Clostridium difficile PCR ribotype 027 comprised 0.2% of a collection of Swedish isolates in 1997-2001 (3 of 1,325 isolates). These isolates had lower moxifloxacin MICs than the epidemic type 027 isolates, but they had the same tcdC sequence and toxin yield. Type 027 produced 3-to 13-fold more toxin than did major Swedish types. One epidemic strain (027/NAP1a) sporulated more than did other type 027 isolates, a feature that should contribute to its survival and spread.

All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P ‫؍‬ 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.

Flexion, abduction, and external rotation of the hip joint were recorded in 30 volunteers randomized into three groups of 10. The measurements were taken before, immediately after, and 30 minutes after treatment of heat, stretching and a combination of heat plus stretching. Heat only did not improve the range of motion of the hip joint. Stretching increased flexion and external rotation, and heat plus stretching in combination gave the greatest increase in flexion motion, and also significantly increased abduction. External rotation after stretching treatment, and flexion and abduction after heat plus stretching treatment were still significantly increased after 30 minutes.J Orthop Sports Phys Ther 1984;6(2):110-115.

The activity of ALP 201 against 350 strains of anaerobic bacteria was determined by an agar dilution method. Its activity was compared with those of piperacillin, cefoxitin, imipenem, clindamycin, metronidazole, and chloramphenicol. ALP 201 and imipenem were the most active agents tested. Based on these results, ALP 201 appears to be a promising antimicrobial agent for anaerobic infections and warrants further clinical investigations.

The activity of meropenem was determined against 350 strains of anaerobic bacteria by an agar dilution method. It was compared with those of piperacillin, cefoxitin, imipenem, clindamycin, metronidazole and chloramphenicol. Meropenem and imipenem were the most active agents tested. On the basis of these results, meropenem appears to be a promising antimicrobial agent for anaerobic infections and warrants further clinical investigation.