Clostridium difficile: a formidable foe

Loo, Vivian G.

doi:10.1503/cmaj.1040836

Cited by 42 publications

(19 citation statements)

References 7 publications

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“…[1][2][3][4] Recent outbreaks in Montreal and Sherbrooke resulted in a 4-fold increase in the number of CDAD cases as well as an increase in the number of attributable deaths. 1,[5][6][7] CDAD is a debilitating and costly illness, particularly among patients with recurring episodes. Probiotics, or naturally occurring "good bacteria," have been suggested as a means of both preventing and treating the disease.…”

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confidence: 99%

Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review

Dendukuri

Costa²,

McGregor³

et al. 2005

Canadian Medical Association Journal

183

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confidence: 99%

Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review

Dendukuri

Costa²,

McGregor³

et al. 2005

Canadian Medical Association Journal

183

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“…[7][8][9] The reasons for the increasing incidence of C. difficile infection are not clear.P ossible explanations include increasing and irrational use of antibiotics, long-term use of PPI, increasing elderly population, overcrowding of hospitals, poor compliance with hand hygiene and environmental cleaning standards, and the emergence of antibiotic resistant and virulent strains of C. difficile. [10][11][12][13] The role of the level of awareness of doctors, nurses and other healthcare workers in the increasing incidence of C. difficile infection is not clear.H igh levels of awareness among hospital staff might reduce the number of infected cases and C. difficile infection associated morbidity and mortality. Our questionnaire demonstrated ag ood level of basic microbiological knowledge about C. difficile infection amongst healthcare professionalsinour hospital.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile: How Much do Hospital Staff Know About it?

Aroori

Blencowe

Pye

et al. 2009

annals

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Ann RC oll Surg Engl 2009; 91:4 64-469 464Clostridium difficile is an opportunistic, Gram-positive, anaerobic, spore-formingb acillus. Its clinical effects can range from mild self-limiting diarrhoea to life-threatening toxic megacolon and peritonitis. After methicillin-resistant Staphylococcus aureus infection (MRSA), C. difficile is the most wide-spread hospital acquired infection in the UK. In the UK, MRSA infection rates are declining, but rates of C. difficile infection continue to rise. There are several reasons for the increasing incidence of C. difficile infection. One possible reason could be lack of awareness and adequate knowledge among healthcare professionals. There are no studies in the literature that examined the level of healthcare professional's knowledge about C. difficile infection. We,t herefore,c onducted aq uestionnaire-based survey within our hospital to address this issue. Subjects and MethodsAq uestionnaire-based survey was conducted in Weston General Hospital, UK, in January 2007. Eligible participants included doctors, nurses, dieticians, physiotherapists, and theatre staff. Participants were recruited on av oluntary SUBJECTS AND METHODS At otal of 132 healthcare professionals (18 consultants, 40 trainee doctors, and 74 nursing staff) in our hospital were randomly surveyed using aq uestionnaire consisting of 17 questions covering various aspects of C. difficile. GENERAL SURGERYRESULTS More than 50% of healthcare professionals correctly identified C. difficile as an anaerobic bacillus. Half of the consultants and one-third of the trainees and nurses were aware that 5% of adults carry C. difficile in the gut. Overall, 80% of doctors and 40% of nursing staff (P =0 .001) were aware of the spectrum of illnesses causedb yC. difficile.S even (39%) consultants, 25 (63%) trainees, and 26 (37%) nurses correctly identified the various predisposing factors for the acquisition of C. difficile infection. Only one-third of doctors and 8% of nursing staff were aware that antibiotic restriction was the single most effective C. difficile infection control measure. In addition, 40% of doctors and 8% of nursing staff were aware that cytotoxin assay is the gold standard diagnostic test. Less than 30% of healthcare professionals were aware of the differences between the most common strain and the strain of C. difficile responsible for recent outbreaks. Only 6( 33%) consultants, 21 (53%) trainees (P =n ot significant), and 28 (38%) nursing staff were aware that hand washing with soap and water is the most effective way of preventing transmission of C. difficile infection. Results showed that 93% of trainees, 78% of consultants (P =0 .05) and 70% of nurses correctly answered that oral metronidazolei st he drug of choice for the treatment of C. difficile infection. Compared to 73% of trainees, only two (11%) consultants (P <0 .0001) and 20 (27%) nursing staff correctly stated that oral vancomycin is the second-line treatment for persistent symptomatic C. difficile infection.CONCLUSIONS There is as ignificant...

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“…An outbreak of a more virulent epidemic strain of C. difficile in Quebec, Canada, was correlated with the death of more than 100 patients within a 6-month period in a single hospital (9)(10)(11)27). A higher level of toxin produced by this toxigenic variant has been implicated in a higher death rate (10,27,47), and this strain has emerged not only in Canada but also in the United States (28,32,48). As concerning as these data are, they are likely a gross underestimate of the actual infection rate since there was not an active surveillance in place for reporting such infections and death rates due to C. difficile-associated disease during this time period.…”

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Analysis of Proline Reduction in the Nosocomial Pathogen Clostridium difficile

et al. 2006

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Clostridium difficile, a proteolytic strict anaerobe, has emerged as a clinically significant nosocomial pathogen in recent years. Pathogenesis is due to the production of lethal toxins, A and B, members of the large clostridial cytotoxin family. Although it has been established that alterations in the amino acid content of the growth medium affect toxin production, the molecular mechanism for this observed effect is not yet known. Since there is a paucity of information on the amino acid fermentation pathways used by this pathogen, we investigated whether Stickland reactions might be at the heart of its bioenergetic pathways. Growth of C. difficile on Stickland pairs yielded large increases in cell density in a limiting basal medium, demonstrating that these reactions are tied to ATP production. Selenium supplementation was required for this increase in cell yield. Analysis of genome sequence data reveals genes encoding the protein components of two key selenoenzyme reductases, glycine reductase and D-proline reductase (PR). These selenoenzymes were expressed upon the addition of the corresponding Stickland acceptor (glycine, proline, or hydroxyproline). Purification of the selenoenzyme D-proline reductase revealed a mixed complex of PrdA and PrdB (SeCys-containing) proteins. PR utilized only D-proline but not L-hydroxyproline, even in the presence of an expressed and purified proline racemase. PR was found to be independent of divalent cations, and zinc was a potent inhibitor of PR. These results show that Stickland reactions are key to the growth of C. difficile and that the mechanism of PR may differ significantly from that of previously studied PR from nonpathogenic species.

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Clostridium difficile: a formidable foe

Cited by 42 publications

References 7 publications

Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review

Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review

Clostridium difficile: How Much do Hospital Staff Know About it?

Analysis of Proline Reduction in the Nosocomial Pathogen Clostridium difficile

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