A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile-Associated Diarrhea with High Morbidity and Mortality

doi:10.1056/NEJMoa051639

A correction has been published: N Engl J Med 2006;354(20):2200.

Volume 353:2442-2449		December 8, 2005		Number 23

A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile–Associated Diarrhea with High Morbidity and Mortality

Vivian G. Loo, M.D., Louise Poirier, M.D., Mark A. Miller, M.D., Matthew Oughton, M.D., Michael D. Libman, M.D., Sophie Michaud, M.D., M.P.H., Anne-Marie Bourgault, M.D., Tuyen Nguyen, M.D., Charles Frenette, M.D., Mirabelle Kelly, M.D., Anne Vibien, M.D., Paul Brassard, M.D., Susan Fenn, M.L.T., Ken Dewar, Ph.D., Thomas J. Hudson, M.D., Ruth Horn, M.D., Pierre René, M.D., Yury Monczak, Ph.D., and André Dascal, M.D.

Full Text

PDF

PDA Full Text

PowerPoint Slide Set

Supplementary Material

Editorial
by Bartlett, J. G.

Letters

Add to Personal Archive

Add to Citation Manager

Notify a Friend

E-mail When Cited

E-mail When Letters Appear

Related Article

PubMed Citation

ABSTRACT

Background In March 2003, several hospitals in Quebec, Canada,noted a marked increase in the incidence of Clostridium difficile–associateddiarrhea.

Methods In 2004 we conducted a prospective study at 12 Quebechospitals to determine the incidence of nosocomial C. difficile–associateddiarrhea and its complications and a case–control studyto identify risk factors for the disease. Isolates of C. difficilewere typed by pulsed-field gel electrophoresis and analyzedfor binary toxin genes and partial deletions in the toxin Aand B repressor gene tcdC. Antimicrobial susceptibility wasevaluated in a subgroup of isolates.

Results A total of 1703 patients with 1719 episodes of nosocomialC. difficile–associated diarrhea were identified. Theincidence was 22.5 per 1000 admissions. The 30-day attributablemortality rate was 6.9 percent. Case patients were more likelythan matched controls to have received fluoroquinolones (oddsratio, 3.9; 95 percent confidence interval, 2.3 to 6.6) or cephalosporins(odds ratio, 3.8; 95 percent confidence interval, 2.2 to 6.6).A predominant strain, resistant to fluoroquinolones, was foundin 129 of 157 isolates (82.2 percent), and the binary toxingenes and partial deletions in the tcdC gene were present in132 isolates (84.1 percent).

Conclusions A strain of C. difficile that was resistant to fluoroquinolonesand had binary toxin and a partial deletion of the tcdC genewas responsible for this outbreak of C. difficile–associateddiarrhea. Exposure to fluoroquinolones or cephalosporins wasa risk factor.

Source Information

From McGill University Health Center (V.G.L., M.D.L., P.B., S.F., K.D., T.J.H., R.H., P.R.); McGill University (V.G.L., M.A.M., M.O., M.D.L., P.B., K.D., T.J.H., R.H., P.R., Y.M., A.D.); Hôpital Maisonneuve-Rosemont (L.P.); Université de Montréal (L.P., A.-M.B.); Sir Mortimer B. Davis–Jewish General Hospital (M.A.M., Y.M., A.D.); St. Mary's Hospital (M.D.L.); Centre Hospitalier Universitaire de Montréal Hôpital St. Luc (A.-M.B.); Hôpital Jean Talon (M.K.); McGill University and Genome Québec Innovation Center (K.D., T.J.H.) — all in Montreal; Cité de la Santé de Laval, Laval, Que., Canada (T.N.); Centre Hospitalier Universitaire de Sherbrooke (S.M.) and Université de Sherbrooke (S.M., C.F.) — both in Sherbrooke, Que., Canada; Hôpital Charles LeMoyne, Longueuil, Que., Canada (C.F.); and Réseau Santé Richelieu-Yamaska, St. Hyacinthe, Que., Canada (A.V.).

Address reprint requests to Dr. Loo at the Department of Microbiology, McGill University Health Center, 1650 Cedar Ave., Rm. D16.168, Montreal, QC H3G 1A4, Canada, or at vivian.loo{at}muhc.mcgill.ca.

Full Text of this Article

Related Letters:

Epidemic Clostridium difficile
Musher D. M., Logan N., Mehendiratta V., Polk R. E., Oinonen M., Pakyz A., Wilcox M. H., Freeman J., Iwata K., Doi A., Furuya N., McDonald L. C., Gerding D. N., Loo V. G., Libman M. D., Dascal A.
Extract | Full Text | PDF
N Engl J Med 2006; 354:1199-1203, Mar 16, 2006. Correspondence

This article has been cited by other articles:

Deneve, C., Bouttier, S., Dupuy, B., Barbut, F., Collignon, A., Janoir, C. (2009). Effects of Subinhibitory Concentrations of Antibiotics on Colonization Factor Expression by Moxifloxacin-Susceptible and Moxifloxacin-Resistant Clostridium difficile Strains. Antimicrob. Agents Chemother. 53: 5155-5162 [Abstract] [Full Text]
Hilger, H., Pust, S., von Figura, G., Kaiser, E., Stiles, B. G., Popoff, M. R., Barth, H. (2009). The Long-Lived Nature of Clostridium perfringens Iota Toxin in Mammalian Cells Induces Delayed Apoptosis. Infect. Immun. 77: 5593-5601 [Abstract] [Full Text]
Twine, S. M., Reid, C. W., Aubry, A., McMullin, D. R., Fulton, K. M., Austin, J., Logan, S. M. (2009). Motility and Flagellar Glycosylation in Clostridium difficile. J. Bacteriol. 191: 7050-7062 [Abstract] [Full Text]
Terhes, G., Urban, E., Soki, J., Nacsa, E., Nagy, E. (2009). Comparison of a Rapid Molecular Method, the BD GeneOhm Cdiff Assay, to the Most Frequently Used Laboratory Tests for Detection of Toxin-Producing Clostridium difficile in Diarrheal Feces. J. Clin. Microbiol. 47: 3478-3481 [Abstract] [Full Text]
Nerandzic, M. M., Pultz, M. J., Donskey, C. J. (2009). Examination of Potential Mechanisms To Explain the Association between Proton Pump Inhibitors and Clostridium difficile Infection. Antimicrob. Agents Chemother. 53: 4133-4137 [Abstract] [Full Text]
Eastwood, K., Else, P., Charlett, A., Wilcox, M. (2009). Comparison of Nine Commercially Available Clostridium difficile Toxin Detection Assays, a Real-Time PCR Assay for C. difficile tcdB, and a Glutamate Dehydrogenase Detection Assay to Cytotoxin Testing and Cytotoxigenic Culture Methods. J. Clin. Microbiol. 47: 3211-3217 [Abstract] [Full Text]
Williams, O. M., Spencer, R. C. (2009). The management of Clostridium difficile infection. Br Med Bull 91: 87-110 [Abstract] [Full Text]
Lawley, T. D., Croucher, N. J., Yu, L., Clare, S., Sebaihia, M., Goulding, D., Pickard, D. J., Parkhill, J., Choudhary, J., Dougan, G. (2009). Proteomic and Genomic Characterization of Highly Infectious Clostridium difficile 630 Spores. J. Bacteriol. 191: 5377-5386 [Abstract] [Full Text]
Zilberberg, M. D., Nathanson, B. H., Sadigov, S., Higgins, T. L., Kollef, M. H., Shorr, A. F. (2009). Epidemiology and Outcomes of Clostridium difficile-Associated Disease Among Patients on Prolonged Acute Mechanical Ventilation. Chest 136: 752-758 [Abstract] [Full Text]
Elvy, J., Riordan, T., Sarsfield, P., Ahmad, T. (2009). A diarrhoeal illness with a difference?. BMJ 339: b2648-b2648 [Full Text]
Wroblewski, D., Hannett, G. E., Bopp, D. J., Dumyati, G. K., Halse, T. A., Dumas, N. B., Musser, K. A. (2009). Rapid Molecular Characterization of Clostridium difficile and Assessment of Populations of C. difficile in Stool Specimens. J. Clin. Microbiol. 47: 2142-2148 [Abstract] [Full Text]
Janvilisri, T., Scaria, J., Thompson, A. D., Nicholson, A., Limbago, B. M., Arroyo, L. G., Songer, J. G., Grohn, Y. T., Chang, Y.-F. (2009). Microarray Identification of Clostridium difficile Core Components and Divergent Regions Associated with Host Origin. J. Bacteriol. 191: 3881-3891 [Abstract] [Full Text]
He, X., Sun, X., Wang, J., Wang, X., Zhang, Q., Tzipori, S., Feng, H. (2009). Antibody-Enhanced, Fc Gamma Receptor-Mediated Endocytosis of Clostridium difficile Toxin A. Infect. Immun. 77: 2294-2303 [Abstract] [Full Text]
Spigaglia, P., Barbanti, F., Louie, T., Barbut, F., Mastrantonio, P. (2009). Molecular Analysis of the gyrA and gyrB Quinolone Resistance-Determining Regions of Fluoroquinolone-Resistant Clostridium difficile Mutants Selected In Vitro. Antimicrob. Agents Chemother. 53: 2463-2468 [Abstract] [Full Text]
Ochsner, U. A., Bell, S. J., O'Leary, A. L., Hoang, T., Stone, K. C., Young, C. L., Critchley, I. A., Janjic, N. (2009). Inhibitory effect of REP3123 on toxin and spore formation in Clostridium difficile, and in vivo efficacy in a hamster gastrointestinal infection model. J Antimicrob Chemother 63: 964-971 [Abstract] [Full Text]
Aldeyab, M. A., Harbarth, S., Vernaz, N., Kearney, M. P., Scott, M. G., Funston, C., Savage, K., Kelly, D., Aldiab, M. A., McElnay, J. C. (2009). Quasiexperimental Study of the Effects of Antibiotic Use, Gastric Acid-Suppressive Agents, and Infection Control Practices on the Incidence of Clostridium difficile-Associated Diarrhea in Hospitalized Patients. Antimicrob. Agents Chemother. 53: 2082-2088 [Abstract] [Full Text]
Sailhamer, E. A., Carson, K., Chang, Y., Zacharias, N., Spaniolas, K., Tabbara, M., Alam, H. B., DeMoya, M. A., Velmahos, G. C. (2009). Fulminant Clostridium difficile Colitis: Patterns of Care and Predictors of Mortality. Arch Surg 144: 433-439 [Abstract] [Full Text]
Gau, J.-T., Shibeshi, M. R., Lu, I-J., Rafique, M., Heh, V., Meyer, D., Carlsen, W. R. (2009). Interexpert Agreement on Diagnosis of Bacteriuria and Urinary Tract Infection in Hospitalized Older Adults. JAOA: Journal of the American Osteopathic Association 109: 220-226 [Abstract] [Full Text]
Johnston, B. L., Bryce, E. (2009). Hospital infection control strategies for vancomycin-resistant Enterococcus, methicillin-resistant Staphylococcus aureus and Clostridium difficile. CMAJ 180: 627-631 [Full Text]
Kelly, C. P. (2009). A 76-Year-Old Man With Recurrent Clostridium difficile-Associated Diarrhea: Review of C difficile Infection. JAMA 301: 954-962 [Abstract] [Full Text]
Monaghan, T, Boswell, T, Mahida, Y R (2009). Recent advances in Clostridium difficile-associated disease. Postgrad. Med. J. 85: 152-162 [Abstract] [Full Text]
Mulvey, M. R. PhD, Simor, A. E. MD (2009). Antimicrobial resistance in hospitals: How concerned should we be?. CMAJ 180: 408-415 [Full Text]
Saxton, K., Baines, S. D., Freeman, J., O'Connor, R., Wilcox, M. H. (2009). Effects of Exposure of Clostridium difficile PCR Ribotypes 027 and 001 to Fluoroquinolones in a Human Gut Model. Antimicrob. Agents Chemother. 53: 412-420 [Abstract] [Full Text]
Blondeau, J. M. (2009). What have we learned about antimicrobial use and the risks for Clostridium difficile-associated diarrhoea?. J Antimicrob Chemother 63: 238-242 [Abstract] [Full Text]
Nerandzic, M. M., Donskey, C. J. (2009). Effective and Reduced-Cost Modified Selective Medium for Isolation of Clostridium difficile. J. Clin. Microbiol. 47: 397-400 [Abstract] [Full Text]
Hubert, B. MD, Gilca, R. MD (2009). Use administrative databases with caution. CMAJ 180: 78-78 [Full Text]
Dial, S. MD MSc, Suissa, S. PhD (2009). Use administrative databases with caution. CMAJ 180: 78-79 [Full Text]
Dries, D. J. (2009). Abdominal Problems in the ICU: Acute Abdomen/Pancreatitis/Biliary Infection and Injury. ACCP Crit Care Med Brd Rev 20: 301-320 [Full Text]
Louie, T., Miller, M., Donskey, C., Mullane, K., Goldstein, E. J. C. (2009). Clinical Outcomes, Safety, and Pharmacokinetics of OPT-80 in a Phase 2 Trial with Patients with Clostridium difficile Infection. Antimicrob. Agents Chemother. 53: 223-228 [Abstract] [Full Text]
Gallagher, J. C, Du, J. K, Rose, C. (2009). Severe Pseudomembranous Colitis After Moxifloxacin Use: A Case Series. The Annals of Pharmacotherapy 43: 123-128 [Abstract] [Full Text]
Kim, J., Smathers, S. A., Prasad, P., Leckerman, K. H., Coffin, S., Zaoutis, T. (2008). Epidemiological Features of Clostridium difficile-Associated Disease Among Inpatients at Children's Hospitals in the United States, 2001-2006. Pediatrics 122: 1266-1270 [Abstract] [Full Text]
Bouvet, P. J. M., Popoff, M. R. (2008). Genetic Relatedness of Clostridium difficile Isolates from Various Origins Determined by Triple-Locus Sequence Analysis Based on Toxin Regulatory Genes tcdC, tcdR, and cdtR. J. Clin. Microbiol. 46: 3703-3713 [Abstract] [Full Text]
Kelly, C. P., LaMont, J. T. (2008). Clostridium difficile -- More Difficult Than Ever. NEJM 359: 1932-1940 [Full Text]
Dial, S. MD MSc, Kezouh, A. PhD, Dascal, A. MD, Barkun, A. MD MSc, Suissa, S. PhD (2008). Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection. CMAJ 179: 767-772 [Abstract] [Full Text]
Wargo, K. A., Wright, B. M., Gupta, R. (2008). The Utility of Fluoroquinolones in the Critically Ill. Journal of Pharmacy Practice 21: 346-355 [Abstract]
Cunha-Cruz, J., Hujoel, P.P., Maupome, G., Saver, B. (2008). Systemic Antibiotics and Tooth Loss in Periodontal Disease. JDR 87: 871-876 [Abstract] [Full Text]
Labbe, A.-C., Poirier, L., MacCannell, D., Louie, T., Savoie, M., Beliveau, C., Laverdiere, M., Pepin, J. (2008). Clostridium difficile Infections in a Canadian Tertiary Care Hospital before and during a Regional Epidemic Associated with the BI/NAP1/027 Strain. Antimicrob. Agents Chemother. 52: 3180-3187 [Abstract] [Full Text]
Martin, H., Willey, B., Low, D. E., Staempfli, H. R., McGeer, A., Boerlin, P., Mulvey, M., Weese, J. S. (2008). Characterization of Clostridium difficile Strains Isolated from Patients in Ontario, Canada, from 2004 to 2006. J. Clin. Microbiol. 46: 2999-3004 [Abstract] [Full Text]
Wilcox, M. H., Mooney, L., Bendall, R., Settle, C. D., Fawley, W. N. (2008). A case-control study of community-associated Clostridium difficile infection. J Antimicrob Chemother 62: 388-396 [Abstract] [Full Text]
O'Connor, J. R., Galang, M. A., Sambol, S. P., Hecht, D. W., Vedantam, G., Gerding, D. N., Johnson, S. (2008). Rifampin and Rifaximin Resistance in Clinical Isolates of Clostridium difficile. Antimicrob. Agents Chemother. 52: 2813-2817 [Abstract] [Full Text]
Hinkson, P. L., Dinardo, C., DeCiero, D., Klinger, J. D., Barker, R. H. Jr. (2008). Tolevamer, an Anionic Polymer, Neutralizes Toxins Produced by the BI/027 Strains of Clostridium difficile. Antimicrob. Agents Chemother. 52: 2190-2195 [Abstract] [Full Text]
Sloan, L. M., Duresko, B. J., Gustafson, D. R., Rosenblatt, J. E. (2008). Comparison of Real-Time PCR for Detection of the tcdC Gene with Four Toxin Immunoassays and Culture in Diagnosis of Clostridium difficile Infection. J. Clin. Microbiol. 46: 1996-2001 [Abstract] [Full Text]
van der Kooi, T. I. I., Koningstein, M., Lindemans, A., Notermans, D. W., Kuijper, E., van den Berg, R., Boshuizen, H., Filius, P. M. G., van den Hof, S. (2008). Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027. J Med Microbiol 57: 709-716 [Abstract] [Full Text]
Dawson, L. F., Stabler, R. A., Wren, B. W. (2008). Assessing the role of p-cresol tolerance in Clostridium difficile. J Med Microbiol 57: 745-749 [Abstract] [Full Text]
Emerson, J. E., Stabler, R. A., Wren, B. W., Fairweather, N. F. (2008). Microarray analysis of the transcriptional responses of Clostridium difficile to environmental and antibiotic stress. J Med Microbiol 57: 757-764 [Abstract] [Full Text]
Stabler, R. A., Dawson, L. F., Phua, L. T. H., Wren, B. W. (2008). Comparative analysis of BI/NAP1/027 hypervirulent strains reveals novel toxin B-encoding gene (tcdB) sequences. J Med Microbiol 57: 771-775 [Abstract] [Full Text]
Monaghan, T, Boswell, T, Mahida, Y R (2008). Recent advances in Clostridium difficile-associated disease. Gut 57: 850-860 [Abstract] [Full Text]
Halsey, J. (2008). Current and future treatment modalities for Clostridium difficile-associated disease. Am J Health Syst Pharm 65: 705-715 [Abstract] [Full Text]
Gilligan, P. H. (2008). Is a Two-Step Glutamate Dehyrogenase Antigen-Cytotoxicity Neutralization Assay Algorithm Superior to the Premier Toxin A and B Enzyme Immunoassay for Laboratory Detection of Clostridium difficile?. J. Clin. Microbiol. 46: 1523-1525 [Abstract] [Full Text]
Akerlund, T., Persson, I., Unemo, M., Noren, T., Svenungsson, B., Wullt, M., Burman, L. G. (2008). Increased Sporulation Rate of Epidemic Clostridium difficile Type 027/NAP1. J. Clin. Microbiol. 46: 1530-1533 [Abstract] [Full Text]
Rafii, F., Park, M., Bryant, A. E., Johnson, S. J., Wagner, R. D. (2008). Enhanced Production of Phospholipase C and Perfringolysin O (Alpha and Theta Toxins) in a Gatifloxacin-Resistant Strain of Clostridium perfringens. Antimicrob. Agents Chemother. 52: 895-900 [Abstract] [Full Text]
Fawley, W. N., Freeman, J., Smith, C., Harmanus, C., van den Berg, R. J., Kuijper, E. J., Wilcox, M. H. (2008). Use of Highly Discriminatory Fingerprinting to Analyze Clusters of Clostridium difficile Infection Cases Due to Epidemic Ribotype 027 Strains. J. Clin. Microbiol. 46: 954-960 [Abstract] [Full Text]
Kokkotou, E., Moss, A. C., Michos, A., Espinoza, D., Cloud, J. W., Mustafa, N., O'Brien, M., Pothoulakis, C., Kelly, C. P. (2008). Comparative Efficacies of Rifaximin and Vancomycin for Treatment of Clostridium difficile-Associated Diarrhea and Prevention of Disease Recurrence in Hamsters. Antimicrob. Agents Chemother. 52: 1121-1126 [Abstract] [Full Text]
Corbett, S. M., Rebuck, J. A. (2008). Medication-Related Complications in the Trauma Patient. J Intensive Care Med 23: 91-108 [Abstract]
Stone, C. D (2008). Prognosis in Clostridium difficile infection complicating inflammatory bowel disease. Gut 57: 150-152 [Full Text]
Byrn, J. C., Maun, D. C., Gingold, D. S., Baril, D. T., Ozao, J. J., Divino, C. M. (2008). Predictors of Mortality After Colectomy for Fulminant Clostridium difficile Colitis. Arch Surg 143: 150-154 [Abstract] [Full Text]
Blossom, D. B., Lewis, F. M.T., McDonald, L. C. (2008). The Changing Spectrum of Clostridium Difficile Associated Disease: Implications for Dentistry. Journal of the American Dental Association 139: 42-47 [Abstract] [Full Text]
Thompson, I. (2008). Clostridium difficile-associated disease: update and focus on non-antibiotic strategies. Age Ageing 37: 14-18 [Abstract] [Full Text]
Fortier, L.-C., Moineau, S. (2007). Morphological and Genetic Diversity of Temperate Phages in Clostridium difficile. Appl. Environ. Microbiol. 73: 7358-7366 [Abstract] [Full Text]
Garcia, C., Samalvides, F., Vidal, M., Gotuzzo, E., Dupont, H. L. (2007). Epidemiology of Clostridium difficile Associated Diarrhea in a Peruvian Tertiary Care Hospital. Am J Trop Med Hyg 77: 802-805 [Abstract] [Full Text]
Mehlhorn, A. J, Brown, D. A (2007). Safety Concerns with Fluoroquinolones. The Annals of Pharmacotherapy 41: 1859-1866 [Abstract] [Full Text]
Carter, G. P., Lyras, D., Allen, D. L., Mackin, K. E., Howarth, P. M., O'Connor, J. R., Rood, J. I. (2007). Binary Toxin Production in Clostridium difficile Is Regulated by CdtR, a LytTR Family Response Regulator. J. Bacteriol. 189: 7290-7301 [Abstract] [Full Text]
Janoir, C., Pechine, S., Grosdidier, C., Collignon, A. (2007). Cwp84, a Surface-Associated Protein of Clostridium difficile, Is a Cysteine Protease with Degrading Activity on Extracellular Matrix Proteins. J. Bacteriol. 189: 7174-7180 [Abstract] [Full Text]
Emerson, C. R. (2007). Clostridium difficile Associated Diarrhea, an Emerging Epidemic: Therapeutic Options. Journal of Pharmacy Practice 20: 347-353 [Abstract]
Hecht, D. W., Galang, M. A., Sambol, S. P., Osmolski, J. R., Johnson, S., Gerding, D. N. (2007). In Vitro Activities of 15 Antimicrobial Agents against 110 Toxigenic Clostridium difficile Clinical Isolates Collected from 1983 to 2004. Antimicrob. Agents Chemother. 51: 2716-2719 [Abstract] [Full Text]
Adams, D. A., Riggs, M. M., Donskey, C. J. (2007). Effect of Fluoroquinolone Treatment on Growth of and Toxin Production by Epidemic and Nonepidemic Clostridium difficile Strains in the Cecal Contents of Mice. Antimicrob. Agents Chemother. 51: 2674-2678 [Abstract] [Full Text]
Jump, R. L. P., Pultz, M. J., Donskey, C. J. (2007). 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. 51: 2883-2887 [Abstract] [Full Text]
Musher, D. M., Manhas, A., Jain, P., Nuila, F., Waqar, A., Logan, N., Marino, B., Graviss, E. A. (2007). Detection of Clostridium difficile Toxin: Comparison of Enzyme Immunoassay Results with Results Obtained by Cytotoxicity Assay. J. Clin. Microbiol. 45: 2737-2739 [Abstract] [Full Text]
Kenneally, C., Rosini, J. M., Skrupky, L. P., Doherty, J. A., Hollands, J. M., Martinez, E., McKenzie, W., Murphy, T., Smith, J. R., Micek, S. T., Kollef, M. H. (2007). Analysis of 30-Day Mortality for Clostridium difficile-Associated Disease in the ICU Setting. Chest 132: 418-424 [Abstract] [Full Text]
Isakow, W., Morrow, L. E., Kollef, M. H. (2007). Probiotics for Preventing and Treating Nosocomial Infections: Review of Current Evidence and Recommendations. Chest 132: 286-294 [Abstract] [Full Text]
Ricciardi, R., Rothenberger, D. A., Madoff, R. D., Baxter, N. N. (2007). Increasing Prevalence and Severity of Clostridium difficile Colitis in Hospitalized Patients in the United States. Arch Surg 142: 624-631 [Abstract] [Full Text]
Ghose, C., Kalsy, A., Sheikh, A., Rollenhagen, J., John, M., Young, J., Rollins, S. M., Qadri, F., Calderwood, S. B., Kelly, C. P., Ryan, E. T. (2007). Transcutaneous Immunization with Clostridium difficile Toxoid A Induces Systemic and Mucosal Immune Responses and Toxin A-Neutralizing Antibodies in Mice. Infect. Immun. 75: 2826-2832 [Abstract] [Full Text]
Pituch, H., van Leeuwen, W., Maquelin, K., Wultanska, D., Obuch-Woszczatynski, P., Nurzynska, G., Kato, H., Reijans, M., Meisel-Mikolajczyk, F., Luczak, M., van Belkum, A. (2007). Toxin Profiles and Resistances to Macrolides and Newer Fluoroquinolones as Epidemicity Determinants of Clinical Isolates of Clostridium difficile from Warsaw, Poland. J. Clin. Microbiol. 45: 1607-1610 [Abstract] [Full Text]
Musher, D. M., Logan, N., Mehendiratta, V., Melgarejo, N. A., Garud, S., Hamill, R. J. (2007). Clostridium difficile colitis that fails conventional metronidazole therapy: response to nitazoxanide. J Antimicrob Chemother 59: 705-710 [Abstract] [Full Text]
Goh, S., Ong, P. F., Song, K. P., Riley, T. V., Chang, B. J. (2007). The complete genome sequence of Clostridium difficile phage {phi}C2 and comparisons to {phi}CD119 and inducible prophages of CD630. Microbiology 153: 676-685 [Abstract] [Full Text]
van den Berg, R. J., Schaap, I., Templeton, K. E., Klaassen, C. H. W., Kuijper, E. J. (2007). Typing and Subtyping of Clostridium difficile Isolates by Using Multiple-Locus Variable-Number Tandem-Repeat Analysis. J. Clin. Microbiol. 45: 1024-1028 [Abstract] [Full Text]
Stare, B. G., Delmee, M., Rupnik, M. (2007). Variant forms of the binary toxin CDT locus and tcdC gene in Clostridium difficile strains. J Med Microbiol 56: 329-335 [Abstract] [Full Text]
Poilane, I., Humeniuk-Ainouz, C., Durand, I., Janoir, C., Cruaud, P., Delmee, M., Popoff, M. R., Collignon, A. (2007). Molecular characterization of Clostridium difficile clinical isolates in a geriatric hospital. J Med Microbiol 56: 386-390 [Abstract] [Full Text]
Curry, S. R., Marsh, J. W., Muto, C. A., O'Leary, M. M., Pasculle, A. W., Harrison, L. H. (2007). tcdC Genotypes Associated with Severe TcdC Truncation in an Epidemic Clone and Other Strains of Clostridium difficile. J. Clin. Microbiol. 45: 215-221 [Abstract] [Full Text]
Jackson, S., Calos, M., Myers, A., Self, W. T. (2006). Analysis of Proline Reduction in the Nosocomial Pathogen Clostridium difficile. J. Bacteriol. 188: 8487-8495 [Abstract] [Full Text]
Kahan, N. R, Chinitz, D. P, Waitman, D.-A., Dushnitzky, D., Kahan, E., Shapiro, M. (2006). Empiric Treatment of Uncomplicated Urinary Tract Infection with Fluoroquinolones in Older Women in Israel: Another Lost Treatment Option?. The Annals of Pharmacotherapy 40: 2223-2227 [Abstract] [Full Text]
Jodlowski, T. Z, Oehler, R., Kam, L. W, Melnychuk, I. (2006). Emerging Therapies in the Treatment of Clostridium difficile-Associated Disease. The Annals of Pharmacotherapy 40: 2164-2169 [Abstract] [Full Text]
Surowiec, D., Kuyumjian, A. G, Wynd, M. A, Cicogna, C. E (2006). Past, Present, and Future Therapies for Clostridium difficile-Associated Disease. The Annals of Pharmacotherapy 40: 2155-2163 [Abstract] [Full Text]
Bartlett, J. G. (2006). Narrative Review: The New Epidemic of Clostridium difficile-Associated Enteric Disease.. ANN INTERN MED 145: 758-764 [Abstract] [Full Text]
Tanaka, K., Mikamo, H., Nakao, K., Watanabe, K. (2006). In Vitro Antianaerobic Activity of DX-619, a New Des-Fluoro(6) Quinolone. Antimicrob. Agents Chemother. 50: 3908-3913 [Abstract] [Full Text]
Bourgault, A.-M., Lamothe, F., Loo, V. G., Poirier, L., the CDAD-CSI Study Group, (2006). In Vitro Susceptibility of Clostridium difficile Clinical Isolates from a Multi-Institutional Outbreak in Southern Quebec, Canada.. Antimicrob. Agents Chemother. 50: 3473-3475 [Abstract] [Full Text]
Stabler, R. A., Gerding, D. N., Songer, J. G., Drudy, D., Brazier, J. S., Trinh, H. T., Witney, A. A., Hinds, J., Wren, B. W. (2006). Comparative Phylogenomics of Clostridium difficile Reveals Clade Specificity and Microevolution of Hypervirulent Strains.. J. Bacteriol. 188: 7297-7305 [Abstract] [Full Text]
von Baum, H., Sigge, A., Bommer, M., Kern, W. V., Marre, R., Dohner, H., Kern, P., Reuter, S. (2006). Moxifloxacin prophylaxis in neutropenic patients. J Antimicrob Chemother 58: 891-894 [Abstract] [Full Text]
Dial, S., Delaney, J.A. C., Schneider, V., Suissa, S. (2006). Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy.. CMAJ 175: 745-748 [Abstract] [Full Text]
Cunningham, R. (2006). Proton pump inhibitors and the risk of Clostridium difficile-associated disease: further evidence from the community.. CMAJ 175: 757-757 [Full Text]
Lorber, B. (2006). Update in infectious diseases.. ANN INTERN MED 145: 354-360 [Full Text]
Noren, T., Wullt, M., Akerlund, T., Back, E., Odenholt, I., Burman, L. G. (2006). Frequent Emergence of Resistance in Clostridium difficile during Treatment of C. difficile-Associated Diarrhea with Fusidic Acid.. Antimicrob. Agents Chemother. 50: 3028-3032 [Abstract] [Full Text]
Dhalla, I. A., Mamdani, M. M., Simor, A. E., Kopp, A., Rochon, P. A., Juurlink, D. N. (2006). Are Broad-Spectrum Fluoroquinolones More Likely To Cause Clostridium difficile-Associated Disease?. Antimicrob. Agents Chemother. 50: 3216-3219 [Abstract] [Full Text]

Comments and questions? Please contact us.