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1
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Kuijper EJ, Coignard B, Brazier JS, et al. Update of Clostridium difficile associated disease due to PCR ribotype 027 in Europe. Euro Surveill 2007; 12:E1-E2. The epidemic strain of C. difficile important in North America has been present in Europe for the past 10 years.
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Kuijper EJ, Coignard B, Brazier JS, et al. Update of Clostridium difficile associated disease due to PCR ribotype 027 in Europe. Euro Surveill 2007; 12:E1-E2. The epidemic strain of C. difficile important in North America has been present in Europe for the past 10 years.
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2
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41549103640
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Mortality of patients with antibiotic associated diarrhoea: The impact of Clostridium difficile
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In patients with CDAD, hypoalbuminemia, renal failure and reduced functional capacity predict mortality
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Bishara J, Peled N, Pitlik S, Samra Z. Mortality of patients with antibiotic associated diarrhoea: the impact of Clostridium difficile. J Hosp Infect 2008; 68:308-314. In patients with CDAD, hypoalbuminemia, renal failure and reduced functional capacity predict mortality.
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J Hosp Infect
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Bishara, J.1
Peled, N.2
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3
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34247550291
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Predicting Clostridium difficile toxin in hospitalized patients with antibiotic- associated diarrhea
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Occurrence of watery diarrhea or otherwise unexplained leukocytosis, presence of hypoalbuminemia and diarrhea in a person taking a PPI or an H2 blocker suggests a diagnosis of CDAD
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Peled N, Pitlik S, Samra Z, et al. Predicting Clostridium difficile toxin in hospitalized patients with antibiotic- associated diarrhea. Infect Control Hosp Epidemiol 2007; 28:377-381. Occurrence of watery diarrhea or otherwise unexplained leukocytosis, presence of hypoalbuminemia and diarrhea in a person taking a PPI or an H2 blocker suggests a diagnosis of CDAD.
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Infect Control Hosp Epidemiol
, vol.28
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Peled, N.1
Pitlik, S.2
Samra, Z.3
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4
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34250195733
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Prevalence of Clostridium difficile environmental contamination and strain variability in multiple healthcare facilities
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difficile spores were shown to frequently contaminate the hospital environment, with rooms housing a patient with CDAD being more frequently contaminated than a room without such a patient
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Dubberke ER, Reske KA, Noble-Wang J, et al. Prevalence of Clostridium difficile environmental contamination and strain variability in multiple healthcare facilities. Am J Infect Control 2007; 35:315-318. C. difficile spores were shown to frequently contaminate the hospital environment, with rooms housing a patient with CDAD being more frequently contaminated than a room without such a patient.
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Am J Infect Control
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Dubberke, E.R.1
Reske, K.A.2
Noble-Wang, J.3
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5
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39349118238
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Bobulsky GS, Al-Nassir WN, Riggs MM, et al. Clostridium difficile skin contamination in patients with C. difficile- associated disease. Clin Infect Dis 2008; 46:447-450. This prospective study of patients with CDAD reported frequent contamination of the skin, which persisted after diarrhea had discontinued possibly playing a role in disease transmission.
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Bobulsky GS, Al-Nassir WN, Riggs MM, et al. Clostridium difficile skin contamination in patients with C. difficile- associated disease. Clin Infect Dis 2008; 46:447-450. This prospective study of patients with CDAD reported frequent contamination of the skin, which persisted after diarrhea had discontinued possibly playing a role in disease transmission.
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6
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39549118889
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Aerial dissemination of Clostridium difficile spores
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Spores of C. difficile were shown in a pilot study to spread by the aerosol route in a hospital
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Roberts K, Smith CF, Snelling AM, et al. Aerial dissemination of Clostridium difficile spores. BMC Infect Dis 2008; 8:7. Spores of C. difficile were shown in a pilot study to spread by the aerosol route in a hospital.
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BMC Infect Dis
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Roberts, K.1
Smith, C.F.2
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7
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42549083472
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Clostridium difficile- associated diarrhea after antibiotic treatment for traveler's diarrhea
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Four patients with CDAD following ciprofloxacin treatment of travelers' diarrhea are reported in this study
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Norman F, Perez-Molina J, de Ayala P, et al. Clostridium difficile- associated diarrhea after antibiotic treatment for traveler's diarrhea. Clin Infect Dis 2008; 46:1060-1063. Four patients with CDAD following ciprofloxacin treatment of travelers' diarrhea are reported in this study.
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Clin Infect Dis
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Norman, F.1
Perez-Molina, J.2
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8
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46249104581
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Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain
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Perioperative antibacterial prophylaxis was shown to contribute to the development of CDI, suggesting that guidelines should be developed for the approach for preventing rare or minor infections
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Carignan A, Allard C, Pepin J, et al. Risk of Clostridium difficile infection after perioperative antibacterial prophylaxis before and during an outbreak of infection due to a hypervirulent strain. Clin Infect Dis 2008; 46:1838-1843. Perioperative antibacterial prophylaxis was shown to contribute to the development of CDI, suggesting that guidelines should be developed for the approach for preventing rare or minor infections.
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Clin Infect Dis
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, pp. 1838-1843
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Carignan, A.1
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9
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34547635096
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Jump RL, Pultz MJ, Donskey CJ. Vegetative Clostridium difficile survives in room air on moist surfaces and in gastric contents with reduced acidity: a potential mechanism to explain the association between proton pump inhibitors and C. difficile- associated diarrhea? Antimicrob Agents Chemother 2007; 51:2883-2887. Vegetative C. difficile cells failed to survive gastric contents at low pH, whereas they were capable of survival at pH of more than 5, as would be seen with PPI therapy, suggesting the mechanism whereby PPIs increased the risk of acquiring CDAD. This study provides a possibly explanation as to why PPIs predispose to CDI.
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Jump RL, Pultz MJ, Donskey CJ. Vegetative Clostridium difficile survives in room air on moist surfaces and in gastric contents with reduced acidity: a potential mechanism to explain the association between proton pump inhibitors and C. difficile- associated diarrhea? Antimicrob Agents Chemother 2007; 51:2883-2887. Vegetative C. difficile cells failed to survive gastric contents at low pH, whereas they were capable of survival at pH of more than 5, as would be seen with PPI therapy, suggesting the mechanism whereby PPIs increased the risk of acquiring CDAD. This study provides a possibly explanation as to why PPIs predispose to CDI.
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10
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34548142191
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Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol 2007; 102:2047-2056; quiz 2057. A systematic review of the risk of PPIs or H2 receptor blockers (H2RB) was carried out. A total of 12 studies evaluating nearly 3000 persons with CDAD were reviewed showing a clear association. The association was greater for PPI use than H2RB use.
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Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol 2007; 102:2047-2056; quiz 2057. A systematic review of the risk of PPIs or H2 receptor blockers (H2RB) was carried out. A total of 12 studies evaluating nearly 3000 persons with CDAD were reviewed showing a clear association. The association was greater for PPI use than H2RB use.
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11
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41549142775
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Bile salts and glycine as cogerminants for Clostridium difficile spores
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Spores of C. difficile are induced to germinate in bile-rich environment as occurs in the small bowel
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Sorg JA, Sonenshein AL. Bile salts and glycine as cogerminants for Clostridium difficile spores. J Bacteriol 2008; 190:2505-2512. Spores of C. difficile are induced to germinate in bile-rich environment as occurs in the small bowel.
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Sorg, J.A.1
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12
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A common polymorphism in the interleukin 8 gene promoter is associated with Clostridium difficile diarrhea
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Jiang ZD, DuPont HL, Garey K, et al. A common polymorphism in the interleukin 8 gene promoter is associated with Clostridium difficile diarrhea. Am J Gastroenterol 2006; 101:1112-1116.
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Jiang, Z.D.1
DuPont, H.L.2
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13
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34547191617
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Association of interleukin-8 polymorphism and immunoglobulin G antitoxin A in patients with Clostridium difficile associated diarrhea
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Host genetics, that has been shown to be associated with susceptibility to CDI, has been shown to be associated with a defective immune response to C. difficile toxin A. The genotype may help determine which patients are destined to have recurrent CDI
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Jiang ZD, Garey KW, Price M, et al. Association of interleukin-8 polymorphism and immunoglobulin G antitoxin A in patients with Clostridium difficile associated diarrhea. Clin Gastroenterol Hepatol 2007; 5:964-968. Host genetics, that has been shown to be associated with susceptibility to CDI, has been shown to be associated with a defective immune response to C. difficile toxin A. The genotype may help determine which patients are destined to have recurrent CDI.
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(2007)
Clin Gastroenterol Hepatol
, vol.5
, pp. 964-968
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Jiang, Z.D.1
Garey, K.W.2
Price, M.3
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14
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39449126226
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Assessment of Clostridium difficile associated disease surveillance definitions, North Carolina, 2005
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A high proportion of the community-onset cases of CDAD are really healthcare associated cases occurring less than 4 weeks after discharge from a medical facility
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Kutty PK, Benoit SR, Woods CW, et al. Assessment of Clostridium difficile associated disease surveillance definitions, North Carolina, 2005. Infect Control Hosp Epidemiol 2008; 29:197-202. A high proportion of the community-onset cases of CDAD are really healthcare associated cases occurring less than 4 weeks after discharge from a medical facility.
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Infect Control Hosp Epidemiol
, vol.29
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Kutty, P.K.1
Benoit, S.R.2
Woods, C.W.3
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15
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47249133004
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A case-control study of community associated Clostridium difficile infection
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Community-onset cases of CDAD may not have definable risk factors including receipt of antibiotics. Additional study of risk factors for these cases is needed
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Wilcox MH, Mooney L, Bendall R, et al. A case-control study of community associated Clostridium difficile infection. J Antimicrob Chemother 2008; 62:388-396. Community-onset cases of CDAD may not have definable risk factors including receipt of antibiotics. Additional study of risk factors for these cases is needed.
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J Antimicrob Chemother
, vol.62
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Wilcox, M.H.1
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41649114003
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Centers for Disease Control and Prevention. Surveillance for community associated Clostridium difficile - Connecticut, 2006. MMWR Morb Mortal Wkly Rep 2008; 57:340-343. Not being reportable, cases of CDAD are not tracked by health department officials. A statewide surveillance system found cases of severe CDAD in otherwise healthy individuals without known risk factors.
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Centers for Disease Control and Prevention. Surveillance for community associated Clostridium difficile - Connecticut, 2006. MMWR Morb Mortal Wkly Rep 2008; 57:340-343. Not being reportable, cases of CDAD are not tracked by health department officials. A statewide surveillance system found cases of severe CDAD in otherwise healthy individuals without known risk factors.
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Benson L, Song X, Campos J, Singh N. Changing epidemiology of Clostridium difficile- associated disease in children. Infect Control Hosp Epidemiol 2007; 28:1233-1235. A steady increase has occurred in patients with CDAD presenting themselves to the emergency department. The proportion of children aged 2 years or older with CDAD is increasing.
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Benson L, Song X, Campos J, Singh N. Changing epidemiology of Clostridium difficile- associated disease in children. Infect Control Hosp Epidemiol 2007; 28:1233-1235. A steady increase has occurred in patients with CDAD presenting themselves to the emergency department. The proportion of children aged 2 years or older with CDAD is increasing.
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42949099550
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Epidemiology of Clostridium difficile associated diarrhea in a Peruvian tertiary care hospital
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One study performed in Peru suggests that CDAD rates may be higher in developing countries than in industrialized regions. Infection control measures directed to reducing CDAD occurrence in low-resource settings are indicated
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Garcia C, Samalvides F, Vidal M, et al. Epidemiology of Clostridium difficile associated diarrhea in a Peruvian tertiary care hospital. Am J Trop Med Hyg 2007; 77:802-805. One study performed in Peru suggests that CDAD rates may be higher in developing countries than in industrialized regions. Infection control measures directed to reducing CDAD occurrence in low-resource settings are indicated.
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Am J Trop Med Hyg
, vol.77
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Garcia, C.1
Samalvides, F.2
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19
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42449157632
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Increased sporulation rate of epidemic Clostridium difficile type 027/NAP1
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The epidemic strain of C. difficile from North America, showing increased sporulation potential, has been found in Europe
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Akerlund T, Persson I, Unemo M, et al. Increased sporulation rate of epidemic Clostridium difficile type 027/NAP1. J Clin Microbiol 2008; 46:1530-1533. The epidemic strain of C. difficile from North America, showing increased sporulation potential, has been found in Europe.
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Akerlund, T.1
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The epidemic strain found to be more virulent in humans shows greater virulence for hamsters
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Razaq N, Sambol S, Nagaro K, et al. Infection of hamsters with historical and epidemic BI types of Clostridium difficile. J Infect Dis 2007; 196:1813-1819. The epidemic strain found to be more virulent in humans shows greater virulence for hamsters.
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Razaq, N.1
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24
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The burden of Clostridium difficile in surgical patients in the United States
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Larchmt, Surgical patients are increasingly experiencing CDI, especially if the surgery is emergent or involving the gastrointestinal tract
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Zerey M, Paton BL, Lincourt AE, et al. The burden of Clostridium difficile in surgical patients in the United States. Surg Infect (Larchmt) 2007; 8:557-566. Surgical patients are increasingly experiencing CDI, especially if the surgery is emergent or involving the gastrointestinal tract.
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Kyne L, Warny M, Qamar A, Kelly CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 2001; 357:189-193.
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Redelings MD, Sorvillo F, Mascola L. Increase in Clostridium difficile-related mortality rates, United States, 1999-2004. Emerg Infect Dis 2007; 13:1417-1419. Mortality rates of CDAD in the United States have increased from 6 million persons in 1999 to 24 per million in 2004, which is felt to be because of the emergence of a more virulent outbreak strain of C. difficile.
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Redelings MD, Sorvillo F, Mascola L. Increase in Clostridium difficile-related mortality rates, United States, 1999-2004. Emerg Infect Dis 2007; 13:1417-1419. Mortality rates of CDAD in the United States have increased from 6 million persons in 1999 to 24 per million in 2004, which is felt to be because of the emergence of a more virulent outbreak strain of C. difficile.
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Defining surgical therapy for pseudomembranous colitis with toxic megacolon
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Toxic megacolon is a complication of CDAD, yet CDI symptoms may not be found in these cases. Toxic dilatation of the colon in the absence of IBD should be assumed to be caused by CDI
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Berman L, Carling T, Fitzgerald TN, et al. Defining surgical therapy for pseudomembranous colitis with toxic megacolon. J Clin Gastroenterol 2008; 42:476-480. Toxic megacolon is a complication of CDAD, yet CDI symptoms may not be found in these cases. Toxic dilatation of the colon in the absence of IBD should be assumed to be caused by CDI.
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J Clin Gastroenterol
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Berman, L.1
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29
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Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease
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CDAD causes a considerable morbidity to patients with IBD and is associated with a higher mortality in these patients
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Ananthakrishnan AN, McGinley EL, Binion DG. Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut 2008; 57:205-210. CDAD causes a considerable morbidity to patients with IBD and is associated with a higher mortality in these patients.
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Ananthakrishnan, A.N.1
McGinley, E.L.2
Binion, D.G.3
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30
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45849135980
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Clostridium difficile infection in patients with ileal pouch-anal anastomosis
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A study of patients with IBD surgically treated with restorative proctocolectomy and ileal pouch-anal anastomosis demonstrated that CDI was associated with pouchitis that improved after anti-C. difficile therapy
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Shen BO, Jiang ZD, Fazio VW, et al. Clostridium difficile infection in patients with ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol 2008; 6:782-788. A study of patients with IBD surgically treated with restorative proctocolectomy and ileal pouch-anal anastomosis demonstrated that CDI was associated with pouchitis that improved after anti-C. difficile therapy.
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(2008)
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, vol.6
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Shen, B.O.1
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31
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Independent risk factors for CDI are leukocytosis, gastrointestinal surgery in the last month and a history of IBD
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Greenstein AJ, Byrn JC, Zhang LP, et al. Risk factors for the development of fulminant Clostridium difficile colitis. Surgery 2008; 143:623-629. Independent risk factors for CDI are leukocytosis, gastrointestinal surgery in the last month and a history of IBD.
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Impact of Clostridium difficile on inflammatory bowel disease
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CDAD has increased in patients with IBD and negatively impacts the clinical outcome
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Issa M, Vijayapal A, Graham MB, et al. Impact of Clostridium difficile on inflammatory bowel disease. Clin Gastroenterol Hepatol 2007; 5:345-351. CDAD has increased in patients with IBD and negatively impacts the clinical outcome.
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38649131025
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Low risk of irritable bowel syndrome after Clostridium difficile infection
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In contrast to the problem with bacterial diarrhea in young persons, postinfectious IBS occurs only rarely in patients with CDAD, presumably because of the older age of these patients
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Piche T, Vanbiervliet G, Pipau FG, et al. Low risk of irritable bowel syndrome after Clostridium difficile infection. Can J Gastroenterol 2007; 21:727-731. In contrast to the problem with bacterial diarrhea in young persons, postinfectious IBS occurs only rarely in patients with CDAD, presumably because of the older age of these patients.
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Can J Gastroenterol
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34
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Clostridium difficile: An under-recognized cause of reactive arthritis?
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CDI may rarely be associated with the development of reactive arthritis
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Birnbaum J, Bartlett JG, Gelber AC. Clostridium difficile: an under-recognized cause of reactive arthritis? Clin Rheumatol 2008; 27:253-255. CDI may rarely be associated with the development of reactive arthritis.
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Birnbaum, J.1
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35
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38849179568
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Short- and long-term attributable costs of Clostridium difficile- associated disease in nonsurgical inpatients
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A recent cost analysis confirms the high cost of CDI in nonsurgical, hospitalized patients
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Dubberke ER, Reske KA, Olsen MA, et al. Short- and long-term attributable costs of Clostridium difficile- associated disease in nonsurgical inpatients. Clin Infect Dis 2008; 46:497-504. A recent cost analysis confirms the high cost of CDI in nonsurgical, hospitalized patients.
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A two-step algorithm for detecting C. difficile in 1 468 stool samples using immunoassay for C. difficile GDH antigen followed by rapid toxin A/B assay of positives was performed in 4 h. IfGDH screen is negative 87% of tested samples, no further testing is needed
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Fenner L, Widmer AF, Goy G, et al. Rapid and reliable diagnostic algorithm for detection of Clostridium difficile. J Clin Microbiol 2008; 46:328-330. A two-step algorithm for detecting C. difficile in 1 468 stool samples using immunoassay for C. difficile GDH antigen followed by rapid toxin A/B assay of positives was performed in 4 h. IfGDH screen is negative (87% of tested samples), no further testing is needed.
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A two-step algorithm for C. difficile detection, in which stools are screened for C. difficile- associated GDH antigen and, if positive, tested for C. difficile toxin by direct cell culture cytotoxicity showed a sensitivity of 77% for detecting the organism
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Reller ME, Lema CA, Perl TM, et al. Yield of stool culture with isolate toxin testing versus a two-step algorithm including stool toxin testing for detection of toxigenic Clostridium difficile. J Clin Microbiol 2007; 45:3601-3605. A two-step algorithm for C. difficile detection, in which stools are screened for C. difficile- associated GDH antigen and, if positive, tested for C. difficile toxin by direct cell culture cytotoxicity showed a sensitivity of 77% for detecting the organism.
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Effect on diagnostic yield of repeated stool testing during outbreaks of Clostridium difficile- associated disease
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During outbreaks of CDI, it is useful to repeat stool testing in suspect cases to identify and help control the outbreak spread
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Debast SB, van Kregten E, Oskam KM, et al. Effect on diagnostic yield of repeated stool testing during outbreaks of Clostridium difficile- associated disease. Clin Microbiol Infect 2008; 14:622-624. During outbreaks of CDI, it is useful to repeat stool testing in suspect cases to identify and help control the outbreak spread.
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Debast, S.B.1
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41
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Comparison of a realtime PCR for detection of the tcdC gene with four toxin immunoassays and culture in the diagnosis of Clostridium difficile infection
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C. difficile culture or real-time PCR assays are more sensitive tests of CDI than standard immunoassays
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Sloan LM, Duresko BJ, Gustafson DR, Rosenblatt JE. Comparison of a realtime PCR for detection of the tcdC gene with four toxin immunoassays and culture in the diagnosis of Clostridium difficile infection. J Clin Microbiol 2008; 46:1996-2001. C. difficile culture or real-time PCR assays are more sensitive tests of CDI than standard immunoassays.
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Peterson LR, Manson RU, Paule SM, et al. Detection of toxigenic Clostridium difficile in stool samples by real-time polymerase chain reaction for the diagnosis of C. difficile- associated diarrhea. Clin Infect Dis 2007; 45:1152-1160. Real-time PCR is a sensitive method of detecting CDI.
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Peterson LR, Manson RU, Paule SM, et al. Detection of toxigenic Clostridium difficile in stool samples by real-time polymerase chain reaction for the diagnosis of C. difficile- associated diarrhea. Clin Infect Dis 2007; 45:1152-1160. Real-time PCR is a sensitive method of detecting CDI.
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Boyce JM, Havill NL. Nosocomial antibiotic- associated diarrhea associated with enterotoxin-producing strains of methicillin-resistant Staphylococcus aureus. Am J Gastroenterol 2005; 100:1828-1834.
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Hogenauer C, Langner C, Beubler E, et al. Klebsiella oxytoca as a causative organism of antibiotic- associated hemorrhagic colitis. N Engl J Med 2006; 355:2418-2426.
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Antibiotic- associated diarrhea: Candidate organisms other than Clostridium difficile
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Antibiotic- associated diarrhea may be due to non-C. difficile pathogens including Klebsiella pneumonia, Candida spp. and Staphylococcus aureus
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Song HJ, Shim KN, Jung SA, et al. Antibiotic- associated diarrhea: candidate organisms other than Clostridium difficile. Korean J InternMed 2008; 23:9-15. Antibiotic- associated diarrhea may be due to non-C. difficile pathogens including Klebsiella pneumonia, Candida spp. and Staphylococcus aureus.
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46
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A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile- associated diarrhea, stratified by disease severity
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Metronidazole and vancomycin were found to be equally effective for mild CDAD, whereas vancomycin was superior for therapy in severe cases of CDAD. This study has led to current recommendations for the management of CDAD cases
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Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile- associated diarrhea, stratified by disease severity. Clin Infect Dis 2007; 45:302-307. Metronidazole and vancomycin were found to be equally effective for mild CDAD, whereas vancomycin was superior for therapy in severe cases of CDAD. This study has led to current recommendations for the management of CDAD cases.
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Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile- associated disease
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Both oral metronidazole and oral vancomycin equally promoted a persistent growth of VRE during therapy of CDAD
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Al-Nassir WN, Sethi AK, Li Y, et al. Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile- associated disease. Antimicrob Agents Chemother 2008; 52:2403-2406. Both oral metronidazole and oral vancomycin equally promoted a persistent growth of VRE during therapy of CDAD.
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Outcomes of Clostridium difficile associated disease treated with metronidazole or vancomycin before and after the emergence of NAP1/027
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Metronidazole and vancomcyin appear to be of equivalent therapeutic efficacy in the management of the hypervirulent NAP1 strain
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Pepin J, Valiquette L, Gagnon S, et al. Outcomes of Clostridium difficile associated disease treated with metronidazole or vancomycin before and after the emergence of NAP1/027. Am J Gastroenterol 2007; 102:2781-2788. Metronidazole and vancomcyin appear to be of equivalent therapeutic efficacy in the management of the hypervirulent NAP1 strain.
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Am J Gastroenterol
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Rifaximin in treatment of recurrent Clostridium difficile- associated diarrhea: An uncontrolled pilot study
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1 Apr [Epub ahead of print, A series of patients with recurrent CDAD were successfully managed with oral rifaximin, providing preliminary evidence that the drug may be useful in the treatment of recurrent CDI
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Garey KW, Jiang ZD, Bellard A, DuPont HL. Rifaximin in treatment of recurrent Clostridium difficile- associated diarrhea: an uncontrolled pilot study. J Clin Gastroenterol 2008; 1 Apr [Epub ahead of print]. A series of patients with recurrent CDAD were successfully managed with oral rifaximin, providing preliminary evidence that the drug may be useful in the treatment of recurrent CDI.
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J Clin Gastroenterol
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Garey, K.W.1
Jiang, Z.D.2
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DuPont, H.L.4
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Interruption of recurrent Clostridium difficile- associated diarrhea episodes by serial therapy with vancomycin and rifaximin
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In eight patients with recurrent CDAD, a 2-week course of rifaximin after therapy led to apparent cure in seven patients with the one failure being infected by a rifaximinresistant strain. Terminal treatment with rifaximin may prevent disease recurrences
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Johnson S, Schriever C, Galang M, et al. Interruption of recurrent Clostridium difficile- associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clin Infect Dis 2007; 44:846-848. In eight patients with recurrent CDAD, a 2-week course of rifaximin after therapy led to apparent cure in seven patients with the one failure being infected by a rifaximinresistant strain. Terminal treatment with rifaximin may prevent disease recurrences.
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Clin Infect Dis
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Musher DM, Logan N, Hamill RJ, et al. Nitazoxanide for the treatment of Clostridium difficile colitis. Clin Infect Dis 2006; 43:421-427.
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OPT-80, a macrocyclic antimicrobial agent for the treatment of Clostridium difficile infections: A review
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OPT-80, also known as tiacumicin B, is a macrocyclic antimicrobial with poor absorption after oral administration and narrow activity spectrum against Grampositive aerobic and anaerobic bacteria
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Gerber M, Ackermann G. OPT-80, a macrocyclic antimicrobial agent for the treatment of Clostridium difficile infections: a review. Expert Opin Investig Drugs 2008; 17:547-553. OPT-80, also known as tiacumicin B, is a macrocyclic antimicrobial with poor absorption after oral administration and narrow activity spectrum against Grampositive aerobic and anaerobic bacteria.
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Gerber, M.1
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Tolevamer, an anionic polymer, neutralizes toxins produced by the BI/027 strains of Clostridium difficile
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Tolevamer neutralizes the toxin of the hypervirulent strain and may be an effective adjunctive therapy
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Hinkson PL, Dinardo C, Deciero D, et al. Tolevamer, an anionic polymer, neutralizes toxins produced by the BI/027 strains of Clostridium difficile. Antimicrob Agents Chemother 2008; 52:2190-2195. Tolevamer neutralizes the toxin of the hypervirulent strain and may be an effective adjunctive therapy.
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Comparison of the efficacy of ramoplanin and vancomycin in both in vitro and in vivo models of clindamycininduced Clostridium difficile infection
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Freeman J, Baines SD, Jabes D, Wilcox MH. Comparison of the efficacy of ramoplanin and vancomycin in both in vitro and in vivo models of clindamycininduced Clostridium difficile infection. J Antimicrob Chemother 2005; 56:717-725.
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Probiotics for Clostridium difficile diarrhea: Putting it into perspective
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Karpa KD. Probiotics for Clostridium difficile diarrhea: putting it into perspective. Ann Pharmacother 2007; 41:1284-1287.
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Pillai A, Nelson R. Probiotics for treatment of Clostridium difficile- associated colitis in adults. Cochrane Database Syst Rev 2008:CD004611. Probiotics have adjunctive value in treating CDI; they are not yet single treatments.
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The value of intravenous immune globulin in severe cases of CDAD has not been established. A controlled clinical trial is needed
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Juang P, Skledar SJ, Zgheib NK, et al. Clinical outcomes of intravenous immune globulin in severe Clostridium difficile- associated diarrhea. Am J Infect Control 2007; 35:131-137. The value of intravenous immune globulin in severe cases of CDAD has not been established. A controlled clinical trial is needed.
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Am J Infect Control
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Musher DM, Aslam S, Logan N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005; 40:1586-1590.
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A good review of the current status of therapy in CDI and newer agents being studied
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Gerding DN, Muto CA, Owens RC Jr. Treatment of Clostridium difficile infection. Clin Infect Dis 2008; 46 (Suppl 1):S32-S42. A good review of the current status of therapy in CDI and newer agents being studied.
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Human monoclonal antibodies directed against toxins A and B prevent Clostridium difficile-induced mortality in hamsters
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Babcock GJ, Broering TJ, Hernandez HJ, et al. Human monoclonal antibodies directed against toxins A and B prevent Clostridium difficile-induced mortality in hamsters. Infect Immun 2006; 74:6339-6347.
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Jiang ZD, Ke S, Palazzini E, et al. In vitro activity and fecal concentration of rifaximin after oral administration. Antimicrob Agents Chemother 2000; 44:2205-2206.
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Fluoroquinolone use and risk factors for Clostridium difficile- associated disease within a Veterans Administration healthcare system
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Fluoroquinolones have become major risk factors for CDI
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McFarland LV, Clarridge JE, Beneda HW, Raugi GJ. Fluoroquinolone use and risk factors for Clostridium difficile- associated disease within a Veterans Administration healthcare system. Clin Infect Dis 2007; 45:1141-1151. Fluoroquinolones have become major risk factors for CDI.
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Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile associated disease caused by the hypervirulent NAP1/027 strain
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A nonrestrictive antibiotic stewardship program designed to improve antibiotic prescribing can be effective if physicians are supportive of the program
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Valiquette L, Cossette B, Garant MP, et al. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007; 45 (Suppl 2):S112-S121. A nonrestrictive antibiotic stewardship program designed to improve antibiotic prescribing can be effective if physicians are supportive of the program.
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Salnikova MS, Joshi SB, Rytting JH, et al. Preformulation studies of Clostridium difficile toxoids A and B. J Pharm Sci 2008; 28 Jan [Epub ahead of print]. CDI vaccines and toxoids represent one possible way to reduce the occurrence of disease.
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Transcutaneous immunization with Clostridium difficile toxoid A induces systemic and mucosal immune responses and toxin A-neutralizing antibodies in mice
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C. difficile toxin A served as an adjuvant and an immunizing agent when given transcutaneously to mice. A C. difficile toxoid preparation may represent a feasible immunization strategy
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Ghose C, Kalsy A, Sheikh A, et al. Transcutaneous immunization with Clostridium difficile toxoid A induces systemic and mucosal immune responses and toxin A-neutralizing antibodies in mice. Infect Immun 2007; 75:2826-2832. C. difficile toxin A served as an adjuvant and an immunizing agent when given transcutaneously to mice. A C. difficile toxoid preparation may represent a feasible immunization strategy.
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The hamster model may be suitable for evaluating effectiveness of CDI vaccine candidates
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Ni Eidhin DB, O'Brien JB, McCabe MS, et al. Active immunization of hamsters against Clostridium difficile infection using surface-layer protein. FEMS Immunol Med Microbiol 2008; 52:207-218. The hamster model may be suitable for evaluating effectiveness of CDI vaccine candidates.
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Ni Eidhin, D.B.1
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