficile -- Poxton 54 (2): 97 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

    .Sources put the death count as low as 36 and as high as 89, with approximately 1,400 cases in 2003 and within the first few months of 2004. C. difficile infections continued to be a problem in the Quebec health care system in late 2004. As of March 2005, it had spread into the Toronto, Ontario area, hospitalizing 10 people.^ Strategies to prevent Clostridium difficile infections in acute care hospitals.
    • NGC - NGC Summary 10 February 2010 13:33 UTC www.guideline.gov [Source type: Academic]

    ^ C. difficile infection is often spread from one patient to another in hospital.
    • Clostridium Difficile | Health | Patient UK 10 February 2010 13:33 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

    ^ The first month I was there I had no problems.
    • Clostridium difficile diarrhea - CareCure Forums 10 February 2010 13:33 UTC sci.rutgers.edu [Source type: Academic]

    .One died while the others were being discharged.
  • A similar outbreak took place at Stoke Mandeville Hospital in the United Kingdom between 2003 and 2005. The local epidemiology of C. difficile may offer clues on how its spread may relate to the amount of time a patient spends in hospital and/or a rehabilitation center.^ C. difficile infection is often spread from one patient to another in hospital.
    • Clostridium Difficile | Health | Patient UK 10 February 2010 13:33 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

    ^ Experienced by patients in extended care facilities, acute care areas, and intensive care units, it has become increasingly prevalent in the United States since 2003, when 178000 cases were diagnosed.
    • Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care -- Pelleschi 28 (1): 27 -- Critical Care Nurse 10 February 2010 13:33 UTC ccn.aacnjournals.org [Source type: Academic]

    ^ Hospitals and chronic care facilities are significant sources of C. difficile infection, with one study finding that 21% of patients acquired C. difficile infection during hospitalization.
    • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

    .It also samples institutions' ability to detect increased rates, and their capacity to respond with more aggressive hand-washing campaigns, quarantine methods, and availability of yoghurt to patients at risk for infection.
  • It has been suggested that both the Canadian and English outbreaks were related to the seemingly more virulent Strain NAP1/027 of bacterium.^ It was assumed that this was related to the increased virulence and relapse rate.
    • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

    ^ These observations have occurred throughout North America and Europe and have been attributed to a new strain designated BI, NAP1 or ribotype 027 (these designations are based on different methods for strain typing and all refer to the same strain, known as strain NAP1/BI/027).
    • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

    ^ The strain of C. difficile was ribotype 027 (also called NAP1, BI and toxinotype III, depending on the method used to type the strain), which is typically considered the most serious strain in people .
    • clostridium : Equid Blog 10 February 2010 13:33 UTC www.equidblog.com [Source type: FILTERED WITH BAYES]

    .This novel strain, also known as Quebec strain, has also been implicated in an epidemic at two Dutch hospitals (Harderwijk and Amersfoort, both 2005).^ Pepin, J, Valiquette, L, Cossette, B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec.
    • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

    ^ The next retrospective recorded 027 isolate was a non-epidemic strain designated BI-1, which was from a patient with CDI in a Minneapolis hospital in 1988 [ 13 ].
    • Genome Biology | Full text | Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium 10 February 2010 13:33 UTC genomebiology.com [Source type: Academic]

    ^ The epidemic 027 strain has five unique genetic regions, absent from both the non-epidemic 027 and strain 630, which include a novel phage island, a two component regulatory system and transcriptional regulators.
    • Genome Biology | Full text | Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium 10 February 2010 13:33 UTC genomebiology.com [Source type: Academic]

    .A theory for explaining the increased virulence of 027 is that it is a hyperproducer of both toxins A and B, and that certain antibiotics may actually stimulate the bacteria to hyperproduce.
  • October 1, 2006, C.diff was said to have killed at least 49 people at hospitals in Leicester, England over eight months, according to a National Health Service investigation.^ (Department of Health, 11 October 2006) .
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    ^ Health Service Journal, 6 October 2009.
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    ^ I say to the cabinet secretary that it is almost two years on from the outbreak at the Vale of Leven hospital, and two years on from people dying of C diff.
    • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

    Another 29 similar cases were investigated by coroners.[37] .A UK Department of Health memo leaked shortly afterwards revealed significant concern in government about the bacterium, described as being "endemic throughout the health service"[38]
  • October 27, 2006, 9 deaths were attributed to the bacterium in Quebec, Canada.^ (Department of Health, 24 July 2006) .
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    ^ (Department of Health, 11 October 2006) .
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    ^ I am really concerned about his health.
    • The Doctors TV Show:The Drs CBS 10 February 2010 13:33 UTC tv.spreadit.org [Source type: FILTERED WITH BAYES]

    [39]
  • .
  • November 18, 2006, the bacterium was reported to have been responsible for 12 deaths in Quebec, Canada.^ Clin Microbiol Infect 2006 ; 12 (Suppl 6) : 2 –18.
    • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

    ^ "It is important to learn lessons."—[ Official Report , 12 November 2009; c 21105.
    • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

    This 12th reported death was only two days after the St. Hyacinthe's Honoré Mercier announced that the outbreak was under control. .Thirty-one patients were diagnosed with Clostridium difficile and four (as of Sat.^ Severe Clostridium difficile – Associated Disease in Populations Previously at Low Risk – Four States, 2005 .
    • Clostridium difficile 10 February 2010 13:33 UTC www.nric.org.uk [Source type: Academic]

    ^ Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial.
    • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]
    • Evaluation of Two Rapid Assays for Detection of Clostridium difficile Toxin A in Stool Specimens -- Fedorko et al. 37 (9): 3044 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

    ^ Hospitals and chronic care facilities are significant sources of C. difficile infection, with one study finding that 21% of patients acquired C. difficile infection during hospitalization.
    • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

    Nov 18th) were still under observation. Cleaning crews took measures in an attempt to clear the outbreak.[40]
  • .
  • C. difficile was mentioned on 6,480 death certificates in 2006 in UK.[41]
  • February 27, 2007, a new outbreak was identified at Trillium Health Centre in Mississauga, Ontario, where 14 people were diagnosed with the bacteria.^ Barry Cookson Correspondence to: Dr Barry Cookson Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London, NW9 5HT, UK; barry.cookson{at}hpa.org.uk Received 4 December 2006 Accepted 16 January 2007 Next Section Abstract .
    • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

    ^ Posted on October 11, 2009 by Scott Weese Clostridium difficile is a high-profile bacterium, being an important cause of illness and death in people .
    • Clostridium difficile : Worms and Germs Blog 10 February 2010 13:33 UTC www.wormsandgermsblog.com [Source type: FILTERED WITH BAYES]

    ^ New cases and relapses can be diagnosed earlier in the disease process, and hopefully, we are reducing the likelihood of outbreaks.
    • Clostridium difficile Testing: after 20 Years, Still Challenging -- Wilkins and Lyerly 41 (2): 531 -- Journal of Clinical Microbiology 10 February 2010 13:33 UTC jcm.asm.org [Source type: Academic]

    .The bacteria was of the same strain as the one in Quebec.^ Molecular typing of the recovered bacteria (from both you and your pet) would be needed to determine if they are the same strain, and this type of testing is not readily available.
    • Clostridium difficile : Worms and Germs Blog 10 February 2010 13:33 UTC www.wormsandgermsblog.com [Source type: FILTERED WITH BAYES]

    ^ At the same time, all obligately heterofermentative (OHEL) group species (except one) did not show antagonistic activity against any C. difficile strain.
    • Inhibition of Clostridium difficile strains by intestinal Lactobacillus species -- Naaber et al. 53 (6): 551 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

    .Officials have not been able to determine whether C. difficile was responsible for deaths of four patients over the prior two months.^ Assays to determine whether an infecting C. difficile strain is toxigenic are also needed.
    • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

    ^ Of C. difficile —positive patients scanned within 3 days of stool testing, 23 (51%) of 45 were correctly diagnosed, compared with three (60%) of five scanned more than 3 days before stool testing ( p > 0.50), and two (50%) of four scanned more than 3 days after stool testing ( p > 0.50).
    • Evaluating the CT Diagnosis of Clostridium difficile Colitis: Should CT Guide Therapy? -- Kirkpatrick and Greenberg 176 (3): 635 -- American Journal of Roentgenology 10 February 2010 13:33 UTC www.ajronline.org [Source type: Academic]

    ^ Deaths linked to Clostridium difficile infection double in two years (Daily Telegraph, 29 August 2008) .
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    [42]
  • .
  • Between February and June 2007, three patients at Loughlinstown Hospital in Dublin, Ireland were found by the coroner to have died as a result of C.diff infection.^ As part of the research, leading experts agreed that C.diff had now joined MRSA in being one of the most serious hospital infections they faced.
    • Clostridium difficile – vaccines must be part of future action plan. - News Press Release | PharmiWeb.com 10 February 2010 13:33 UTC www.pharmiweb.com [Source type: Academic]

    ^ Hospitals and chronic care facilities are significant sources of C. difficile infection, with one study finding that 21% of patients acquired C. difficile infection during hospitalization.
    • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

    ^ I say to the cabinet secretary that it is almost two years on from the outbreak at the Vale of Leven hospital, and two years on from people dying of C diff.
    • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

    .In an inquest, the Coroner's Court found that the hospital had no designated infection control team or consultant microbiologist on staff.^ That is also a reminder for the hospital staff of how important the infection control measures are.
    • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

    ^ The benefits of such a system are that it reduces infections, the antibiotics that are used and lengths of stay in hospital, and it leads to the more effective use of resources, the safer management of beds and the integration of infection control into daily staff routines.
    • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

    ^ No, it is not, because, as I also said earlier, every single time a patient contracts an infection in hospital it appals me.
    • Clostridium Difficile: 19 Nov 2009: Scottish Parliament debates (TheyWorkForYou.com) 10 February 2010 13:33 UTC www.theyworkforyou.com [Source type: FILTERED WITH BAYES]

    [43]
  • .
  • October 2007, Maidstone and Tunbridge Wells NHS Trust was heavily criticized by the Healthcare Commission regarding its handling of a major outbreak of C. difficile in its hospitals in Kent from April 2004 to September 2006. In its report, the Commission estimated that about 90 patients "definitely or probably" died as a result of the infection.^ (Healthcare Commission, 11 October 2007) .
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    ^ Undercover reporter working as cleaner ) The official Healthcare Commission on Maidstone and Kent NHS Hospital trust does not not provide happier reading.
    • NHS Blog Doctor: Clostridium Difficile : more diarrhoea 10 February 2010 13:33 UTC nhsblogdoc.blogspot.com [Source type: FILTERED WITH BAYES]

    ^ Quarterly reporting results for Clostridium difficile infections and MRSA Bacteraemia .
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    [44][45]
  • .
  • November 2007, the 027 strain has spread into several hospitals in southern Finland, with ten deaths out of 115 infected patients reported on 2007-12-14.[46]
  • November 2009, four deaths at Our Lady of Lourdes Hospital in Ireland, have possible links to Clostridium Difficile infection.^ Hypervirulent strains of Clostridium difficile .
    • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

    ^ Clostridium difficile : the epidemiology and prevention of hospital-acquired infection.
    • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

    ^ Pathogenesis of Clostridium difficile Infection.
    • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

    A further 12 patients tested positive for infection, and another 20 show signs of infection, 10 November 2009.[47]

Research

Genome sequencing

.The first complete genome sequence of a Clostridium difficile strain was first published in 2006 by Sanger Institute in the UK. This was of the C. difficile strain 630, a virulent and multidrug-resistant strain.^ Hypervirulent strains of Clostridium difficile .
  • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

^ Detection of capsule in strains of Clostridium difficile .
  • A Clostridium difficile gene encoding flagellin -- Tasteyre et al. 146 (4): 957 -- Microbiology 10 February 2010 13:33 UTC mic.sgmjournals.org [Source type: Academic]

^ Toxin B is essential for virulence of Clostridium difficile.
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

.Researchers at McGill University in Montreal, Quebec, sequenced the genome of the highly virulent Quebec strain of C. difficile in 2005 using ultra-high-throughput sequencing technology.^ It has been suggested that the virulence of C. difficile strains is not solely attributable to toxin production; other factors such as presence of flagella could contribute to virulence.
  • A Clostridium difficile gene encoding flagellin -- Tasteyre et al. 146 (4): 957 -- Microbiology 10 February 2010 13:33 UTC mic.sgmjournals.org [Source type: Academic]

^ Pepin, J, Valiquette, L, Cossette, B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec.
  • Epidemiology, microbiology, and pathophysiology of Clostridium difficile infection 10 February 2010 13:33 UTC www.uptodate.com [Source type: Academic]

^ Many individuals colonized by pathogenic strains of C difficile remain asymptomatic, and this carrier state has been associated with high circulating titers of IgG antitoxin.
  • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

.The tests involved doing 400,000 DNA parallel sequencing reactions of the bacterium's genome which had been fragmented for sequencing.^ For example, the testing for the presence of C. difficile toxin A or toxin B can involve amplification of a nucleic acid that encodes toxin A or toxin B, or a portion of said nucleic acid, by polymerase chain reaction and detecting the presence of the amplified nucleic acid.
  • Diagnostic tests and kits for Clostridium difficile - Patent 5965375 10 February 2010 13:33 UTC www.freepatentsonline.com [Source type: Academic]

.These sequences were assembled computationally to form a complete genome sequence.^ Given the medical and economic importance of CDI and the difficulties in studying the genetics of C. difficile , we recently reported the complete genome sequence of a pathogenic C. difficile strain [ 22 ].
  • Genome Biology | Full text | Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium 10 February 2010 13:33 UTC genomebiology.com [Source type: Academic]

^ To compare these results to the distance between 2 OTUs we computed identities between all considered OTUs using their representative sequences in the complete alignment (all reads and all reference sequences).
  • PLoS Pathogens: Like Will to Like: Abundances of Closely Related Species Can Predict Susceptibility to Intestinal Colonization by Pathogenic and Commensal Bacteria 10 February 2010 13:33 UTC www.plospathogens.org [Source type: Academic]

[13][48]

See also

References

  1. ^ American Heritage Dictionary (Fourth ed.). 2000. http://www.bartleby.com/61/67/D0216700.html. Retrieved 2009-02-15. 
  2. ^ a b c d e f g h i j Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 322–4. ISBN 0-8385-8529-9. 
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  14. ^ McDonald L (2005). "Clostridium difficile: responding to a new threat from an old enemy" (PDF). Infect Control Hosp Epidemiol 26 (8): 672–5. doi:10.1086/502600. PMID 16156321. http://www.cdc.gov/ncidod/dhqp/pdf/infDis/Cdiff_ICHE08_05.pdf. 
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  17. ^ Anna Salleh (2009-03-02). "Researchers knock down gastro bug myths". ABC Science Online. http://www.abc.net.au/news/stories/2009/03/02/2504466.htm. Retrieved 2009-03-02. 
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  37. ^ Trust confirms 49 superbug deaths - BBC News
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  41. ^ Hospitals struck by new killer bugAn article by Manchester free newspaper 'Metro', May 7, 2008
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  46. ^ Ärhäkkä suolistobakteeri on tappanut jo kymmenen potilasta - HS.fi - Kotimaa
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Further reading

.
  • Dallal R, Harbrecht B, Boujoukas A, Sirio C, Farkas L, Lee K, Simmons R (2002).^ Dallal, RM, Harbrecht, BG, Boujoukas, AJ, et al.
    • Treatment of antibiotic-associated diarrhea caused by Clostridium difficile 10 February 2010 13:33 UTC www.uptodateonline.com [Source type: Academic]

    ^ Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, et al.
    • Clostridium difficile-Associated Diarrhea - March 1, 2005 - American Family Physician 10 February 2010 13:33 UTC www.aafp.org [Source type: Academic]

    ."Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications".^ Deaths involving Clostridium difficile .
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    ^ Clostridium difficile: number of deaths increase in 2006 .
    • NHS Evidence - Health management - Healthcare Associated Infection (HCAI): Clostridium difficile 10 February 2010 13:33 UTC www.library.nhs.uk [Source type: Academic]

    ^ Clostridium difficile : number of deaths increase in 2007.
    • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

    .Ann Surg 235 (3): 363–72. doi:10.1097/00000658-200203000-00008.^ Ann Surg 2002; 235:363.
    • Treatment of antibiotic-associated diarrhea caused by Clostridium difficile 10 February 2010 13:33 UTC www.uptodateonline.com [Source type: Academic]

    ^ DOI: 10.1128/IAI.72.5.2827-2836.2004 Copyright © 2004 , American Society for Microbiology .
    • Clostridium difficile Toxin A Carboxyl-Terminus Peptide Lacking ADP-Ribosyltransferase Activity Acts as a Mucosal Adjuvant -- Castagliuolo et al. 72 (5): 2827 -- Infection and Immunity 10 February 2010 13:33 UTC iai.asm.org [Source type: Academic]

    PMID 11882758. PMC 1422442. .http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=11882758. 
  • Martin S, Jung R (2005).^ Also see: http://www.eurosurveillance.org/ew/2005/050630.asp#2 (Accessed 25 Nov 2006).
    • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

    Gastrointestinal infections and enterotoxigenic poisonings. In: Pharmacotherapy: A Pathophysiologic Approach (DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors). (6th ed.). McGraw-Hill. pp. 2042–2043. .ISBN. 
  • McDonald L, Killgore G, Thompson A, Owens R, Kazakova S, Sambol S, Johnson S, Gerding D (2005).^ McDonald LC, Killgore GE, Thompson A, et al.
    • The Clostridium difficile Epidemic: A Potential Disaster for Long-Term Care 10 February 2010 13:33 UTC www.experts.com [Source type: Academic]

    ^ McDonald LC, Killgore GE, Thompson A, Owens RC Jr, Kazakova SV, Sambol SP. An epidemic, toxin gene-variant strain of Clostridium difficile.
    • Pseudomembranous Colitis: eMedicine Infectious Diseases 10 February 2010 13:33 UTC emedicine.medscape.com [Source type: Academic]

    ^ McDonald LC, Killgore GE, Thompson A; et al.
    • JAMA -- A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection, March 4, 2009, Kelly 301 (9): 954 10 February 2010 13:33 UTC jama.ama-assn.org [Source type: Academic]

    ."An epidemic, toxin gene-variant strain of Clostridium difficile". N Engl J Med 353 (23): 2433–41. doi:10.1056/NEJMoa051590.^ Positive regulation of Clostridium difficile toxins.
    • Clostridium difficile Toxins: Mechanism of Action and Role in Disease -- Voth and Ballard 18 (2): 247 -- Clinical Microbiology Reviews 10 February 2010 13:33 UTC cmr.asm.org [Source type: Academic]

    ^ Epidemic Clostridium difficile.
    • Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review -- Thomas et al. 51 (6): 1339 -- Journal of Antimicrobial Chemotherapy 10 February 2010 13:33 UTC jac.oxfordjournals.org [Source type: Academic]

    ^ A Clostridium difficile gene encoding flagellin .
    • A Clostridium difficile gene encoding flagellin -- Tasteyre et al. 146 (4): 957 -- Microbiology 10 February 2010 13:33 UTC mic.sgmjournals.org [Source type: Academic]

    PMID 16322603. 
  • Yamada T; Alpers DH (editors) (2003). Textbook of Gastroenterology (4th ed.). Lippincott Williams & Wilkins. pp. 1870–1875. .ISBN 0-7817-2861-4. 
  • van den Hof S, van der Kooi T, van den Berg R, Kuijper E, Notermans D (2006).^ S. C Numan, P. Veldkamp, E. J Kuijper, R. J van den Berg, and J. T van Dissel Clostridium difficile-associated diarrhoea: bovine anti-Clostridium difficile whey protein to help aid the prevention of relapses Gut, June 1, 2007; 56(6): 888 - 889.
    • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

    ^ Goorhuis A, Kooi T, Vaessen N, Dekker FW, Berg R, Harmanus C, Hof S, Notermans DW, Kuijper EJ: Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands.
    • Genome Biology | Full text | Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium 10 February 2010 13:33 UTC genomebiology.com [Source type: Academic]

    ^ T. I. I. van der Kooi, M. Koningstein, A. Lindemans, D. W. Notermans, E. Kuijper, R. van den Berg, H. Boshuizen, P. M. G. Filius, and S. van den Hof Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027 J. Med.
    • Antibiotic prescribing policy and Clostridium difficile diarrhoea -- O'Connor et al. 97 (7): 423 -- QJM 10 February 2010 13:33 UTC qjmed.oxfordjournals.org [Source type: Academic]

    ."Clostridium difficile PCR ribotype 027 outbreaks in the Netherlands: recent surveillance data indicate that outbreaks are not easily controlled but interhospital transmission is limited".^ PCR-ribotype 027 outbreaks [ 38 - 40 ].
    • Genome Biology | Full text | Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium 10 February 2010 13:33 UTC genomebiology.com [Source type: Academic]

    ^ Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance.
    • Clostridium difficile-associated diarrhea in adults -- Poutanen and Simor 171 (1): 51 -- Canadian Medical Association Journal 10 February 2010 13:33 UTC www.cmaj.ca [Source type: Academic]

    ^ Environmental control to reduce transmission of Clostridium difficile .
    • Alternative treatments for Clostridium difficile disease: what really works? -- McFarland 54 (2): 101 -- Journal of Medical Microbiology 10 February 2010 13:33 UTC jmm.sgmjournals.org [Source type: Academic]

    Euro Surveill 11 (1): E060126.2. PMID 16801713. .http://www.eurosurveillance.org/ew/2006/060126.asp#2. 
  • Sunenshine R, McDonald L (2006).^ Available on http://www.hpa.org.uk/infections/topics_az/hai/MandSurvHCAI2006.pdf : (accessed 25 Nov 2006).
    • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

    ^ Health Statistics Quarterly; Spring, 2006b: 56–60, http://www.hpa.org.uk/infections/topics_az/clostridium_difficile/documents/ReportDeathsinvolvingCdifficile.pdf (accessed 25 Nov 2006).
    • Hypervirulent strains of Clostridium difficile 10 February 2010 13:33 UTC pmj.bmj.com [Source type: Academic]

    ^ Other statistical analyses (Pearson correlation, Kolmogorov-Smirnov test) were performed using the statistical language and environment R ( http://www.r-project.org/ ).
    • PLoS Pathogens: Like Will to Like: Abundances of Closely Related Species Can Predict Susceptibility to Intestinal Colonization by Pathogenic and Commensal Bacteria 10 February 2010 13:33 UTC www.plospathogens.org [Source type: Academic]

    "Clostridium difficile-associated disease: New challenges from an established pathogen". Cleveland Clinic J. Med. 73: 187. doi:10.3949/ccjm.73.2.187. 

External links


Wiktionary

Up to date as of January 15, 2010

Definition from Wiktionary, a free dictionary

Translingual

Noun

  1. A particular bacterium which can be fatal to humans, associated with hospital-acquired infections.

Wikispecies

Up to date as of January 23, 2010

From Wikispecies

Taxonavigation

Main Page
Superregnum: Bacteria
Regnum: Bacteria
Phylum: Firmicutes
Classis: Clostridia
Ordo: Clostridiales
Familia: Clostridiaceae
Genus: Clostridium
Species: Clostridium difficile

Name

Clostridium difficile (Hall & O'Toole), 1935

Citable sentences

Up to date as of December 30, 2010

Here are sentences from other pages on Clostridium difficile, which are similar to those in the above article.








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